272 - Facilitators of and Barriers to Disclosure of Suicidal Ideation During Healthcare Visits Among Lesbian and Bisexual Young Women at Risk for Suicide.

Publication Number: 2262.272

Eunice M.. Areba, University of Minnesota School of Nursing, Minneapolis, MN, United States; Karli M. Reeves, University of Central Florida College of Medicine, Orlando, FL, United States; Eric W. Schrimshaw, University of Central Florida, College of Medicine, Orlando, FL, United States; Sarah A. Job, University of Central Florida College of Medicine, Kissimmee, FL, United States; Iris Borowsky, University of Minnesota Medical School, Minneapolis, MN, United States; Lindsay A.. Taliaferro, University of Central Florida College of Medicine, Orlando, FL, United States

Background: Most young people who die by suicide have seen a clinician in the prior six months, yet little is known about what influences disclosure of suicide ideation to a clinician, especially among high-risk, understudied groups like lesbian and bisexual women/nonbinary individuals assigned female at birth (LBWNB). We examined qualitative data from a sample of young LBWNB with a healthcare encounter within 30 days of a suicide attempt to identify factors influencing their disclosure of suicide ideation.

Objective: Discuss facilitators of and barriers to disclosing suicide ideation during healthcare encounters among young lesbian and bisexual women/nonbinary individuals at high risk of suicide.

Design/Methods: Data were collected in 2023-2024 as part of a longitudinal mixed-methods study. Participants were recruited via paid social media advertisements and snowball sampling. A subsample who reported suicide ideation within the preceding four months on the baseline survey completed an in-depth individual telephone interview (n=72). This analysis focuses on data from 39% of those who attempted suicide, specifically—five lesbian and four bisexual individuals aged 15–24 who had a healthcare visit within 30 days prior to their attempt. We used thematic analysis to identify factors that facilitated or hindered disclosure of suicide ideation.

Results: Factors related to disclosure of suicide ideation included (a) having a consistent, trusting, and supportive relationship with a clinician (e.g., even if she was going to say something I didn't want to hear, she would still be supportive and try to get me the help I needed); and (b) feeling scared, uncertain, and needing support (e.g., I wanted more support because I felt like I was so scared all the time). Barriers to disclosing suicide ideation included (a) clinicians dismissing or minimizing prior health concerns (e.g., she should have called the hospital when I told her that, but she did not); (b) Mistrust and invalidation (e.g., I had told them I was gay the last time. Then she asked me "Do you still think that you're gay? Yes. Then I was like, "I'm not telling you any … then I didn't); (c) a resolved intent to die by suicide; and (d) absence of suicide ideation at the time of the clinical visit.

Conclusion(s): Findings indicate clinicians working with young LBWNB individuals should build trusting and safe relationships with this patient population by remaining supportive, non-judgmental and following through on care planning. Consistent and non-stigmatizing suicide risk screening is essential, even during visits for physical health concerns.