(PS3-41) Predictors of Response to Cognitive Behavioral Therapy for Suicidal Ideation in Transgender Youth: A Longitudinal Study

Abstract Text:

Background: Transgender youth face disproportionately high rates of suicidal ideation, yet limited research exists on predictors of response to Cognitive Behavioral Therapy for Suicide Prevention (CBT-SP) within this population. This study examined individual and social factors influencing treatment outcomes, including gender affirmation, minority stress, emotion regulation, and parental support.

Methods: A 12-week longitudinal cohort study was conducted with 250 transgender youth (ages 13-24) experiencing clinically significant suicidal ideation. Participants completed weekly CBT-SP sessions, incorporating suicide safety planning, cognitive restructuring, behavioral activation, and emotion regulation training, with gender identity validation integrated throughout treatment. Assessments were conducted at baseline, mid-treatment, post-treatment, and at 3- and 6-month follow-ups. Key measures included suicidal ideation (Columbia Suicide Severity Rating Scale), depression (Beck Depression Inventory-II), emotion regulation (Difficulties in Emotion Regulation Scale), minority stress (Gender Minority Stress and Resilience Scale), parental support (Parental Acceptance-Rejection Questionnaire), and social gender affirmation (Transgender Congruence Scale).

Results: Hierarchical linear modeling (HLM) revealed a significant reduction in suicidal ideation over time (β = -0.67, p < .001), with 72% of participants experiencing at least a 50% reduction in suicidal thoughts by post-treatment. Multiple regression analyses indicated that higher baseline gender affirmation (β = -0.42, p < .001) and parental support (β = -0.36, p < .001) predicted greater reductions in suicidal ideation, while higher minority stress (β = 0.51, p < .001) and poorer emotion regulation (β = 0.39, p = .002) were associated with weaker treatment response. Moderation analyses showed that parental support buffered the negative effects of minority stress on treatment outcomes (interaction effect: β = -0.29, p = .004).

Conclusion: Findings underscore the importance of gender-affirming, family-inclusive, and minority stress-informed approaches in suicide prevention for transgender youth. Enhancing social gender affirmation and parental support may improve the effectiveness of CBT-SP, while interventions addressing minority stress and emotion regulation difficulties may be necessary for non-responders. This study contributes to the evidence base for inclusive, affirming therapies, helping bridge the gap between rigorous science and identity-affirming mental health care.