Examining the relationship between sexual orientation and suicidality

Recent UCL research finds that lesbian, gay, and bisexual adults report higher rates of suicidal thoughts and suicide attempts than their heterosexual peers. In this blog Garrett Kidd describes how the study came about and its significance.

In the 2021 census lesbian, gay and bisexual (LGB) people represented 3.2% of the English and Welsh populations.

However, the UK is a heteronormative society where LGB people have experienced systemic and historical persecution under British law; homosexuality was partially decriminalised only in 2017. Legal recognition and protections have advanced since then, but a legacy of discrimination and lack of legal protection has impacted the lives of generations of LGB individuals.  Minority stress theory suggests that experiences such as discrimination or bullying might account for the poorer mental health of LGB people, as suggested in our previous work at UCL.

We wanted to investigate whether this applied to suicidal thoughts and suicide attempts -which we collectively term suicidality – as well as non-suicidal self-harm, and whether minority stress variables (discrimination and bullying) might be implicated.

We noticed that previous studies investigating suicidality in LGB people have tended to use unrepresentative samples or lack sufficient statistical power.

Data collected in the Adult Psychiatric Morbidity Surveys (APMS) for England offered us an opportunity to answer research questions about suicidality risk in LGB people using a large representative sample, with the opportunity to distinguish between individual sexual minority groups, separate out specific suicidality outcomes, and to take into account other relevant factors such as common mental health conditions.

Our study

We examined the association between sexual orientation and suicidality and self-harm among LGB groups, focussed on three separate outcomes: past-year suicidal thoughts, past-year suicide attempt, and lifetime non-suicidal self-harm (NSSH). We also explored whether factors such as bullying or discrimination might contribute to any associations observed, and whether any inequalities in suicidality or self-harm have changed over time. To do this we used nationally representative data from two survey years of the APMS for England, with a combined sample of 10,443 people.

What we found

Our results were sadly unsurprising, showing that lesbian and gay people were more likely to report past-year suicidal thoughts than heterosexuals. All LGB individuals were more likely to report experiences of non-suicidal self-harm. There was some evidence to support a contribution of bullying in the association between lesbian/gay identity and past-year suicidal thoughts, and of each minority stress variable in the associations with non-suicidal self-harm. We found that no sexual minority group had an increased probability of suicide attempt compared with heterosexuals.

Implications for health services

The specific health inequalities we reported in the study may be related to systemic issues within health service provision, particularly in locations or services less accepting of or literate in the needs of LGBTQ+ people.

Behind the numbers presented in our study is a personal story of a queer person who has experienced mental health challenges.

Garrett Kidd, Division of Psychiatry

It is possible that queer service users may be less likely to disclose their sexuality in heteronormative environments, for a variety of reasons, and this hinders our understanding of the health needs of queer communities.

My reflections on our research

Behind the numbers presented in our study is a personal story of a queer person who has experienced mental health challenges. I first began work on our study during my time on the MSc in Clinical Mental Health Sciences at UCL, where I worked alongside the co-authors Dr Louse Marston, Professor Irwin Nazareth, Professor David Osborn, and Dr Alexandra Pitman. The late Professor Michael King had previously played a core role in the study, gaining the initial permission to analyse APMS data to investigate mental disorders and help-seeking for mental or physical health conditions in sexual minority groups. However, he sadly passed away in September 2021 before we drafted the paper.

Professor King’s long career in international mental health research has changed the landscape of LGBTQ+ mental health. As a gay man, I am thankful that his work paved the way for future generations of queer people to do research that impacts on our community.

It must also be said that queer people are still actively persecuted in several parts of the world. It strikes me that doing this research would not have been possible in some jurisdictions, and in fact, could result in being prosecuted in countries that actively discriminate against people who just so happen to be part of the LGBTQ+ community.

What is the take home message of this study?

We need to move from accepting sexual orientation as a risk factor for suicidality, to questioning why this is the case and gaining an understanding of how we can reduce the risk of suicidality among LGB people living in England and internationally.

Garrett Kidd is a senior assistant psychologist in a Specialist Forensic Community Team at West London NHS Trust. He also works as a research assistant on the HOME study in the Department of Older People’s Mental Health within Division of Psychiatry at UCL. You can follow him on Twitter at @Garrettkidd_

Other recent studies on sexual and gender minorities:

• TRANS project
• A rapid realist review of universal interventions to promote inclusivity and acceptance of diverse sexual and gender identities in schools