Marzetti, Hazel Louise (2020) Exploring and understanding young LGBT+ people's suicidal thoughts and attempts in Scotland. PhD thesis. https://theses.gla.ac.uk/82314/ Copyright and moral rights for this work are retained by the author A copy can be downloaded for personal non-commercial research or study, without prior permission or charge This work cannot be reproduced or quoted extensively from without first obtaining permission in writing from the author The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the author When referring to this work, full bibliographic details including the author, title, awarding institution and date of the thesis must be given Enlighten: Theses https://theses.gla.ac.uk/ [email protected] Exploring and understanding young LGBT+ people's suicidal thoughts and attempts in Scotland Hazel Louise Marzetti, MA (Hons), MSc. Submitted in fulfillment of the requirements for the Degree of Doctor of Philosophy. MRC/CSO Social and Public Health Sciences Unit Institute of Health and Wellbeing College of Medical, Veterinary and Life Sciences University of Glasgow December 2020 © Hazel Louise Marzetti, 2020 2 Abstract Background: Suicide is the second leading cause of death amongst young people aged 15-29. Amongst this young population it is estimated that lesbian, gay, bi and trans (LGBT+) young people are more likely than their cisgender (non-trans), heterosexual peers to think about and attempt suicide. In the UK there has been a paucity of research on this topic, and despite Scotland having higher suicide rates than England & Wales, UK-based research seeking to understand LGBT+ youth suicide is yet to include Scotland. Furthermore, existing research has focussed on the prevalence of suicidal thoughts and attempts amongst LGBT+ young people, demonstrating the disproportionate burden of suicide amongst this population. However, in doing so it has paid less attention to why this disparity exists. This research seeks to address these limitations in our understanding. Aims: I used a multi-disciplinary approach to better understand how young LGBT+ people make sense of their experiences of suicidal distress, questioning what they identified as the pertinent contributory and protective factors, as well as their ideas for future LGBT+ youth suicide prevention. Methods: To explore these questions in-depth, I undertook qualitative, semi- structured, conversational interviews with a community sample of 24 LGBT+ young people aged 16-24 with lived experience of suicidal distress from across Scotland. The interviews were then analysed using reflexive thematic analysis. Findings: Participants identified a range of LGBT+ specific and youth-specific factors that interacted, contributing to and protecting against suicide. Adverse childhood experiences, bullying and social isolation, a cis-heteronormative community climate, concerns and challenges coming out, and difficulties in education were seen as contributory factors, to which suicide was often conceptualised as a response. For many underlying this were feelings of entrapment, defeat, burdensomeness, and a lack of belonging, and it was in response to this that participants in this study began to experience suicidal distress. Staying safe from suicide therefore often relied on dismantling these 3 feelings, both through accessing support and gaining a sense of social connection. Relatedly, suggestions for reducing LGBT+ youth suicide in the future centred upon improving mental health support and challenging queerphobic stigma. Conclusion: The cumulative weight of both LGBT+ specific and youth specific contributory factors meant that many participants in this study articulated a lack of spaces in which they could safely exist. This appeared to be exacerbated by an ontological rejection of participants as LGBT+ people by those around them, which could often feel irresolvable. Consequently, future suicide prevention needs to focus both on individual psychological support for LGBT+ young people who think about suicide, as well as social interventions that tackle queerphobia at its roots. Table of Contents Exploring and understanding young LGBT+ people's suicidal thoughts and attempts in Scotland ...................................................................... 1 Abstract ..................................................................................... 2 Table of Contents .......................................................................... 4 List of Tables ............................................................................... 8 List of Figures............................................................................... 9 Acknowledgements .......................................................................10 Author’s Declaration ......................................................................12 Glossary ....................................................................................13 Chapter 1 Introduction ................................................................16 1.1 Introduction ......................................................................16 1.2 Background .......................................................................16 1.3 Context ...........................................................................17 1.3.1 Criminalisation and legislation of suicide ..............................19 1.3.2 Pathologising suicide .....................................................19 1.3.3 Suicide stigma .............................................................20 1.3.4 Legal reform of LGBT+ Rights ...........................................21 1.3.5 Pathologisation of LGBT+ people .......................................23 1.4 Terminology ......................................................................25 1.4.1 LGBT+ Terminology .......................................................25 1.4.2 Suicide and self-harm terminology .....................................27 1.5 LGBT+ Youth Suicide ............................................................28 1.5.1 Prevalence of LGBT+ young people’s suicidal thoughts and attempts 28 1.5.2 Prevalence of trans young people’s suicidal thoughts and attempts 29 1.5.3 Prevalence of LGBT+ young people’s suicidal thoughts and behaviours in the UK ................................................................31 1.6 Aims of this study ...............................................................33 1.7 Map of the thesis ................................................................34 Chapter 2 Literature Review .........................................................35 2.1 Introduction ......................................................................35 2.2 Search strategy ..................................................................35 2.3 Theories of suicide ..............................................................37 2.4 Understanding Youth Suicide ..................................................40 2.4.1 Abuse and Adverse Childhood Experiences ............................41 5 2.4.2 Bullying .....................................................................44 2.4.3 Mental health problems ..................................................46 2.5 Understanding LGBT+ Youth Suicide ..........................................47 2.5.1 Stigma theory ..............................................................47 2.5.2 Minority stress theory ....................................................51 2.5.3 Cis-heteronormativity ....................................................53 2.5.4 The ‘suicide consensus’ ..................................................56 2.5.5 Empirical work to understand LGBT+ youth suicide in the UK ......58 2.6 Youth suicide prevention and help-seeking ..................................69 2.7 Summary ..........................................................................71 Chapter 3 Methods and Methodologies .............................................74 3.1 Introduction ......................................................................74 3.2 Epistemology .....................................................................74 3.2.1 Theoretical perspective: background and critique ...................75 3.2.2 Intersectional theory .....................................................78 3.2.3 From theory to practice ..................................................79 3.3 Methodology .....................................................................79 3.3.1 Developing Research Questions .........................................79 3.3.2 Negotiating levels of participation .....................................80 3.4 Methods ...........................................................................82 3.4.1 Early engagement: Third Sector organisations and community groups. 82 3.4.2 Considering the selection of research methods .......................83 3.4.3 Considering the inclusion of under 16s .................................85 3.5 Undertaking the research ......................................................87 3.5.1 Recruitment................................................................87 3.5.2 Initial contact with participants ........................................89 3.5.3 Overview of the sample ..................................................91 3.5.4 Designing the interview schedule .......................................93 3.5.5 Interview Questions .......................................................94 3.5.6 Planning to minimise distress