The roles of school in supporting LGBTQ+ youth: A systematic review and ecological framework for understanding risk for suicide-related thoughts and behaviors

Abstract

The extant literature on suicide-related thoughts and behaviors (STB) has highlighted increased patterns of risk among specific minoritized populations, including lesbian, gay, bisexual, transgender, questioning, intersex, two spirit, and queer (LGBTQ+) youth. Compared to their heterosexual and cisgender peers, LGBTQ+ youth are at increased risk for having STB. Identity-specific stressors such as homonegativity and anti-queerness are among the unique factors posited to contribute to this risk and inhibit factors that protect against suicide. The school setting has been a focal point for suicide prevention and intervention and may also play a key role in linking students to care; however, schools also hold the potential to provide supports and experiences that may buffer against risk factors for STB in LGBTQ+ students. This systematic literature review presents findings from 44 studies examining school-related correlates of STB in LGBTQ+ students, informing an ecological approach to suicide prevention for school settings. Findings underscore the importance of school context for preventing STB in LGBTQ+ youth. Approaches that prioritize safety and acceptance of LGBTQ+ youth should span multiple layers of a student's ecology, including district and state level policies and school programs and interventions, such as Gender and Sexuality Alliances and universal bullying prevention programs. Beyond their role as a primary access point for behavioral health services, schools offer a unique opportunity to support suicide prevention by combating minority stressors through promoting positive social relationships and a safe community for LGBTQ+ students.

Keywords: Gender diverse; LGBTQ+; Schools; Sexual gender minoritized; Sexual orientation; Suicide.

Figure 1

PRISMA 2009 Flow Diagram of School-Related Influences of Suicide-Related Thoughts and Behaviors in LGBTQ+ Youth

Figure 2

Systems View of School-Related Influences of Suicide-Related Thoughts and Behaviors for LGBTQ+ Youth Note. Figure adapted from Rudasill et al. (2018); School microsystem includes components salient to suicide-related risk in sexual and gender minoritized youth shown with dashed lines; mesosystem indicated by shaded area intersecting student ontosystem, microsystems, and nanonsystems; minority stressors shown at top of figure to indicate influence across systems.