3 - (SYM 91) Suicidal Thoughts and Behaviors Among Transgender and Gender-diverse Adolescents: The Role of Parental Invalidation of Adolescents' Gender Identity

Transgender and gender diverse youth (TGD; i.e., gender identity differs from birth-assigned sex) are at disproportionately high risk of suicide and non-fatal suicidal thoughts and behaviors (STBs; e.g., suicide ideation [SI], suicide attempts) compared to non-TGD peers. The minority stress theory posits that elevated STB rates may be due to additional, minority-group specific stressors that do not exist for non-TGD peers. Stressors specifically related to TGD adolescents’ gender identity (e.g., adolescent-perceived invalidation) may be one such minority-specific factor influencing TGD youth STB risk.

This study examines how TGD adolescents’ (ages 12-18) perceptions of parental invalidation of their gender identity relates to: 1) STBs over the past year and month, 2) same-day SI within-person, and 3) next-day SI using ecological momentary assessment (EMA). EMA extends prior research by increasing temporal resolution and ecological validity by soliciting information multiple times/day, minimizing recall bias, and capturing within- and between-day fluctuations in naturally dynamic processes (e.g., stress, SI) both at the sample- and person-level. We hypothesize that greater parental invalidation of adolescents’ gender identity will be associated with STBs contemporaneously (aims 1 & 2) and prospectively (aim 3). Data collection is ongoing with 14 of 20 parent-adolescent dyads enrolled to date. Dyads complete a 2-hour baseline assessment, with adolescents also completing a 14-day EMA protocol. Baseline measures include a validated interview-based assessment of STBs, qualitative interview of parent-adolescent relationships and adolescent gender identity, and self-report measures regarding SI severity, parental gender identity invalidation, and broader parent and family relationship quality. EMA assesses SI, parental gender invalidation, and family stressors (broadly and specifically related to gender identity) multiple times/day. Adolescent gender identity is assessed daily over follow-up. Bootstrapped zero-inflated binomial regression models will examine the relationship between parental gender identity invalidation and STBs cross-sectionally at baseline (aim 1), and multilevel modeling will examine within-person effects within-day (aim 2) and prospectively (between-day; aim 3). Findings will have implications for TGD youth-specific supplements for existing evidence-based interventions for high-risk youth involving family acceptance, validation, and parent-teen communication (e.g., DBT-A).