Suicide Risk and Sexual Orientation: A Critical Review
Many studies have reported higher rates of suicide attempts among sexual minority individuals compared with their heterosexual counterparts. For suicides, however, it has been argued that there is no sexual orientation risk difference, based on the results of psychological autopsy studies. The purpose of this article was to clarify the reasons for the seemingly discrepant findings for suicide attempts and suicides. First, we reviewed studies that investigated if the increased suicide attempt risk of sexual minorities resulted from biased self-reports or less rigorous assessments of suicide attempts. Second, we reanalyzed the only two available case–control autopsy studies and challenge their original “no difference” conclusion by pointing out problems with the interpretation of significance tests and by applying Bayesian statistics and meta-analytical procedures. Third, we reviewed register based and clinical studies on the association of suicides and sexual orientation. We conclude that studies of both suicide attempts and suicides do, in fact, point to an increased suicide risk among sexual minorities, thus solving the discrepancy. We also discuss methodological challenges inherent in research on sexual minorities and potential ethical issues. The arguments in this article are necessary to judge the weight of the evidence and how the evidence might be translated into practice.
KeywordsSuicide Sexual orientation Homosexuality Sexual minority Bayesian statistics
We thank Lu Tian, Simon Jackman, and Antonio Martín-Andrés for helping us with statistical issues and we also thank Anthony D’Augelli for his feedback on a draft of the article.
- Alaska Injury Prevention Center. (2007). Alaska suicide follow-back study. Final report study period September 1, 2003 to August 31, 2006. Retrieved from http://www.hss.state.ak.us/suicideprevention/pdfs_sspc/sspcfollowback2-07.pdf.
- Australian Government Department of Health and Ageing. (2008). Research and evidence in suicide prevention. Retrieved from http://www.livingisforeveryone.com.au/uploads/docs/LIFE-research-web.pdf.
- Beskow, J. (1979). Suicide in mental disorder in Swedish men. Acta Psychiatrica Scandinavica, 277(Suppl.), 1–138.Google Scholar
- Bolton, S. L., & Sareen, J. (2011). Sexual orientation and its relation to mental disorders and suicide attempts: Findings from a nationally representative sample. Canadian Journal of Psychiatry, 56, 35–43.Google Scholar
- Bortz, J. (1993). Statistik für Sozialwissenschafter. Berlin: Springer.Google Scholar
- British Columbia Child Death Review Unit & BC Coroner Service. (2008). A five-year retrospective review of child and youth suicide in B.C. Retrieved from http://www.pssg.gov.bc.ca/coroners/child-death-review/docs/cdru-suicidereportfull.pdf.
- Centers of Disease Control (CDC). (1991). Pilot study of a household survey to determine HIV seroprevalence. Morbidity and Mortality Weekly Report, 40, 1–5.Google Scholar
- Chandra, A., Mosher, W. D., Copen, C., & Sionean, C. (2011, June 10). Sexual behavior, sexual attraction, and sexual identity in the United States: Data from the 2006–2008 National Survey of Family Growth. National health statistics reports; no 36. Hyattsville, MD: National Center for Health Statistics. Retrieved from www.cdc.gov/nchs/data/nhsr/nhsr036.pdf.
- Dorais, M., & Lajeunesse, S. L. (2004). Dead boys can’t dance: Sexual orientation, masculinity and suicide (P. Tremblay, Trans.). Montreal: McGill-Queens University Press.Google Scholar
- European Commission. (2008, July). Discrimination in the European Union: Perceptions, experiences and attitudes. Special Eurobarometer 296. Retrieved from http://ec.europa.eu/public_opinion/archives/ebs/ebs_296_en.pdf.
- Fox, R. C. (1995). Lesbian, gay, and bisexual identities over the lifespan: Psychological perspectives. In A. R. D’Augelli & C. P. Patterson (Eds.), Lesbian, gay, and bisexual identities over the lifespan: Psychological perspectives (pp. 48–86). New York: Oxford University Press.CrossRefGoogle Scholar
- Haas, A. P., Eliason, M., Mays, V. M., Mathy, R. M., Cochran, S. D., & D’Augelli, A. R.,… Clayton, P. J. (2011). Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: Review and recommendation. Journal of Homosexuality, 58, 10–51.Google Scholar
- Irish Departments of Public Health. (2001). Suicide in Ireland. A national study. Retrieved from http://www.nosp.ie/suicide_in_ireland.pdf.
- Jeffreys, H. (1961). Theory of probability. Oxford: Oxford University Press.Google Scholar
- Kann, L., Olsen, E. O., McManus, T., Kinchen, S., Chyen, D., Harris, W. A.,… Centers for Disease Control and Prevention (CDC). (2011). Sexual identity, sex of sexual contacts, and health-risk behaviors among students in grades 9-12—Youth risk behavior surveillance, selected sites, United States, 2001–2009. MMWR, 60, 1–133. Retrieved from http://www.cdc.gov/mmwr/pdf/ss/ss6007.pdf.
- Kass, R. E., & Raftery, A. E. (1995). Bayes factors. Journal of the American Statistical Association, 90, 377–395.Google Scholar
- King, M., Semlyen, J., Tai, S. S., Killaspy, H., Osborn, D., Popelyuk, D., & Nazareth, I. (2008). A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry, 8, 70. doi: 10.1186/1471-244X-8-70.
- Lee, M. D., & Wagenmakers, E. J. (2010, August 23). A course in Bayesian graphical modeling for cognitive science. Retrieved from http://www.ejwagenmakers.com/BayesCourse/BayesBookWeb.pdf.
- Marshal, M. P., Dietz, L. J., Friedman, M. S., Stall, R., Smith, H. A., McGinley, J., Thoma, B. C.,… Brent, D. A. (2011). Suicidality and depression disparities between sexual minority and heterosexual youth: A meta-analytic review. Journal of Adolescent Health, 49, 115–123.Google Scholar
- Miller, D. N., & Eckert, T. L. (2009). Youth suicidal behavior: An introduction and overview. School Psychology Review, 38, 153–167.Google Scholar
- Mitterauer, B. (1981). The suicidal axis syndrome. A medico-biological study of the estimation of suicide-proneness. Wiener Medizinische Wochenschrift, 68(Suppl.), 1–28.Google Scholar
- Murphy, H. E. (2007). Suicide risk among gay, lesbian and bisexual college youth. Unpublished doctoral dissertation, University of Washington. Retrieved from http://hdl.handle.net/1773/7522.
- Plöderl, M., Sauer, J., & Fartacek, R. (2006). Suizidalität und psychische Gesundheit von homo- und bisexuellen Männern und Frauen. Eine metaanalytische Zusammenfassung internationaler Zufallsstichproben [Suicidality and mental health of homosexual and bisexual men and women. A meta-analysis of international probability samples]. Verhaltenstherapie und psychosoziale Praxis, 117, 4–10.Google Scholar
- R Development Core Team. (2010). R: A language and environment for statistical computing [Software]. Vienna, Austria. Available from http://www.r-project.org/.
- Ramsay, R., & Tremblay, P. (2012a). Gay, lesbian, bisexual & transgender “attempted suicide” incidences/risks. Suicidality studies from 1970 to 2012. Retrieved from http://people.ucalgary.ca/~ramsay/attempted-suicide-gay-lesbian-all-studies.htm.
- Ramsay, R., & Tremblay, P. (2012b). Homosexually oriented people are at greater risk for more serious suicidal behaviors. Retrieved from http://people.ucalgary.ca/~ramsay/gay-more-risk-suicide.htm.
- Reis, B., & Saewyc, E. (1999, May). Eighty-three-thousand youth: Selected findings of eight population based studies as they pertain to anti-gay harassment and the safety and well-being of sexual minority students. The Safe Schools Coalition of Washington. Retrieved from http://www.safeschoolscoalition.org/83000youth.pdf.
- Renaud, J., Berlim, M. T., Begolli, M., McGirr, A., & Turecki, G. (2010). Sexual orientation and gender identity in youth suicide victims: An exploratory study. Canadian Journal of Psychiatry, 55, 29–34.Google Scholar
- Silverman, M. M., Berman, A. L., Sanddal, N. D., O’Carroll, P. W., & Joiner, T. E. (2007). Rebuilding the tower of Babel: A revised nomenclature for the study of suicide and suicidal behaviors part 2: Suicide-related ideations, communications, and behaviors. Suicide and Life-Threatening Behavior, 37, 264–277.PubMedCrossRefGoogle Scholar
- Tian, L., Cai, T., Pfeffer, M. A., Piankov, N., Cremieux, P. Y., & Wei, L. J. (2009). Exact and efficient inference procedure for meta-analysis and its application to the analysis of independent 2 × 2 tables with all available data but without artificial continuity correction. Biostatistics, 10, 275–281.PubMedCrossRefGoogle Scholar
- Tremblay, P., Plöderl, M., & Ramsay, R. (2012). Adolescent gay/lesbian suicide risk. An expanded homosexuality factor in adolescent suicide. Retrieved from http://people.ucalgary.ca/~ramsay/adolescent-gay-lesbian-suicide-risk.htm.
- Tremblay, P., & Ramsay, R. (2000, September). Orientations homosexuelles ou bisexuelles chez les jeunes présentant des problèmes suicidaires: recherche, problématique et propositions. Le Vis-à-Vie, 10, 5–8. Retrieved from http://web.archive.org/web/20071222142530/www.aqps.info/docs/vav/v10/v10n2-02.html.
- Villarroel, M. A., Turner, C. F., Eggleston, E., Al-Tayyib, A., Rogers, S. M., Roman, A. M.,… Gordek, H. (2006). Same-gender sex in the United States. Public Opinion Quarterly, 70, 166–196.Google Scholar
- Wasserman, D., & Wasserman, C. (Eds.). (2009). Oxford textbook of suicidology and suicide prevention: A global perspective. New York: Oxford University Press.Google Scholar
- Whitehead, N. E. (2009, April 18). Homosexuality and mental health problems. Retrieved from http://narth.com/2009/04/homosexuality-and-mental-health-problems/.