Interventions addressing suicide and depression in those identifying as Lesbian, Gay, Bisexual, Trans, Queer, Intersex, Asexual and other gender identities: A systematic review and intervention component analysis

Objective: Few interventions target suicide in people identifying as lesbian, gay, bisexual, trans, queer, intersex, asexual, and other gender identities (LGBTQIA+). This systematic review examined interventions addressing suicide or depression among LGBTQIA+ people and conducted an intervention component analysis to assess effectiveness of design components, implementation, and alignment with existing evidence. Method: We screened 8, 046 abstracts from PubMed, PsycINFO, and Embase for relevance, and assessed full text against inclusion criteria. Eligible studies had to target LGBTQIA+ people, and the primary outcome had to be suicidal thoughts or behaviours, or depression (or related constructs, such as hopelessness). Studies were synthesised narratively and according to the intervention component analysis method. Risk of bias was assessed using the RoB-2 and ROBINS-I tools. Results: 4,400 individuals were represented across 39 included studies. While some single-group designs showed reductions in suicidal thoughts and behaviours, no studies demonstrated significantly greater reductions relative to treatment as usual/waitlist groups. In contrast, many interventions which targeted depression reported significantly greater reductions compared to control conditions. Analysis of intervention components revealed little attention to concepts which may be effective for those experiencing minority stress, and of those pertinent to preventing suicide, such as safety planning. Conclusions: Findings highlighted the value of shared experiences, yet also revealed that LGBTQIA+ adaptation alone may be insufficient to reduce suicidality. Across studies, there were notable gaps between components used and mediators of suicide in LGBTQIA+ populations. We discuss implications for research, particularly recommendations for interventions designed to reduce suicidal ideation in LGTBQIA+ people.