By Katherine Schreiber
According to the Centers for Disease Control and Prevention, suicide is the second leading cause of death among youth aged 15 to 24 and the third leading cause of death among youth aged 10 to 14 (CDC, 2010). Among youth who identify as sexual minorities, the likelihood of death by suicide has been estimated to be two to seven times greater than the likelihood of death by suicide among heterosexual youth (Haas et al., 2011). Haas et al. suggest that such a range exists because records of death rarely include a person’s sexual orientation. More precise data exist on the prevalence of suicidal ideation among sexual minority youth, however, with twice as many reporting a desire or intent to die when compared to heterosexual youth (King et al., 2008).
Various theories abound as to why rates of suicide and/or suicidal ideation are higher among youth who identify as lesbian, gay, bisexual, transgender, queer/questioning, intersex, or asexual (LGBTQ-IA). Chief among them: the minority stress hypothesis and the interpersonal psychological theory of suicide (Russell & Fish, 2016). Irrespective of theoretical orientation, however, most researchers, psychologists, and mental health practitioners agree that youth identifying as a sexual minority are exposed to a higher number of risk factors than their heterosexual counterparts. Sexual minority youth also face several unique risk factors for suicidal ideation and completed suicide (Mustanski & Liu, 2012).
General risk factors for suicide identified over the past several decades include a family history of suicide, childhood maltreatment, having a mental illness (in particular: borderline personality disorder, schizophrenia and psychotic disorders, antisocial personality disorder, conduct disorder, and depression), struggling with substance abuse, experiencing chronic feelings of hopelessness, and having access to a means of completing suicide (i.e., access to a weapon) (Franklin et al., 2017). Perceived burdensomeness and thwarted belongingness have also been shown to increase one’s risk of suicidal ideation and death by suicide (Baams, Grossman, & Russel, 2015). Additionally, a substantial amount of evidence has linked episodes of self-harm to suicidal ideation and suicide attempts. Though the relationship between self-harm and suicide is complicated by the fact that not all episodes of self-harm are directly related to or derivative of an intention to die, a systematic review and meta-analysis by Chan et al. (2016) of various factors correlated with suicide in the wake of self-harm found self-harm to be predictive of death by suicide. The same review also found that poor physical health and male gender increased one’s risk of suicide completion.
Risk factors specific to sexual minority youth include gender nonconformity, low (or lack of) family support, and victimization for being a sexual minority (Mustanski & Liu, 2013). That LGBTQ-IA youth are exposed to these additional risk factors, atop those normally increasing one’s risk for suicidal ideation and completed suicide, helps to explain why sexual minority youth are at a greater risk of desiring to end, and sometimes successfully ending, their own lives. Mustanski & Liu also posit that such factors specific to sexual minority youth are mediated by the emotional and affective vicissitudes characteristic of adolescence. Indeed, intense affect is itself a risk factor for suicidal behavior (Hendin et al., 2010).
It is important to note that predicting whether or not a specific person will commit suicide is a scientifically impossible feat (Franklin et al., 2017). There is no critical threshold of risk factors beyond which one is guaranteed to do so. One may, for instance, identify as transgender and gay, struggle with mental illness, recall memories of childhood abuse, feel hopeless, have access to weapons, yet elect not to end one’s own life. This is because the completion of suicide, as well as the intensity and duration of suicidal ideation, are open to moderation and mediation by a range of protective factors, some of which, like risk factors, are unique to sexual minority youth.
Generally speaking, factors that protect against suicide in youth include having a positive relationship with one or more parent, feeling positively connected to and included in school settings as well as feeling involved in a group of peers (Brent et al., 2009). Brent et al. have also identified adaptive family coping (namely: the willingness and ability of a family to alter its rules, structures of power, and relationship roles) as a protective factor against youth suicidal behavior and ideation.
Specific to sexual minority youth, family cohesion, school safety, and the perception of being cared for and about by adults outside the nuclear family have been found to lower the risk of suicide and suicidal ideation (Haas et al., 2011). Family and peer support have been shown to have a comparably favorable effect on reducing suicidal ideation and completion (Mustanski, & Liu, 2013).
Various therapeutic modalities have also been found to reduce suicidal ideation among adults and adolescents. A systematic review and meta-analysis by Ougrin et al. (2015) underscored the efficacy of dialectical behavior therapy (DBT) mentalization-based therapy (MBT), and cognitive-behavioral therapy (CBT) in reducing intent to die and the likelihood of completing suicide, largely by reducing risk factors for suicide like depression and self-harm.
While further research needs to verify their effectiveness in reducing the total number of deaths by suicide (especially among youth), several studies measuring crisis and suicide prevention hotlines’ effects on hopelessness, psychological pain, and intent to die have found positive results in adult populations (i.e., Gould, Kalafat, Munfakh, & Kleinman, 2007). Youth tend to be less aware of the availability of crisis and suicide prevention hotlines and, as a result, tend to utilize them less (Budinger, Cwik, & Riddle, 2015). Interventions and services provided via text-messaging, online chats, Twitter, Facebook, and other forms of social media have not been extensively studied but may offer younger generations inroads to support, and therefore, another means of reducing suicidal ideation, via mediums that are more appealing and/or accessible to them.
Crisis prevention services can also connect users to mental health services via referrals; an additional avenue through which psychological suffering can be salved. Gould, Munfakh, Kleinman, & Lake (2012) found that approximately half of all adult callers in a study of crisis hotline referral outcomes utilized ongoing resources provided by a crisis counselor over the phone. The percentage of youth who are able to secure ongoing support following contact with a crisis lifeline, however, has yet to be documented.
If you identify as an LGTBQ-IA youth and are in crisis, or know someone who is, call The Trevor Project: 1-866-488-7386.
If you are an adult in crisis, call the National Suicide Prevention Lifeline: 1-800-273-8255.
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Brent, D., Greenhill, L., Compton, S., Emslie, G., Wells, K., Walkup, J., … Turner, J. B. (2009). The treatment of adolescent suicide attempters (tasa) study: predictors of suicidal events in an open treatment trial. Journal of the American Academy of Child and Adolescent Psychiatry, 48(10), 987–996. doi:10.1097/CHI.0b013e3181b5dbe4
Budinger, M. C., Cwik, M. F., & Riddle, M. A. (2015). Awareness, attitudes, and use of crisis hotlines among youth at-risk for suicide. Suicide and Life-Threatening Behavior, 45(2), 192-198. doi:10.1111/sltb.12112.
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