The Journal of Homosexuality and the American Foundation for Suicide Prevention have worked together to produce a report on suicides in LGBT (lesbian, gay, bisexual and trangender or transsexual) individuals. The report is a meta analysis, which means that it reviews and summarizes original research. It’s well known that LGBT people are at a higher risk for suicide attempts than heterosexual or cisgendered people.
LGB risk factors:
- Suicidal ideation does not appear to be a stable predictor of suicide attempts.
- Gay and bisexual men are at higher risk than lesbian and bisexual women.
- Not enough is known about age or race/ethnicity to clearly state how these affect risk.
- LGB people, as a whole, have higher rates of mental illnesses, especially mood disorders, anxiety disorders, and substance abuse, than heterosexual people. Mental disorders are a huge risk factor for suicide. Non-heterosexual men more frequently have depression and panic disorders than heterosexual men; non-heterosexual women are dependent on substances more frequently than heterosexual women. Insecurity in sexual orientation increases the chances of mental illness.
- Stress relating to homophobia increases suicide and mental illness risk. The report identifies two kinds of discrimination: individual (e.g., rejection, harassment, bullying) and institutional (e.g., no legal rights or protections). Both increase the risk for mental illness. Institutional discrimination can also lead to lack of health care for mental illness, which increases the risk of suicide.
- HIV/AIDS, as a significant stressor, also increases the risk of both mental illness and suicide.
Factors that reduce the suicide risk for LGB people are not yet well known. For youth, family and other adult support and safe schools appear to be important; for adults, connection to the LGB community and positive sexual identity.
Information about transgender suicide risk is likewise unclear. It’s known that transgender people are at a higher risk for depression, substance abuse, and suicide. Rejection by parents and discrimination appear to be the most well-known risk factors. Transgender people also have very high rates of job discrimination (e.g., harassment, privacy invasion, use of the wrong gender pronouns, not being hired or promoted) and unemployment, and low levels of health insurance through their employers.
There is a lot of information missing here, clearly. Research needs to shift, and the authors acknowledge and address this. Specifically, the right questions (e.g., asking for gender identity on large-scale population studies) and the right studies (e.g., looking at the differences between specific subgroups) need to be done.
There is no information about how well suicide prevention strategies work with LGBT people.
For me, these other aspects within the report stood out:
- LGBT people need access to high quality, evidence-based psychiatric care tailored to their needs that are accessible and affordable. The report notes that there were high levels of dissatisfaction with mental health services in the 1990s. I doubt that’s changed. And while it’s known that LGBT people acces more mental health services than the general population, the quality of those services cannot be ascertained.
- Public policy must change to support and protect sexual minorities. Institutional discrimination must be banished. Now.
- Researchers themselves need to be educated about LGBT issues so that current research efforts can be expanded to include LGBT people.
The report is available here. It also includes some statistics and a lot of good recommendations for public health and public policy.