Presentation by Mathijs Lucassen at the symposium LGBTTI Wellness & Suicide: What do we need to change? Hosted in Auckland on 27 February 2013 by Auckland DHB, Affinity Services, OUTLine NZ, Rainbow Youth and the Mental Health Foundation.

1. “SUICIDE AND
LGBTTI YOUTH”
Mathijs Lucassen PhD
Research Fellow - Werry Centre for Child
and Adolescent Mental Health & Youth’12
Team, Department of Psychological
Medicine & School of Nursing
University of Auckland

2. OVERVIEW
 Definitions – suicide and LGBTTI young
people
 Suicide and young people generally
 Suicide and LGBTTI young people
 Two specific interventions/research projects

3. DEFINITIONS - SUICIDE
 Suicidal ideation = Refers to thoughts of
harming or killing oneself.
 Attempted suicide = Is a non-fatal, self-
inflicted destructive act with explicit or inferred
intent to die.
 Suicide = Is a fatal self-inflicted destructive
act with explicit or inferred intent to die.
(O‟Carroll et al., 1996)

4. DEFINITIONS – LGBTTI
YOUNG PEOPLE
Is this young person….
Bisexual?

5. SUICIDE AND
YOUNG PEOPLE GENERALLY

6. Trends in youth suicide rates per
100 000 people 15-19 years
18
16
Italy
14 UK
OECD-33
12 USA
Australia
10
NZ
8 Linear (Italy)
Linear (OECD-33)
6 Linear (NZ)
4
2
0
1985 1990 1995 2000 2005 2010
Source Dr Sonia Lewycka (Youth‟12 Team)

7. RISK FACTORS FOR YOUTH SUICIDE
INCLUDE…
 ↑ Age (Brent et al., 1999)
 Male sex (Fergusson, Woodward, & Horwood, 2000)
 Ethnicity (Beautrais, 2001; Borowsky, Resnick, Ireland, & Blum, 1999;
Fortune et al., 2010)
 Severe and frequent suicidal ideation
(Lewinsohn, Rohde, & Seeley, 1996)
 Previous suicide attempt (Brent et al., 1999)
 Lethality of suicide attempt (Brent et al., 1998)

8. RISK FACTORS FOR YOUTH SUICIDE
INCLUDE…
 Inter-personal conflict or loss (Brent et al., 1999)
 Mental ill-health (Brent et al., 1998)
 Maltreatment (Brent et al., 1999)
 Exposure to suicide (Brent et al., 1989; Bridge, Goldstein &
Brent, 2006)

9. PROTECTIVE FACTORS FOR YOUTH
SUICIDE INCLUDE…
 Sound mental and emotional wellbeing
 Good social skills
 Problem-solving abilities
 Positive engagement with school
 Family cohesiveness
(Fortune et al., 2010)

10. SUICIDE AND LGBTTI
YOUNG PEOPLE

11. LGBTTI YOUNG PEOPLE

12. YOUTH’07
REPRESENTATIVE NZ SAMPLE
(Lucassen et al., 2011; Rossen, Lucassen, Denny, & Robinson, 2009)

13. YOUTH’07
6% „SEXUAL MINORITY‟ YOUTH
1% 3%2% 2%
92%
Opposite-sex attracted
Same-sex attracted
Both-sex attracted
Not sure
Attracted to neither sex

14. Longitudinal
Christchurch Health
and Development
Study 2.8% LGB
(Fergusson, Horwood & Beautrais, 1999)

15. YOUTH’07…
 Mostof the sexual minority youth were
not suicidal and did not have significant
depressive symptoms…But

16. YOUTH’07 - INCREASED RISK…
n (%) OR (95% CL) p v a lu e
Cu rre n t d e p re s s iv e
<.0001
s y m p to m s
Opposit e-sex 687 (9.5) 1.0
Sa m e-sex 16 (23.3) 1.9 (1.1-3.1)
Bot h -sex 86 (32.3) 3.7 (2.8-4.7)
Not su r e 30 (21.8) 2.1 (1.3-3.3)
Neit h er 14 (9.7) 1.0 (0.6-1.7)
Atte m p te d s u ic id e <.0001
Opposit e-sex 291 (4.0) 1.0
Sa m e-sex 10 (13.9) 4.8 (2.4-9.6)
Bot h -sex 59 (21.7) 7.0 (5.2-9.4)
Not su r e 14 (10.1) 2.4 (1.1-5.1)
Neit h er 8 (5.0) 1.1 (0.6-1.9)

17. YOUTH’07 – INCREASED RISK…
n (%) OR (95% CL) p v a lu e
D e libe ra te ly s e lf-
<.0001
h a rm e d
Opposit e-sex 1426 (19.4) 1.0
Sa m e-sex 27 (36.9) 2.8 (1.8-4.4)
Bot h -sex 156 (57.9) 5.8 (4.4-7.6)
Not su r e 44 (30.4) 1.8 (1.1-2.7)
Neit h er 20 (13.4) 0.6 (0.4-0.9)

18. Christchurch Health and Development
Study
(Fergusson, Horwood & Beautrais, 1999)
% OR (95% CL) p v a lu e
Ma jo r d e p re s s io n
(14 to 21 y e a rs o f <.001
age)
H et er osexu a l 38.2% 1.0
LGB 71.4% 4.0 (1.8-9.3)
Atte m p te d s u ic id e
<.001
(e v e r)
H et er osexu a l 7.1% 1.0
LGB 32.1% 6.2 (2.7-14.3)

19. YOUTH’07
SEXUAL MINORITY YOUTH
WANT & NEED HELP…

20. WHY ARE LGBTTI YOUTH AT INCREASED
RISK?

21. WHY ARE LGBTTI YOUTH AT INCREASED
RISK?
↑ Rates of bullying/victimisation
 Family rejection
 ↑ Substance abuse
 ↑ Rates of mood disorders (e.g.
depression)
(Bridge, Goldstein, & Brent, 2006; Russell & Joyner, 2001)

22. BRIEFLY - TWO RESEARCH PROJECTS
 Rainbow SPARX
 Rainbow Youth’s Education Package
in Schools (a formal evaluation)

23. SPARX

24. UNIQUE ISSUES…
Ways participants can Environments &
tell that they are their impact
different
Ways Depression &
participants sexuality
cope

25. SPARX: THE RAINBOW VERSION

26. SPARX: THE RAINBOW VERSION
Expressed interest in study
(N=44)
Not enrolled
(N=17)
Participants enrolled (N=27)
Did not meet
criteria (N=6)
Depressive symptoms pre-intervention
(N=21)
Withdrew (N=2)
Completed intervention
(N=19) [91% of pre-intervention]
Lost to follow-up
(N=2)
Completed three month follow up
(N=17) [81% of pre-intervention]

27. SPARX: THE RAINBOW VERSION –FINDINGS
 Sexual minority youth were more likely
to complete treatment (p=0.007)
 85% of sexual minority youth thought
the treatment would appeal to other
young people
 Depressive symptoms  significantly
from pre- to post-intervention
(p<0.0001) with a large pre to post
effect size (d=1.01) & this positive
change was maintained at follow-up

28. DO YOU THINK RAINBOW SPARX
HELPED YOU FEEL BETTER?
“Yes, it made me feel a lot better. I have been much happier
because I was able to relate and use the information that I
learnt to better my situation” (Troy, 16).

29. DO YOU THINK RAINBOW SPARX
HELPED YOU FEEL BETTER?
“Not really, but it did give me something to do at nights so it
kind of helped” (Lara, 17).

30. DO YOU THINK RAINBOW SPARX
HELPED YOU FEEL BETTER?
“…it worked for me” (Bob, 13).

31. RAINBOW YOUTH’S EDUCATION
PACKAGE - EVALUATION
 237 Yr 9 and 10 students from two schools
participated in x 2 workshops (sexuality and
gender diversity)
 School climates perceived to be “hard” and
“bullying/mocking” for LGBTTI students
 ¾ believed the workshops would ↓ bullying
(Burford, Lucassen, Penniket & Hamilton, unpublished report)

32. QUESTIONS…

33. REFERENCES
Beautrais, A.L. (2001). Child and young adolescent suicide in New Zealand. Australian and New Zealand Journal of
Psychiatry, 35, 647-653.
Brent, D.A., Baugher, M., Bridge, J., Chen, T., & Chiappetta, L. (1999). Age- and sex-related risk factors for adolescent
suicide. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1497-1505.
Brent, D.A., Kerr, M.M., Goldstein, C., Bozigar, J., Wartella, M., & Allan, M.J. (1989). An outbreak of suicide and
suicidal behavior in a high school. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 918-
924.
Brent, D.A., Perper, J.A., Goldstein, C.E., Kolko, D.J., Allan, M.J., Allman, C.J., et al. (1988). Risk factors for
adolescent suicide. A comparison of adolescent suicide victims with suicidal inpatients. Archives of General
Psychiatry, 45, 581-588.
Bridge, J.A., Goldstein, T.R., & Brent, D.A. (2006). Adolescent suicide and suicidal behavior. Journal of Child
Psychology and Psychiatry, 47(3/4), 372-394.
Borowsky, I.W., Resnick, M.D., Ireland, M., & Blum, R.W. (1999). Suicide attempts among American Indian and Alaska
Native youth: Risk and protective factors. Archives of Pediatrics and Adolescent Medicine, 153, 573-580.
Fergusson, D. M., Horwood, L. J., & Beautrais, A. L. (1999). Is sexual orientation related to mental health problems and
suicidality in young people? Archives of General Psychiatry, 56(10), 876-880.
Fergusson, D.M., Woodward, L.J., & Horwood, L.J. (2000). Risk factors and life processes associated with the onset
of suicidal behaviour during adolescence and early adulthood. Psychological Medicine, 30, 23-39.
Fortune, S., Watson, P., Robinson, E., Fleming, T., Merry, S., & Denny, S. (2010). Youth’07: The health and wellbeing
of secondary school students in New Zealand: Suicide behaviours and mental health in 2001 and 2007.
Auckland: The University of Auckland.

34. Lewinsohn, P.M., Rohde, P., & Seeley, J.R. (1996). Adolescent suicidal ideation and attempts: Prevalence, risk
factors, and clinical implications. Clinical Psychology Science and Practice, 3, 25-36.
Lucassen et al. (2011). Sexual attraction, depression, self-harm, suicidality and help-seeking behaviour in
New Zealand secondary school students. Australian and New Zealand Journal of Psychiatry, 45, 376-
383.
O’Carroll, P.W., Berman, A.L., Marris., R.W., Moscicki, E.K., Tanney, B.L., & Silverman, M.M. (1996). Beyond the Tower
of Babel: A nomenclature for suicidology. Suicide and Life-Threatening Behavior, 26, 237-252.
Rossen, F.V., Lucassen, M.F.G., Denny, S., & Robinson, E. (2009). Youth’07 The health and wellbeing of secondary
school students in New Zealand: Results for young people attracted to the same sex or both sexes. Auckland:
The University of Auckland.
Russell, S., & Joyner, K. (2001). Adolescent sexual orientation and suicide risk: Evidence from a national study.
American Journal of Public Health, 91(8), 1276-1281.