Suicide Risk in LGB Individuals
Martin Plöderl, PhD
Suicide Prevention Research Program
Institute of Public Health
Paracelsus Private Medical University
Salzburg, Austria
Content
 Evidence
 Theoretical models
 Environmental causes - empirical examples
 Discussion
2
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.
3
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
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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)
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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.
6
Evidence for completed suicides?
 Psychological autopsy studies: no increased risk
Rich 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
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Completed Suicides - Danish Register
 Same-sex registered couples vs. heterosexual married couples
Qin 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 life
Riggle et al. (2010). Psychological distress, well-being, and legal recognition in same-sex couple
relationships. J Fam Psychol;24(1):82-6
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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.
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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.
10
Examples of Environmenal Influences
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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.
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Example 2 – Religion
protective
risk
Suicide
Ideation
Belongingness
to Religious
Community
Suicide
Attempts
Religion
Religious
Affiliation
General
Social Support
LGB-specific
social support
Suicidality
Internalized
Homophobia
Kralovec et al. (in prep).
The effect of religion on suicide risk in
lesbian, gay and bisexual individuals
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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
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protective
Example 3 – School
risk
Homophobic
Harassment
by peers
Positive reaction
to coming out by
peers
Better school
performance
Acceptance
at school
School related
Suicide
Attempts
Do not adress
homosexuality
In classroom
= stress
Never
experiencing
homophobic
harassment
Harassment
based on gender
nonconformity
Coming out
to only few
(vs. outed or
closeted)
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
Homophobic
Harassment
by peers
Positive reaction
to coming out by
peers
Better school
performance
Acceptance
at school
School related
Suicide
Attempts
Never
experiencing
homophobic
harassment
Harassment
based on gender
nonconformity
Do not adress
homosexuality
In classroom
= stress
Coming out
to only few
(vs. outed or
closeted)
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
Open
gay/lesbian
teachers
Positive reaction
to coming out by
teachers
Open
gay/lesbian
peers
Teachers
intervening
against
homophobia
risk
Homophobic
Harassment
by peers
Positive reaction
to coming out by
peers
Better school
performance
Acceptance
at school
School related
Suicide
Attempts
Never
experiencing
homophobic
harassment
Somebody to
talk to about
homosexuality
Books about
homosexuality
in school
Harassment
based on gender
nonconformity
Do not adress
homosexuality
In classroom
= stress
Coming out
to only few
(vs. outed or
closeted)
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
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
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Summary




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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
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Thank you for your attention!
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