PCPs can assist LGBTQ adolescents in high-risk coming out to family

BALTIMORE — PCPs can play a “central role” in assisting adolescent LGBTQ patients when they decide to reveal their sexual or gender identity to family members, particularly when they are at risk for rejection and violence, according to data presented at the Pediatric Academic Societies Meeting.

“On one hand, some LGBTQ people receive a welcoming attitude and support from their parents and siblings after breaking the news,” Arnaud Merglen, MD, of the University of Geneva, Switzerland, said in an interview. “This experience has a major positive impact on health and self-esteem. On the other hand, other LGBTQ people receive, in response to their coming out, verbal or physical violence from their parents or siblings, rejection, or expulsion from home. Such family conflicts often result in homelessness, and increase the risk of mental health problems and suicide.”

 

To devise strategies for PCPs seeking to support their adolescent patients who identify as LGBTQ during their coming-out to family members, Merglen and colleagues reviewed literature and analyzed outpatient clinic cases in which such patients were at risk for rejection and violence. An interdisciplinary team discussed the cases before refining their strategies for supporting coming-out.

The researchers identified 8 factors PCPs and their patients should consider in the planning, support and follow-up of coming out. They organized their system into the acronym TRANS:

• Talk and timing: Pros and cons of coming out. Focusing not on “if,” but “when” is a good time in one’s life to come out;
• Risks and resources: Determine the patient’s risk of violence, rejection and vulnerability. PCPs should consider the adolescent’s cultural background, financial independence, coping strategies and job;
• Allies: Identify any people the adolescent knows who will provide unconditional support;
• Network: Without breaching confidentiality, establish a support network, including peers, teachers, neighbors, social workers or others, that can send a discrete alert if coming out goes wrong. Call for appropriate reactions to alerts, whether that be contacting a clinic, the parents, or the police; and
• Support and self-esteem: Schedule short- and long-term follow-up appointments to discuss immediate safety, shelter needs, education and job opportunities, and risk for PTSD. Focus on self-esteem, community support and development, and advocacy.

“Coming out to parents and siblings is a critical and life-changing moment for LGBTQ adolescents, which have major health impacts,” Merglen said. “Health care providers should discuss with LGBTQ patients’ options and timing regarding coming out to their family, and support best informed decisions that take into account the patient’s context, personal risk of violence and rejection, as well as available resources.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.

Reference:

Merglen A, et al. Strategies to support LGBTQ adolescents in high-risk coming-out to family. Presented at: Pediatric Academic Societies meeting; April 30 to May 3, 2016; Baltimore.