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Kidd G, Marston L, Nazareth I, Osborn D, Pitman A. Suicidal thoughts, suicide attempt and non-suicidal self-harm amongst lesbian, gay and bisexual adults compared with heterosexual adults: analysis of data from two nationally representative English household surveys. Soc Psychiatry Psychiatr Epidemiol 2024; 59:273-283. [PMID: 37291332 PMCID: PMC10838834 DOI: 10.1007/s00127-023-02490-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/30/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE We aimed to compare differences in suicidality and self-harm between specific lesbian, gay and bisexual (LGB) groups, and investigate whether minority stress factors might contribute to any associations, addressing methodological limitations of previous research. METHODS We analysed data combined from two population-based representative household surveys of English adults (N = 10,443) sampled in 2007 and 2014. Using multivariable logistic regression models adjusted for age, gender, educational attainment, area-level deprivation, and common mental disorder, we tested the association between sexuality and three suicide-related outcomes: past-year suicidal thoughts, past-year suicide attempt, and lifetime non-suicidal self-harm (NSSH). We added bullying and discrimination (separately) to final models to explore whether these variables might mediate the associations. We tested for interactions with gender and survey year. RESULTS Lesbian/gay people were more likely to report past-year suicidal thoughts [adjusted odds ratio (AOR) = 2.20; 95% CI 1.08-4.50] than heterosexuals. No minority group had an increased probability of suicide attempt. Bisexual (AOR = 3.02; 95% CI = 1.78-5.11) and lesbian/gay (AOR = 3.19; 95% CI = 1.73-5.88) individuals were more likely to report lifetime NSSH than heterosexuals. 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 NSSH. There was no interaction with gender or survey year. CONCLUSION Specific LGB groups are at elevated risk of suicidal thoughts and NSSH, with a possible contribution of lifetime bullying and homophobic discrimination. These disparities show no temporal shift despite apparent increasing societal tolerance towards sexual minorities.
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Affiliation(s)
- Garrett Kidd
- UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Louise Marston
- UCL Research Department of Primary Care and Population Health, Upper Third Floor, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
| | - Irwin Nazareth
- UCL Research Department of Primary Care and Population Health, Upper Third Floor, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
| | - David Osborn
- UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, St Pancras Way, London, NW1 0PE, UK
| | - Alexandra Pitman
- UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, St Pancras Way, London, NW1 0PE, UK.
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Song S, Zhang J. Genetic variants underlying human bisexual behavior are reproductively advantageous. SCIENCE ADVANCES 2024; 10:eadj6958. [PMID: 38170769 PMCID: PMC10796114 DOI: 10.1126/sciadv.adj6958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024]
Abstract
Because human same-sex sexual behavior (SSB) is heritable and leads to fewer offspring, how SSB-associated alleles have persisted and whether they will remain in human populations are of interest. Using the UK Biobank, we address these questions separately for bisexual behavior (BSB) and exclusive SSB (eSSB) after confirming their genetic distinction. We discover that male BSB is genetically positively correlated with the number of offspring. This unexpected phenomenon is attributable to the horizontal pleiotropy of male risk-taking behavior-associated alleles because male risk-taking behavior is genetically positively correlated with both BSB and the number of offspring and because genetically controlling male risk-taking behavior abolishes the genetic correlation between male BSB and the number of offspring. By contrast, eSSB is genetically negatively correlated with the number of offspring. Our results suggest that male BSB-associated alleles are likely reproductively advantageous, which may explain their past persistence and predict their future maintenance, and that eSSB-associated alleles are likely being selected against at present.
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Affiliation(s)
- Siliang Song
- Department of Ecology and Evolutionary Biology, University of Michigan, Ann Arbor, MI 48109, USA
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Clark KA, Blosnich JR. Sexual Orientation and Disclosure of Suicidal Thoughts Before Suicide Mortality. Am J Prev Med 2023; 65:953-963. [PMID: 37429387 PMCID: PMC10772205 DOI: 10.1016/j.amepre.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/03/2023] [Accepted: 07/03/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Disclosure of suicidal thoughts and behaviors represents an opportunity to intervene before suicide mortality, representing a cornerstone for suicide prevention. Sexual minority (e.g., lesbian/gay, bisexual) people experience sharply elevated suicide risk, yet there is scant research on patterns of disclosure of suicidal thoughts and behaviors before suicide that might uncover missed opportunities for suicide prevention. Thus, authors leveraged postmortem suicide data to evaluate associations among sexual orientation, sex, and disclosure of suicidal thoughts and behaviors in the month preceding death. METHODS Data on suicides from the 2013-2019 National Violent Death Reporting System (N=155,516) were classified for sexual orientation and denoted disclosure of suicidal thoughts and behaviors and to whom suicidal thoughts and behaviors were disclosed in the month preceding death. Logistic regression models stratified by sex and adjusted for sociodemographic covariates assessed the associations between sexual orientation and suicidal thoughts and behaviors disclosure. Analyses were conducted from October 2022 to February 2023. RESULTS Among females, sexual minority decedents were 65% more likely to disclose suicidal thoughts and behaviors than heterosexual decedents (95% CI=37%, 99%, p<0.001). No difference in suicidal thoughts and behaviors disclosure was observed between sexual minority and heterosexual men. Of decedents who disclosed suicidal thoughts and behaviors, one in five sexual minority decedents disclosed to a friend/colleague, whereas fewer than 5% disclosed to a healthcare professional. Among sexual minority females, younger age, intimate partner problems, and physical health problems were positively associated with disclosing suicidal thoughts and behaviors. CONCLUSIONS These findings suggest that reducing suicide mortality in sexual minority populations will require considering contexts beyond the healthcare system, including engaging peer networks. Gatekeeper training for suicide prevention may be an especially promising approach for reducing suicide among sexual minority women.
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Affiliation(s)
- Kirsty A Clark
- Department of Medicine, Health, and Society, Vanderbilt University, Nashville, Tennessee.
| | - John R Blosnich
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
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Chum A, Kim C, Nielsen A, Dusing GJ, O'Campo P, Matheson FI, Barker L, Vigod S, Ling V, Fung K, Kennedy S. Disparities in Suicide-Related Behaviors Across Sexual Orientations by Gender: A Retrospective Cohort Study Using Linked Health Administrative Data. Am J Psychiatry 2023; 180:660-667. [PMID: 37282552 DOI: 10.1176/appi.ajp.20220763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The authors used a population-representative sample and health administrative data to quantify suicide-related behavior leading to acute care or deaths across self-identified heterosexual, gay/lesbian, and bisexual individuals. METHODS Data from a population-based survey (N=123,995) were linked to health administrative data (2002-2019), and differences in time to suicide-related behavior events across sexual orientations were examined using Cox proportional hazards regression. RESULTS The crude incidence rates of suicide-related behavior events per 100,000 person-years were 224.7 for heterosexuals, 664.7 for gay/lesbian individuals, and 5,911.9 for bisexual individuals. In fully adjusted (gender-combined) models, bisexual individuals were 2.98 times (95% CI=2.08-4.27) more likely to have an event, and gay men and lesbians 2.10 times (95% CI=1.18-3.71) more likely, compared with heterosexual individuals. CONCLUSIONS In a large population-based sample of Ontario residents, using clinically relevant outcomes, the study found gay/lesbian and bisexual individuals to be at elevated risk of suicide-related behavior events. Increased education among psychiatric professionals is needed to improve awareness of and sensitivity to the elevated risk of suicide-related behavior among sexual minority individuals, and further research on interventions is needed to reduce such behaviors.
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Affiliation(s)
- Antony Chum
- School of Kinesiology and Health Science, York University, Toronto (Chum, Kim, Dusing); Dalla Lana School of Public Health, University of Toronto, Toronto (Chum, Matheson); MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto (Chum, Nielsen, O'Campo, Matheson); Department of Psychiatry, Women's College Hospital, Toronto (Barker, Vigod); Department of Psychiatry, University of Toronto, Toronto (Vigod); Institute for Clinical Evaluative Sciences, Toronto (Ling, Fung); Centre for Depression and Suicide Studies, St. Michael's Hospital, Toronto (Kennedy)
| | - Chungah Kim
- School of Kinesiology and Health Science, York University, Toronto (Chum, Kim, Dusing); Dalla Lana School of Public Health, University of Toronto, Toronto (Chum, Matheson); MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto (Chum, Nielsen, O'Campo, Matheson); Department of Psychiatry, Women's College Hospital, Toronto (Barker, Vigod); Department of Psychiatry, University of Toronto, Toronto (Vigod); Institute for Clinical Evaluative Sciences, Toronto (Ling, Fung); Centre for Depression and Suicide Studies, St. Michael's Hospital, Toronto (Kennedy)
| | - Andrew Nielsen
- School of Kinesiology and Health Science, York University, Toronto (Chum, Kim, Dusing); Dalla Lana School of Public Health, University of Toronto, Toronto (Chum, Matheson); MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto (Chum, Nielsen, O'Campo, Matheson); Department of Psychiatry, Women's College Hospital, Toronto (Barker, Vigod); Department of Psychiatry, University of Toronto, Toronto (Vigod); Institute for Clinical Evaluative Sciences, Toronto (Ling, Fung); Centre for Depression and Suicide Studies, St. Michael's Hospital, Toronto (Kennedy)
| | - Gabriel John Dusing
- School of Kinesiology and Health Science, York University, Toronto (Chum, Kim, Dusing); Dalla Lana School of Public Health, University of Toronto, Toronto (Chum, Matheson); MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto (Chum, Nielsen, O'Campo, Matheson); Department of Psychiatry, Women's College Hospital, Toronto (Barker, Vigod); Department of Psychiatry, University of Toronto, Toronto (Vigod); Institute for Clinical Evaluative Sciences, Toronto (Ling, Fung); Centre for Depression and Suicide Studies, St. Michael's Hospital, Toronto (Kennedy)
| | - Patricia O'Campo
- School of Kinesiology and Health Science, York University, Toronto (Chum, Kim, Dusing); Dalla Lana School of Public Health, University of Toronto, Toronto (Chum, Matheson); MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto (Chum, Nielsen, O'Campo, Matheson); Department of Psychiatry, Women's College Hospital, Toronto (Barker, Vigod); Department of Psychiatry, University of Toronto, Toronto (Vigod); Institute for Clinical Evaluative Sciences, Toronto (Ling, Fung); Centre for Depression and Suicide Studies, St. Michael's Hospital, Toronto (Kennedy)
| | - Flora I Matheson
- School of Kinesiology and Health Science, York University, Toronto (Chum, Kim, Dusing); Dalla Lana School of Public Health, University of Toronto, Toronto (Chum, Matheson); MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto (Chum, Nielsen, O'Campo, Matheson); Department of Psychiatry, Women's College Hospital, Toronto (Barker, Vigod); Department of Psychiatry, University of Toronto, Toronto (Vigod); Institute for Clinical Evaluative Sciences, Toronto (Ling, Fung); Centre for Depression and Suicide Studies, St. Michael's Hospital, Toronto (Kennedy)
| | - Lucy Barker
- School of Kinesiology and Health Science, York University, Toronto (Chum, Kim, Dusing); Dalla Lana School of Public Health, University of Toronto, Toronto (Chum, Matheson); MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto (Chum, Nielsen, O'Campo, Matheson); Department of Psychiatry, Women's College Hospital, Toronto (Barker, Vigod); Department of Psychiatry, University of Toronto, Toronto (Vigod); Institute for Clinical Evaluative Sciences, Toronto (Ling, Fung); Centre for Depression and Suicide Studies, St. Michael's Hospital, Toronto (Kennedy)
| | - Simone Vigod
- School of Kinesiology and Health Science, York University, Toronto (Chum, Kim, Dusing); Dalla Lana School of Public Health, University of Toronto, Toronto (Chum, Matheson); MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto (Chum, Nielsen, O'Campo, Matheson); Department of Psychiatry, Women's College Hospital, Toronto (Barker, Vigod); Department of Psychiatry, University of Toronto, Toronto (Vigod); Institute for Clinical Evaluative Sciences, Toronto (Ling, Fung); Centre for Depression and Suicide Studies, St. Michael's Hospital, Toronto (Kennedy)
| | - Vicki Ling
- School of Kinesiology and Health Science, York University, Toronto (Chum, Kim, Dusing); Dalla Lana School of Public Health, University of Toronto, Toronto (Chum, Matheson); MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto (Chum, Nielsen, O'Campo, Matheson); Department of Psychiatry, Women's College Hospital, Toronto (Barker, Vigod); Department of Psychiatry, University of Toronto, Toronto (Vigod); Institute for Clinical Evaluative Sciences, Toronto (Ling, Fung); Centre for Depression and Suicide Studies, St. Michael's Hospital, Toronto (Kennedy)
| | - Kinwah Fung
- School of Kinesiology and Health Science, York University, Toronto (Chum, Kim, Dusing); Dalla Lana School of Public Health, University of Toronto, Toronto (Chum, Matheson); MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto (Chum, Nielsen, O'Campo, Matheson); Department of Psychiatry, Women's College Hospital, Toronto (Barker, Vigod); Department of Psychiatry, University of Toronto, Toronto (Vigod); Institute for Clinical Evaluative Sciences, Toronto (Ling, Fung); Centre for Depression and Suicide Studies, St. Michael's Hospital, Toronto (Kennedy)
| | - Sidney Kennedy
- School of Kinesiology and Health Science, York University, Toronto (Chum, Kim, Dusing); Dalla Lana School of Public Health, University of Toronto, Toronto (Chum, Matheson); MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto (Chum, Nielsen, O'Campo, Matheson); Department of Psychiatry, Women's College Hospital, Toronto (Barker, Vigod); Department of Psychiatry, University of Toronto, Toronto (Vigod); Institute for Clinical Evaluative Sciences, Toronto (Ling, Fung); Centre for Depression and Suicide Studies, St. Michael's Hospital, Toronto (Kennedy)
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Milne BJ, D'Souza S, Andersen SH, Richmond-Rakerd LS. Use of Population-Level Administrative Data in Developmental Science. ANNUAL REVIEW OF DEVELOPMENTAL PSYCHOLOGY 2022; 4:447-468. [PMID: 37284522 PMCID: PMC10241456 DOI: 10.1146/annurev-devpsych-120920-023709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Population-level administrative data-data on individuals' interactions with administrative systems (e.g., health, criminal justice, and education)-have substantially advanced our understanding of life-course development. In this review, we focus on five areas where research using these data has made significant contributions to developmental science: (a) understanding small or difficult-to-study populations, (b) evaluating intergenerational and family influences, (c) enabling estimation of causal effects through natural experiments and regional comparisons, (d) identifying individuals at risk for negative developmental outcomes, and (e) assessing neighborhood and environmental influences. Further advances will be made by linking prospective surveys to administrative data to expand the range of developmental questions that can be tested; supporting efforts to establish new linked administrative data resources, including in developing countries; and conducting cross-national comparisons to test findings' generalizability. New administrative data initiatives should involve consultation with population subgroups including vulnerable groups, efforts to obtain social license, and strong ethical oversight and governance arrangements.
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Affiliation(s)
- Barry J Milne
- School of Social Sciences and Centre of Methods and Policy Application in the Social Sciences (COMPASS), University of Auckland, Auckland, New Zealand
| | - Stephanie D'Souza
- School of Social Sciences and Centre of Methods and Policy Application in the Social Sciences (COMPASS), University of Auckland, Auckland, New Zealand
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Sullins DP. Sexual Orientation Change Efforts Do Not Increase Suicide: Correcting a False Research Narrative. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:3377-3393. [PMID: 36066677 DOI: 10.1007/s10508-022-02408-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 05/25/2023]
Abstract
Sexual orientation change efforts (SOCEs) signify activities designed to change or reduce homosexual orientation. Recent studies have claimed that such therapies increase suicide risk by showing positive associations between SOCE and lifetime suicidality, without excluding behavior that pre-dated SOCE. In this way, Blosnich et al.'s (2020) recent analysis of a national probability sample of 1518 sexual minority persons concluded that SOCE "may compound or create…suicidal ideation and suicide attempts" but after correcting for pre-existing suicidality, SOCE was not positively associated with any form of suicidality. For suicidal ideation, Blosnich et al. reported an adjusted odds ratio (AOR) of 1.92 (95% CI 1.01-3.64); the corrected AOR was .44 (.20-.94). For suicide planning, Blosnich et al.'s AOR was 1.75 (1.01-3.06); corrected was .60 (.32-1.14). For suicide attempts, Blosnich et al.'s AOR was 1.75 (.99-3.08); corrected was .74 (.36-1.43). Undergoing SOCE after expressing suicidal behavior reduced subsequent suicide attempts from 72 to 80%, compared to those not undergoing SOCE, when SOCE followed a prior expression of suicidal ideation (AOR .17, .05-.55), planning (AOR .13, .04-.45) or intention (AOR .10, .03-.30); however, SOCE following an initial suicide attempt did not significantly reduce further attempts. By violating the principle that a cause cannot occur after an effect, Blosnich et al. misstated the correct conclusion. Experiencing SOCE does not result in higher suicidality, as they claim, and may sharply reduce subsequent suicide attempts. Restrictions on SOCE will not reduce suicidal risk among sexual minorities and may deprive them of an important resource for reducing suicide attempts.
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Affiliation(s)
- D Paul Sullins
- Department of Sociology, The Catholic University of America, Washington, DC, 20064, USA.
- Ruth Institute, Lake Charles, LA, USA.
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Schneider B, Reif A, Wagner B, Wolfersdorf M. [Why do we require clinical guidelines for suicide prevention?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 65:58-66. [PMID: 34967913 PMCID: PMC8732821 DOI: 10.1007/s00103-021-03468-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/26/2021] [Indexed: 11/28/2022]
Abstract
Trotz der Relevanz des Themas Suizidalität und gut bekannter Risikofaktoren gibt es bisher keine deutsche Leitlinie zur Suizidalität im Erwachsenenalter. In diesem Beitrag werden zunächst die Geschichte und die Hintergründe der Arbeit mit Leitlinien beschrieben. Der aktuelle Stand der Leitlinien für psychische Erkrankungen in Deutschland wird dargestellt und auf suizidpräventive Inhalte hin untersucht. Die Notwendigkeit evidenzbasierter Suizidprävention und einer spezifischen Leitlinie zur Suizidprävention bei Erwachsenen wird diskutiert. Nur durch gezielte Suizidpräventionsstrategien und Interventionen für die jeweiligen Risikogruppen und unter Beachtung von Alters- und Geschlechtsspezifität kann für alle Betroffenen eine flächendeckende, gut erreichbare, bedarfs- und versorgungsgerechte, finanzierbare sowie nachhaltige medizinische Versorgung auf einem hohen Niveau sichergestellt werden. Dies gilt für den ambulanten und den stationären Bereich sowie für deren Schnittstellen. Bei Suizidalität handelt es sich um ein diagnoseübergreifendes, in unterschiedlichen Versorgungskontexten auftretendes Syndrom mit komplexem Behandlungsbedarf, weshalb intersektorale und multiprofessionelle Aspekte in einer entsprechenden Leitlinie besonders zu adressieren sind. Wissenschaftliche Evidenz und interdisziplinärer Konsens unter Expertinnen und Experten zum Umgang mit suizidalem Verhalten in der medizinischen Versorgung können dazu beitragen, Morbidität und Mortalität im Zusammenhang mit Suizidalität zu reduzieren. Im August 2021 wurde die Finanzierung einer S3-Leitlinie „Umgang mit Suizidalität“ vom Innovationsfonds des Gemeinsamen Bundesausschusses bewilligt.
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Affiliation(s)
- Barbara Schneider
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie, Johann Wolfgang-Goethe-Universität Frankfurt/Main, Frankfurt/Main, Deutschland. .,Abteilung für Abhängigkeitserkrankungen, Psychiatrie und Psychotherapie, LVR-Klinik Köln, Wilhelm-Griesinger-Str. 23, 51109, Köln, Deutschland.
| | - Andreas Reif
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie, Johann Wolfgang-Goethe-Universität Frankfurt/Main, Frankfurt/Main, Deutschland
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Suicide in American Cities. CURRENT TRAUMA REPORTS 2021. [DOI: 10.1007/s40719-021-00220-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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9
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Clark KA, Björkenstam C, Kosidou K, Björkenstam E. Psychological Distress, Suicidal Ideation, and Suicide Attempt Among Lesbian, Gay, and Bisexual Immigrants: Population-Based Findings from the Stockholm Public Health Cohort. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:3563-3574. [PMID: 34725752 PMCID: PMC9308978 DOI: 10.1007/s10508-021-01997-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/25/2021] [Accepted: 03/27/2021] [Indexed: 06/13/2023]
Abstract
In a large, population-based sample in Sweden, we sought to examine mental health disparities between lesbian, gay and bisexual (LGB) and heterosexual individuals with different immigration statuses. We conducted a population-based study including 1799 LGB and 69,324 heterosexual individuals, recruited in 2010 and 2014 as part of the Stockholm Public Health Cohort. Data were obtained from self-administered surveys that were linked to nationwide registers. We examined associations between mental health outcomes (i.e., psychological distress, suicidal ideation, and suicide attempt) and sexual orientation (LGB versus heterosexual), immigration status (immigrant versus Nordic-born), and their interaction. Sex-stratified weighted multivariable logistic regression analyses were used to calculate adjusted odds ratios with 95% confidence intervals. LGB individuals demonstrated substantially elevated odds of all mental health outcomes compared to heterosexuals; immigrants reported moderately elevated odds of psychological distress and suicide attempt, but not suicidal ideation, compared to Nordic-born individuals. Interaction terms between sexual orientation and immigration status were significant at p < 0.05 for psychological distress for both sexes and for suicidal ideation and attempt among women. Unexpectedly, models probing interactions generally demonstrated that Nordic-born LGB individuals demonstrated greater risk of psychological distress, suicidal ideation, and suicide attempt than did immigrant LGB individuals, especially among women. Supplemental analyses showed that Nordic-born bisexual women demonstrated the highest risk of all studied outcomes. Being LGB in Sweden is generally a stronger risk factor for poor mental health among Nordic-born than immigrant populations. These findings call for future intersectionality-focused research to delineate the unique cultural, social, and psychological factors associated with mental health and resilience among LGB immigrants.
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Affiliation(s)
- Kirsty A Clark
- Department of Medicine, Health, and Society, Vanderbilt University, Nashville, TN, 37235, USA.
| | | | - Kyriaki Kosidou
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Center for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Emma Björkenstam
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Community Health Sciences, Fielding School of Public Health and California Center for Population Research, University of California Los Angeles, Los Angeles, CA, USA
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Sakai K, Tanifuji T. Suicides Among Lesbian, Gay, Bisexual, and Transgender People: Medical Examiner Reports in the Special Wards of Tokyo, Japan, 2009-2018. LGBT Health 2021; 8:519-525. [PMID: 34582270 DOI: 10.1089/lgbt.2020.0266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: We aimed to report the occurrence of suicide death and to reveal the characteristics among LGBT people in the special wards of Tokyo. Methods: All suicide deaths between 2009 and 2018 were identified from the Tokyo Medical Examiner's Office database, and the characteristics were compared between LGBT people and non-LGBT people by retrospective review of the medical examiner reports. Results: Among 17,638 people who died by suicide, 84 (0.5%) were identified as LGBT people, of which a large proportion was gay males (51.2%) and transgender people (42.9%). Smaller proportions of lesbian (3.6%) and bisexual (2.4%) females were identified. Compared with suicides among non-LGBT people, there were several differences in the circumstances surrounding suicides among LGBT people, namely method of suicide, source of income, and number of household members (transgender people), and toxic substance in poisoning and medical history (gay males). Conclusions: The results tentatively suggest the risk or supportive factors that should be considered for preventing suicides among LGBT people; however, the present data are likely to be underestimated. To better understand suicides among LGBT people, systematic efforts to collect sexual orientation and gender identity data for suicide are needed.
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Affiliation(s)
- Kentaro Sakai
- Tokyo Medical Examiner's Office, Tokyo Metropolitan Government, Tokyo, Japan
| | - Takanobu Tanifuji
- Tokyo Medical Examiner's Office, Tokyo Metropolitan Government, Tokyo, Japan
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Pitman A, Marston L, Lewis G, Semlyen J, McManus S, King M. The mental health of lesbian, gay, and bisexual adults compared with heterosexual adults: results of two nationally representative English household probability samples. Psychol Med 2021; 52:1-10. [PMID: 33592165 DOI: 10.1017/s0033291721000052] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Evidence on inequalities in mental health in lesbian, gay, and bisexual people arises primarily from non-random samples. AIMS To use a probability sample to study change in mental health inequalities between two survey points, 7 years apart; the contribution of minority stress; and whether associations vary by age, gender, childhood sexual abuse, and religious identification. METHODS We analysed data from 10 443 people, in two English population-based surveys (2007 and 2014), on common mental disorder (CMD), hazardous alcohol use, and illicit drug use. Multivariable models were adjusted for age, gender, and economic factors, adding interaction terms for survey year, age, gender, childhood sexual abuse, and religious identification. We explored bullying and discrimination as mediators. RESULTS Inequalities in risks of CMD or substance misuse were unchanged between 2007 and 2014. Compared to heterosexuals, bisexual, and lesbian/gay people were more likely to have CMD, particularly bisexual people [adjusted odds ratio (AOR) = 2.86; 95% CI 1.83-4.46], and to report alcohol misuse and illicit drug use. When adjusted for bullying, odds of CMD remained elevated only for bisexual people (AOR = 3.21; 95% CI 1.64-6.30), whilst odds of alcohol and drug misuse were unchanged. When adjusted for discrimination, odds of CMD and alcohol misuse remained elevated only for bisexual people (AOR = 2.91; 95% CI 1.80-4.72; and AOR = 1.63; 95% CI 1.03-2.57 respectively), whilst odds of illicit drug use remained unchanged. There were no interactions with age, gender, childhood sexual abuse, or religious identification. CONCLUSIONS Mental health inequalities in non-heterosexuals have not narrowed, despite increasing societal acceptance. Bullying and discrimination may help explain the elevated rate of CMD in lesbian women and gay men but not in bisexual people.
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Affiliation(s)
- Alexandra Pitman
- UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, NW1 0PE, UK
| | - Louise Marston
- UCL Research Department of Primary Care and Population Health, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
| | - Gemma Lewis
- UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Joanna Semlyen
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Sally McManus
- NatCen Social Research, 35 Northampton Square, London, EC1V 0AX, UK
- School of Health Sciences, City University, Northampton Square, London, EC1V 0HB, UK
| | - Michael King
- UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
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Structural stigma and sexual orientation disparities in healthcare use: Evidence from Australian Census-linked-administrative data. Soc Sci Med 2020; 255:113027. [PMID: 32408084 DOI: 10.1016/j.socscimed.2020.113027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/14/2020] [Accepted: 04/23/2020] [Indexed: 01/10/2023]
Abstract
This study explores the extent to which structural stigma (which encompasses sociocultural and institutional constraining factors) is associated with sexual orientation disparities in healthcare service and prescription medicine use. Using the responses to the 2017 Australian Marriage Law Postal Survey, we use the regional percentage of votes against legalising same-sex marriage as a measure of structural stigma. We then map these results to Census-linked-administrative data, including 83,519 individuals in same-sex relationships - one of the largest administrative datasets to date where individuals in same-sex relationships are identified. Controlling for regional and individual-level confounders, we find that structural stigma is associated with increased use of nervous system medications (which largely comprise antidepressants) but reduced GP visits for both females and males in same-sex relationships. More regional stigma is also associated with reduced use of pathology services and anti-infective prescriptions for males in same-sex relationships. Altogether, our results suggest that individuals in same-sex relationships living in stigmatised regions are in poorer health but are less likely to access primary healthcare.
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