Lesbian, Homosexual, and Bisexual (LGB) people (typically termed ‘sexual minorities’) are at elevated threat of experiencing despair, anxiousness, and substance dependence compared to heterosexuals (King et al., 2008; Plöderl & Tremblay, 2015), findings which lengthen to these figuring out with different sexual minority identities (e.g., pansexual; Borgogna et al., 2019; Feinstein et al., 2023). This disparity is usually defined by Meyer’s (2003) minority stress mannequin, which implicates the distinctive further stressors that sexual minorities face because of their minority identification (e.g., discrimination as a result of sexual identification, internalised homophobia).
Analysis additionally means that LGB people are at elevated threat of suicide makes an attempt (King et al., 2008), and a Psychological Elf weblog by Talen Wright summarises a evaluation by Dunlop et al. (2020) exhibiting that bisexual people are at elevated threat of participating with Non-Suicidal Self-Hurt (NSSH). Analysis has additionally demonstrated that homosexual males and lesbians regularly cite their sexual orientation as partially or wholly the motive for self-harming (King et al., 2003).
Systematic critiques have recognized gaps within the literature concerning our data of sexual minorities within the UK, suicidality, and self-harm. Garrett Kidd et al. (2023) got down to overcome weaknesses of earlier literature on this space (e.g., low statistical energy, not adjusting for cofounders), with the purpose of describing the proportion, traits, and associations between sexual orientation teams within the UK and self-harm and suicidality.
Kidd et al. (2023) carried out a secondary evaluation of the Grownup Psychiatric Morbidity Surveys (APMS), combining the 2007 and 2014 survey years. APMS “makes use of a stratified, multistage random sampling design” to create a consultant pattern of the 16+ inhabitants residing in non-public households in England, with knowledge collected utilizing computer-assisted face-to-face interviewing and computer-based self-interviewing for delicate questions (e.g., sexuality, suicide).
For the present examine, all members with sexuality knowledge out there had been included, which resulted in a pattern of 10,443 folks aged 16-64. Sexual orientation was outlined barely in another way between survey years, so the authors “harmonised” the information to create 4 classes:
- Heterosexual and primarily heterosexual (reference group)
- Lesbian/homosexual and primarily gay
The authors investigated the affiliation of sexuality with lifetime Non-Suicidal Self-Hurt (NSSH), past-year suicide try, and past-year suicidal ideas, adjusting for potential confounders (e.g., age, frequent psychological dysfunction, gender, survey yr). In addition they examined for attainable mediation by minority stress variables.
Of the ten,443 members:
- 10,016 recognized as heterosexual and primarily heterosexual (96.0%)
- 116 recognized as bisexual (1.1%)
- 163 recognized as lesbian/homosexual and primarily gay (1.5%)
- 148 recognized as different (1.5%)
Males represented the vast majority of those that recognized as lesbian/homosexual (69.6%), while a bigger proportion of females recognized as bisexual (72.5%).
For the minority stress variables, the lesbian/homosexual group had the best prevalence of a historical past of bullying victimisation (51.7%) in comparison with people figuring out as bisexual (47.5%), heterosexual/primarily heterosexual (25.3%), and different (22.9%). The prevalence of past-year discrimination as a result of sexual orientation was additionally highest within the homosexual/lesbian group (23.2%), adopted by these figuring out as bisexual (9.4%), different (2.7%) then heterosexual/primarily heterosexual (0.3%).
Suicidality and self-harm prevalence
The prevalence of suicidal ideas, suicide try, and Non-Suicidal Self-Hurt (NSSH) was highest within the bisexual group, with 47.0% of this group reporting lifetime suicidal ideas, 24.1% reporting a lifetime suicide try, and 26.9% reporting lifetime NSSH.
For all suicidality and self-harm outcomes, heterosexual people had the bottom prevalence (except for past-week suicidal ideas, and past-week suicide try, the place there have been no variations).
Desk 1. The proportion (%) of every sexual orientation group reporting suicidal ideas and suicide try (past-week, past-year, and lifelong) and NSSH (lifetime)
|Final result variable||Heterosexual / primarily heterosexual||Bisexual||Lesbian / homosexual / primarily gay||Different||p worth|
|Suicidal ideas, past-week (%)||0.9||2.0||1.0||1.5||0.483|
|Suicidal ideas, past-year (%)||5.0||13.4||11.4||8.8||< .001|
|Suicidal ideas, lifetime (%)||16.7||47.0||36.7||18.4||< .001|
|Suicide try, past-week (%)||< 1||0.0||0.0||0.0||0.990|
|Suicide try, past-year (%)||0.7||4.3||1.1||1.5||< .001|
|Suicide try, lifetime (%)||5.4||24.1||15.2||8.9||< .001|
|NSSH, lifetime (%)||5.3||26.9||15.2||9.4||< .001|
Sexuality and past-year suicidal ideas
Relative to heterosexuals, homosexual/lesbian people had higher odds of experiencing suicidal ideas prior to now yr (OR = 2.47, 95% CI 1.37 to 4.48), even after controlling for socio-demographic elements and CMD (OR = 2.20, 95% CI 1.08 to 4.50). These elevated odds remained when adjusting for socio-demographic elements, CMD, and discrimination (OR = 2.20, 95% CI 1.04 to 4.64), however decreased when adjusting for bullying (p > .05).
Bisexual people additionally confirmed elevated odds of experiencing past-year suicidal ideas relative to heterosexuals (OR = 2.95, 95% CI 1.60 to five.45). These elevated odds remained after adjusting for socio-demographic elements (OR = 2.37, 95% CI 1.28 to 4.38), however not after adjusting for each socio-demographic elements and CMD (p > .05).
Sexuality and past-year suicide try
Bisexual people (however no different sexual minority group) had larger odds of reporting a past-year suicide try relative to heterosexuals (OR = 6.23, 95% CI 2.10 to 18.53), together with after adjusting for socio-demographic elements (OR = 3.95, 95% CI 1.23 to 12.72). Nonetheless, this grew to become non-significant after adjusting for each socio-demographic elements and CMD (p > .05).
Sexuality and lifelong NSSH
Relative to heterosexuals, the bisexual group (OR = 6.61, 95% CI 4.14 to 10.56) and the lesbian/homosexual group (OR = 3.20, 95% CI 2.00 to five.11) had larger odds of reporting lifetime NSSH. This was barely attenuated for each teams, however continued to be vital, after controlling for socio-demographic elements, frequent psychological dysfunction, discrimination primarily based on sexual orientation, and historical past of bullying.
Interactions with gender and survey yr
There was no proof to recommend that results had been modified by gender or by survey yr.
On this population-based examine, lesbian/homosexual and bisexual people had been at elevated threat of lifetime Non-Suicidal Self-Hurt (NSSH) and past-year suicidal ideas, relative to heterosexuals.
The elevated threat of NSSH in each lesbian/homosexual and bisexual people was barely attenuated (however remained vital) for each teams when adjusting for frequent psychological dysfunction (CMD), discrimination primarily based on sexual orientation, and bullying, suggesting these elements might play a task within the elevated threat skilled by these teams. As compared, outcomes confirmed that the elevated threat of suicidal ideas and past-year suicide try for bisexual people decreased when adjusting for CMD, suggesting that CMD could also be a key part on this threat.
Lastly, these disparities endured over the interval 2007-2014, regardless of the introduction of latest protections for sexual minorities (e.g., The Equality Act, 2010), suggesting that these new protections have had no constructive impression on suicidality and NSSH outcomes for sexual minorities.
Strengths and limitations
That is the primary population-based examine within the UK to research the associations between sexual orientation, suicidal ideas, suicide try, and Non-Suicidal Self-Hurt (NSSH). By combing two pattern years, the examine has a giant pattern, giving the examine larger statistical energy relative to different research and subsequently strengthening the reliability of the findings. This paper additionally makes use of validated measures to research a number of sides of self-harm and suicidality, permitting us to exactly perceive the place sexual minorities expertise elevated threat.
Nonetheless, there are some limitations associated to the examine’s design:
- The examine relied on members defining solely their sexual orientation, however there’s rising recognition that people can establish as heterosexual, while additionally reporting same-sex points of interest and/or behaviours. There may be proof that implies that the variety of folks figuring out as heterosexual and reporting same-sex points of interest and/or behaviours could also be related, and even bigger, than the quantity who establish as LGB (Hoy & London, 2018; Krueger et al., 2018; Gattis et al., 2012).
- Some analysis means that people figuring out as “largely heterosexual” expertise disparities just like different sexual minorities (Vrangalova & Savin-Williams, 2014), which means it could have been extra acceptable to classify people figuring out as “primarily heterosexual” into a bunch separate from “heterosexual”, or to hold out a sensitivity evaluation.
- While utilizing a cross-sectional design with two time factors allowed an examination of adjustments within the disparities skilled by sexual minorities earlier than and after key laws (i.e., the Equality Act 2010), a cohort examine with the identical pattern would have offered stronger proof on the impression (or lack of impression) of this laws.
- Lastly, a cohort examine with mediation evaluation is required earlier than conclusions could be reached on whether or not the minority stress variables lie on the pathway between sexual orientation, suicidality, and self-harm outcomes.
Implications for apply
This examine deepens our understanding of suicidality and self-harm in sexual minorities in England. The outcomes present an elevated threat of suicidal ideas and NSSH in bisexual and lesbian/homosexual people and spotlight CMD, discrimination and bullying as potential contributors to this extra threat.
This data could also be helpful for clinicians who’re working with sexual minority people, significantly when finishing up threat assessments for suicidality and NSSH. It could be useful for clinicians to be aware of the potential of a historical past discrimination and bullying, and clinicians can sensitively enquire about this, when acceptable, as a part of complete therapeutic assessments.
We should additionally look past clinicians to psychological well being providers. It will be important for psychological well being providers to contemplate if they’re assembly the wants of sexual minorities. Analysis means that not solely do some sexual minority teams have poorer remedy outcomes in UK psychological well being providers (Rimes et al., 2019), however in addition they face boundaries inside these providers. A few of these boundaries are summarised in a Psychological Elf weblog by Siobhan D’Almeida, who reported on a paper by Morris et al. (2022) that explored sexual minority service customers’ experiences of Bettering Entry to Psychological Therapies (IAPT) and first care counselling providers. Boundaries included fears of revealing one’s sexual identification and a lack of awareness, and sexual minority service customers proposed employees coaching and visual indicators of inclusivity as among the ways in which providers may very well be improved.
Lastly, on a private observe, as a homosexual man who has accessed psychological well being providers within the UK, I can recognise among the points mentioned and the function they’ve performed in each my very own constructive and damaging experiences with psychological well being providers prior to now. Personally, the occasions when providers have been overtly inclusive (e.g., by delight flags and lanyards) I’ve felt extra snug from the start and this enabled me to overtly focus on my sexuality and its relationship to my psychological well being. Moreover, practitioners who’ve been educated on sexual minority themes have enabled a stronger therapeutic alliance to be achieved and the remedy has felt more practical.
Assertion of pursuits
Liam shall be beginning a PhD within the UCL Division of Psychiatry in September 2023. Liam’s PhD will look to enhance how psychological well being professionals work with folks from sexual minorities. David Osborn will supervise Liam’s PhD challenge, and Irwin Nazareth shall be a part of Liam’s thesis committee. Nonetheless, Liam had no involvement within the present paper.
Liam is at present enhancing his MSc dissertation manuscript with the hope of submitting it for publication. Liam’s dissertation was a scientific evaluation of psychological well being help-seeking in LGBTQ+ people.
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