An Exploration of LGBTQA+ Young People’s Coping Strategies When Navigating Suicidal Thoughts and Behaviors

LGBTQA+ young people experience suicidal thoughts and behaviors at a much greater rate than their heterosexual and cisgen-der peers. This study explored firsthand accounts of the coping strategies employed by LGBTQA+ young people when experiencing suicidal thoughts and behaviors. LGBTQA+ young people ( N = 27; ages 14–25) in Australia with a history of suicidal thoughts and/or attempts participated in semi-structured inter-views. Using reflexive thematic analysis, four major themes were developed: (1) It’s about the journey, not the destination , (2) Connecting with others , (3) When I knew better, I coped better , and (4) Doing the best I can with what I have . LGBTQA+ young people reported utilizing a range of coping strategies, however these were limited by a lack of knowledge around mental health, gender and sexuality diversity, and available resources. Experiences of discrimination within support settings and limited access to clinicians with knowledge of sexuality and gender diversity were cited as significant barriers. Interventions to increase mental health literacy in LGBTQA+ young people and improvements to clinician knowledge of sexuality and gender diversity are needed to enhance LGBTQA+ young people’s access to effective coping strategies when experiencing suicidal thoughts and behaviors.

experience thoughts of suicide, engage in suicidal behaviors, and attempt suicide at much greater rates than their heterosexual and cisgender peers (di Giacomo et al., 2018;Marchi et al., 2022;Surace et al., 2021).Results from Australia's largest survey of LGBTQA+ young people showed 78.5% of respondents had thought about suicide, 47.3% had made a suicide plan, and 25.6% had attempted suicide at some point in their lives (Hill et al., 2021).LGBTQA+ young people aged between 12 and 24 report experiencing suicidal thoughts more frequently than older LGBTQA+ people and are more likely to attempt suicide (Nodin et al., 2015;Skerrett et al., 2015).Researchers note LGBTQA+ young people are likely overrepresented in fatal suicide attempts, although information regarding diverse gender or sexuality is seldom recorded, and young people may not have previously disclosed their identity to others (Lyons et al., 2019;Nodin et al., 2015;Skerrett et al., 2015).Despite elevated rates of suicidal thoughts and behaviors in LGBTQA+ young people, little is known about strategies they use to navigate periods of suicidal crisis.Information is urgently needed for developing suicide prevention strategies targeted to their specific needs.

Suicidal thoughts and behaviors in LGBTQA+ young people
Adolescence is a period in which LGBTQA+ young people are at greatest risk of experiencing suicidal thoughts and behaviors (Gilbey et al., 2020).This is potentially due to being at a crucial point of identity development whilst also becoming acutely aware of how society stigmatizes LGBTQA+ identities.Minority stress theory suggests the increased prevalence of mental health difficulties and suicidal thoughts and behaviors experienced by LGBTQA+ young people are attributable to the discrimination, prejudice, and stigma they experience as members of a marginalized group living within a dominantly cisgender, heteronormative society (Haas et al., 2011;Meyer, 2003).As trans young people do not conform to society's prevailing norms of experiencing gender as determined by one's sex presumed at birth, and sexuality diverse young people similarly do not conform to heterosexual norms, LGBTQA+ young people are frequently exposed to bullying, harassment, violence, and alienation from family and peers (Jonas et al., 2022;Van Der Pol-Harney & McAloon, 2019;Williams et al., 2021).Significant stressors relating to suicidal thoughts and behaviors specific to LGBTQA+ young people include rejection by family members, bullying, harassment, and violence due to their sexuality and/or gender (Gorse, 2022;Wang et al., 2023).Although there is a solid evidence base of increased risk of suicidal thoughts and behaviors experienced by this population (di Giacomo et al., 2018;Surace et al., 2021), there is limited research into the unique coping strategies available to, and utilized by, LGBTQA+ young people.

Minority stress theory and coping
Coping strategies are the efforts individuals make to adapt or respond to times of stress (Meyer, 2015).Minority stress theory proposes that due to the stigma, prejudice, and discrimination experienced by LGBTQA+ young people, they are exposed to greater stress and fewer coping resources than their cisgender and heterosexual peers (Meyer, 2003).Exposure to high levels of discrimination and harassment at home, in educational settings and workplaces, and from health care providers limits the availability of safe mental health supports to LGBTQA+ young people (Hill et al., 2021;Lim et al., 2024).However, effective coping strategies can buffer the effects of these increased stressors to reduce suicidal thoughts and behaviors (Meyer, 2015).There is also potential for unique coping resources to be available to LGBTQA+ young people through connection with LGBTQA+ communities.Supportive peers and family, as well as feelings of acceptance, safety, and community connection, are significant protective factors for suicidal thoughts and behaviors experienced by this population (Gorse, 2022;Hill et al., 2021;Kwon, 2013;Van Der Pol-Harney & McAloon, 2019;Wang et al., 2023).However, knowledge of specific coping strategies LGBTQA+ young people employ remains underexplored.

Coping strategies and suicidal thoughts and attempts
Inconsistencies in conceptual definitions of "coping" and focus on risk factors have hampered research into coping strategies utilized by young people in the general population.Even less research has been conducted concerning LGBTQA+ young people specifically (Compas et al., 2017;Lucassen et al., 2022).Ongoing cognitive development throughout adolescence allows young people to utilize an increasingly wide range of coping strategies and tailor these to their circumstances (Compas et al., 2017).Many young people in general do not seek professional support when experiencing suicidal thoughts and behaviors, and instead are most likely to seek help from peers and family members (Michelmore & Hindley, 2012).Rivers et al. (2018) explored risk and protective circumstances recounted by LGBT adults in the UK who attempted suicide in their youth.Participants reported employing a variety of strategies to cope with suicidal thoughts and behaviors, and to withstand stigma, including substance use, binge eating, self-isolation, self-harm, and masking their true identities by engaging in stereotypically gendered behaviors.Some participants also shared the importance of connecting with others in LGBT communities to cope.However, this strategy was not available to all participants because of family members either explicitly stopping participants from connecting with other LGBT people or participant's perceptions that their parents would be unsupportive (Rivers et al., 2018).This is consistent with other UK research findings from McDermott et al. (2018), where stigma surrounding both suicidal thoughts and diverse gender/sexuality were identified as significant barriers to help-seeking for LGBTQ+ young people.LGBTQ+ young people primarily sought professional help for experiences of self-harm and suicidal thoughts when they were in crisis and had exhausted their capacity to cope (2018a).Difficulty articulating distressing feelings was another challenge in help-seeking for LGBTQ+ young people (McDermott et al., 2018).Further, inability to share negative emotions with others again showed a significant association with suicide risk (McDermott et al., 2018).Although prior research has provided some insight into types of coping strategies adopted by this population and their perspectives of them, there remains limited engagement with LGBTQA+ young people themselves to investigate the breadth, motivations, and efficacy of coping strategies they utilize when experiencing suicidal thoughts and behaviors.

The current study
Existing research regarding strategies that help LGBTQA+ young people cope when experiencing suicidal crises is limited, and inclusion of LGBTQA+ youth voices in mental health research is imperative to develop suicide prevention interventions informed by the populations they intend to target.This information is vital to mental health professionals, parents, and young people to better support LGBTQA+ young people as they navigate experiences of suicidal thoughts and behaviors, and to develop appropriate suicide prevention interventions.This study aimed to explore firsthand accounts of the coping strategies employed by LGBTQA+ young people as they navigated periods of experiencing suicidal thoughts and behaviors.

Method
This was a cross-sectional qualitative study utilizing semi-structured in-depth interviews with LGBTQA+ young people with a lived experience of suicidal thoughts and/or attempts.The interview guide and analysis were informed by a realist conceptual framework.This study formed part of a larger project which developed best practice guidelines for suicide prevention in LGBTQA+ young people within clinical and community settings (Strauss et al., 2022).Approval for this study was granted by the University of Western Australia Human Research Ethics Committee (RA/4/20/5467).A completed COREQ Checklist is provided in Supplementary File 1.

Reflexivity statement
To further depathologize LGBTQA+ identities and mental health challenges, this study was informed by a strengths-based approach (Xie, 2013).Rather than problematize coping strategies, we aimed to explore LGBTQA+ young peoples' coping with suicidal thoughts and behaviors through a positive lens of asset utilization and resilience (Xie, 2013).The research team comprised people of cisgender, heterosexual, and queer identities.They represent diverse lived experiences and multidisciplinary expertise.All authors are also affirming of diverse genders and sexualities, and of the truth of people's lived experiences.From these perspectives, they sought to uphold LGBTQA+ young people's identities and experiences throughout this research.The primary author undertook analysis of these data as partial fulfillment of requirements for her Degree of Bachelor of Psychology with Honors.The analysis process was overseen by the second and last authors, both experienced researchers familiar with the field.

Participants
Participants (N = 27) were recruited from across Australia and aged between 14 and 25 years (M = 19.37,SD = 3.16) at time of interview.Individual demographics are presented in Table 1.

Procedure
Young people were eligible to participate if they identified as LGBTQA+, were aged between 14 and 25 years, had a self-reported lived experience of suicidal thoughts and/or attempts, were fluent in English, and lived in Australia.Recruitment materials were distributed through the research team's professional networks, Telethon Kids Institute's youth reference group and related research study social media accounts, paid social media advertising, and word of mouth.A purposive sample of approximately 20 young people was anticipated to appropriately represent a diversity of sexualities, genders, and experiences within the narrow study aim.However, as this study was exploratory and analysis was conducted across participant responses, 27 young people were ultimately interviewed to attain sufficient information power (Malterud et al., 2016).Participants were not known to members of the research team prior to the study.A waiver of parental consent was obtained for participants' safety and to ensure that young people potentially ostracized from their families still had an opportunity to participate.Interviews were conducted between July 2019 and November 2020 by PS and HM and audio recorded.One participant was interviewed face-to-face, with all other interviews conducted via telephone.The interview schedule (see Supplementary File 2) was developed in consultation with LGBTQA+ young people to ensure questions were relevant and appropriately worded.
Participant information and consent forms were made available online through Qualtrics prior to interview.Participants provided consent by clicking through and completing a registration form.When starting each interview, interviewers confirmed that participants understood the research and were well enough to complete the interview at that time.Although interviewers took some small notes during interviews, these were not subsequently developed into detailed field notes.Much of the information typically preserved by field notes, such as the context and setting of interviews (Phillippi & Lauderdale, 2018), was recorded within the transcripts and other study documentation reviewed during analysis.Interviewer reflections (Phillippi & Lauderdale, 2018) were also discussed within the research team and incorporated into the findings.During interviews, participants were prompted to reflect on personal experiences of suicidal thoughts and/or attempts through a paradigm of resilience, and were asked such questions as, "Can you tell me a bit about when you were thinking of suicide?" "What kinds of support did you have when you were going through that time?" and "What did you find most useful about those supports?"Interviewers concluded interviews by summarizing key themes to check for accuracy of their interpretation and to provide opportunity for clarifications.Participants were remunerated for their time.
Interviews ranged from 19 to 64 minutes in duration (M = 46 minutes).No repeat interviews or member checking of interview data were conducted.No participants withdrew consent during or after their interviews.

Data analysis
Interview data were professionally transcribed verbatim.Data were qualitatively analyzed using an inductive approach informed by a realist conceptual framework.Reflexive thematic analysis of the interview data was undertaken by LM in collaboration with EAN and PS, utilizing procedures outlined by Braun andClarke (2012, 2019).LM read transcripts twice to gain familiarity, making preliminary notes during second readings.Notes were discussed with EAN and PS and initial codes created from categories of identified patterns."Codes were revised responsively throughout analysis.NVivo software was used by LM to code imported transcripts.LM, EAN, and PS developed potential themes through discussions regarding codes, relationships between codes, and code meanings.Themes were refined and revised to identify those most pertinent to coping strategies employed by LGBTQA+ young people experiencing suicidal thoughts and behaviors.

Results
Four major themes were developed: (1) It's about the journey, not the destination, (2) Connecting with others, (3) When I knew better, I coped better, and (4) Doing the best I can with what I have.These themes and related subthemes are outlined in Figure 1.These themes are interconnected and dynamic in nature.For example, as participants' knowledge regarding mental health and sexuality and gender diversity increased, this enabled greater access to supports, which in turn provided more opportunities for connection with others.

It's about the journey, not the destination
Participants described coping with suicidal thoughts and behaviors as an iterative process.Many identified different coping strategies throughout their history and described how these were influenced by internal and external factors.Trust in others and confidence in themselves also appeared to significantly impact coping strategies.As knowledge and support was gained, many reported subsequently "paying it forward" through support of LGBTQA + peers.This appeared in turn to strengthen connection to community, improve availability of trusted coping resources, and enhance confidence in coping.

Evolution of coping strategies
Participants framed their history as a journey, progressing through periods of utilizing different coping strategies in response to their developing knowledge, changing needs, and the availability of resources.Participants reflected on multiple strategies that they utilized in various combinations across their journeys.They described harming themselves through non-suicidal selfinjury, use of alcohol and other drugs, disordered eating, and socially isolating themselves when they first began experiencing suicidal thoughts and/or behaviors.Attempts to conceal mental health difficulties and cope on their own were common experiences across participants.
Participants' attempts to cope on their own were often driven by real or feared rejection from significant people in their lives due to their gender and sexuality.As such, when initially experiencing suicidal thoughts and feelings, many participants reported not knowing who to turn to.
I don't have a lot of experience in relationships of any kind where people actually care about how I'm doing . . .I don't want to burden someone given that a lot of my issues are quite complex to the point that this would be a massive burden.(Female, straight, 21) Participants often expressed disbelief that others genuinely cared about their wellbeing and would be willing to help them if they disclosed their current challenges.Participants also expressed lacking knowledge around resources potentially available to them when first experiencing suicidal thoughts and/or behaviors, further isolating them from help.
Several participants eventually reached a crisis point, during which they reached out to others for help or harmed themselves significantly enough to warrant external intervention from family or health services.
I've also had to be hospitalized before, purely because I was at risk to myself at such a regular basis.(Female,bisexual,15) Participants often had to find ways to cope alone until they were able to access support people who took their mental health difficulties seriously and offered them help.Participants' coping strategies also appeared to change and evolve over time as they developed capacity to increase their own knowledge and sought out sources of support.

Establishing trust
Participants reflected on the ongoing difficulties they experienced when talking about suicidal thoughts and/or feelings, such as feeling sufficiently comfortable with mental health professionals to share what they were going through.Participants also spoke about the emotional burden of reaching out for support from mental health services.
I need to feel super comfortable with someone before I kind of, open up a lot.So, it is a bit of a process, and sometimes it just doesn't seem worth the whole process.(Questioning, queer/lesbian, 16) It's very tiring to talk about because then you're also dealing with the mental exhaustion of being suicidal on top of carrying half of the conversation about it, because the person on the other end just doesn't understand.(Agender/trans masculine, bisexual, 25) Good relationship quality and a shared understanding between themselves and mental health professionals appeared to be important facilitators of effective mental health support for participants.Additionally, the exhaustion associated with educating professionals who lacked knowledge around gender and sexuality diversity was a significant barrier when seeking appropriate support.Ongoing support from mental health professionals alone did not typically alleviate suicidal thoughts and/or behaviors in participants.However, it did appear to significantly enhance their confidence and capacity to cope.
Although I had suicidality, I had mental health professionals help me deal with that.I had people to teach me the right way to deal with issues and anxiety, and how to recognize the warning signs of when you're getting low.(Male,homosexual,17) Participants noted that cognitive strategies such as mindfulness and cognitive behavioral therapy were helpful, but these appeared to be most beneficial when supported by other coping strategies, including developing psychological skills and recognizing when they required additional support.When cognitive strategies in isolation were suggested by health professionals to participants early on in their journey, or experiencing acute suicidal thoughts, these were at times interpreted as patronizing and insufficient.

Becoming the person I needed
Participants greatly valued the positive aspects of LGBTQA+ communities in sharing knowledge and support while coping with suicidal thoughts and behaviors.Several participants engaged in informal advocacy for friends navigating similar experiences of suicidal thoughts and behaviors, supported peers who were questioning their own gender and/or sexuality, and formal advocacy in working within their schools and wider communities to better support other LGBTQA+ young people.
I'm constantly talking about my experience just to try and raise awareness for it and to make sure people realize that they're not alone . . .I've had that happen a couple of times where friends who were questioning their sexuality . . .and they feel that if they need to talk to someone, they'll come to you.(Male,queer,23) This comment illustrates how keenly participants valued peer support and the sharing of mental health knowledge, and how they now invest their time in being the person that they themselves needed earlier in their journey.

Connecting with others
Participants described extensive impacts relationships had on their coping with suicidal thoughts and behaviors.Some relationships appeared instrumental to safe navigation through periods of crisis and to accessing further supports.These relationships seemed to be underpinned by trust, identified in the previous theme.Conversely, relationships in which participants were unable to trust the capacity or competence of others to support them were challenging.Dismissive and discriminatory comments appeared to adversely impact participants' ability to cope, to reduce trust in systems overall (such as schooling or healthcare), and to limit their confidence in seek out alternate positive relationships.

Seeking understanding
Participants sought out connection with others as a main coping strategy when experiencing suicidal thoughts.Friends and family, alongside professionals, were the most mentioned supports, and seeking out friends and family was reported by many as an initial step in coping during periods of crisis.
I think having my friend there as a support was really important, now, because it's just kind of reassured me, which I didn't have before, that I'm genuinely not alone.(Cisgender female, asexual, 16) I tried to build a more of a support structure around myself with my friends and family instead since I didn't feel like I could rely on other support services.(Female,panromantic,asexual,polyamorous,23) Close relationships where trust and respect already existed were seen as safe places for disclosure and support-seeking.
Definitely [my] friend group and the support behind that, being able to talk about it with them, and I meet a couple of people in my friend group that have been through a similar experience or were going through a similar experience.(Male,gay,17) Friends and family were preferred over health professionals when seeking support, especially when participants did not want to articulate the extent of their suicidal thoughts and behaviors, if at all, but seemed to desire someone to just 'be' with.Spending time with others appeared to serve two purposes: allowing participants to co-regulate their emotions, and to access supports that provided them hope for a more positive future.
It's not even necessarily that I would go there to tell everyone and be like, "Hey, this is how I'm feeling, help me," but rather be in a space that I think there are a bunch of young people here who are enjoying life and who can show me at least that it's not all that bad.(Female,queer,17) I have all the coping skills, and all that stuff, but for me, being with someone and having that time for things to de-escalate a bit is probably the biggest thing that's been helpful at the time.(Female,bisexual,21) Participants who had poor relationships with family members commonly relied heavily on friends.Participants with LGBTQA+ friends reflected on shared histories of discrimination and rejection from family and wider society.
I might go to my other gender and sexuality diverse friends because it's rather common for them to not have good -it's very often for queer kids to have trauma . . .so, I trust them a lot.(Girl, lesbian/woman loving woman, 17) These shared experiences appeared to engender trust and understanding when support-seeking.

Challenges when reaching out
Participants also articulated challenges in seeking out others for support and were very thoughtful in who they approached.Many were cognizant that for some friends or family members, their understanding of mental health difficulties came from lived experiences of poor mental health.As participants did not want to burden others with worry or exacerbate existing mental health difficulties in others, they would only reach out to those individuals when participants knew they were in a safe place.
My friends, sort of have the same issues, so they sort of know where I'm coming from.So, if they are in a good mental space, I feel comfortable talking to them.(Male/trans male, pansexual, 17) It seems like they're already going through so much, they don't need to worry about my stuff as well, that's why I find talking to professionals a little bit easier, just because I don't wanna have to burden my friends with it all the time.(Cis female, queer, 22) Participants indicated that the strength and closeness of friendships fluctuated over time, limiting availability as supports.
I used to have a small number of close relationships but some of those deteriorated and I've now found myself having a greater number of much more superficial relationships, so I don't feel like . . .there's friends I can confide in.(Female,straight,21) Thus, sometimes participants preferred seeking support from health professionals, who were viewed as better positioned to remain objective and resilient regarding suicidal ideation disclosure.Some participants attempted reaching out to school counselors, but had mixed experiences.Notably, chaplains or other religious counselors who were not affirming appeared to have a harmful effect on participants' wellbeing and their willingness to seek out support at school.My counsellor ended up giving me material which was based around the idea of aligning religion with homosexuality, and they all pretty much said I either had to be behaviorally heterosexual, or celibate . . .So, I felt pretty unsafe in that environment from there on.I kind of dismissed every meeting I had . . .I just said, "Yeah, I'm fine," despite whatever I was going through at the time.(Genderqueer man, gay, 19)

When I knew better, I coped better
Participants shared how their coping strategies changed over time as they gained greater knowledge, acceptance, and resources.These appeared limited initially by challenges within relationships when seeking support, such as uncertainty, fear, and exhaustion from self-advocacy.Additionally, a dearth of accessible and affirming mental health and suicide prevention resources and supports across modalities also seemed to hamper coping.

Seeking knowledge
A lack of both mental health literacy and knowledge around sexuality and gender diversity was common among participants early on in their experiences of suicidal thoughts and behaviors, as well as in those around them.
Participants expressed disappointment at both the inadequacy of the mental health education they received and the lack of discussion surrounding diverse sexualities and genders in their schools, connecting these with their resulting negative mental health experiences.
I guess in school, we don't really learn about mental health that early on, or if we do, we don't learn about it, like to [that] extent, and we don't really learn how to take care of our mental health, until this year, and I definitely needed it a long time ago.(Questioning, queer/lesbian, 16) Many participants' lack of accurate mental health knowledge appeared to undermine their understanding of the severity and seriousness of their suicidal thoughts and behaviors, and that these were common experiences that they could seek help for.The shame and isolation experienced by several participants appeared to be perpetuated by misinformation from their families, as well as internalized homophobia, transphobia, and stigma regarding mental illness.
I think it was truly that if I had known about the fact that there [were] people out there who identified in a certain way or presented themselves . . . in a certain way and who had mental health issues and things like that, that self-realization and self-acceptance probably would have happened a lot faster.(Female,queer,17) This comment illustrates how participants often expressed that earlier knowledge and normalization of both mental health difficulties and diverse sexualities and genders would have helped them recognize and articulate their internal experiences, enabled them to seek external support sooner, and helped them view their sexuality and/or gender positively.

Exploring digital supports
Many participants reported using the internet as a primary means of gaining accurate knowledge about both mental health and sexuality and gender diversity.Participants accessed a range of mental health websites and social media.Online spaces enabled participants to research types of mental health difficulties they experienced and ways to cope more effectively.
I found much better resources from reading blog posts from other people who had gone through the same kind of things . . .I looked at some websites like headspace and beyondblue and the It Gets Better Project, but they all felt kind of condescending.(Genderqueer/transgender,bisexual,22) This quote demonstrates the importance to participants of honesty and understanding within wider discussions of suicidal thoughts and behaviors, particularly valuing knowledge from those with lived experience.Lived experience was also highly valued as participants sought out examples of LGBTQA+ representation.
I think that the opportunity to learn and find resources [on social media] that allowed me to think, "Okay, wait, actually, this is okay, and I'm allowed to feel this way and I'm allowed to do this," and . . .allowed me to take the next step and involve myself in events that then help me get out of that negative mental space.(Female,queer,17) Social media was described as particularly useful for finding positive LGBTQA+ representation and participating within LGBTQA+ communities.These spaces importantly enabled participants to gain information regarding accessing affirming mental health professionals.However, some participants reported difficulties in interactions, where some people appeared to "compete" against one another by emphasizing their own mental health experiences, rather than contributing to the supportive environment participants sought.
It's not that they're not accepting of you, everyone is very accepting of it, just that they're constantly trying, it seems like they're constantly trying to one-up each other . . .But that's a bit frustrating 'cause you don't really feel listened to.(Cis female,queer,22) Digital mental health support services were accessed by many participants.However, they reflected on long wait times and reported mixed experiences when contact was established.
There have been a few instances where I've had to call Lifeline when I was feeling especially down, but I mean I really don't think that was of much help because [I'll] be like, "Yeah, you know, I'm feeling really suicidal right now," and it'll be like, "Oh, it's cool.Wait time 40 minutes," I'm like, "Oh, okay.Alright.See you never then".(Female,bisexual,15) Because of my history of invalidation and stuff like that, I just find that someone that is warm and empathetic and understanding makes a big difference.(Female,bisexual,21) Digital support service providers perceived to be warm and friendly were reported as most helpful, with overly prescriptive responses sounding robotic and off-putting.Variations across participant's needs also influenced their experiences.Those who experienced social anxiety, spoke English as a second language, and those fearful of being overheard often preferred text chat services.In addition, participants often expressed a desire to speak face to face to reduce ambiguity and ensure privacy in conversations.
Sometimes there were instances where I felt it was unsafe to be on a call, because if somebody had heard what I was talking about, I knew that I'd get berated.(Genderqueer man,gay,19) Many digital services were perceived to have a low tolerance of risk and were unable to support participants when experiencing acute periods of suicidal crisis.
I recently chatted with QLife online on their chat, but it wasn't that great 'cause I was sort of quite suicidal and they're not a crisis service, which I didn't realise, so they were making sure that I can't really talk about that with them.(Transgender, bisexual or pansexual, 23)

Service safety and alternatives
Reported experiences of emergency department (ED) and inpatient services within public hospitals universally had negative aspects, yet participants also acknowledged the necessity of being physically safe when experiencing acute suicidal thoughts and behaviors.However, these spaces were also mentally unsafe for participants, due to a lack of affirming staff, and difficult and traumatizing admission processes.
Hospital can be pretty confronting, and it's a long wait in emergency department, and not always -doesn't feel, like, very emotionally safe.(Transgender,bisexual or pansexual,23) I don't really go through ED anymore because it's just too traumatic, and yeah, I don't know, they treat you differently if you haven't hurt yourself.(Female,bisexual,21) Experiences with private hospital and private outpatient services were much more positively reported and more effective in keeping participants mentally, and physically, safe.However, access was contingent on available finances or private health insurance, and few participants had these consistently available.
I know you got the ten, Medicare health plan sessions that are rebated, but I'm pretty lucky in that obviously, I do work full-time so I can afford psych.They're still pretty expensive.(Male,heterosexual,23) Negative experiences, predominantly within public hospitals, resulted in participants seeking alternatives, such as staying with family or friends.
It's just like, why would I go to a setting that's supposed to help but actually just makes me want to die more?So, let's just not do that and instead we've kind of developed informal systems in our community of, sort of like, when you're really, really bad you go to this person's house and they'll watch over you and then they'll take a shift off and the next person will come in and look after you (Genderqueer,queer,14) This quote highlights the necessity of informal mechanisms established within LGBTQA+ communities for keeping those experiencing suicidal thoughts and behaviors safe, due to harms faced by LGBTQA+ young people in formal clinical settings.Participants shared how important word-of-mouth connections through LGBTQA+ communities were in identifying affirming mental health professionals.
There are some closed or private Facebook groups where queer or trans people can ask questions.Some trans organizations facilitate that, like I know Ygender has a page on their website where people can submit reviews of any medical professionals, so like, including psych[ologist]s.(Genderqueer/transgender,bisexual,22) Participants also highlighted challenges in accessing LGBTQA+ communities as young people.
I think the most important thing to know is that a lot of times young folk in the community don't actually have a sense of community.A lot of the time we don't have access to those communities until we get older.(Agender/Transmasculine,bisexual,25) Access to LGBTQA+ communities could confer great benefits of belonging and additional resources.However, these spaces were not always accessible to participants when needed.Similarly, support services tailored to youth and LGBTQA+ young people specifically were incredibly helpful to participants when they were able to access them.However, a lack of awareness of the existence of such services, self-doubting if their difficulties whilst exploring their sexuality and/or gender identity were appropriate enough to warrant accessing services, and long wait times created barriers to access.

Discussion
This research aimed to explore coping strategies employed by LGBTQA+ young people as they navigated experiences of suicidal thoughts and behaviors.Themes developed from the interview data illustrate that participants engaged in a wide variety of coping strategies, including speaking to and spending time with supportive friends and family, accessing health providers such as GPs and mental health services, use of digital supports, engaging in risk-taking behaviors and self-harm, seeking mental health knowledge and LGBTQA+ representation online, and participating within LGBTQA+ communities.Which coping strategies employed were largely dependent on participants' knowledge and perception of available resources, as well as timely access to these resources.Both of these changed over time and through experience.To our knowledge, this study has been the first within Australia to explore the coping strategies utilized by LGBTQA+ young people to navigate suicidal thoughts and behaviors directly informed by this population.Viewing coping strategies through a strengths-based lens underscores LGBTQA+ young people's resilience and adds to the unique perspective of this research.The findings hold important potential to better support LGBTQA+ young people experiencing suicidal thoughts and behaviors in ways most appropriate and helpful to them.
Our findings highlight how a lack of knowledge regarding sexuality and gender diversity can be harmful to LGBTQA+ young people experiencing suicidal thoughts and behaviors, as it can contribute to feelings of hopelessness and shame, and deter them from sharing their suicidal thoughts with others.Meyer (2015) proposes that for LGBTQA+ individuals, identification with sexuality and gender diverse communities is essential for facilitating access to coping resources available within these communities.Our findings illustrate that young people's identification as LGBTQA+ can be constrained by a lack of knowledge around diverse gender and sexuality identities, which can subsequently limit their access to these potential coping resources.Prior research has found that LGBTQA+ young people develop an awareness of their sexuality and gender diversity younger than their cisgender and heterosexual peers (Smith et al., 2014).In addition, sexuality-diverse young people have been found to experience suicidal thoughts and behaviors from a younger age than their heterosexual peers (Luk et al., 2021).Therefore, improved education for young people regarding sexuality and gender diversity and normalization of diversity among all who work with young people is urgently needed (Lim et al., 2024).Our findings suggest that this may reduce continuing stigma that surrounds diverse sexualities and genders, the suicidal thoughts and behaviors LGBTQA+ young people experience as a result, and barriers faced when seeking support.
A further barrier is frequent experiences of invalidation of diverse genders and sexualities in health settings, and young people having to educate mental health professionals themselves when seeking care and support (Smith et al., 2014).Our findings are consistent with McDermott et al.'s (2018) research, in which historic negative reactions, abuse, and dismissal from others were identified as major sources of harm and ongoing fear for LGBTQA+ young people when contemplating seeking support.This included concerns regarding hostile professionals within mental health services and fears of professionals disclosing information to non-affirming parents (McDermott et al., 2018).LGBTQA+ young people greatly value care provided by affirming clinicians (Hoffman et al., 2009;Smith et al., 2014), however these clinicians frequently have long wait lists (Erasmus et al., 2015;Strauss et al., 2021).Our findings echo this and suggest that because of these barriers, LGBTQA+ young people may utilize support from affirming GPs as more accessible alternatives when experiencing suicidal thoughts and behaviors.It is clear from our findings that mental health services require increased resources and training to appropriately support LGBTQA+ young people experiencing suicidal thoughts and behaviors in a timely manner.Additionally, a key facilitator for anyone providing mental health support to LGBTQA+ young people is demonstrating understanding and respect of sexuality and gender diversity (Lim et al., 2024;C. E. Newman et al., 2021).
Poor experiences with mental health service providers often resulted in participants choosing to access support and information through social media.These findings are consistent with prior research that found social media use to be a prominent coping strategy for LGBTQA+ youth to connect with and access resources from affirming community members (Chang et al., 2024).However, these online resources, particularly regarding mental health difficulties, may not be evidence-based and may expose LGBTQA+ young people to misinformation, as well as experiences of sexuality-and genderbased harassment and victimization (Ybarra et al., 2015).This highlights the need for inclusive, easily accessible, and evidence-based mental health information to be available to all young people and those who support them.
The current findings regarding digital supports are also comparable to prior research with LGBTQA+ adults, indicating privacy concerns and lacking access to safe locations to call or text from can be significant barriers for LGBTQA+ people utilizing these supports, regardless of age (Waling et al., 2019).Similar barriers have been noted by clinicians and clients regarding telehealth, with variability in the quality of technology available to clients also an obstacle (McQueen et al., 2022;Paulik et al., 2021).Given increasing availability of digital health services, these barriers need to be addressed to enable greater mental health support provision for LGBTQA+ young people.Current findings also highlight issues regarding low tolerance of risk.This is particularly pertinent to LGBTQA±specific digital services, as these were perceived as most helpful.McDermott et al. (2018) emphasize comparable findings that LGBTQA+ young people typically do not seek out mental health support until reaching crisis.As such, LGBTQA±specific services must be empowered and adequately resourced to accommodate high levels of mental health risk.Additionally, mainstream crisis support services need to urgently upskill their workforce to ensure all LGBTQA+ people they interact with receive inclusive and affirming support.
Our findings suggest that LGBTQA+ young people are acutely aware of their peers also having lived experience of suicidal thoughts and behaviors, and often limited capacity to offer support.As such, if they are not confident peers can safely provide mental health support, they will not seek support from them in times of crisis.Feelings of burdensomeness in sexuality diverse young people are associated with greater suicidal thoughts and attempts (Fulginiti et al., 2020).Such feelings can be a significant obstacle to LGBTQA+ young people utilizing social supports.Empowering LGBTQA+ young people with knowledge and resources regarding suicidal thoughts and behaviors could address perceived burdensomeness.
Parental rejection of diverse gender and/or sexuality is a known risk factor for increased suicidal thoughts and attempts in LGBTQA+ young people, and strong parental support has been associated with lower suicidal thoughts and attempts (Poštuvan et al., 2019;Rivas-Koehl et al., 2022;Travers et al., 2012).Supportive parents can also improve LGBTQA+ young people's access to mental health professionals, particularly for trans young people (Smith et al., 2014;Taliaferro et al., 2019).Our findings suggest affirming parents, particularly those in good mental health, can be critical supports for LGBTQA+ young people.Therefore, interventions that improve parental mental health and increase LGBTQA+ knowledge may enable them to provide greater support to their children.
Discrimination, lack of knowledge around available services, and feelings of not wanting to be a burden have also been identified as significant barriers by LGBTQA+ adults when seeking to access mental health support services (Waling et al., 2019).Additionally, LGBTQA+ adults report commonly seeking support from friends, family, general practitioners, and therapists when experiencing mental health crises, while others may engage in self-harm (Waling et al., 2019).When reflecting on navigating past suicidal thoughts and behaviors, trans older adults also stress the importance of social support (Gaveras et al., 2023).Our findings are strikingly consistent with this research, indicating that these coping strategies and recognized barriers may not be age-related, but could be common across the lifespan.Existing literature reports LGBTQA+ young people experience greater rates of self-harm, and alcohol, tobacco, and other drug use, compared to their cisgender and heterosexual peers (Fox et al., 2018;Hill et al., 2021, McDermott et al., 2018;Strauss et al., 2020).Our findings suggest increased prevalence of these self-injurious and risk-taking behaviors may partly result from use as coping strategies to deal with suicidal thoughts or behaviors.Any intervention reducing these behaviors should therefore explore potential for co-occurring suicidal thoughts, and ensure LGBTQA+ young people have access to alternative coping strategies.

Strengths and limitations
This was a large qualitative study with a broad range of genders, sexualities, and experiences of suicidal thoughts and attempts represented.Prior studies within Australia have explored this topic with much smaller samples of adults (n = 10; Waling et al., 2019).Our sample's significant size and diversity provides rich insight into coping strategies to be considered when supporting LGBTQA+ young people.The study was informed by a youth reference group, which was consulted from inception of this research, ensuring the study aims were aligned with needs identified by this population.
As we aimed to deeply explore the experiences of a limited number of sexuality and gender diverse young people, these findings cannot be taken as representative of all Australian LGBTQA+ young people, although they are consistent with existing literature regarding coping strategies of LGBTQA+ young people and adults (McDermott et al., 2018;Rivers et al., 2018;Waling et al., 2019).Participants were not asked for ethnicity information and non-English-speaking LGBTQA+ young people were not eligible to participate.Consequently, the extent to which these findings may be transferrable to culturally or linguistically diverse populations is unknown.Future research should explore the impact of intersectional identities on coping strategies employed by LGBTQA+ young people experiencing suicidal thoughts and behaviors in collaboration with these communities.LGBTQA+ young people are not a homogenous group.Sexuality diverse and gender diverse young people may have additional divergent experiences and needs (Hawkins & Giesking, 2017).Future research separately exploring coping strategies employed by those belonging to individual identity groups encompassed within the LGBTQA+ acronym could illuminate these.

Conclusions
The current findings illustrate the variety of coping strategies employed by LGBTQA+ young people when navigating suicidal thoughts and behaviors, and highlight the capacity, determination, and resourcefulness of this population.LGBTQA+ young people continue to face significant challenges in accessing appropriate supports when experiencing suicidal crises due to pervasive and systemic discrimination perpetuating a lack of knowledge about mental health and poor availability of affirming mental health services.Improvement in the capacity of LGBTQA+ young people to access effective coping strategies when experiencing suicidal thoughts and behaviors requires a greater degree of mental health literacy in this population, greater normalization of gender and sexuality diversity in the general population, and increased capacity of all health professionals to inclusively and promptly engage with LGBTQA+ young people.