Effects of "It Gets Better" Suicide Prevention Videos Targeting LGBQ Adolescents

LGBQ adolescents are a risk group for suicide, but evaluations of interventions to prevent suicide in this group are scarce. In response to several LGBQ suicides, the It Gets Better project has been developed by volunteering LGBQ persons who provide short video narratives of their experiences during their coming-out phase and afterwards. The main goal of the videos is to empower young LGBQ persons facing difficulties due to their sexual identity and to reduce suicide. The project has spread to several countries including Austria (www.eswirdbesser.at), but evaluations are lacking. The project will be conducted in Austria over three phases. In Phase 1, a short list of the best German-language videos will be created based on input from experts and LGBQ adolescents. In Phase 2, we will conduct discussions with a total of n=28 LGBQ adolescents and experts participating in Phase 1. The goal is to scrutinize what participants find relevant in good-quality videos. In Phase 3, we will conduct an evaluation of the effects of the best video featuring boys/ men and girls/women, respectively. A total of 288 14-22 year olds will be recruited from LGBQ organisations including services that provide counselling to sexual minority adolescents. They will be allocated at random to view (a) the suicide prevention video or (b) a control video on an unrelated health issue with similar stylistic features. Before the start of the experiment, participants will complete a socio-demographic questionnaire and a series of measures to assess various aspects of their sexual identity, their psychological and emotional well-being (e.g., suicidal ideation), including a scale to assess current suicide risk in order to identify individuals at risk for suicidal behavior, who will be offered help. Immediately post-viewing, participants will complete questionnaires about the video itself, and about identification with the featured protagonists. They will also complete the questionnaires from before the viewing in order to investigate immediate effects of the PSA. Four weeks later, the participants will complete the outcome measures again, in order to analyze the sustainability of effects. We will also investigate if the effects vary with regard to identification or vulnerability of the participants, and with selected aspects of LGBQ identity, such as sexual orientation or internalized homophobia. The project is important and innovative in that it uses videos that are produced by LGBQ people and therefore more likely to resonate with young LGBQ people. Without this research, it is quite possible that ineffective prevention videos could be rolled out. It addresses the impact of important individual variables such as vulnerability, sexual identity and identification on the effects, as well as the sustainability of effects. The project will provide crucial novel knowledge on how to tailor suicide prevention videos to LGBQ adolescents in Austria and elsewhere. The results from this project can contribute to combatting suicide and help save young LGBQ lives.

Young individuals who are gay, lesbian, bisexual, queer or belong to other sexual or gender identity minorities (LGBTQ+) are a risk group for suicidal ideation and behaviour. The "It Gets Better" project (IGBP; https://www.itgetsbetter.org) is a suicide prevention project that specifically targets young LGBTQ+ people by using short videos featuring mainly adult LGBTQ+ persons who provide their personal narratives of hope and successful coping with adversity during their coming out. Interventions specifically tailored to LGBTQ+ youth are scarce and have not been tested so far. The main aim of this project, therefore, was to test effects of selected IGBP videos on LGBTQ+ youth regarding mental health-related outcomes such as suicidal ideation or help-seeking intentions. The project was conducted in three phases. Phase 1 involved a content analysis of the total pool of Austrian IGBP videos. In the videos, which mainly featured the perspective from gay men, coming out was framed as both a positive experience and a tool to make things better. Suicidal ideation and behaviour or options to get professional help were barely mentioned in the videos. In phase 2, focus groups were conducted with LGBQ+ adolescents and suicide prevention experts to investigate how they perceived selected IGBP videos and how they could be improved. The videos were perceived as helpful and suitable to promote feelings of hope. Core aspects on how to improve the videos were about how to increase identification with the featured characters, especially by tailoring videos to the subgroups, which appeared crucial to any positive video effects. On the other hand, participants criticized the current lack of videos featuring transgender and bisexual individuals. The weak focus of video messages in regard to dealing with suicidal ideation, how to cope with it and professional help-seeking were identified as crucial areas for improvement. In phase 3, two selected IGBP videos were tested in a randomised controlled trial with LGBTQ+ youth aged 14-22 years (n=483), who were randomized either to an IGBP (n=242) or control video (n=241). There was no statistically significant overall effect on suicidal ideation, but non-binary/transgender individuals experienced a small-sized improvement. This appeared most pronounced in transgender youth with some symptoms of depression. An indirect preventive effect on suicidal ideation through identification with the featured protagonist was observed. There was also some improvement in help-seeking intentions in the intervention group, as compared to the control group. The findings provide clear signs that video narratives featuring positive coping with adversities during coming out might have some potential to decrease suicidal ideation and encourage help-seeking among vulnerable youth who identify with videos. Future videos should carefully consider how to tailor narratives to specific LGBTQ+ groups and how to address coping with suicidal ideation and help-seeking.