WORKING WITH Gender and sexual minorities (GSM) is an

umbrella term that encompasses all individuals

whose sexual orientation and/or gender identity
GENDER AND fall outside of the cisgender heterosexual majority.

SEXUALly GSM individuals face disparities in mental

health outcomes, such as increased rates
diverse of anxiety, depression, and suicidality.
1.5x more likely to report depression and anxiety

populations More likely to be targets of interpersonal violence

At higher risk for developing body image and eating disorders
Higher rates of substance abuse and risky behaviors
A TOOLKIT FOR CLINICIANS
More likely to experience negative social outcomes
LGB teens 2-2.5x more likely to experience SI
Gender minorities include trans-
gender, gender nonconforming,
and other people whose gender
identity and expression do not
align with the sex (e.g., male, fe-
male) they were assigned at birth
(e.g., nonbinary, agender, pangen-
der, etc.)

Sexual minorities are people

whose sexual orientations differ
from societal norms of heterosexu-
ality. These groups include gay, les-
bian, bisexual, pansexual, asexual,
queer, and other sexual orientation
identities
GSM identity formation model
Identity Confusion - Begins with initial thoughts and feelings associated with
GSM identity; emotional turmoil, denial
Identity Comparison - Begins to accept GSM identity could apply to them;
begins to explore implications of GSM identity
Identity Tolerance - Begins to understand they are “not the only one.” Seeks out
other GSM to decrease social isolation
Identity Acceptance - Attaches positive meaning to GSM identity
Identity Pride - When “coming out” is likely to occur; wants to share GSM
identity. Begins to think in “us vs. them” mentality toward heterosexuals
Cass Identity Synthesis - Integrates GSM identity with all other aspects of self; GSM
Identity identity becomes just one aspect of the self
Formation
Model groups at increased risk
Although GSM people face an overall higher risk of negative
outcomes, there are some subsets of this poulation at an even
higher risk:
Trans and gender nonconforming
Bisexual-identified (and others under the bisexual umbrella)
QTPOC face increased stigma due to multiple stigmatized
identities
CLINICAL GUIDELINES
Don’t be afraid to address sensitive topics
Be mindful of your own stereotypes and bias
Be aware of clients’ mistrust of mental health
professionals
Ask questions and normalize disclosures
Express and maintain confidentiality
AREAS OF CLINICAL FOCUS
Don’t overemphasize the role of gender identity
and sexual orientation
If they feel like it would be helpful, work on
exploring gender and sexual identity, addressing
the negative impact of GSM status and stigma,
and assess the role of multiple identities
Build coping skills for alleviating internalized
homophobia and transphobia

Be familiar with referrals and resources specific Helping develop and enhance peer support
to the GSM population networks

Use inclusive language! Explore impact of family dynamics and work to

gender-neutral pronouns ehance family support. Build coping skills to
protect against negative family interactions.

Examples:
considerations for working with
“Are “Hi, medically transitioning individuals
you romantically my name is
Sara. How do you During the process of medically transitioning, individuals
involved?” instead of
want to be identified?” experience a multitude of physical and emotional changes.
“Do you have a boy-
friend?” This process presents a unique set of challenges for trans
individuals. Hormone treatments will likely cause changes in
emotion for people who are medically transitioning.
“Hi, I’m
Sara. I identify as
female and use female
The time surrounding transition is one of heightened
pronouns.” vulnerability for trans people. Althoguh eventually, outcomes
will improv following transition and gender confirmation
treatment, the transition process is an especially difficult one
to navigate.

resources for working with gsm individuals

UC Berkeley’s Glossary of GSM Terms (http://ejce.berkeley.edu/geneq/resources/lgbtq-resources/definition-terms)
SAMHSA’s LGBT Resource Kit (https://store.samhsa.gov/product/Top-Health-Issues-for-LGBT-Populations/SMA12-4684)
APA’s Guidelines for working with LGB Clients (http://www.apa.org/pi/lgbt/resources/)
APA’s Guidelines for working with Trans and GNC clients (http://www.apa.org/pi/lgbt/resources/)
World Professional Association for Transgender Health www.wpath.org
Trans Lifeline 1 (877) 565-8860 | www.translifeline.org
The Trevor Project thetrevorproject.org | 1 (866) 488-7386

local resources
Fairness Campaign (http://fairness.org)
Lousville Youth Group (https://www.facebook.com/Louisville-Youth-Group-119561211422440/)
UofL’s LGBT Center (http://louisville.edu/lgbt)
ACLU of Kentucky (http://www.aclu-ky.org/)
 The Gender Unicorn Gender Identity
Graphic by:

Female/Woman/Girl
Male/Man/Boy
Other Gender(s)
Gender Expression
Feminine
Masculine
Other

Sex Assigned at Birth

Female Male Other/Intersex

Physically Attracted to
Women
Men
Other Gender(s)

To learn more, go to:

Emotionally Attracted to
www.transstudent.org/gender
Women
Men
Design by Landyn Pan and Anna Moore
Other Gender(s)
Key Terms and Concepts in Understanding
Gender Diversity and Sexual Orientation
Among Students

INFORMATIONAL GUIDE
About this Series
This resource is part of a series of informational guides from Division 16 (School Psychology) and Division 44 (Society for
the Psychological Study of Lesbian, Gay, Bisexual and Transgender Issues) of the American Psychological Association.
This series, “Promoting Resiliency for Gender Diverse and Sexual Minority Students in Schools,” sets out best practices
for educators, school counselors, administrators and personnel, based on the latest research on the needs of lesbian,
gay, bisexual, transgender, queer, gender diverse, questioning and intersex students. The series includes topics such
as gender diversity among students, helping to support families with LGBT children and youth, risk factors and resiliency
factors within schools around health and wellbeing of LGBT youth, and basic facts about gender diversity and sexual
orientation among children and youth.

SERIES INCLUDES:
Pamphlet 01
How Educators Can Support Families With Gender
Diverse And Sexual Minority Children and Youth
Pamphlet 04
School-Based Risk and Protective Factors for
Gender Diverse and Sexual Minority Children and
Youth: Improving School Climate

Pamphlet 02 Pamphlet 05
Supporting Transgender and Gender Diverse Key Terms and Concepts in Understanding Gender
Students in Schools: Key Recommendations for Diversity and Sexual Orientation among Students
School Health Personnel

Pamphlet 03
Supporting Transgender and Gender Diverse
Students in Schools: Key Recommendations for
School Administrators

Sobering Statistics
A national survey (Kosciw, Greytak, Bartkiewicz, Boesen, & Palmer, 2012) finds that gender diverse and sexual
minority youth:

71% 57% 82% 38%

Hear peers make negative Hear teachers make negative Are verbally harassed Are physically harassed
remarks about sexual remarks about sexual because of sexual because of sexual
orientation (71%) and orientation (57%) and orientation (82%) or orientation (38%) or
gender expression (61%) gender expression (57%) gender expression (64%) gender expression (27%)

64% of students feel unsafe at school because of sexual orientation prejudice, and 44% feel unsafe at school because
of gender expression. When gender diverse and sexual minority youth experienced harassment or assault, over 60%
did not report the incident to school staff, often because they believed that little action would be taken or that the
situation would be made worse by reporting (Kosciw, Greytak, Bartkiewicz, Boesen, & Palmer, 2012).

19
Definitions and Limitations of Language
The language around gender and sexuality continues to
evolve rapidly, even as this resolution was being written.
Words and their definitions change or become refined
as our understanding of complex constructs related to
sexuality and gender evolves. We recognize that learning
which words or phrases are most accurate, respectful and
useful is an important goal in adopting this resolution.
Given how rapidly terminology changes, we recognize
that even this list of terms and definitions might undergo
significant change in the future. Therefore, it is important
to explicitly and consciously articulate our current
understanding of the following terms that appear in this
resolution and in its supporting documents:

Key Recommendations
Asexual refers to a person who does not experience sexual attraction or has
little interest in sexual activity.

Bullying is unwanted, repetitive, and aggressive behavior marked by an

imbalance of power. It can take on multiple forms, including physical (e.g.,
hitting), verbal (e.g., name calling or making threats), relational (e.g., spreading
rumors), and electronic (e.g., texting, social networking). (Rossen & Cowan,
2012).

Cisgender replaces the terms “nontransgender” or “bio man/bio woman” to

refer to individuals who have a match between the sex they were assigned at
birth, their bodies, and their gender identity. (Schilt & Westbrook, 2009).

DSD refers to “disorders of sex development”, a term that is used to discuss

intersex and variations in sex development by some medical professionals and
community members. See entry for Intersex.

Gender refers to the attitudes, feelings, and behaviors that a given culture associates with a person’s biological sex.
Behavior that is compatible with cultural expectations is referred to as gender-normative; behaviors that are viewed as
incompatible with these expectations constitute gender non-conformity. (APA guidelines)

Gender Expression An individual’s presentation, including physical appearance, clothing choice and accessories,
and behavior that communicates aspects of gender or gender role. Gender expression may or may not conform to a
person’s gender identity.

Gender Identity A person’s deeply-felt, inherent sense of being a boy, a man, or male; a girl, a woman, or female; or
an alternative gender (e.g., genderqueer, gender non-conforming, boygirl, ladyboi) which may or may not correspond
to a person’s sex assigned at birth or to a person’s primary or secondary sex characteristics. Since gender identity is
internal, a person’s gender identity is not necessarily visible to others. ‘Affirmed gender identity’ refers to a person’s
gender identify after coming out as transgender or gender non-conforming or undergoing a social and/or medical
transition process.

Gender Diversity refers to the extent to which a person’s gender identity, role, or expression differs from the cultural
norms prescribed for people of a particular sex. This term is becoming more popular as a way to describe people
without reference to a particular cultural norm, in a manner that is more affirming and potentially less stigmatizing than
gender nonconformity. (Gender Spectrum, 2013; https://www.genderspectrum.org/understanding-gender).

Gender Dysphoria refers to discomfort or distress that is associated with a discrepancy between a person’s gender
identity and that person’s sex assigned at birth (and the associated gender role and/or primary and secondary sex
characteristics) (Fisk, 1974; Knudson, De Cuypere, & Bockting, 2010b). Only some gender-nonconforming people
experience gender dysphoria at some point in their lives. (Coleman, et al. 2011)

20
Gender Identity refers to one’s sense of oneself as male, female, or
something else (American Psychological Association, 2006). When one’s
gender identity and biological sex are not congruent, the individual may
identify along the transgender spectrum (cf. Gainor, 2000; APA guidelines).

Gender Identity and Sexual Orientation are Different Constructs

Transgender people, like cisgender people, may be sexually oriented toward
men, women, both sexes, or neither sex, and like most people, usually
experience their gender identity (who they feel themselves to be) and their
sexual orientation (whom they are attracted to) as separate phenomena
(Bockting & Gray, 2004; Chivers & Bailey, 2000; Coleman, Bockting, &
Gooren, 1993; Docter & Fleming, 2001; Docter & Prince, 1997). Many
transgender people experience a shift in their sexual attractions at some point
(Daskalos, 1998; Meier, Pardo, Labuski, & Babcock, 2013), indicating that
sexual orientation may be more dynamic than previously thought.

Gender Non-Conforming is an adjective and umbrella term to describe

individuals whose gender expression, gender identity, or gender role differs
from gender norms associated with their assigned birth sex. Subpopulations
of the TGNC community can develop specialized language to represent their
experience and culture, such as the term “masculine of center” that is used in
communities of color to describe a GNC identity.

Gender Role fefers to a pattern of appearance, personality, and behavior that, in a given culture, is associated with
being a boy/man/male or being a girl/woman/female.. A person’s gender role may or may not conform to what is
expected based on a person’s sex assigned at birth. Gender role may also refer to the social role one is living in (e.g.,
as a woman, a man, or another gender), with some role characteristics conforming and others not conforming to what is
associated with girls/women or boys/men in a given culture and time.

Genderqueer refers to a person whose gender identity falls outside of the gender binary (i.e. identifies with neither
or both genders). Genderqueers may also use the term “gender fluid” as an identifier but typically reject the term
“transgender” because it implies a change from one gender category to another.

Intersex refers to a range of conditions associated with atypical development of physical sex characteristics (American
Psychological Association [APA], 2006). Intersex individuals may be born with chromosomes, genitals, and/or gonads
that do not fit typical female or male presentations (OII-USA, 2013). Some examples of these conditions include
ambiguous external genitals, inability of the body to respond typically to sex-related hormones, and inconsistency
between external genitals and internal reproductive organs (APA, 2006). Since 2006, the medical and research
community has used the term Disorders of Sex Development. This term refers to congenital conditions characterized by
atypical development of chromosomal, gonadal, or anatomical sex (Houk, Hughes, Ahmed, Lee, & Writing Committee
for the International Intersex Consensus Conference Participants, 2006). An alternate term – Differences of Sex
Development – has been recommended to prevent a view of these conditions as diseased or pathological (Wisemann,
Udo-Koeller, Sinnecker, & Thyen, 2010). In order to be inclusive of various terminology preferences, this document will
use intersex/DSD when referring to individuals who are part of this community.

Pansexual “is most commonly used in the world outside academia as a sexual identity [and sexual orientation] term
similar to ‘bisexuality,’ but more inclusive of trans people. It also shows an awareness of the implied gender binary in
the term ‘bisexual.’” (Elizabeth, 2013, p. 333)

Pushout: a student who leaves school before graduation due to the encouragement of school personnel, often to
enable the school to achieve a performance goal or to lower disruption within the school or because the school views
the student as too much trouble. This term is in contrast to “drop out” to highlight the institutional influence on individual
behavior. (retrieved from http://www.findyouthinfo.gov/youth-topics/lgbtq-youth)

21
Queer is an umbrella term that individuals may use to describe a sexual orientation, gender identity, or gender
expression that does not conform to dominant societal norms. Historically, it has been considered a derogatory or
pejorative term and the term may continue to be used by some individuals with negative intentions. Still, many LGBT
individuals today embrace the label in a neutral or positive manner (Russell, Kosciw, Horn, & Saewyc, 2010). Some youth
may adopt ‘queer’ as an identity term to avoid limiting themselves to the gender binaries of male and female or to the
perceived restrictions imposed by lesbian, gay, and bisexual sexual orientations (Rivers, 2010).

Questioning is an identity label for a person who is exploring their sexual orientation or gender identity, and is in a state
of moratorium in terms of identity formation.

Sex refers to a person’s biological status and is typically categorized as male, female, or intersex (i.e., atypical
combinations of features that usually distinguish male from female). There are a number of indicators of biological sex,
including sex chromosomes, gonads, internal reproductive organs, and external genitalia. (APA guidelines).

Sex assignment is the initial categorization of an infant as male or female.

Sexual orientation refers to the sex of those to whom one is sexually and romantically attracted. Categories of
sexual orientation typically have included attraction to members of one’s own sex (gay men or lesbians), attraction to
members of the other sex (heterosexuals), and attraction to members of both sexes (bisexuals). Some people identify
as pansexual or queer in terms of their sexual orientation, which means they define their sexual orientation outside of the
gender binary of “male” and “female” only. While these categories continue to be widely used, research has suggested
that sexual orientation does not always appear in such definable categories and instead occurs on a continuum (e.g.,
Kinsey, Pomeroy, Martin, & Gebhard, 1953; Klein, 1993; Klein, Sepekoff, & Wolff, 1985; Shiveley & DeCecco, 1977). In
addition, some research indicates that sexual orientation is fluid for some people; this may be especially true for women
(e.g., Diamond, 2007; Golden, 1987; Peplau & Garnets, 2000).

Sexual Orientation A component of identity that includes a person’s sexual and emotional attraction to another person
and the behavior that may result from this attraction. An individual’s sexual orientation may be lesbian, gay, heterosexual,
bisexual, queer, pansexual, or asexual. A person may be attracted to men, women, both, neither, genderqueer,
androgynous or have other gender identities. Sexual orientation is distinct from sex, gender identity, gender role and
gender expression.

Transgender is an umbrella term that incorporates differences in gender identity wherein one’s assigned biological
sex doesn’t match their felt identity. This umbrella term includes persons who do not feel they fit into a dichotomous
sex structure through which they are identified as male or female. Individuals in this category may feel as if they are in
the wrong gender, but this perception may not correlate with a desire for surgical or hormonal reassignment (Meier &
Labuski, 2013).

22
A publication of the American
Psychological Association,
Divisions 16 and 44 © 2015
 LGBTQ-INCLUSIVE LANGUAGE DOs and DON’Ts
AVOID SAYING... SAY INSTEAD... WHY? EXAMPLE
Hermaphrodite is a stigmatizing, "What are the best practices for
"Hermaphrodite" "Intersex" inaccurate word with a negative the medical care of intersex
medical history. infants?"

"Homosexual" often connotes a "We want to do a better job of

"Homosexual" "Gay" medical diagnosis, or a discomfort being inclusive of our gay
with gay/lesbian people. employees."

"Assigned" language accurately

"Born female" or
depicts the situation of what
"Born male"
happens at birth

"Max was assigned female at birth,

"Assigned female/male
then he transitioned in high
at birth"
school."
"-bodied" language is often
"Female-bodied" or interpreted as as pressure to
"Male-bodied" medically transition, or invalidation
of one's gender identity

"A gay" or "a "A gay/transgender Gay and transgender are adjectives "We had a transgender athlete in
transgender" person" that describe a person/group our league this year. "

Saying "normal" implies "This group is open to both

"Transgender people "Transgender people
"abnormal," which is a stigmatizing transgender and cisgender
and normal people" and cisgender people"
way to refer to a person. people."

"Both" implies there are only two; "Video games aren't just a boy
"Both genders" or
"All genders" "Opposite" reinforces antagonism thing -- kids of all genders play
"Opposite sexes"
amongst genders them."

Moving away from binary language

"Ladies and "Everyone," "Folks," "Good morning everyone, next
is more inclusive of people of all
gentlemen" "Honored guests," etc stop Picadilly Station."
genders
"Mail clerk,"
"Mailman," "fireman," "I actually saw a firefighter rescue
"Firefighter," "Police People of all genders do these jobs
"policeman," etc. a cat from a tree."
officer," etc.

"It" when referring to

"It" is for referring to things, not "You know, I am not sure how they
someone (e.g., when "They"
people. identify."
pronouns are unknown)
 Sexual Orientation
and Gender Identity
Questions:
Information for Patients

Thank you for taking the time

to complete these questions.
If you have additional questions,
we encourage you to speak with
your provider.

This project was supported by the Health Resources and Services

Administration (HRSA) of the U.S. Department of Health and
Human Services (HHS) as part of an award totaling $449,985.00
with 0 percentage financed with non-governmental sources. The
contents are those of the author(s) and do not necessarily repre-
sent the official views of, nor an endorsement, by HRSA, HHS, or
the U.S. Government. For more information, please visit HRSA.gov.
We are asking you about your sexual orientation
and gender identity in order to provide more
patient-centered care. Read inside to learn what
the questions mean, and how the information
will be used to improve health care for all.

TFIE-47
Q: WHY AM I BEING ASKED ABOUT
MY SEXUAL ORIENTATION AND
GENDER IDENTITY?
Learning about the sexual orientation and gender
identity of our patients helps us better under-
stand the populations we are serving. It also
allows us to offer culturally responsive care that
focuses on a patient’s specific needs.
Q: WHAT IS GENDER IDENTITY?
Gender identity is a person’s inner sense of being
a girl/woman/female, a boy/man/male, some-
thing else, or having no gender.
The term “transgender” describes people whose
gender identity and sex assigned at birth do not
correspond based on traditional expectations.
• Transgender woman/female describes some-
one assigned male at birth who has a female
gender identity.
• Transgender man/male describes someone
assigned female at birth who has a male
gender identity.
Additional gender identities include, but are
not limited to:
• Gender fluid: describes someone whose
gender identity is not fixed.
• Genderqueer/non-binary: describe people
whose gender identity falls outside the
traditional gender binary of either
girl/woman/female or boy/man/male.
Q: WHAT IS SEXUAL ORIENTATION?
Sexual orientation is how people describe their
emotional and physical attraction to others.
• Heterosexual (straight) describes women who
are primarily attracted to men, and men who are
primarily attracted to women.
• Gay describes people who are primarily
attracted to the same gender as themselves. The
term “gay” most commonly refers to
men attracted to men.
• Lesbian describes women who are primarily at-
tracted to other women.
• Bisexual describes people who are emotionally
and physically attracted to women/females and
men/males. Some people define bisexuality as
attraction to all genders.
Some people use other terms, such as queer, to
describe their sexual orientation.
Q: WHAT IF I’M NOT SURE HOW TO ANSWER?
You can select “Don’t know” if you are not sure, or
you can talk with your provider.
Q: WHAT IF NONE OF THE CATEGORIES
DESCRIBE ME?
There are many sexual orientations and gender
identities. Unfortunately, it is not possible to list
them all. If your sexual orientation or gender identi-
ty is not included in the list provided, you can select
an additional category or, if space is provided, you
can write in the terms you use to describe yourself.
Q: WHAT IF I DON’T WANT TO SHARE
THIS INFORMATION?
You can select “Choose not to disclose.” Later, your
provider may ask you these questions privately, and
you can ask your provider questions. You never
have to answer if you do not want to.
Q: WHO WILL SEE THIS INFORMATION?
Your health care providers will see this information,
and it may become part of your electronic health
record. If a staff member enters the information into
your health record, that person will also see your
answers. If you have concerns, talk to your provider.
Q: HOW WILL MY INFORMATION BE PROTECTED?
Your sexual orientation and gender identity infor-
mation is confidential and protected by law, just like
all of your other health information. If you are under
18 years old, your parent/guardian may have access
to this information. Talk to your provider if you have
any concerns.
Q: HOW WILL THIS INFORMATION BE USED?
Your provider(s) will use this information to better
understand and meet your health care needs. In ad-
dition, gathering this information from all patients
allows health centers to see if there are gaps in care
or services across different populations.
Q: WHY DO HEALTH CENTERS ASK
ABOUT PRONOUNS?
Pronouns are the words people use when they are
referring to you, but not using your name. Exa-
mples of pronouns are she/her/hers, he/him/his,
and they/them/theirs. Asking about pronouns helps
staff correctly refer to patients. Otherwise, staff
need to make assumptions, which can lead to
embarrassing and disrespectful situations.
MARYLAND SUICIDE PREVENTION AND EARLY INTERVENTION NETWORK (SPIN)

BEST PRACTICES
IN SUICIDE
PREVENTION
AMONG LGBTQ+
YOUTH

LGBTQ + YOUTH ARE AT A

GREATER RISK FOR SUICIDE
COMPARED TO
PREVENTING SUICIDE AMONG HETEROSEXUAL YOUTH:
LGBTQ+ YOUTH IS A Lesbian, Gay, and Bisexual (LGB) youth are 3
NATIONAL HEALTH PRIORITY times more likely to report having thoughts of
suicide.
LGB youth are 5 times more likely to have
attempted suicide.
17% of LGB populations and 40% of trans
people have made suicide attempts.

WHAT DO I SAY TO SOMEONE

WHO IS COMING OUT TO ME? SUPPORTIVE PHRASES:

"Thank you for sharing with me. What does your

It can be difficult to know what to say to
identity mean to you?"
someone when they are coming out to you.
However, thanking the person for sharing with
“I’m so happy you told me, and I want you to
you, being present, validating their
know this won’t change our relationship in
experience, and expressing love for the person
anyway.”
are ways to show support. It is important not
to use denying phrases (e.g., “it’s just a
“I’m really excited for you.”
phase”), and rather, show support (e.g.,
“thank you so much for sharing with me”). Try DENYING PHRASES:
to be supportive of the person regardless of
personal feelings. If you have strong religious “You don’t really mean that, do you?”
beliefs or other beliefs about the LGBTQ +
community, work through them with the “It’s just a phase – I’m sure you’ll grow out of it.”
support of a therapist. After someone comes
out to you, call them, continue to do activities “Everybody’s experimenting with their sexuality
with the person, include the person’s partner these days.”
in plans (as you would with other people), and
learn more about the LGBTQ + community to
demonstrate your support.

USING LGBTQ+ AFFIRMING

ADDITIONAL RESOURCES:
LANGUAGE
· Eliminate gendered language, and instead use affirmative, i
inclusive, and person-first language. For instance, use the Core Vocabulary Handout:
phrase “you all” instead of “you guys.” http://bit.ly/2tvaMDP
· Ask how someone identifies AND what that means to that Inclusive Language Handout:
person. 
http://bit.ly/2tooTdX
- Include your pronouns when you introduce yourself (e.g.,
Genderbread Person: http://bit.ly/2SRZSpL
she/her/hers; he/him/his; they/their/theirs;
ze/hir/zir/hirs/zirs).
Queer Umbrella: http://bit.ly/2Idk41h

FOR MORE INFORMATION ON SUICIDE PREVENTION IN MARYLAND

VISIT:HTTPS://HEALTH.MARYLAND.GOV/SUICIDEPREVENTION/PAGES/H
OME.ASPX OR EMAIL MDH.SUICIDEPREVENTION@MARYLAND.GOV
 RISK AND PROTECTIVE FACTORS OF SUICIDE
AMONG LGBTQ+ YOUTH

RISK FACTORS

Mental Illness: LGBTQ+ populations are 3 times more likely to

experience a mental illness
 Perceived burdensomeness and low sense of belongingness
Stigma and discrimination
Higher rates of victimization and trauma
Rejection from family or friends
Lethal means: LGBTQ+ populations are more likely to use
firearms when attempting suicide

PROTECTIVE FACTORS

Connection with mental health or substance use resources

Connection with supportive faith-based organizations and
other communities
Being accepted after coming out
Social support (from family, friends, clubs)
Sense of making a difference in the world (i.e., meaningful
employment, volunteering, mentoring)
Coping, problem-solving, and conflict resolution skills
Positive role models

SUICIDE INTERVENTION WITH LGBTQ+ YOUTH

Assess family dynamics: When discussing a support system, gain a
knowledge of family dynamics, as not all families are supportive of the youth’s
identity. Assess whether it is appropriate to recommend seeking family
support, and also, emphasize a “chosen family” rather than “blood family.”

Assess access to lethal means: Because LGBTQ+ individuals are more

likely to use firearms when attempting suicide than heterosexual individuals,
assess for access to lethal means and create a means safety plan.

ADDITIONAL RESOURCES REFERENCES

Chase Brexton Health Services AFSP. (2017). Talking About Suicide and LGBT Populations. Retrieved from http://afsp.org/wp-
content/uploads/2016/01/talking-about-suicide-and-lgbt-populations-2nd-edition.pdf
Phone: 410-837-2050
APA. (2009). The Interpersonal-Psychological Theory of Suicidal Behavior: Current Empirical Status.
chasebrexton.org Retrieved from https://www.apa.org/science/about/psa/2009/06/sci-brief.aspx
 
CDC. (2017). Adolescent and School Health. Retrieved from
Grassroots Crisis Intervention Center and Safe Space Training https://www.cdc.gov/healthyyouth/data/yrbs/results.htm
Hotline: 410-531-6677 CDC. (2017). Violence Prevention. Retrieved from
Website: grassrootscrisis.org https://www.cdc.gov/violenceprevention/suicide/riskprotectivefactors.html

  Dant, K., McCleary, M., Field, T. (2018). MD-SPIN: Best Practices for Suicide Prevention with LGBTQ+
GLSEN (Gay, Lesbian, and Straight Education Network) Youth. [webinar]. Retrieved from https://csmh.adobeconnect.com/p4itmhwk2mvl/

Maryland chapter: (443) 509-1108
8 Market Pl. Ste 300, Baltimore, MD 21202
My3 Safety Planning App
https://my3app.org/
SPRC Counseling on Access to Lethal Means Training
https://training.sprc.org/enrol/index.php?id=20
Kalra, G., Ventriglio, A., & Bhugra, D. (2015). Sexuality and mental health: Issues and what next?.
International Review Of Psychiatry, 27(5), 463-469. doi:10.3109/09540261.2015.109403
Herreria, C. (2018). Over 50% Of LGBTQ Youths Struggle With Eating Disorders, Survey Finds.
Retrieved from https://www.huffingtonpost.com/entry/lgbtq-eating-
disordesurvey_us_5a975aa1e4b07dffeb6f8786utm_campaign=hp_fb_pages&utm_source=qv_fb&utm_m
edium=facebook&ncid=fcbklnkushpmg00000050
Hill, R. M., & Pettit, J. W. (2012). Suicidal Ideation and Sexual Orientation in College Students: The
Roles of Perceived Burdensomeness, Thwarted Belongingness, and Perceived Rejection Due to Sexual
Orientation. Suicide and Life-Threatening Behavior, 42(5), 567-579. doi:10.1111/j.1943-
278x.2012.00113.x

  Matarazzo, B. B., Barnes, S. M., Pease, J. L., Russell, L. M., Hanson, J. E., Soberay, K. A., & Gutierrez, P. M.
(2014). Suicide Risk among Lesbian, Gay, Bisexual, and Transgender Military Personnel and Veterans:
The Safe Zone Project What Does the Literature Tell Us? Suicide and Life-Threatening Behavior, 44(2), 200-217.
Thesafezoneproject.com doi:10.1111/sltb.12073

Miami University. (n.d.). Ongoing and Upcoming Research Projects. Retrieved from
https://miamioh.edu/cas/academics/departments/psychology/about/faculty-staff/smith-april/reds-
Trans Lifeline lab/projects/index.html
translifeline.org
NAMI. (n.d.). Risk of Suicide. Retrieved from https://www.nami.org/Learn-More/Mental-Health-
Conditions/Related-Conditions/Suicide
Trevor Project
Trevor Lifeline: 1-866-488-7386
TrevorText at 202-304-1200
suicide prevention
compassion and community
Suicide is the 2nd leading cause of death for individuals aged 15-34 and the 10th
leading cause of death overall. On average, one suicide occurs every 11.7 minutes
in the U.S., with approximately 25 attempts occurring for every suicide death.*

warning signs of suicide warning signs of acute risk

Expressed or Communicated Ideation
I Suicide ideation • Threatening to hurt or kill themselves
Increased substance use • Talking of wanting to hurt or kill themselves
S • Looking for ways to kill themselves, such as seeking
access to firearms, pills, or other means
• Talking or writing about death, dying, or suicide
P Sense of purposelessness

A Anxiety, agitation, sleep changes

What to do if you're concerned
T Feeling trapped
Ask. Are you okay? How can I support you?
H Hopelessness
Have an open, honest conversation.
• Talk to them in private.
• Listen to their story.
W Withdrawal from friends/family • Tell them you care about them.
• Ask them directly if they’re thinking about suicide or
A Rage, uncontrolled anger taking their life.
• Encourage them to seek treatment or contact their
R Acting reckless therapist/doctor.
If the person says they are considering suicide:
M Dramatic mood changes • Take them seriously.
• Stay with them.
? • Help them remove lethal means.
• Call the Suicide Prevention Lifeline (1-800-273-8255)
or text the Crisis line (741-741) for support from a
Suicide prevention is trained counselor.
• Go with them to the nearest Emergency Room or
everyone’s business. mental health services

Crisis Resources
National Suicide Prevention Lifeline 1-800-273-8255 | TTY 1–800–799–4889
Crisis Text Line Text “Home” to 741741
Trans Lifeline 1-877-565-8860
The Trevor Project 1-866-488-7386 | Text “Trevor” to 1-202-304-1200 | Chat @ thetrevorproject.org
Veterans Crisis Line 1-800-273-8255 and press 1

Learn More
American Association of Suicidology www.suicidology.org
American Foundation for Suicide Prevention www.afsp.org
National Instititue of Mental Health www.nimh.nih.gov/health/publications/suicide-faq
Drapeau C. W., McIntosh J. L. (2015). U.S.A. suicide 2013: Official final data. Retrieved from http://www.suicidology.org/Portals/14/docs/
Resources/FactSheets/2013datapgsv2alt.pdf
In crisis?
HELLO

Free, 24/7 support for people in crisis.

The Trevor Project focuses on ending suicide among LGBTQ youth.
If you or someone you know needs help, we are here for you.

TrevorLifeline
If you’re thinking about suicide, you deserve immediate help.
Call us anytime.
866.488.7386

TrevorText
Talk to a Trevor counselor via text message.
Text “START” to 678678

TrevorChat
Online instant messaging with a TrevorChat counselor.
TrevorChat.org

TrevorSpace
A social networking site for LGBTQ youth under 25, and their
friends & allies.
TrevorSpace.org

Suicide Prevention & General Info

Information on suicide prevention and FAQs on sexual orientation,
gender identity and other topics can be found at:
TheTrevorProject.org/resources
TheTrevorProject.org