Evidence indicates that lesbian, gay, bisexual, and transgender (LGBT) populations are at increased risk for suicide.1 This article reviews what is known and unknown about LGBT suicide risk, discusses risk and protective factors for LGBT adolescents and adults, and provides recommendations for assessing and treating LGBT patients.
Sexual orientation and gender identity
Researchers measure sexual orientation on the basis of sexual behavior or sexual identity. The two constructs identify different populations, however. An estimated 8.2% of US adults report lifetime same-sex sexual behavior and 3.5% identify as lesbian, gay, or bisexual.2 Sexual attraction is also used to measure orientation, although this is even less definitive of minority sexual identity than sexual behavior.
The prevalence of transgender people in the US is estimated at 0.3%.2 This includes individuals who transition from natal sex to another distinct gender (usually with transition-related health services) and persons who are transgender part-time, who cross-dress, or who identify as gender-nonconforming. Gender identity and sexual orientation are different but sometimes overlap. In one survey of transgender adults, 71% identified as gay/lesbian, bisexual, or “queer”; 23% as heterosexual; and 6% as asexual or other.3
Suicide deaths in LGBT populations
Because sexual orientation and gender identity are not systematically recorded at time of death, the number of LGBT deaths from suicide (or any other cause) is not known. This is a barrier to understanding and addressing LGBT suicide risk. Studies asking whether LGB people are over-represented among suicide decedents have produced inconsistent or inconclusive findings. However, high rates of suicide have been reported among individuals receiving medical interventions for gender transition.4,5 Findings from a recent Australian study indicate that depression, relationship problems, and other life stressors were more prevalent among LGBT suicide decedents than among non-LGBT decedents, and the LGBT decedents were less likely to have received psychiatric treatment.6
Attempted suicide in LGBT populations
There is strong evidence of elevated rates of suicide attempts in sexual minorities. Lifetime suicide attempts, on average, are 4-fold higher in gay and bisexual men, and twice as high in lesbian and bisexual women, compared with heterosexuals.7 Among adolescents, those who are LGB report making a lifetime suicide attempt at 3 times the rate of heterosexual youths.8 Moreover, LGB youths report 4 times as many medically serious attempts. Recent research suggests adolescent suicide risk is more strongly associated with LGB identity than with same-sex sexual behavior and is higher in behaviorally bisexual youths than in those with exclusively same-sex sexual behavior.9,10
Surveys of transgender adults likewise suggest high rates of suicidal behavior in gender minorities: lifetime suicide attempts have been reported by 25% to 43% of respondents.11 While the self-identified samples may not be representative of transgender populations as a whole, the consistency of survey findings suggests lifetime suicide attempts are likely more prevalent in transgender individuals than in the US general population, in which suicide attempts are reported by fewer than 5% of adults.12
Risk and protective factors
The higher prevalence of suicide attempts in LGBT adults and adolescents has been linked to the higher incidence of mental disorders in these populations—in particular, depression, anxiety, and substance abuse.7,13,14 High rates of depression and panic disorder have been observed among gay and bisexual males, while substance use disorders are more prevalent in lesbian and bisexual women than in heterosexual women.7 These findings suggest different gender patterns among LGB persons than among the population as a whole, which may be related in part to lower tolerance of sexual orientation differences in men than in women.
Meyer’s minority stress model15 attributes elevated rates of mental disorders and suicidal behavior in sexual minorities to greater exposure to prejudice, discrimination, and victimization as well as to internalization of negative social views. Hatzenbuehler and colleagues16,17 found that discriminatory laws and policies increase the prevalence of mental disorders in LGB adults. Hatzenbuehler18 also observed increased suicide attempts in LGB youths who lack supportive social environments, including protection against bullying and discrimination. Family rejection is also strongly related to depression and suicide attempts in LGB youths.19
Dr Haas is Senior Consultant at the American Foundation for Suicide Prevention. Dr Drescher is Clinical Professor at New York Medical College and Adjunct Professor at New York University in New York. They report no conflicts of interest concerning the subject matter of this article.
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