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Suicidality Among Sexual Minority Adults: Gender, Age, and Race/Ethnicity Differences

Published:November 08, 2021DOI:https://doi.org/10.1016/j.amepre.2021.07.012

      Introduction

      Lesbian, gay, and bisexual individuals have elevated suicide risk, but there is little information available about how this risk may vary by gender, age, and race/ethnicity.

      Methods

      This study examined past-year suicide thoughts, plans, and attempts among adult respondents to the 2015–2019 National Surveys on Drug Use and Health (pooled N=191,954). Logistic regression was used to examine the differences between lesbian, gay, and bisexual and heterosexual adults for each outcome, once by gender and age category and once by gender and race/ethnicity category, while controlling for core sociodemographic characteristics. Race/ethnicity and age differences were also estimated within sexual identity groups.

      Results

      Suicide thoughts, plans, and attempts were more common among lesbian, gay, and bisexual adults in almost every age and race/ethnicity category relative to that among corresponding heterosexual adults. In some age and race/ethnicity categories, bisexual women were more likely to report suicidal thoughts than lesbian/gay women. Each outcome decreased significantly across age groups among women of all sexual identity groups and heterosexual men; yet, this age effect was less pronounced among gay and bisexual men. Black women had significantly lower rates of suicidal thoughts and plans than White women in all sexual identity groups.

      Conclusions

      In light of consistently elevated rates of suicide thoughts and behaviors, lesbian, gay, and bisexual adults may expressly benefit from enhanced prevention, identification, and treatment of suicide risk. Additional research is needed to assess the associations between sexual identity and suicide mortality as well as to understand the heterogeneity in suicide risk among lesbian, gay, and bisexual youth, particularly by race/ethnicity.
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      REFERENCES

        • Substance Abuse and Mental Health Services Administration
        Key substance use and mental health indicators in the United States: results from the 2019 National Survey on Drug Use and Health.
        Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD2020
        • Blosnich JR
        • Nasuti LJ
        • Mays VM
        • Cochran SD
        Suicidality and sexual orientation: characteristics of symptom severity, disclosure, and timing across the life course.
        Am J Orthopsychiatry. 2016; 86: 69-78https://doi.org/10.1037/ort0000112
        • Capistrant BD
        • Nakash O
        Suicide risk for sexual minorities in middle and older age: evidence from the National Survey on Drug Use and Health.
        Am J Geriatr Psychiatry. 2019; 27: 559-563https://doi.org/10.1016/j.jagp.2018.12.023
        • Haney JL
        Suicidality risk among adult sexual minorities: results from a cross-sectional population-based survey.
        J Gay Lesbian Soc Serv. 2021; 33: 250-271https://doi.org/10.1080/10538720.2021.1875946
        • Salway T
        • Gesink D
        • Ferlatte O
        • et al.
        Age, period, and cohort patterns in the epidemiology of suicide attempts among sexual minorities in the United States and Canada: detection of a second peak in middle adulthood.
        Soc Psychiatry Psychiatr Epidemiol. 2021; 56: 283-294https://doi.org/10.1007/s00127-020-01946-1
        • Hottes TS
        • Bogaert L
        • Rhodes AE
        • Brennan DJ
        • Gesink D
        Lifetime prevalence of suicide attempts among sexual minority adults by study sampling strategies: a systematic review and meta-analysis.
        Am J Public Health. 2016; 106: e1-e12https://doi.org/10.2105/AJPH.2016.303088
        • Salway T
        • Ross LE
        • Fehr CP
        • et al.
        A systematic review and meta-analysis of disparities in the prevalence of suicide ideation and attempt among bisexual populations.
        Arch Sex Behav. 2019; 48: 89-111https://doi.org/10.1007/s10508-018-1150-6
        • Haas AP
        • Lane AD
        • Blosnich JR
        • Butcher BA
        • Mortali MG
        Collecting sexual orientation and gender identity information at death.
        Am J Public Health. 2019; 109: 255-259https://doi.org/10.2105/AJPH.2018.304829
        • Cochran SD
        • Mays VM
        Mortality risks among persons reporting same-sex sexual partners: evidence from the 2008 General Social Survey-National Death Index data set.
        Am J Public Health. 2015; 105: 358-364https://doi.org/10.2105/AJPH.2014.301974
        • Lynch KE
        • Gatsby E
        • Viernes B
        • et al.
        Evaluation of suicide mortality among sexual minority U.S. veterans from 2000 to 2017.
        JAMA Netw Open. 2020; 3e2031357https://doi.org/10.1001/jamanetworkopen.2020.31357
        • Layland EK
        • Exten C
        • Mallory AB
        • Williams ND
        • Fish JN
        Suicide attempt rates and associations with discrimination are greatest in early adulthood for sexual minority adults across diverse racial and ethnic groups.
        LGBT Health. 2020; 7: 439-447https://doi.org/10.1089/lgbt.2020.0142
        • Canetto SS
        • Sakinofsky I
        The gender paradox in suicide.
        Suicide Life Threat Behav. 1998; 28: 1-23https://doi.org/10.1111/j.1943-278X.1998.tb00622.x
        • Curtin SC
        • Hedegaard H
        Suicide rates for females and males by race and ethnicity: United States, 1999 and 2017.
        Centers of Disease Control and Prevention, Atlanta, GA2019
        • Bray MJC
        • Daneshvari NO
        • Radhakrishnan I
        • et al.
        Racial differences in statewide suicide mortality trends in Maryland during the coronavirus disease 2019 (COVID-19) pandemic.
        JAMA Psychiatry. 2021; 78: 444-447https://doi.org/10.1001/jamapsychiatry.2020.3938
        • Mitchell TO
        • Li L
        State-level data on suicide mortality during COVID-19 quarantine: early evidence of a disproportionate impact on racial minorities.
        Psychiatry Res. 2021; 295113629https://doi.org/10.1016/j.psychres.2020.113629
      1. Suicide. NIH, National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/suicide.shtml. Accessed March 14, 2021.

      2. WISQARSTM injury data: WISQARSTM – Web-Based Injury Statistics Query and Reporting System.
        Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 2020 (Updated July 1)
        • Fish JN
        • Rice CE
        • Lanza ST
        • Russell ST
        Is young adulthood a critical period for suicidal behavior among sexual minorities? Results from a U.S. national sample.
        Prev Sci. 2019; 20: 353-365https://doi.org/10.1007/s11121-018-0878-5
        • Russell ST
        • Toomey RB
        Men's sexual orientation and suicide: evidence for U.S. adolescent-specific risk.
        Soc Sci Med. 2012; 74: 523-529https://doi.org/10.1016/j.socscimed.2010.07.038
        • Coulter RWS
        • Ware D
        • Fish JN
        • Plankey MW
        Latent classes of polysubstance use among adolescents in the United States: intersections of sexual identity with sex, age, and race/ethnicity.
        LGBT Health. 2019; 6: 116-125https://doi.org/10.1089/lgbt.2018.0149
        • Rodriguez-Seijas C
        • Eaton NR
        • Pachankis JE
        Prevalence of psychiatric disorders at the intersection of race and sexual orientation: results from the National Epidemiologic Survey of Alcohol and Related Conditions-III.
        J Consult Clin Psychol. 2019; 87: 321-331https://doi.org/10.1037/ccp0000377
        • Vu M
        • Li J
        • Haardörfer R
        • Windle M
        • Berg CJ
        Mental health and substance use among women and men at the intersections of identities and experiences of discrimination: insights from the intersectionality framework.
        BMC Public Health. 2019; 19: 108https://doi.org/10.1186/s12889-019-6430-0
        • Cyrus K
        Multiple minorities as multiply marginalized: applying the minority stress theory to LGBTQ people of color.
        J Gay Lesbian Ment Health. 2017; 21: 194-202https://doi.org/10.1080/19359705.2017.1320739
        • Hammack PL
        • Frost DM
        • Meyer IH
        • Pletta DR
        Gay men's health and identity: social change and the life course.
        Arch Sex Behav. 2018; 47: 59-74https://doi.org/10.1007/s10508-017-0990-9
      3. 2019 National Survey of Drug Use and Health (NSDUH) releases. U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). https://www.samhsa.gov/data/release/2019-national-survey-drug-use-and-health-nsduh-releases. Accessed March 14, 2021.

        • Center for Behavioral Health Statistics and Quality
        2019 National Survey on Drug Use and Health: methodological summary and definitions.
        Substance Abuse and Mental Health Services Administration, Rockville, MD2020
        • Substance Abuse and Mental Health Services Administration
        Reliability of key measures in the National Survey on Drug Use and Health.
        Substance Abuse and Mental Health Services Administration, Office of Applied Studies, Rockville, MD2010
        • Archer KJ
        • Lemeshow S
        Goodness-of-fit test for a logistic regression model fitted using survey sample data.
        Stata J. 2006; 6: 97-105https://doi.org/10.1177/1536867X0600600106
        • Meyer IH
        Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence.
        Psychol Bull. 2003; 129: 674-697https://doi.org/10.1037/0033-2909.129.5.674
        • Yeh HH
        • Westphal J
        • Hu Y
        • et al.
        Diagnosed mental health conditions and risk of suicide mortality.
        Psychiatr Serv. 2019; 70: 750-757https://doi.org/10.1176/appi.ps.201800346
        • Bowleg L
        The problem with the phrase women and minorities: intersectionality-an important theoretical framework for public health.
        Am J Public Health. 2012; 102: 1267-1273https://doi.org/10.2105/AJPH.2012.300750
        • Crenshaw K
        Mapping the margins: intersectionality, identity politics, and violence against women of color.
        Stanford Law Rev. 1991; 43: 1241-1299https://doi.org/10.2307/1229039
        • Bauer GR
        Incorporating intersectionality theory into population health research methodology: challenges and the potential to advance health equity.
        Soc Sci Med. 2014; 110: 10-17https://doi.org/10.1016/j.socscimed.2014.03.022
        • Bränström R
        • van der Star A
        • Pachankis JE
        Untethered lives: barriers to societal integration as predictors of the sexual orientation disparity in suicidality.
        Soc Psychiatry Psychiatr Epidemiol. 2020; 55: 89-99https://doi.org/10.1007/s00127-019-01742-6
        • Schuler MS
        • Prince DM
        • Collins RL
        Disparities in social and economic determinants of health by sexual identity, gender, and age: results from the 2015-2018 National Survey on Drug Use and Health.
        LGBT Health. 2021; 8: 330-339https://doi.org/10.1089/lgbt.2020.0390
        • Clark KA
        • Blosnich JR
        • Coulter RWS
        • Bamwine P
        • Bossarte RM
        • Cochran SD
        Sexual orientation differences in gun ownership and beliefs about gun safety policy, General Social Survey 2010-2016.
        Violence Gend. 2020; 7: 6-10https://doi.org/10.1089/vio.2019.0019
        • RAND Corporation
        The relationship between firearm availability and suicide.
        RAND Corporation, Santa Monica, CA2018 (Published March 2)
        • Meyer IH
        Identity, stress, and resilience in lesbians, gay men, and bisexuals of color.
        Couns Psychol. 2010; 38: 442-454https://doi.org/10.1177/0011000009351601
        • Bowleg L
        When Black + lesbian + woman ≠ Black lesbian woman: the methodological challenges of qualitative and quantitative intersectionality research.
        Sex Roles. 2008; 59: 312-325https://doi.org/10.1007/s11199-008-9400-z
        • King C
        • Bennett M
        • Fulford KWM
        • et al.
        From preproduction to coproduction: COVID-19, whiteness, and making black mental health matter.
        Lancet Psychiatry. 2021; 8: 93-95https://doi.org/10.1016/S2215-0366(20)30458-2
        • Chaudoir SR
        • Wang K
        • Pachankis JE
        What reduces sexual minority stress? A review of the intervention “toolkit”.
        J Soc Issues. 2017; 73: 586-617https://doi.org/10.1111/josi.12233
        • Miller IW
        • Camargo Jr, CA
        • Arias SA
        • et al.
        Suicide prevention in an emergency department population: the ED-SAFE Study.
        JAMA Psychiatry. 2017; 74: 563-570https://doi.org/10.1001/jamapsychiatry.2017.0678
        • Roaten K
        • Johnson C
        • Genzel R
        • Khan F
        • North CS
        Development and implementation of a universal suicide risk screening program in a safety-net hospital system.
        Jt Comm J Qual Patient Saf. 2018; 44: 4-11https://doi.org/10.1016/j.jcjq.2017.07.006
        • Pisani AR
        • Cross WF
        • West JC
        • Crean HF
        • Caine ED
        Brief video-based suicide prevention training for primary care.
        Fam Med. 2021; 53: 104-110https://doi.org/10.22454/FamMed.2021.367209
        • Bass B
        • Nagy H
        Cultural competence in the care of LGBTQ patients.
        StatPearls Publishing, Treasure Island, FL2021
        https://www.ncbi.nlm.nih.gov/books/NBK563176/
        Date accessed: October 3, 2021
        • Schuler MS
        • Collins RL
        Sexual minority substance use disparities: bisexual women at elevated risk relative to other sexual minority groups.
        Drug Alcohol Depend. 2020; 206107755https://doi.org/10.1016/j.drugalcdep.2019.107755
        • Kerridge BT
        • Pickering RP
        • Saha TD
        • et al.
        Prevalence, sociodemographic correlates and DSM-5 substance use disorders and other psychiatric disorders among sexual minorities in the United States.
        Drug Alcohol Depend. 2017; 170: 82-92https://doi.org/10.1016/j.drugalcdep.2016.10.038
        • Ross LE
        • Salway T
        • Tarasoff LA
        • MacKay JM
        • Hawkins BW
        • Fehr CP
        Prevalence of depression and anxiety among bisexual people compared to gay, lesbian, and heterosexual individuals: a systematic review and meta-analysis.
        J Sex Res. 2018; 55: 435-456https://doi.org/10.1080/00224499.2017.1387755
        • Taylor J
        Bisexual mental health: a call to action.
        Issues Ment Health Nurs. 2018; 39: 83-92https://doi.org/10.1080/01612840.2017.1391904
        • Zivony A
        • Saguy T
        Stereotype deduction about bisexual women.
        J Sex Res. 2018; 55: 666-678https://doi.org/10.1080/00224499.2018.1437116
        • Feinstein BA
        • Dyar C
        Bisexuality, minority stress, and health.
        Curr Sex Health Rep. 2017; 9: 42-49https://doi.org/10.1007/s11930-017-0096-3
        • Walters M
        • Chen J
        • Breiding M
        The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 findings on victimization by sexual orientation.
        National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA2013 (Accessed October 3, 2021)
        • Dyar C
        • Feinstein BA
        • London B
        Dimensions of sexual identity and minority stress among bisexual women: the role of partner gender.
        Psychol Sex Orientat Gend Divers. 2014; 1: 441-451https://doi.org/10.1037/sgd0000063
        • Khazem LR
        • Jahn DR
        • Cukrowicz KC
        • Anestis MD
        Physical disability and the interpersonal theory of suicide.
        Death Stud. 2015; 39: 641-646https://doi.org/10.1080/07481187.2015.1047061
        • Lund EM
        • Nadorff MR
        • Samuel Winer E
        • Seader K
        Is suicide an option?: the impact of disability on suicide acceptability in the context of depression, suicidality, and demographic factors.
        J Affect Disord. 2016; 189: 25-35https://doi.org/10.1016/j.jad.2015.08.028
        • Fox KR
        • Choukas-Bradley S
        • Salk RH
        • Marshal MP
        • Thoma BC
        Mental health among sexual and gender minority adolescents: examining interactions with race and ethnicity.
        J Consult Clin Psychol. 2020; 88: 402-415https://doi.org/10.1037/ccp0000486
        • Ribeiro JD
        • Franklin JC
        • Fox KR
        • et al.
        Self-injurious thoughts and behaviors as risk factors for future suicide ideation, attempts, and death: a meta-analysis of longitudinal studies.
        Psychol Med. 2016; 46: 225-236https://doi.org/10.1017/S0033291715001804
        • Jobes DA
        • Joiner TE
        Reflections on suicidal ideation.
        Crisis. 2019; 40: 227-230https://doi.org/10.1027/0227-5910/a000615