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 (Ruch et al. 2019). 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 (Agencies 2013; Casiano et al. 2013; Evans et al. 2017; Gallagher and Dobrin 2005; Gray et al. 2002; Hayes 2009; Katz et al. 2011; Scott, Underwood, and Lamis 2015; Vinnerljung, Hjern, and Lindblad 2006). 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 (Luk et al.2021; Nock et al. 2013; Perez-Brumer et al. 2017). Notably, SGM youth are disproportionately overrepresented in child welfare and juvenile justice, with estimates ranging from 16% to 32% (Grant et al. 2011; Majd, Marksamer, and Reyes 2009; Matarese et al. 2021; Wilson and Bouton 2022; Wilson and Kastanis 2018; Wilson et al. 2017) compared to 2%–8% in the general population (Conron et al. 2014). In sum, the risk of SITB for SGM youth who are involved with public systems is compounded (Dettlaff et al. 2018; Johns et al. 2020; Scannapieco, Painter, and Blau 2018).

Child welfare and juvenile justice systems can screen, assess, and refer to treatment youth who may not otherwise access services (Casiano et al. 2013; Gallagher and Dobrin 2005; Gray et al. 2002). 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 (Busby et al. 2020; Call, Challa, and Telingator 2021; Evans et al. 2017; Rider et al. 2019). 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.

Sexual and gender minority youth involved in public systems experience very pronounced disparities in terms of mental and behavioral health, yet remain underserved and understudied. Disparities are likely to become even more pronounced in the current sociopolitical reality. A surge of anti-LGBTQ bills have been introduced in the past 3 years, many targeting youth and transgender/gender diverse youth in particular, severely limiting access to gender affirming care (Gzesh et al. 2024). Structural- and systems-level drivers of health disparities must be addressed to influence long-term social change and advance health equity for marginalized SGMY.