Suicide and Suicide Risk in Lesbian, Gay, Bisexual, and Transgender Populations: Review and Recommendations

Despite strong indications of elevated risk of suicidal behavior in lesbian, gay, bisexual, and transgender people, limited attention has been given to research, interventions or suicide prevention programs targeting these populations. This article is a culmination of a three-year effort by an expert panel to address the need for better understanding of suicidal behavior and suicide risk in sexual minority populations, and stimulate the development of needed prevention strategies, interventions and policy changes. This article summarizes existing research findings, and makes recommendations for addressing knowledge gaps and applying current knowledge to relevant areas of suicide prevention practice.

[1]  A. Beautrais,et al.  Sexual orientation and mental health in a birth cohort of young adults , 2005, Psychological Medicine.

[2]  R. Savin-Williams,et al.  Verbal and physical abuse as stressors in the lives of lesbian, gay male, and bisexual youths: associations with school problems, running away, substance abuse, prostitution, and suicide. , 1994, Journal of consulting and clinical psychology.

[3]  I. Meyer.  Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. , 2003, Psychological bulletin.

[4]  D. Oslin,et al.  A double-blind, placebo-controlled trial combining sertraline and naltrexone for treating co-occurring depression and alcohol dependence. , 2010, The American journal of psychiatry.

[5]  C. Goodenow,et al.  School support groups, other school factors, and the safety of sexual minority adolescents , 2006 .

[6]  J. Gagnon,et al.  The Social Organization of Sexuality: Sexual Practices in the United States , 1994 .

[7]  W. Pedersen,et al.  Homosexual Experience, Desire and Identity Among Young Adults , 2008, Journal of homosexuality.

[8]  M. Rotheram-Borus,et al.  Suicidal Behavior and Gay-Related Stress among Gay and Bisexual Male Adolescents , 1994 .

[9]  L. Diamond.  Sexual Fluidity: Understanding Women's Love and Desire , 2008 .

[10]  J. Moskowitz,et al.  Suicide attempts among gay and bisexual men: lifetime prevalence and antecedents. , 2002, American journal of public health.

[11]  R. Sell,et al.  Health care access among individuals involved in same-sex relationships. , 2006, American journal of public health.

[12]  A. Fausto-Sterling.  Sexing the Body: Gender Politics and the Construction of Sexuality , 2020 .

[13]  M. Tsuang,et al.  Sexual orientation and suicidality: a co-twin control study in adult men. , 1999, Archives of general psychiatry.

[14]  I. Nazareth,et al.  A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people , 2008, BMC psychiatry.

[15]  Janet B W Williams,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[16]  P. Mortensen,et al.  Suicide risk in relation to socioeconomic, demographic, psychiatric, and familial factors: a national register-based study of all suicides in Denmark, 1981-1997. , 2003, The American journal of psychiatry.

[17]  M. Berlim,et al.  Sexual Orientation and Gender Identity in Youth Suicide Victims: An Exploratory Study , 2010, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[18]  C. Mclaughlin.  Delays in treatment for mental disorders and health insurance coverage. , 2004, Health services research.

[19]  Ronald C Kessler,et al.  Delays in initial treatment contact after first onset of a mental disorder. , 2004, Health services research.

[20]  M. Plöderl,et al.  Childhood Gender Nonconformity and Harassment as Predictors of Suicidality among Gay, Lesbian, Bisexual, and Heterosexual Austrians , 2009, Archives of sexual behavior.

[21]  Dc Washington.  Diagnostic and Statistical Manual of Mental Disorders, 4th Ed. , 1994 .

[22]  S. Russell,et al.  Men's sexual orientation and suicide: evidence for U.S. adolescent-specific risk. , 2012, Social science & medicine.

[23]  V. Sadock.  The Social Organization of Sexuality: Sexual Practices in the United States , 1995 .

[24]  A. Beautrais,et al.  Is sexual orientation related to mental health problems and suicidality in young people? , 1999, Archives of general psychiatry.

[25]  R. Mathy.  Transgender Identity and Suicidality in a Nonclinical Sample , 2003 .

[26]  L. Gise,et al.  Group for the Advancement of Psychiatry , 1979 .

[27]  H. Maddever,et al.  Psychosocial characteristics of applicants evaluated for surgical gender reassignment , 1984, Archives of sexual behavior.

[28]  R. Fowler,et al.  San Diego suicide study: comparison of gay to straight males. , 1986, Suicide & life-threatening behavior.

[29]  J. Drescher.  Transsexualism, Gender Identity Disorder and the DSM , 2010 .

[30]  J. S. McDaniel,et al.  The relationship between sexual orientation and risk for suicide: research findings and future directions for research and prevention. , 2001, Suicide & life-threatening behavior.

[31]  B. Liddle.  Therapist sexual orientation, gender, and counseling practices as they relate to ratings on helpfulness by gay and lesbian clients. , 1996 .

[32]  Nicholas P. Salter,et al.  Predicting the suicide attempts of lesbian, gay, and bisexual youth. , 2005, Suicide & life-threatening behavior.

[33]  T. Hughes,et al.  Dimensions of sexual orientation and the prevalence of mood and anxiety disorders in the United States. , 2010, American journal of public health.

[34]  S. Cochran,et al.  "Living Apart Together" relationships in the United States. , 2009, Demographic research.

[35]  K. Conron,et al.  A population-based study of sexual orientation identity and gender differences in adult health. , 2010, American journal of public health.

[36]  Brady T. West,et al.  The relationship between discrimination and substance use disorders among lesbian, gay, and bisexual adults in the United States. , 2010, American journal of public health.

[37]  R. Mathy.  Suicidality and Sexual Orientation in Five Continents: Asia, Australia, Europe, North America, and South America , 2002 .

[38]  S. Cochran,et al.  Influence of gender, sexual orientation, and need on treatment utilization for substance use and mental disorders: Findings from the California Quality of Life Survey , 2009, BMC Psychiatry.

[39]  S T Russell,et al.  Adolescent sexual orientation and suicide risk: evidence from a national study. , 2001, American journal of public health.

[40]  Paul R Duberstein,et al.  Sexual orientation and risk factors for suicidal ideation and suicide attempts among adolescents and young adults. , 2007, American journal of public health.

[41]  A. D’augelli,et al.  Transgender youth and life-threatening behaviors. , 2007, Suicide & life-threatening behavior.

[42]  Shoshannah A. Pearlman.  The Patient Protection and Affordable Care Act , 2013, Journal of the American Psychiatric Nurses Association.

[43]  Christopher S. Carpenter,et al.  Gay and lesbian partnership: Evidence from California , 2008, Demography.

[44]  S. Cochran,et al.  Mental health and substance use disorders among Latino and Asian American lesbian, gay, and bisexual adults. , 2007, Journal of consulting and clinical psychology.

[45]  Robin M. Mathy,et al.  Methodological Rigor with Internet Samples: New Ways to Reach Underrepresented Populations , 2002, Cyberpsychology Behav. Soc. Netw..

[46]  S. Cochran,et al.  The association between relationship markers of sexual orientation and suicide: Denmark, 1990–2001 , 2009, Social Psychiatry and Psychiatric Epidemiology.

[47]  B. Shain.  Suicide and Suicide Attempts in Adolescents , 2007, Pediatrics.

[48]  H. Christensen,et al.  Sexual orientation and mental health: results from a community survey of young and middle-aged adults. , 2002, The British journal of psychiatry : the journal of mental science.

[49]  A. Beck,et al.  Cognitive therapy for the prevention of suicide attempts: a randomized controlled trial. , 2005, JAMA.

[50]  S. Cochran,et al.  Lifetime prevalence of suicide symptoms and affective disorders among men reporting same-sex sexual partners: results from NHANES III. , 2000, American journal of public health.

[51]  P. V. van Kesteren,et al.  Mortality and morbidity in transsexual subjects treated with cross‐sex hormones , 1997, Clinical endocrinology.

[52]  R. Kaleigh.  Feinberg, Leslie. 1992. "Transgender Liberation: A Movement Whose Time Has Come." New York: World View Forum , 2010 .

[53]  Leslie Feinberg.  Transgender Liberation: A Movement Whose Time Has Come , 1992 .

[54]  S. Hershberger,et al.  Suicidality patterns and sexual orientation-related factors among lesbian, gay, and bisexual youths. , 2001, Suicide & life-threatening behavior.

[55]  L Fisher,et al.  National Strategy for Suicide Prevention: Goals and Objectives for Action. , 2002 .

[56]  B. West,et al.  Sexual orientation, substance use behaviors and substance dependence in the United States. , 2009, Addiction.

[57]  R. Durant,et al.  The association between health risk behaviors and sexual orientation among a school-based sample of adolescents. , 1998, Pediatrics.

[58]  R. Savin-Williams,et al.  Suicide attempts among sexual-minority youths: population and measurement issues. , 2001, Journal of consulting and clinical psychology.

[59]  K. Cranston,et al.  Correlates of same-sex sexual behavior in a random sample of Massachusetts high school students. , 1998, American journal of public health.

[60]  S. Hershberger,et al.  Aspects of mental health among older lesbian, gay, and bisexual adults , 2001, Aging & mental health.

[61]  M. Felice.  GROUP FOR THE ADVANCEMENT OF PSYCHIATRY , 1979 .

[62]  J. Lonnqvist,et al.  Suicide prevention strategies: a systematic review. , 2005, JAMA.

[63]  A. Kposowa,et al.  Marital status and suicide in the National Longitudinal Mortality Study , 2000, Journal of epidemiology and community health.

[64]  D. Hasin,et al.  The impact of institutional discrimination on psychiatric disorders in lesbian, gay, and bisexual populations: a prospective study. , 2010, American journal of public health.

[65]  P. Jensen,et al.  Guidelines for Adolescent Depression in Primary Care (GLAD-PC): I. Identification, Assessment, and Initial Management , 2007, Pediatrics.

[66]  M. Katz,et al.  Attempted Suicide Among Transgender Persons , 2006, Journal of homosexuality.

[67]  R. Wilchins,et al.  GenderQueer: Voices From Beyond the Sexual Binary , 2002 .

[68]  K. Fitzpatrick,et al.  Gender role, sexual orientation and suicide risk. , 2005, Journal of affective disorders.

[69]  T. Hughes.  Lesbians’ Drinking Patterns: Beyond the Data# , 2003, Substance use & misuse.

[70]  G. Diamond,et al.  Attachment-Based Family Therapy for Depressed Adolescents: Programmatic Treatment Development , 2003, Clinical child and family psychology review.

[71]  G. R. Brown,et al.  Suicidal tendencies in women with human immunodeficiency virus infection. , 1989, The American journal of psychiatry.

[72]  H. Kulkin,et al.  Suicide Among Gay and Lesbian Adolescents and Young Adults , 2000, Journal of homosexuality.

[73]  Christopher S. Carpenter,et al.  Disparities in health insurance coverage, access, and outcomes for individuals in same-sex versus different-sex relationships, 2000-2007. , 2010, American journal of public health.

[74]  J. Farrow,et al.  Risk factors for attempted suicide in gay and bisexual youth. , 1991, Pediatrics.

[75]  Lowell J. Taylor,et al.  Demographics of the gay and lesbian population in the United States: Evidence from available systematic data sources , 2011, Demography.

[76]  D. Hasin,et al.  State-level policies and psychiatric morbidity in lesbian, gay, and bisexual populations. , 2009, American journal of public health.

[77]  R. Durant,et al.  Victimization, use of violence, and drug use at school among male adolescents who engage in same-sex sexual behavior. , 1998, The Journal of pediatrics.

[78]  S. Cochran,et al.  The effects of unequal access to health insurance for same-sex couples in California. , 2010, Health affairs.

[79]  B. Thombs,et al.  Suicidal ideation and attempt among adolescents reporting "unsure" sexual identity or heterosexual identity plus same-sex attraction or behavior: forgotten groups? , 2010, Journal of the American Academy of Child and Adolescent Psychiatry.

[80]  M. Rosario,et al.  Gay-related stress and emotional distress among gay, lesbian, and bisexual youths: a longitudinal examination. , 2002, Journal of consulting and clinical psychology.

[81]  G. Kenagy.  Transgender health: findings from two needs assessment studies in Philadelphia. , 2005, Health & social work.

[82]  Gianna E. Israel,et al.  Transgender Care: Recommended Guidelines, Practical Information, and Personal Accounts , 2001 .

[83]  E. Goodman,et al.  Sexual orientation and risk of suicide attempts among a representative sample of youth. , 1999, Archives of pediatrics & adolescent medicine.

[84]  M. Resnick,et al.  Suicidality among gay, lesbian and bisexual youth: the role of protective factors. , 2006, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[85]  R. Kessler,et al.  Risk of psychiatric disorders among individuals reporting same-sex sexual partners in the National Comorbidity Survey. , 2001, American journal of public health.

[86]  Heather L. Corliss,et al.  Pervasive trauma exposure among US sexual orientation minority adults and risk of posttraumatic stress disorder. , 2010, American journal of public health.

[87]  C. Chew‐Graham,et al.  Randomised controlled trial of brief psychological intervention after deliberate self poisoning. , 2001, BMJ.

[88]  S. Shoptaw,et al.  Depression ratings, reported sexual risk behaviors, and methamphetamine use: latent growth curve models of positive change among gay and bisexual men in an outpatient treatment program. , 2007, Experimental and clinical psychopharmacology.

[89]  S. Cochran,et al.  Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States. , 2003, Journal of consulting and clinical psychology.

[90]  R. Kessler,et al.  Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. , 1999, Archives of general psychiatry.

[91]  P. Jensen,et al.  Guidelines for Adolescent Depression in Primary Care (GLAD-PC): II. Treatment and Ongoing Management , 2007, Pediatrics.

[92]  K. Hancock,et al.  Guidelines for psychotherapy with lesbian, gay, and bisexual clients. , 2000, The American psychologist.

[93]  G. Remafedi.  Suicidality in a venue-based sample of young men who have sex with men. , 2002, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[94]  M. Pompili,et al.  Completed Suicide and Marital Status According to the Italian Region of Origin , 2010, Psychiatric Quarterly.

[95]  D. Shaffer,et al.  Sexual orientation in adolescents who commit suicide. , 1995, Suicide & life-threatening behavior.

[96]  S. Cochran,et al.  Relation between psychiatric syndromes and behaviorally defined sexual orientation in a sample of the US population. , 2000, American journal of epidemiology.

[97]  S. Cochran.  Emerging issues in research on lesbians' and gay men's mental health: does sexual orientation really matter? , 2001, The American psychologist.

[98]  J. Mann,et al.  Comparison of clinical and research assessments of diagnosis, suicide attempt history and suicidal ideation in major depression. , 2009, Journal of Affective Disorders.

[99]  Ian Rivers,et al.  Recollections of bullying at school and their long-term implications for lesbians, gay men, and bisexuals. , 2004, Crisis.

[100]  R. Sell.  Defining and Measuring Sexual Orientation: A Review , 1997, Archives of sexual behavior.

[101]  D. Frost,et al.  Social and psychological well-being in lesbians, gay men, and bisexuals: the effects of race, gender, age, and sexual identity. , 2009, The American journal of orthopsychiatry.

[102]  I. Meyer.  Minority stress and mental health in gay men. , 1995, Journal of health and social behavior.

[103]  T. Hart,et al.  Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men. , 2003, American journal of public health.

[104]  L. Hankoff.  Reducing Suicide: A National Imperative , 2003 .

[105]  S. Russell.  Sexual Minority Youth and Suicide Risk , 2003 .

[106]  M. Katz,et al.  HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: implications for public health intervention. , 2001, American journal of public health.

[107]  N. Mulé,et al.  International Journal for Equity in Health Open Access Promoting Lgbt Health and Wellbeing through Inclusive Policy Development , 2009 .

[108]  G. Koeske,et al.  The impact of gender-role nonconforming behavior, bullying, and social support on suicidality among gay male youth. , 2006, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[109]  S. Schwartz,et al.  Lifetime prevalence of mental disorders and suicide attempts in diverse lesbian, gay, and bisexual populations. , 2008, American journal of public health.

[110]  S. Cochran,et al.  Prevalence of non-medical drug use and dependence among homosexually active men and women in the US population. , 2004, Addiction.

[111]  Daniel E. Bontempo,et al.  Effects of at-school victimization and sexual orientation on lesbian, gay, or bisexual youths' health risk behavior. , 2002, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[112]  Michael T. Starks,et al.  Childhood Gender Atypicality, Victimization, and PTSD Among Lesbian, Gay, and Bisexual Youth , 2006, Journal of interpersonal violence.

[113]  E. Walker,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[114]  A. Mijch,et al.  Suicidal Behaviour in People with HIV/AIDS: A Review , 2001, The Australian and New Zealand journal of psychiatry.

[115]  The Role of Biomarkers in the Treatment of Alcohol Use Disorders, 2012 Revision , 2006 .

[116]  J. Cheong,et al.  Gay-related Development, Early Abuse and Adult Health Outcomes Among Gay Males , 2008, AIDS and Behavior.

[117]  R. de Graaf,et al.  Suicidality and Sexual Orientation: Differences Between Men and Women in a General Population-Based Sample From The Netherlands , 2006, Archives of sexual behavior.

[118]  F. Mostashari,et al.  Discordance between Sexual Behavior and Self-Reported Sexual Identity: A Population-Based Survey of New York City Men , 2006, Annals of Internal Medicine.

[119]  Stephen,et al.  Canadian Journal of Psychiatry , 1979 .

[120]  A T McLellan,et al.  Substance Abuse Treatment , 2011 .

[121]  A. Beautrais,et al.  Multiple Aspects of Sexual Orientation: Prevalence and Sociodemographic Correlates in a New Zealand National Survey , 2011, Archives of sexual behavior.

[122]  G. Gates,et al.  Best Practices for Asking Questions about Sexual Orientation on Surveys , 2009 .

[123]  S. Cochran,et al.  Mental health correlates of perceived discrimination among lesbian, gay, and bisexual adults in the United States. , 2001, American journal of public health.

[124]  Carl Keane,et al.  Don't Ask, Don't Tell , 2008 .

[125]  M. Resnick,et al.  Measuring sexual orientation in adolescent health surveys: evaluation of eight school-based surveys. , 2004, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[126]  T. Hughes,et al.  Substance abuse and mental health disparities: comparisons across sexual identity groups in a national sample of young Australian women. , 2010, Social science & medicine.

[127]  C. Ryan,et al.  Family Rejection as a Predictor of Negative Health Outcomes in White and Latino Lesbian, Gay, and Bisexual Young Adults , 2009, Pediatrics.

[128]  J. Trost,et al.  Living apart together , 1999 .

[129]  Michael D. Shankle.  The Handbook of Lesbian, Gay, Bisexual, and Transgender Public Health: A Practitioner's Guide to Service , 2006 .

[130]  Alain Giami,et al.  Laumann (E.O), Gagnon (J.H), Michael (R.T), Michaels (S) — The Social Organization of Sexuality. Sexual Practices in the United States; Michael (R.), Gagnon (J.), Laumann (E.), Kolata (G.) — Sex in America. A Definitive Survey , 1997 .