Suicide Risk in LGB Individuals

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Suicide Risk in LGB Individuals

• Martin Plöderl, PhD
• Suicide Prevention Research Program Institute of
  Public HealthParacelsus Private Medical
  University
• Salzburg, Austria

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Content

• Evidence
• Theoretical models
• Environmental causes - empirical examples
• Discussion

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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.

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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.
GB males at greater risk
Heterosexual males at greater risk 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.

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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

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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 (2.238.36)
• OR 3.63 (1.717.67) adjusted for many
  confounding variables
• Mathy et al. (2010)
• Men adjusted OR 8.19 (5.4812.24)
• Women adjusted OR 1.65 (0.743.68)
• 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 Psychol24(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, 674697.
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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.
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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
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
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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 ones 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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Example 3 School
protective
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
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Example 3 School
protective
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
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Example 3 School
protective
risk
Positive reaction to coming out byteachers
Positive reaction to coming out bypeers
HomophobicHarassmentby peers
Open gay/lesbianteachers
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
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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

• 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!