Suicide prevention intervention for vulnerable emerging adult sexual minorities: A pilot hybrid effectiveness randomized control trial

BACKGROUND: Suicide attempts and suicide death disproportionately affect sexual and gender minority emerging adults (ages 18-24). However, suicide prevention strategies tailored for emerging adult sexual and gender minorities (EA-SGM) are not widely available. OBJECTIVE: We will pilot test the combination of peer mentoring alongside an app-based intervention (Supporting Transitions to Adulthood and Reducing Suicide; STARS) designed to reduce suicidal ideation and behaviors. STARS will include suicide prevention content and will target positive affect, discrimination, and social support. After an in-person Safety Planning Intervention (SPI) with a clinician, STARS users can access content and activities to increase their intentions to use the SPI and overcome obstacles to its use. METHODS: Guided by the RE-AIM framework, we will recruit and enroll a racially/ethnically diverse sample of 60 EA-SGM reporting past-month suicidal ideation. Using a Type 1 Effectiveness-Implementation Hybrid Design, participants will be randomized to receive the SP intervention (Control arm) or to receive the SP intervention alongside STARS (Intervention arm). We will follow participants for six months, with evaluations at 2, 4, and 6 months. Preliminary effectiveness outcomes (suicidal ideation and behavior) and hypothesized mechanisms of change (positive affect, coping with discrimination, and social support) will serve as our primary outcomes. Secondary outcomes include key implementation indicators, including participants’ willingness and adoption of SPI and STARS, and staff’s experiences delivering the program. RESULTS: Research activities began in September 2021 and are ongoing. The University of Pennsylvania is the central institutional review board for this study (protocol #849500). Study recruitment began on October 14, 2022. CONCLUSIONS: This project will be among the first tailored, mobile-based interventions for EA-SGM at risk for suicide. This project is responsive to documented gaps for this population: 1) approaches that address chosen family; 2) focus on a life-course perspective; 3) online approaches; and 4) focus on health equity and provision of additional services relevant to sexual minority youth. CLINICALTRIAL ClinicalTrials.gov NCT05018143