There is a long report in the most recent Journal of Homosexuality on suicide, suicidal behavior and suicidal ideation among lesbian, gay, bisexual and trans people. The report starts by defining the sexual orientation and gender identity minorities described in this paper. The authors are aware that gender identity and sexual orientation both run on a fluid continuum, and that hence LGBT is not the right term. However, they use it anyway because it is used overall in the research community. That makes me wonder whether no-one wants to change the terminology used in research papers to more accurately reflect the reality of sexual orientation and gender identity minorities.
The authors follow by examining the rate of suicide, suicide attempts and suicidal ideation among LGB people. It is thought that gay and bisexual males are more likely to commit suicide or to attempt suicide than heterosexual males, whereas lesbian and bisexual females are more likely to have suicidal ideation than straight women do. The fact that gay or bisexual men are more likely to attempt suicide, contrasts with findings in the genral population, where women are more likely to attempt suicide. As for age at suicide attempt, this varies across studies. Some studies say that adolescents are most likely to attempt suicide, while others report that suicide attempts are more evenly distributed over the lifespan. A potential explanation may be that suicide attempts are more linked to the age at which LGB people start to identify and disclose their sexual orientation than to chronological age.
Mental illness is one of the most significant risk factors for suicide attempts in the general population. Indeed, LGB people, particularly adolescents and bisexual men, are more likely to have a mental disorder than straight people. This, however, does not explain fully why LGB people are more likely to attempt suicide: when controlling for mental disorders, one study found that LGB people were still two to three times more likely to attempt suicide than straight people.
Another risk factor for suicide attempts and mental disorders is discrimination. Several studies found a relationship between parental rejection and school bullying or violence because of sexual orientation and suicide attempts among LGB adolescents. IN LGB adults, experiences with discrimination and harassment were also correlated to suicide attempt. There was, however, an interesting racial disparity between Whites on the one hand and Latinos and Blacks on the other, where White LGB people were more likely to have mental disorders, while Black and especially Latino people were more likely to attempt suicide. The explanation for this might be that Latino/Black people are more likely to attempt suicide because of social stressors rather than mental illness.
Institutional discrimination is also a factor in the increased rate of mental illness among LGB people. In states which do not provide protections from discrimination based on sexual orientation or that have constitutional amendments prohibiting gay marriage, there are elevated rates of mental disorders as compared to those in states with more equality. Poor health insurance, for example due to the lack of coverage for same-sex partners, may also lead to elevated rates of untreated mental illness.
Lastly, HIV/AIDS is also a possible risk factor for suicde attempts, but data on this are inconclusive. It is suggested that substance abuse and other mental disorders may be more relevant predictors of suicide attempt among HIV-positive men than is the virus itself. However, rates of suicide attempts among HIV-positive persons have decreased since there are better antiretroviral treatments available.
There are several protective factors against suicide among LGB people. Among adolescents, family connectedness, support from other adults, and school safety protect against suicide attempts. In adults, connections to an LGB community help. It is also suggested that intimate relationships protect against suicide attempts, but that has not been studied.
The authors go on to discuss suicide risk among transgendered people. One study reports an alarming 80-fold increase in suicide deaths among trans individuals as compared to the general popluation. Another study found that trans people were more likely than any comparison group – heterosexuals, gay and lesbian people, and cis people matched on age, relationship status and several other variables -, except for lesbian females, to attempt suicide. Several risk factors are being reported among trans people for suicde attempts, among them mental disorders and discrimination, particularly rejection by parents in adolescence and on-the-job discriminination and harrassment in adults.
The researchers make many recommendations to improve mental health services, suicide prevention services, and public policies relevant to LGBT individuals. With regard to mental health programs, they encourage furthering of LGBT-specific programs and interventions in mental health and substance abuse services. There are several guides to LGBT care, but none provide specific guidelines on suicide prevention. It is recommended, lastly, that DSM-V be revised to make it clear that sexual and gender identity minorities are not per se mentally ill.
There are very few suicide prevention programs specifically for LGBT people. The only one mentioned in this study is the Trevor Project. It is recommended that interventions, education and awareness related to suicide among LGBT people be increased.
Lastly, several public policy changes are recommended. It is recommended that LGBT groups and allies advocate for:
- Better access to health and mental health services through non-discriminiation policies;
- Explicit protection against school violence and bullying based on sexual orientation or gender identity;
- Improvements in discriminatory legislation related to factors contributing to suicde or mental health problems;
- Inclusion of sexual orientation and gender identity questions on surveys relevant to health and mental health.
The authors conclude that, although many questions related to suicide among LGBT populations are as yet unanswered, there appears to be little doubt that a broad national effort will be needed to encourage and fund the needed research, raise awareness of the problem among LGBT and suicide prevention leaders, and develop
the interventions, prevention strategies, and policy changes through which suicidal behavior and suicide risk in LGBT populations can be reduced./P>
Reference
Haas AP, Eliason M, Mays VM, Mathy RM, Cochran SD, D’Augelli AR, Silverman MM, Fisher PW, Hughes T, Rosario M, Russell ST, Malley E, Reed J, Litts DA, Haller E, Sell RL, Remafedi G, Bradford J, Beautrais AL, Brown GK, Diamond GM, Friedman MS, Garofalo R, Turner MS, Hollibaugh A, Clayton PJ (2011), Suicide and Suicide Risk in Lesbian, Gay, Bisexual, and Transgender Populations: Review and Recommendations. Journal of Homosexuality, 58(1):10-51. DOI: 10.1080/00918369.2011.534038.
in: http://astridvanwoerkom.wordpress.com/2011/01/30/suicide-among-lgbt-people-review-and-recommendations/
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