Suicide Risk in LGB Individuals

1. Suicide Risk in LGB Individuals Martin Plöderl, PhD Suicide Prevention Research Program Institute of Public HealthParacelsus Private Medical University Salzburg, Austria

2. Content • Evidence • Theoretical models • Environmental causes - empirical examples • Discussion

3. Evidence – Suicide Attempts • Research problems before 1995 • Since then high quality studies • First meta-analysis in 2006 (Dennert, 2006; Plöderl et al., 2006) Dennert, G. Die psychische Gesundheit von Lesben und Schwulen – eine Übersicht europäischer Studien. Verhaltenstherapie & psychosoziale Praxis, 2006, 38. Jg. (3), 559-576 Plöderl et al. (2006). Suizidalität und psychische Gesundheit von homo- und bisexuellen Männern und Frauen. Eine Metaanalyse internationaler Zufallsstichproben. Verhaltenstherapie und Psychosoziale Praxis, 38, 537-558. Plöderl (2009). Homosexualität als Risikofaktor für Depression und Suizidalität bei Männern. Blickpunkt der Mann, 7, 28-37.

4. Suicide Attempts (lifetime), Adult Men - Metaanalysis 1 Plöderl et al. (2009).Homosexualität als Risikofaktor für Depression und Suizidalität bei Männern. Blickpunkt der Mann, 7, 28-37. Plöderl et al. (2006). Suizidalität und psychische Gesundheit von homo- und bisexuellen Männern und Frauen. Eine Metaanalyse internationaler Zufallsstichproben. Verhaltenstherapie und Psychosoziale Praxis, 38, 537-558. Heterosexual males at greater risk risk GB males at greater risk

5. Suicide Attempts (lifetime), Adult Men - Metaanalysis 2 King et al. (2008) RR = 4.28 (2.32-7.88) Plöderl et al. (2009) RR = 5.01 (3.61-6.97)

6. Sexual Minority? Suicide attempts? • Definition of sexual orientation • Behavior • Attraction / Fantasy • Self-identification • Definition of suicide attempts • With intent to die • Injuries • For all definitions: increased risk among sexual minority members Plöderl et al. (2010). The relation between sexual orientation and suicide attempts in Austria. Archives of Sexual Behavior.

7. Evidence for completed suicides? • Psychological autopsy studies: no increased riskRich et al. (1986), Shaffer et al. (1995), Renaud et al. (2010) • Major methodological problems • Small samples – statistical power • Do relatives know about the sexual minority status? • Stronger evidence: Danish suicide registers

8. Completed Suicides - Danish Register • Same-sex registered couples vs. heterosexual married couplesQin et al. (2003). Suicide risk in relation to socioeconomic, demographic, psychiatric, and familial factors: A national register-based study of all suicides in Denmark, 1981-1997. Am J Psychiatry, 160, 765-772. • OR = 4.31 (2.23–8.36) • OR = 3.63 (1.71–7.67) – adjusted for many confounding variables • Mathy et al. (2010) • Men: adjusted OR = 8.19 (5.48–12.24) • Women: adjusted OR = 1.65 (0.74–3.68) • How representative are those in a registered partnership?Less internalized homophobia, depression, stress; more meaning in lifeRiggle et al. (2010). Psychological distress, well-being, and legal recognition in same-sex couple relationships. J Fam Psychol;24(1):82-6

9. Theoretical Models – Minority Stress (Meyer, 2003) Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697.

10. Theoretical Models – Hatzenbuehler (2009) Hatzenbuehler, M. (2009). How Does Sexual Minority Stigma “Get Under the Skin”? A Psychological Mediation Framework. Psychological Bulletin, 135, 707-730.

11. Examples of Environmenal Influences

12. Example 1 – State Level Policies • Large US prospective study; 2001/2002 vs. 2004/2005 • „Gay marriage ban“ 2004/2005 in 16 states Hatzenbuehler et al. (2010). The impact of institutional discrimination on psychiatric disorders in lesbian, gay, and bisexual populations: a prospective study. American Journal of Public Health, 100, 452-459.

13. Example 2 – Religion protective Internalized Homophobia risk ReligiousAffiliation Suicide Ideation Suicidality Religion Belongingnessto ReligiousCommunity SuicideAttempts LGB-specificsocial support General Social Support Kralovec et al. (in prep). The effect of religion on suicide risk in lesbian, gay and bisexual individuals

14. Example 3 – School • Retrospective study on Austrian 468 gay/bisexual males • Gayromeo • 18% suicide attempt • Nearly 50% reported that hard times at school related to one’s homosexuality partly or mainly caused suicide attempt • Wide range of potential risk/protective factors Plöderl et al. (in press). The Contribution of School to the Feeling of Acceptance and the Risk of Suicide Attempts among Austrian Gay and Bisexual Males. Journal of Homosexualtiy

15. protective Example 3 – School risk Positive reaction to coming out bypeers HomophobicHarassmentby peers Better school performance Acceptanceat school School relatedSuicideAttempts Do not adresshomosexuality In classroom= stress Never experiencing homophobicharassment Coming out to only few (vs. outed orcloseted) Harassmentbased on gendernonconformity Plöderl et al. (in press). The Contribution of School to the Feeling of Acceptance and the Risk of Suicide Attempts among Austrian Gay and Bisexual Males. Journal of Homosexualtiy

16. protective Example 3 – School risk Positive reaction to coming out bypeers HomophobicHarassmentby peers Better school performance Acceptanceat school School relatedSuicideAttempts Do not adresshomosexuality In classroom= stress Never experiencing homophobicharassment Coming out to only few (vs. outed orcloseted) Harassmentbased on gendernonconformity Plöderl et al. (in press). The Contribution of School to the Feeling of Acceptance and the Risk of Suicide Attempts among Austrian Gay and Bisexual Males. Journal of Homosexualtiy

17. protective Example 3 – School risk Positive reaction to coming out byteachers Positive reaction to coming out bypeers Open gay/lesbianteachers HomophobicHarassmentby peers Better school performance Acceptanceat school Open gay/lesbianpeers School relatedSuicideAttempts Do not adresshomosexuality In classroom= stress Never experiencing homophobicharassment Teachers intervening againsthomophobia Somebody to talk to about homosexuality Coming out to only few (vs. outed orcloseted) Harassmentbased on gendernonconformity Books abouthomosexualityin school Plöderl et al. (in press). The Contribution of School to the Feeling of Acceptance and the Risk of Suicide Attempts among Austrian Gay and Bisexual Males. Journal of Homosexualtiy

18. Example 4 – Childhood Gender Nonconformity (CGNC) • Largest sexual orientation differences • Negative social reactions, especially for nonconforming males • Retrospective study on Austrian adults • LGB vs. heterosexuals: • More current suicidality • More CGNC • More childhood harassment – but not after controlling for CGNC • CGNC and childhood harassment correlated with current suicidality • Main result: no sexual orientation difference for current suicidality after controlling for CGNC and childhood harassment

19. Summary • Increased suicide risk among sexual minority individuals • Empirically founded theoretical models available • Individual + environmental processes • Risk starts before coming out • Work to do • Awareness - Ignorance • Research • Lack of minority specific prevention programs

20. Thank you for your attention!