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Synthesis of Trials to Prevent Suicide Risk Behavior in Sexual and Gender Minorities

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Sexual and gender minority (SGM) youth have annual prevalence rates of suicide attempts of 29%, up to 4.6 times higher than that of other youth. We propose to test whether prevention programs that target suicide directly, or a range of factors that increase risk for suicide (internalizing symptoms, alcohol abuse, drug use, externalizing, bullying and interpersonal violence) reduce suicide risk for youth in general, and whether SGM youth benefit more or less from such programs. Working with a broad network of prevention trials researchers, we have received permission to obtain individual-level data from 21 randomized prevention trials involving 100,851 participants. All trials include direct or surrogate measures of suicide risk, and information about SGM status. Although all trials have tested and reported intervention impact on specific behavioral health outcomes, few have tested specific impact on SGM youth, given that such youth make up a relatively small proportion of the samples in each study. Our work and that of others indicates that combining data across trials will provide far greater power for testing several key hypotheses about impact on suicide risk, and whether SGM youth receive differential benefit from these interventions. We will use methods developed in our prior work to combine these datasets, and utilize findings from two measurement development studies of SGM and non-SGM youth suicide risk to guide advanced psychometric analyses for harmonizing outcome measures and developing a common index of suicide risk. We will apply integrative data analysis (IDA) methods that account for missing data to test three sets of hypotheses. Aim 1. Test whether different types of interventions decrease risk for suicidal thought and behavior among youth in the general population. We hypothesize that preventive programs reduce risk for suicidality regardless of primary target. We will use IDA to test this hypothesis on 21 trials (n=100,851). Aim 2. Test whether preventive effects differ for SGM youth. Given the unique risks often faced by SGM youth, we hypothesize that prevention programs will reduce risk for suicidality for SGM youth, but will be less effective compared with other youth. We will test moderation on 5,232 SGM and 95,619 non-SGM youth. Aim 3. Test whether preventive effects on SGM youth vary by type of intervention. We hypothesize that interventions targeting bullying and internalizing symptoms will be more effective in reducing suicide risk for SGM youth compared with interventions targeting alcohol and drug use and externalizing behavior. We will use IDA to compare the preventive effects of interventions across trial target behaviors (e.g., bullying) and individual factors (e.g., female vs male SGM youth). Findings from this study will fill major gaps in our understanding of how current prevention programs impact suicide risk both generally and in SGM and non-SGM youth, and will provide guidance in directing the next generation of prevention trials targeted towards this at-risk population.
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