The study, published in Social Psychiatry and Psychiatric Epidemiology, is the first ever to analyse nationally representative data on sexual orientation and suicidality in England whilst being able to compare individual sexual minority groups. The researchers analysed data combined from two household surveys of 10,443 English adults (aged 16 and over), representative of the population, sampled in 2007 and 2014.
As well as finding an increased probability of past-year suicidal thoughts among lesbian or gay adults when compared with heterosexuals, and of lifetime non-suicidal self-harm among bisexual, lesbian or gay people, they also found that depression, anxiety, and experiences of discrimination or bullying may contribute in part to these increased risks.
Concerningly, the researchers found no improvement in these inequalities in suicidal thoughts and self-harm between the two time points.
Lead author Dr Alexandra Pitman (UCL Psychiatry) said: "While national surveys of British attitudes towards same-sex relationships suggest that society has become more tolerant of people who are gay, lesbian or bisexual, there is clearly a long way to go, as the mental health outcomes we were studying did not improve across our study period.
"People with sexual minority identities continue to face more discrimination and bullying than heterosexual people and are also more likely to experience common mental health problems such as depression and anxiety. Our study suggests that these experiences of discrimination and bullying may have some role to play in increasing the risk of suicidality and this requires further research.
"Clinicians should be aware of these issues, so that we can best support the mental health of LGB patients, while society as a whole also has a role to play in helping to reduce discrimination. Government bodies, schools, workplaces and individuals should all consider their own cultures and attitudes towards people from sexual minority groups and challenge discriminatory behaviour."
The researchers had previously found, when analysing the same dataset (see note*), an increased probability of depression, anxiety, alcohol misuse and drug misuse among LGB adults compared with their heterosexual peers**. In the current study they found that half of lesbian or gay adults had experienced bullying and one in five had experienced discrimination based on their sexual orientation within the past year. For bisexual adults, almost half had experienced bullying and one in ten had experienced discrimination based on their sexual orientation within the past year.
The researchers found that even after accounting for the increased risk of common mental health problems (depression and anxiety), lesbian and gay adults were still more than twice as likely as heterosexuals to report past-year suicidal thoughts, and lesbian, gay and bisexual adults were more than three times as likely to report lifetime non-suicidal self-harm than heterosexuals. The findings were similar for both men and women, and these inequalities had not changed between 2007 and 2014.
When investigating the comparative likelihood of past-year suicide attempt, the researchers found an increased risk for bisexual adults when compared with heterosexuals, but this was no longer apparent when taking into account the increased risk of common mental health problems. The researchers caution that as the proportions with past-year suicide attempt were relatively low, their findings do not necessarily rule out an elevated suicide attempt risk among the sexual minority group as a whole.
Further analysis suggested that experiences of bullying may contribute to the increased probability of suicidal thoughts among lesbian or gay adults, and that experiences of discrimination and bullying (both categorised as minority stress factors) may each contribute to the increased risk of self-harm among lesbian, gay and bisexual adults.
First author Garrett Kidd, who worked on the study as his dissertation for a Clinical Mental Health Sciences MSc in UCL Psychiatry, said: "Our findings add to a concerning picture of health inequalities experienced by lesbian, gay and bisexual people.
"Our health services need to be improved to meet the needs of LGBTQ+ people, as some people may not feel comfortable disclosing their sexual orientation, which can hamper an understanding of their health and social needs. We also need to offer more mental health services specifically catered to LGBTQ+ people, ideally alongside community-based support."
The researchers say that further research is needed to fully understand the reasons why sexual minority groups are more likely to experience suicidal thoughts or self-harm, such as how victimisation, family environment or stigma might be contributing factors, and in order to develop public health interventions that could reduce suicidality and potentially save lives.
The lead researchers were supported by the NIHR University College London Hospitals Biomedical Research Centre.
* The dataset, the Adult Psychiatric Morbidity Survey (APMS) for England, included questions on sexual orientation but not gender identity. The next survey in the APMS series will include questions about gender identity, so that future analyses will be able to look at both gender and sexual identity, and therefore investigate mental health in LGB groups as well as transgender and gender diverse groups.
** UCL News, 2021: Mental health disorders and alcohol misuse more common in LGB people. See also evidence that LGB youth are more likely to experience depressive symptoms from as young as age 10 and these symptoms persist at least into their early 20s ( UCL News, 2018: Depressive symptoms higher for gay, lesbian and bisexual youth from age 10 ); the UCL researchers also studied to how reduce LGBTQ+-targeted discrimination and bullying in schools ( , full study ).
Suicide is preventable and support is available. Readers affected by this story can contact Samaritans on 116 123, email them at email@example.com , or visit www.samaritans.org. UCL students can access mental health support at our Support and wellbeing pages.
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