The first analysis of nationally representative data on sexual orientation to compare suicidality between individual sexual minority groups in England has shown that lesbian, gay, and bisexual (LGB) people are more than twice as likely as heterosexual people to have suicidal thoughts or self-harming behaviours.
The study, led by researchers from University College London (UCL), and published in Social Psychiatry and Psychiatric Epidemiology, used data from the Adult Psychiatric Morbidity Survey for England, which included questions on sexual orientation but not gender identity (though the latter will be included in future).
Mental Health Issues More Likely but Don't Explain Most Risks
The nationally representative household surveys included 10,443 English adults (aged 16 and over) sampled in 2007 and 2014. The researchers used multivariable logistic regression models adjusted for age, gender, educational attainment, area-level deprivation, and common mental disorder, to test the association between sexuality and three suicide-related outcomes – past-year suicidal thoughts, past-year suicide attempt, and lifetime non-suicidal self-harm.
They added bullying and discrimination, separately, to the final models to explore whether these variables might mediate the associations, and tested for interactions with gender and survey year.
Results showed that lesbian and gay people were more than twice as likely as heterosexuals to report past-year suicidal thoughts, with an adjusted odds ratio (AOR) of 2.20 (95% CI 1.08 to 4.50). Lifetime non-suicidal self-harm was more than three times as common among these groups (AOR 3.19; 95% CI 1.73 to 5.88) and among bisexual individuals (AOR 3.02; 95% CI 1.78 to 5.11). No minority group had an increased probability of actual suicide attempts.
In a previous analysis of the same dataset, the researchers had found an increased probability of depression, anxiety, alcohol misuse and drug misuse among LGB adults.
The increased risk of common mental health problems among sexual minorities was also apparent in the new study, but the increases in suicidal ideation and self-harm persisted even after accounting for this. However an increased likelihood of past-year suicide attempts among bisexual adults was no longer apparent when taking into account their increased risk of mental health problems.
Experiences of Bullying and Discrimination Common
In addition, the team reported, half of lesbian or gay adults reported experiencing bullying and 1 in 5 discrimination within the previous year. For bisexual adults, almost half had experienced bullying and 1 in 10 discrimination.
Further analyses suggested that experiences of bullying could have contributed to the increased probability of suicidal thoughts among lesbian or gay adults, and that experiences of discrimination and bullying could each have contributed to the increased risk of self-harm among lesbian, gay, and bisexual adults.
There was no interaction with gender or survey year – the latter suggesting "concerningly" that there had been no improvement between the two time points.
Lead author Dr Alexandra Pitman, an associate professor in the department of psychiatry at UCL , 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," she said, in order to support the mental health of LGB patients.
The lead researchers were supported by the NIHR University College London Hospitals Biomedical Research Centre. All authors state that they have no conflicts of interest.