Suicide and Self-Injury
Anna DiMarcello, B.A.
Research Assistant
University of Denver
Denver, Colorado
Samantha Scott, M.A.
PhD Candidate
University of Denver
Denver, Colorado
Taylor Burke, Ph.D.
Member of the Faculty
Massachusetts General Hospital/Harvard Medical School
Providence, Rhode Island
Alex Bettis, Ph.D.
Assistant Professor
Vanderbilt University Medical Center
Nashville, Tennessee
Kathryn R. Fox, Ph.D.
Assistant Professor
University of Denver
Denver, Colorado
Objective: Self-injurious thoughts and behaviors (SITBs) including nonsuicidal self-injury, suicidal ideation (SI), and suicide attempts are prevalent public health issues amongst adolescents, especially for Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) youth. Evidence-based recommendations for mental health care clinicians involve asking youth directly and frequently about SITBs. Less is known about what promotes a positive disclosure experience for youth. This study aimed to describe positive experiences when disclosing SITBs to mental health care providers from adolescents’ perspectives.
Method: A majority LGBTQ+ sample of N=1,495 adolescents aged 13-17 (79.8% non-heterosexual, 21.7% nonbinary/gender queer; M=16.8 years; 64% White, 17.5% Hispanic, 3% Black/African American, 8.6% Bi- or multiracial, 4% Asian, 2% as other, including American Indian/Alaska Native) completed an online survey and were entered into a raffle for a $25 gift card. Participants were prompted to think about their best experiences sharing thoughts/behaviors of SITBs with a mental health provider (i.e., clinician). Participants then answered open-ended questions about what they shared, how the therapist responded, what happened after the disclosure, and whether/how the therapist involved parents. Responses were collapsed to represent one response per participant.
Results: Using open and axial coding, we identified N=2107 unique thematic units and 13 thematic categories, including Nature of SITB (18.5% of responses), Therapist Traits/Supportive Behaviors (17.1%), Coping Skills/Resources (9.2%), Recovery (7.8%), Negative Consequences/Aspects (7.6%), Feelings Therapist Creates (7.3%), Step Up in Care (5.8%), Emotion Processing (5.6%), Safety (5.6%), Appropriate Parent Involvement (5.3%), Rationale for SITB (4.5%), and Withholding Information/Minimizing (3.8%).
Conclusions: Understanding positive experiences disclosing SITBs to clinicians may be important for promoting and reinforcing disclosure, a cornerstone of suicide prevention. Positive experiences may be especially important for LGBTQ+ youth, given higher rates of SITBs compared to peers. Results suggest that asking youth to describe the nature of their SITB in detail, responding calmly and with empathy, and offering concrete coping skills and resources are associated with positive experiences with disclosure.