Systematic Review: Exploring the Effectiveness of Health Care Competency Training as a Means of Suicide Prevention in LGBTQ+ Youth

Objective: To evaluate the effectiveness of LGBTQ+ competency training programs for health care professionals and examine the impact of these programs on LGBTQ+ youth suicidal thoughts, behavior, attempts, and risk. Method: This systematic review included quantitative studies that assessed LGBTQ+ cultural competency. Searches of 6 electronic databases yielded 6,317 records and 77 grey literature records (last searched on May 20, 2024); 19 studies met the inclusion criteria. Risk of bias was assessed using Cochrane ROB 2.0 and the Cochrane Robins I tool. Data on study design, sample characteristics, training details, and outcomes were extracted in line with the Cochrane Handbook and Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Included studies varied: 13 mixed methods, 4 quasi-experimental, 1 randomized controlled trial, and 1 time series. All studies were conducted in Western countries and involved health care professionals, with varying training formats and durations. Training programs generally improved objective measures of knowledge, skills, and clinical preparedness. However, self-perceived knowledge, attitudes, and comfort levels showed inconsistencies. Only 6 studies addressed health care workers' knowledge of LGBTQ+ youth suicide risk, focusing on general cultural competency rather than suicide risk reduction. None of the studies examined suicide prevention outcomes. Conclusion: Although LGBTQ+ cultural competency training shows improvements in health care professionals' competence, studies are limited by methodological flaws, including reliance on self-assessments, small sample sizes, limited long-term data, high attrition rates, and variable assessment tools. A gap exists in understanding the impact of training on LGBTQ+ youth suicide risk. Future research should explore the association between health care provider cultural competency training and long-term suicide prevention outcomes. Study registration information: Ask for their pronouns, save their life: Exploring the effectiveness of training programs on healthcare competency as a means of suicide prevention in LGBTQ+ youth: A systematic review; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024529991. Diversity & Inclusion Statement: One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science.