The relationship between sexual and gender stigma and suicide attempt and ideation among LGBTQI + populations in Thailand: findings from a national survey

A scoping review examining measurement of anti-transgender stigma in low- and middle-income countries

Globally, transgender and other gender diverse (trans) people experience widespread prejudice, discrimination, violence, and other forms of stigma, which contribute to negative health outcomes. Most anti-trans stigma research has been conducted in high-income countries. Measurement of anti-trans stigma in low- and middle-income countries (LMICs) is important for understanding and improving the health of trans populations globally. Accordingly, this scoping review explores the use of quantitative anti-trans stigma measures in LMICs. This scoping review follows the guidance of the PRISMA extension for Scoping Reviews (PRISMA-ScR) Checklist and examines empirical research with trans populations in LMICs published in English, Spanish, Arabic, and Russian between 2001-2024. Study eligibility criteria included: 1) trans study population, 2) LMIC study location, 3) quantitative or mixed-method study design, and 4) quantitative measurement of anti-trans stigma. The search yielded 82 articles (representing 65 unique studies) from 34 LMICs. Most articles were published since 2018. No articles focused exclusively on trans men. About 62% of articles included a primary focus on stigma; health outcomes primarily examined HIV and mental health. Nearly all articles (95%) measured enacted stigma; other forms of stigma (e.g., internalized and anticipated) were less commonly measured, and structural stigma was only measured in 4 articles. More than half of the articles (55%) measured stigma both broadly and within specific contexts (e.g., from family, in health care). More research exploring anti-trans stigma is needed, especially with trans-masculine and other gender diverse people, measuring outcomes beyond HIV and mental health, and measuring forms of stigma beyond enacted stigma. Expanding and improving measurement of anti-trans stigma in LMICs can improve our understanding of the mechanisms shaping health equity to inform context specific and tailored health interventions to support trans communities worldwide.

Burden of the Fruity: Family Support and Suicide Ideation as Mediators Between Discrimination and Suicide Behavior in LGBTQ+ Malaysians

Malaysian pervasive climate places its LGBTQ+ residents at heightened risk for suicidal behaviors (SB). This cross-sectional study aimed to elucidate connections between minority stressors (discrimination), types of social supports, and suicidality in this marginalized population. Utilizing online surveys, 317 LGBTQ+ Malaysians aged 18-49 provided data regarding experienced discrimination, perceived social support from family, friends, and significant others, suicidal ideation (SI), and SB. Quantitative analyses illuminated several key findings. First, discrimination is positively associated with SB, while all support types are inversely related to SB, with family support demonstrating the strongest correlation. Regression modeling revealed family support as the sole unique predictor of reduced SB. Serial mediation analysis uncovered nuanced indirect pathways from discrimination to SB, with SI, but not family support alone, significantly mediating this relationship. However, reduced family support resulting from discrimination sequentially heightened SI and SB. Despite pervasive societal bias, family and friend acceptance may curb the LGBTQ+ community's elevated suicide risk by mitigating resultant ideation. These insights highlight the need for public health initiatives promoting social support and LGBTQ+ inclusivity laying the groundwork to safeguard this population's psychological wellbeing.

A Syndemic Clustering of Adversities on Suicide Risk among YMSM Living with HIV in Bangkok: A Causal Latent Class Analysis

This study investigated the clustering of psychosocial adversities and their synergistic effect with depression on suicidality in a 12-month prospective cohort (N = 214) of YMSM living with HIV in Bangkok, Thailand. Latent class analysis identified subgroups with distinct combinations of adversities, including bullying, intimate partner violence, substance use, HIV stigma, low social support, histories of sex work, and below-income status. Significant interactive synergism were found as hypothesized, supporting a syndemic effect with qualitatively increasing levels of adversities on suicidality (score range: 3-17) over the 12 months. The interaction between moderate adversity clustering and depression (βow = 2.50, 95% CI: 1.12-3.88) and high adversity clustering and depression (βow = 3.61, 95% CI: 1.12-6.09) indicated that the impact of depression on suicidality was modified by pre-existing adversities. The findings suggest that, while a multi-component intervention addressing psychosocial problems is ideal, effective depression treatment alone could significantly reduce suicidality among YMSM living with HIV.

LGBT Myanmar Migrants in Thailand: Unveiling Diverse Forms of Abuse, Healthy and Unhealthy Coping Strategies

This study investigates the challenges faced by LGBT Myanmar migrants in Thailand, including discrimination and abuse due to their gender identity or sexual orientation, and their coping strategies. Through qualitative interviews with 20 self-identified LGBT Myanmar migrants aged over 18 years who experienced discrimination or abuse in Thailand, the findings underscore the presence of a segment within the Myanmar LGBT migrant community in Thailand subject to discrimination and violence across diverse settings, including workplaces, public areas, and even within their homes. Additionally, the research identified healthy coping strategies like self-soothing thoughts, relaxation activities, and seeking support, contrasted with unhealthy coping strategies such as negative self-talk, rumination, and suppressing one's identity, leading to harmful behaviors and even suicidality. The experiences of severe discrimination and violence among LGBT migrants help this study advocate for policy interventions, such as extending the coverage of the Gender Equality Act to encompass LGBT migrants and implementing mental health support services as a form of secondary prevention. Given the significant contribution of LGBT migrants to various sectors of Thailand's workforce, these measures are essential. However, the existing legislation concerning gender equality in Thailand inadequately addresses the specific concerns of this demographic group.

Investigating the Interrelationships Among Mental Health, Substance Use Disorders, and Suicidal Ideation Among Lesbian, Gay, and Bisexual Adults in the United States: Population-Based Statewide Survey Study

BACKGROUND

Mental health disparities have been documented among lesbian, gay, and bisexual (LGB) adults in the United States. Substance use disorders and suicidal ideation have been identified as important health concerns for this population. However, the interrelationships among these factors are not well understood.

OBJECTIVE

This study aims to investigate the interrelationships among mental health, substance use disorders, and suicidal ideation among LGB adults in the United States using a population-based statewide survey.

METHODS

Our study was an observational cross-sectional analysis, and the data for this study were collected from a sample of LGB adults who participated in the statewide survey. The survey collected information on mental health, substance use disorders, and suicidal ideation using validated measures. Descriptive statistics and inferential data analysis were conducted to explore the interrelationships among these factors.

RESULTS

The results showed that LGB adults who reported higher levels of depression and drug abuse and dependence also reported higher levels of suicidal tendency and mental illness. Inferential data analysis using χ2 tests revealed significant differences in depression score (χ22=458.241; P<.001), drug abuse and dependence score (χ22=226.946; P<.001), suicidal tendency score (χ22=67.795; P<.001), and mental illness score (χ22=363.722; P<.001) among the 3 sexual identity groups. Inferential data analysis showed significant associations between sexual identity and mental health outcomes, with bisexual individuals reporting the highest levels of depression, drug abuse and dependence, suicidal tendency, and mental illness.

CONCLUSIONS

This study provides important insights into the interrelationships among mental health, substance use disorders, and suicidal ideation among LGB adults in the United States. The findings underscore the need for targeted interventions and research aimed at addressing the mental health needs of sexual minority populations. Future research should aim to better understand the underlying mechanisms driving these disparities and develop culturally sensitive and tailored interventions that meet the unique needs of LGB individuals. Reducing stigma and discrimination against sexual minority populations is also crucial to improving their mental health outcomes.

Suicides among sexual minority populations in Asia: a battle in the shadows

Sexual minorities, comprising of individuals with non-heterosexual orientation or non-binary gender identities, are being increasingly recognized as populations with distinct needs throughout the world. These communities face several psychological and socio-political challenges, making them vulnerable to mental health conditions, including suicides. Research indicates a higher risk of suicidal deaths and attempts in sexual minorities as compared to the general population. However, this remains an under-researched topic in South Asia where social integration and minority rights are still in their nascent stages. This narrative review aims to understand the various issues related to suicides among sexual minority communities of South Asia.

A narrative inquiry into caregivers' experiences and management after a relative's suicide attempt in a rural community in Northeast Thailand

Suicide attempts have long-term negative consequences for families. This study reports a narrative inquiry using a social constructionist perspective to investigate how caregivers in rural northeast Thailand describe their experiences and management strategies following a family member's suicide attempt. From thematic analysis, three themes emerged: (1) distress and embarrassment, (2) managing to prevent re-attempts, and (3) letting go and moving on with my life. The implications discussed for mental health professionals include recognizing caregivers' experiences and developing more effective ways to manage the risk of future attempts.

Table 2 Fallacy in Descriptive Epidemiology: Bringing Machine Learning to the Table

There is a lack of rigorous methodological development for descriptive epidemiology, where the goal is to describe and identify the most important associations with an outcome given a large set of potential predictors. This has often led to the Table 2 fallacy, where one presents the coefficient estimates for all covariates from a single multivariable regression model, which are often uninterpretable in a descriptive analysis. We argue that machine learning (ML) is a potential solution to this problem. We illustrate the power of ML with an example analysis identifying the most important predictors of alcohol abuse among sexual minority youth. The framework we propose for this analysis is as follows: (1) Identify a few ML methods for the analysis, (2) optimize the parameters using the whole data with a nested cross-validation approach, (3) rank the variables using variable importance scores, (4) present partial dependence plots (PDP) to illustrate the association between the important variables and the outcome, (5) and identify the strength of the interaction terms using the PDPs. We discuss the potential strengths and weaknesses of using ML methods for descriptive analysis and future directions for research. R codes to reproduce these analyses are provided, which we invite other researchers to use.

Behavioral health and experience of violence among cisgender heterosexual and lesbian, gay, bisexual, transgender, queer and questioning, and asexual (LGBTQA+) adolescents in Thailand

BACKGROUND

Assessment of health disparities between population groups is essential to provide basic information for resource prioritization in public health. The objective of this study is to assess the extent that behavioral health outcomes and experience of violence varied between cisgender heterosexual adolescents and those who identified as lesbian, gay, bisexual, transgender, queer and questioning, and asexual (LGBTQA+) in the 5th National School Survey on Alcohol Consumption, Substance Use and Other Health-Risk Behaviors.

METHODS

We surveyed secondary school students in years 7, 9 and 11 in 113 schools in Thailand. We used self-administered questionnaires to ask participants about their gender identity and sexual orientation and classified participants as cisgender heterosexual, lesbian, gay, bisexual, transgender, queer and questioning, or asexual, stratified by sex assigned at birth. We also measured depressive symptoms, suicidality, sexual behaviors, alcohol and tobacco use, drug use, and past-year experience of violence. We analyzed the survey data using descriptive statistics with adjustment for sampling weights.

RESULTS

Our analyses included data from 23,659 participants who returned adequately-completed questionnaires. Among participants included in our analyses, 23 percent identified as LGBTQA+ with the most common identity being bisexual/polysexual girls. Participants who identified as LGBTQA+ were more likely to be in older year levels and attending general education schools rather than vocational schools. LGBTQA+ participants generally had higher prevalence of depressive symptoms, suicidality, and alcohol use than cisgender heterosexual participants, whereas the prevalence of sexual behaviors, lifetime history of illicit drug use, and past-year history of violence varied widely between groups.

CONCLUSION

We found disparities in behavioral health between cisgender heterosexual participants and LGBTQA+ participants. However, issues regarding potential misclassification of participants, limitation of past-year history of behaviors to the context of the COVID-19 pandemic, and the lack of data from youths outside the formal education system should be considered as caveats in the interpretation of the study findings.