Opportunities to Address Health Disparities in Suicidality for Sexual and Gender Minority Youth in Public Systems

The prevention of self-injurious thoughts and behaviors (SITB) among youth continues to be a public health imperative. In the general population, suicide is the second-leading cause of death for ages 10-24. However, specific subgroups of youth are at significantly greater risk of SITB. Public systems involvement, LGBTQ+ status, and Black and/or Latinx youth are at elevated risk. Moreover, LGBTQ+ and Black/Latinx youth—and those who are both—are disproportionately overrepresented in the child welfare and juvenile justice systems. Child welfare and juvenile justice involved youth have approximately three times greater risk for suicide ideation, attempts, and completions (i.e., self-injurious thoughts and behaviors) than non-systems-involved youth. Sexual and Gender Minority (SGM) youth in the general population have two to four times the risk of SITB compared to their heterosexual, cisgender peers. Notably, SGM youth are disproportionately overrepresented in child welfare and juvenile justice, with estimates ranging from 16% to 32% compared to 2%-8% in the general population. In sum, the risk of SITB for SGM youth who are involved with public systems is compounded.

Child welfare and juvenile justice systems can screen, assess, and refer to treatment youth who may not otherwise access services. The unique needs of system-involved SGM youth have been largely ignored, with few child welfare and juvenile justice jurisdictions systematically identifying SGM youth or providing SGM-affirming care. There is a clear and urgent need for system-level interventions to provide SGM youth with equitable care to improve SITB and other behavioral health outcomes. In this paper, we provide a conceptual framework that can guide system-level research in this area, as well as highlighting several key knowledge gaps and research opportunities.