Psychological comorbidities and suicidality in sexual and gender minority foster youth

Objective: Sexual and gender minority youth (SGMY), or those who identify as lesbian, gay, bisexual, transgender or gender diverse and questioning are suggested to be overrepresented in the U.S. foster care system. Lack of systematized data collection on youths' sexual orientation and/or gender identity in child welfare has curtailed studies of this population. This community-based study assessed psychological and behavioral health of youth with current or past foster care involvement in an urban public child welfare system, and examined relations between types of victimization (e.g. LGBTQ-based victimization, caregiver rejection, intimate partner violence) and psychological functioning.Methods: A total of 35 (12-26 years old) participants were administered a survey assessing multiple domains of health and wellbeing between October 2018 and February 2020. Primary quantitative outcomes included depression, anxiety, post-traumatic stress symptomatology, suicide ideation, planning, and attempt, and nonsuicidal self-injury.Results: 42.7 % of participants identified as lesbian or gay, 37.1 % as bisexual or pansexual, and 20 % identified as heterosexual. 54.3 % identified as transgender or gender diverse (TG/GD). Over 75 % (75.06 %, n = 25) of the total sample met the clinical cutoff for Total Internalizing, 64.71 % (n = 22) met the clinical cutoff for Depression, and 78.79 % (n = 26) met the clinical cutoff for Anxiety. 70 % reported suicidal ideation and 45 % past suicide attempt. Rejection experiences based on sexual orientation were associated with anxiety, depression and post-traumatic symptoms; discrimination experiences based on sexual orientation or TG/GD expression were associated with anxiety. Loneliness and everyday discrimination were associated with post-traumatic stress symptoms. IPV, everyday discrimination, rejection, discrimination, and victimization based on sexual orientation and gender identity, while not statistically significant within this sample, did emerge as factors warranting further investigation concerning suicide ideation, planning, and attempt.Conclusion: 75% of the SGMY in this this study met the clinical threshold for mood disorders, reinforcing the importance of integrated behavioral health support in clinical and wraparound care for SGMY in foster care, and the critical role of SGM-specific competencies for the entire care team. Teams caring for SGMY should be aware of community resources that are competent in addressing SGM-specific stressors and the impacts of multiple forms of victimization, including intimate partner violence for SGMY. Targeted efforts and to work with families are needed.