Dialectical Behaviour Therapy for LGBTQ+ Adolescents at High Risk of Suicide; the Co-Development and Piloting of an LGBTQ-Affirmative Treatment Component.

Background Self-harm and suicide in adolescent populations are a rising public health concern. Up to one in four adolescents engage in self-harming behaviours. Self-harm significantly increases the risk of death by suicide.

Lesbian, Gay, Bisexual, Transgender, Queer, and other gender- and sexuality-diverse (LGBTQ+) adolescents are two to six times more likely to self-harm and attempt suicide compared to cisgender and heterosexual adolescents. Despite this increased risk, LGBTQ+ adolescents report poor experiences of services.

Dialectical Behaviour Therapy (DBT) is an effective psychological intervention for adolescents at high risk of self-harm and suicide.

However, qualitative feedback from LGBTQ+ adolescents suggests that there may be important LGBTQ-associated experiences, that are contributors to risk, which are not targeted in the current model.

These include difficulties with LGBTQ-identity confusion, managing stigma experiences, and connecting with similar others. This highlights the potential need for an addition to the DBT model to meet these LGBTQ-associated needs. Any intervention adaptation for minoritised groups would benefit from utilising co-production methodology.

Aims and Objectives The first aim of these projects is to co-produce an intervention component for LGBTQ+ adolescents that can be integrated into existing DBT programmes and similar contexts. This intervention will aim to target LGBTQ-associated difficulties that contribute to distress, self-harm, and suicide.

The second aim is to pilot this component to assess feasibility, acceptability, and early indicators of effectiveness to inform future trials.

Methods This project will include three phases: A systematic scoping review of the literature to summarise current therapy techniques used to reduce difficulties with LGBTQ+ identity confusion, managing stigma, and connecting with similar others. A co-production study to develop a new DBT component with LGBTQ+ adolescents and DBT therapists.

Feedback will be sought on the feasibility and acceptability of the co-production methods process using interviews and ratings.

A nested study will pilot the new therapy components with eight LGBTQ+ adolescents and use session-by-session feedback for refinement.

A single-arm pilot trial of the new therapy component within an existing DBT programme will gain information about the feasibility and acceptability of the intervention and trial methodology. Feedback will be sought from DBT therapists on the new component and considerations around implementation.

Early indicators of effectiveness will be collected, including key outcomes collected in DBT (e.g., self-harm) and LGBTQ-associated difficulties. Timeline for delivery The projects will be completed over four years. Phase 1 and 2 will be completed in the first two years, and Phase 3 in the latter two years.

Anticipated impact and dissemination It is anticipated that the LGBTQ+ adolescents will benefit from the inclusion of the new component to better meet their minority-specific needs, reduce self-harm behaviours, and improve mental health.

Therapists will also benefit from the guidance and training in how to provide therapy for LGBTQ-associated difficulties. These projects aim to stimulate continued research into culturally-sensitive care for LGBTQ+ people.

The results will be presented to participants, therapists, and other stakeholders in the project using multiple platforms. The dissemination strategy will be further developed with PPI representatives.