Understanding self-harm among lesbian, gay, bisexual, transgender, queer and questioning young people

Williams, Amy Jessica ORCID: 0000-0002-3987-3824 (2022). Understanding self-harm among lesbian, gay, bisexual, transgender, queer and questioning young people. University of Birmingham. Ph.D.

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Abstract

Self-harm is recognised as a global health concern. Among LGBTQ+ young people, self-harm is particularly prevalent. While studies have investigated potential stressors which may relate to high rates of self-harm, there are still gaps in the literature. The purpose of this thesis was to conduct an in-depth exploration of the processes underlying self-harm among LGBTQ+ young people, thereby extending the understanding of self-harm within this population.

To do this, an exploratory, sequential, mixed-method approach was taken. This allowed for different methods to be used to better inform the overall research aim. The empirical studies were co-designed with the LGBTQ+ Advisory Group. This was to ensure that relevant and meaningful research was undertaken. Firstly, a systematic review of risk factors associated with LGBTQ+ young people with self-harm experiences was conducted. Key risk factors were meta-analysed to determine their prevalence within the population (Chapter 3). These results demonstrated a pooled prevalence of 36% victimisation and 39% for mental health difficulties within LGBTQ+ young people with experiences of self-harm. Furthermore, these key risk factors were greater than those calculated for heterosexual, cisgender counterparts (Victimisation OR=3.74; mental health difficulties OR=2.67).

Following this, perspectives of LGBTQ+ young people were explored. This was to determine what LGBTQ+ young people felt were underlying causes leading to their self-harm (Chapter 4). Using thematic analysis and member-checking a thematic framework was developed. This highlighted that self-harm was perceived to be related to i) young people struggling to process and understand their LGBTQ+ identity, ii) negative responses to being LGBTQ+ from others, and iii) life stressors. Across these two studies, mental health difficulties, bullying, stigma or discrimination, and internal perceptions of LGBTQ+ identity were highlighted as key experiences relating to self-harm.

Therefore, these were built into an experience sampling study (Chapter 5), a novel methodology exploring real-time monitoring of daily experiences. This was the first study ever to use experience sampling methods with LGBTQ+ young people who self-harm. The findings from this study indicate that such studies are feasible, acceptable, and worthwhile. Highlighting significant research, clinical, and ethical implications.

The overall findings from the thesis, indicate that there is a high degree of stigma and discrimination facing LGBTQ+ young people. These experiences may also be having negative consequences to the young people’s perception of their own identity, which then further their self-harmful thoughts and behaviours. Further work is needed to identify the exact mechanisms to reduce the impact of these experiences. This thesis offers several theoretical enhancements and evidenced-based implications. The principle of theoretical extensions being: i) the Minority Stress Model, such that this is considered in relation to young people’s experiences leading to self-harm and includes transgender and gender diverse accounts; and ii) the Integrated Motivational-Volitational Model, offering a specialised understanding of how LGBTQ+ young people may move through a pathway to self-harm. Furthermore, key implications offer insight into LGBTQ+ presentations to primary care settings may be managed, how experience sampling can be used to understand and track self-harm in the community, and how education can be used to reduce peer and family discrimination.

To conclude, this thesis offers a holistic understanding of how specific experiences underlying self-harm in LGBTQ+ young people, potentially explaining the high prevalence within this group. Through suggested implications, it is possible that self-harm and mental health difficulties more widely could be reduced in this population.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):