Predicting and Preventing Suicidal Ideation among High-Risk Sexual and Gender Minority Adolescents

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PROJECT SUMMARY Sexual and gender minority (SGM) adolescents are at increased risk for suicide. Approximately 1 in 3 SGM adolescents report having attempted suicide compared to 1 in 10 non-SGM adolescents. SGM adolescents are thought to be vulnerable to suicide because they must negotiate typical stressors of adolescence alongside coming to terms with an SGM identity, which can involve managing exposure to stigma-related stressors including external stressors (e.g., bullying) and navigating taxing internal psychological stressors (e.g., identity concealment). The overarching goal of this proposed K01, entitled Project SPIRiT (Suicide Prediction In Real- Time), is to examine the influence of stigma-related stressors (e.g., bullying, identity concealment) and universal suicide precursors (e.g., hopelessness) on suicidal ideation among SGM adolescents recently hospitalized for acute suicidality. I will utilize state-of-the-art real-time mobile monitoring methods incorporating both ecological momentary assessment (EMA) and global positioning system (GPS) data to pursue the project’s three aims: (Aim 1) develop an EMA+GPS assessment approach capable of capturing both self- reported and place-based exposure to stigma through focus groups with SGM adolescent recent inpatients; (Aim 2) examine precursors to suicidal ideation among SGM adolescent recent inpatients through a 28-day EMA+GPS study; and (Aim 3) develop and refine components of a just-in-time adaptive intervention (JITAI) targeting SGM adolescent suicide risk, informed by qualitative data from focus groups with Aim 2 participants and in-depth interviews with clinicians and JITAI experts. Evidence from Project SPIRiT will lay the groundwork for an NIMH R01 to further test an empirically informed suicide prevention JITAI for high-risk SGM adolescents. To successfully conduct the proposed research project, I will: (1) obtain training in innovative approaches to micro-longitudinal research methodology, including EMA+GPS technology; (2) develop expertise in conducting responsible research with clinical populations and addressing safety concerns; and (3) acquire skills in developing an empirically informed JITAI to reduce suicide risk. By engaging in mentored research with Dr. John Pachankis (primary mentor) and an expert team of co-mentors and collaborators at Yale University and beyond, and participating in coursework, seminars, workshops, scientific conferences, and regular mentorship meetings, I will develop the skills necessary to successfully carry out the proposed research activities and meet my long-term career goal of becoming an independent scientist. Yale University offers rich intellectual and practical resources, an interdisciplinary research and training environment, and professional development and collaborative opportunities to support early-career investigators in launching their independent research careers. The proposed K01 will provide me with the training, mentorship, and protected time necessary to establish an independent program of research focused on SGM disparities and suicide prevention through rigorous scientific inquiry and intervention development.