Self-harm and suicidal behaviours among trans and gender diverse youth from culturally and linguistically diverse backgrounds

What’s the issue

Trans and gender diverse (TGD) youth have an increased risk of experiencing discrimination and poor mental health outcomes as well as increased rates of self-harm and suicidality (suicidal thoughts and behaviour) when compared to cisgender counterparts.

TGD youth from culturally and linguistically diverse backgrounds (CALD) may experience additional pressure and discrimination due to cultural expectations and practices. CALD TGD youth may be placed at increased risk of developing mental health conditions or experiencing suicidal thoughts and behaviours if they experience additional race-based discrimination, transgenerational refugee or migrant trauma, or feel they have unsupportive family and social networks.

What was done?

Researchers examined studies related to drivers of self-harm and suicidal thoughts and behaviours in young TGD people from CALD backgrounds. A scoping review was conducted to explore the following research questions:

• What are the main concepts, approaches, themes and types of evidence available for understanding self-harm and suicidality among TGD youth from CALD backgrounds?
• What are the main barriers and facilitators for engaging TGD youth from CALD backgrounds in mental healthcare delivery and suicide prevention initiatives?
• Are the lived experience perspectives of young participants considered in the development and interpretation of studies on suicidal behaviours of TGD youth from CALD backgrounds?
• What examples of best practices are there for what works effectively to reduce self-harm and suicidal behaviour for TGD youth from CALD backgrounds?

Data included English language studies published between 2003-2023 that related to the above research questions and met eligibility criteria. Websites and other online grey literature were included in the search.

The literature search found seven peer-reviewed academic papers and five research reports to meet the criteria. The selected studies included references to youth who identified with multiple forms of gender and sexual identities. The acronyms used in the studies selected included LGBT, LGBTQ and LGBTQI+.

The scoping review findings were analysed using a theme-based approach.

What was found?

The qualitative analysis found that:

• Experience of stigma and discrimination was identified as a contributing factor for mental health concerns and suicidal thoughts and behaviours
• Experience of physical harm and parental pressure due to LGBTQI+ identities were associated with higher rates of suicidal behaviour.
• Perceived cultural barriers to receiving care prevented TGD youth from CALD backgrounds from seeking support.
• CALD TGD youth who experienced TGD-based discrimination, physical harm, housing instability, or underwent treatment to discourage or change their TGD status experienced suicidal thoughts and behaviours 12 times higher than other TGD youth who did not experience these additional factors.
• CALD TGD youth who reported experiences of trauma had greater odds of having attempted suicide in the past year.
• CALD TGD youth subjected to conversion therapy had higher rates of attempting suicide in the past year.
• Increases of suicidal behaviour was found for TGD youth with CALD backgrounds that reported high levels of personal impulsivity, had a history of suicide attempt, and had low social support.

The researchers identified some factors that mitigated the risk of suicide for CALD TGD youth:

• Peer support and family support helped to prevent suicidal thoughts and behaviours in TGD young people from CALD backgrounds.
• High levels of family and social support significantly reduced the risk of suicide attempts in black TGD youth.

Using these findings, the researchers suggest the following to improve cultural and gender-based understanding and practices of people working with TGD youth from CALD backgrounds.

(1) practicing trauma-informed care

(2) safety through culturally informed practice

(3) enhancing access to gender-affirming services and spaces

(4) enhancing family acceptance and integration in safe support networks

(5) supporting young people's coping strategies

(6) inclusion of lived experience perspectives in care delivery, research and policy formulation; and

(7) fostering community connection and macrosocial changes.

Why are findings important?

TGD youth with CALD backgrounds are at a heightened risk of experiencing mental health concerns and suicidal behaviour because of the complexity between their TGD identity and their cultural identities, expectations and acceptance.

Perceived or existing cultural barriers when receiving care can discourage young TGB youth with CALD backgrounds from seeking help.

Culturally appropriate and supportive care is paramount in supporting the mental health of TGD youth with CALD backgrounds.