Negotiating multiple minoritised identities: An Interpretative Phenomenological Analysis (IPA) exploring the complex intersection of sexual orientation, gender identity, and suicidality among transgender and gender-diverse young adults

Transgender and gender-diverse young adults, the vast majority of whom identify as lesbian, gay, bisexual, or queer, encounter considerable health, social, and systemic inequalities, resulting in increased rates of discrimination, marginalisation, and suicidality compared to their heterosexual and cisgender peers. The complex relationship between sexual orientation, gender identity, and suicidality has thus generated much discussion, primarily from quantitative studies focused on ‘vulnerable’ or at-risk narratives, rather than an individual’s lived experiences or specific healthcare needs. The aim was to explore the lived experiences of transgender and gender-diverse young adults, encompassing identity development, family and peer relationships, navigating multiple minoritised identities, unmet healthcare needs, encounters with suicidal distress, and access to mental health services and gender-affirming care. Six young adults from Northern Ireland (UK) took part in semi-structured interviews which were analysed using Interpretative Phenomenological Analysis (IPA). Five group experiential themes were identified: 1) Delicate peace, delicate progress; 2) Queer suffering, safety and otherness; 3) Queerness shaping ones’ worldview; 4) Unresolved trauma, and unmet healthcare needs; 5) Suicidal distress, and recovery. The findings elucidated two central narratives; the psychosocial impact of negotiating multiple minoritised identities in a heteronormative and cisnormative society and navigating suicidal distress by regaining a sense of control over your life. Suicide was framed as a response to the increasingly unbearable psychological pain of ‘being othered’, to the ‘collective struggle’ experienced, perceived risk of victimisation and chronic threat-vigilance. Many young adults also expressed that ‘suicide was an escape’ from traumatic experiences of ‘queer suffering’, existential rejection, bullying, and thwarted belongingness. The findings provide valuable insight into the unique lived experiences and specific healthcare needs of this population. Clinical implications are discussed, including the importance of cultural competence among practitioners, tailored suicide prevention strategies, and accessible gender-affirming care for transgender and gender-diverse young adults in Northern Ireland.