Health Condition being Studied
Suicide is an important public health problem and the second leading cause of death in the United States among youth. Sex- and gender-diverse young adults (SGDYA) are at highest risk for suicide compared to other youth. They have high rates of depression and other stress. They may not have the support from people in their lives that they need.

The Need for the Study
Asking youth about depression when they go to see their doctor or other care professional is something that may help identify youth who may have thoughts of suicide (called suicidal ideation). However, there is little research to indicate which interventions work best for SGDYA. Without this information, doctors and other healthcare professionals do not know which interventions are best to use.

The Aims of the Study
The aim of the study is to reduce suicide among SGDYA ages 18-24 years old. The team will compare two brief interventions after adapting and piloting them to see which works best to decrease thoughts about suicide and other factors related to suicide.

Description of the Study
The study has two main phases:

• The team will collect information on the needs of SGDYA regarding suicide prevention and mental health. SGDYA and other people from the community (stakeholders) will be part of the process by sharing their ideas and feedback. The team will then pilot the new interventions in a small study with 40 SGDYA and then make any needed changes.
• The team will conduct a larger study with 592 SGDYA from primary care clinics to see which intervention works better. Clinics will be assigned by chance (like the flip of a coin) to one of two interventions. SGDYA enrolled in the study will receive the interventions using video technology.

Using the Results to Help Youth
Once the study is complete, the results can be used by doctors and other health professionals, such as counselors and therapists, to decide how to help youth who are seen in primary care clinics.

Patients
The team will recruit SGDYA ages 18-24 from primary care clinics in the Dallas and Austin, Texas areas.
The team has selected two brief suicide prevention interventions to study:

• “Suicidal Teens Accessing Treatment after an ED Visit” (STAT-ED), which helps youth stay safe and seek help after going to the emergency room. The intervention also connects youth with mental health care. The team will make changes to this intervention to use it in primary care.
• “Youth-Nominated Support Team for Suicidal Adolescents” (YST-II) also connects youth with mental health services but also involves connecting youth with a support person to help them. The youth will pick the support person and the study team will train that person on how to help.

Study Outcomes
When youth start the study, the team will ask them questions about themselves, their lives, and their experiences. Then the team will ask them about a variety of outcomes. Those questions will be repeated at 1, 3, 6, 9, and 12 months later. The team will collect information on suicidal ideation using a survey that the youth will fill out. The team will also ask about mental health services that they have used, feelings of depression, stigma, social support, and suicide attempts. While the team hopes that no youth in the study dies of suicide, it will also collect this information should it occur.

Stakeholders
Stakeholders, people from the community, including SGDYA, who care about or have been affected by depression and/or suicide, are key partners in this study. They are part of the engagement team, which includes a smaller group of youth called the youth advisory board (YAB). The group is diverse and brings a variety of views based on their different identities. This group builds upon work from another project funded by PCORI called TransFORWARD, which focuses on the health of transgender and gender-diverse people in Texas (EA#10671). This group has worked hard to help the team develop all parts of this project. They will continue to work with the team going forward. They will give the team advice about the study and help it get information that is learned out to the community and other people who are interested in preventing youth suicide.