Suicidal behaviour in LGBTI populations in Australia
Dr Delaney Michael Skerrett
Dr Kairi Kõlves
Prof. Diego De Leo

Austr...
Overview
•
•
•
•
•
•
•

AISRAP
Introduction
International research
Australian research
Risk & protective factors
Limitatio...
Australian Institute for Suicide Research and Prevention
 The Institute conducts research in all aspects of suicide preve...
Introduction
• LGBT(IQ) = lesbian, gay, bisexual, transsexual,
(intersex, queer/questioning)
• Same-sex attraction ubiquit...
Introduction (cont.)
• Nothing inherently suicidogenic about
sexuality/gender minority status
• Continued societal stigma,...
Introduction (cont.)
• LGBTI recognised as high risk groups by Australian
Senate Committee report (2010)
– “Targeted appro...
Aim
• In light of international research (to follow) and
Australian government agency recommendations,
establish the evide...
Method
• Scopus, Medline, and Proquest
– Articles in English in peer-reviewed academic journals
– Title/key words/abstract...
INTERNATIONAL RESEARCH

AISRAP, National Centre of Excellence in Suicide Prevention
Studies on non-fatal suicidal behaviours:
North American adults
• Paul et al (2002): 2,881 gay and bisexual men (USA)
– Li...
Studies on non-fatal suicidal behaviours:
North American adolescents
• Hatzenbuehler (2011): 31, 852 11th graders in Orego...
Studies on non-fatal suicidal behaviours:
non-North American
• Wichstrøm & Hegna (2003): 2,924 high-schoolers (representat...
Recent research on fatal suicidal behaviour
• Mathy et al (2011): nested case-control study using national
cross-referenci...
Suicidal behaviours and minority gender role
• Fitzpatrick et al (2005): 77 UG psych students, cross-gender
role uniquely ...
AUSTRALIAN RESEARCH

AISRAP, National Centre of Excellence in Suicide Prevention
Studies on non-fatal suicidal behaviours: Australia
• Buhrich & Loke (2005): first study identified
– Greater proportion o...
Studies on non-fatal suicidal behaviours: Australia
• Jorm et al (2002): 4,824 from electoral roll 20-24yrs & 40-44yrs (Ca...
Studies on non-fatal suicidal behaviours: Australia
• Nicholas & Howard (1998): 57 G and 54 non-G men from Sydney (snowbal...
• Pitts et al (2006): 5,476 LGBTI (65% male, 35% female) online, broadly
geographically representative of all States and T...
Studies on fatal suicidal behaviours: Australia
• There were no studies identified on fatal suicidal behaviours
among LGBT...
RISK & PROTECTIVE FACTORS

AISRAP, National Centre of Excellence in Suicide Prevention
Common risk factors with non-LGBT
• Substance abuse
– G more likely to have tried a variety of drugs; L more likely alcoho...
Specific risk factors
• Developmental stressors
– “Coming out” in adolescence/early adulthood

• Prejudice & discriminatio...
Protective factors
• Talking about & acceptance of one’s sexuality:
– Suicide attempts tend to occur before “coming out” a...
LIMITATIONS & IMPLICATIONS FOR
RESEARCH

AISRAP, National Centre of Excellence in Suicide Prevention
Limitations
• Keyword search limited to article titles given the
large amount of international research on the topic

AISR...
Implications for research
• No representative studies have been carried out in
Australia
– Jorm et al (2002) carried out o...
QUEENSLAND SUICIDE REGISTER (QSR)
STUDY FOR BEYONDBLUE

AISRAP, National Centre of Excellence in Suicide Prevention
The Queensland Suicide Register
• The QSR is a comprehensive suicide database maintained by
the Australian Institute for S...
QSR
Causes of death are scrutinised in the QSR following the Suicide
Classification Flow Chart, developed by AISRAP
All su...
Queensland Suicide Register (QSR) study
• Part one of two-part study for beyondblue
– Part two is a psychological autopsy ...
Queensland Suicide Register (QSR) study
• 35 cases identified (L=11(10); G=22; B=1(2); T=1; I=0)
– Underreporting: sexuali...
Conclusion
• Early studies found no significant increased risk of
suicide among LGBT but more recent work, including
repre...
THANK YOU!

d.skerrett@griffith.edu.au
(07) 3735 3393

Copyright © Australian Institute for Suicide Research and Preventio...
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Dr Delaney Skerrett, Australian Institute for Suicide Research & Prevention: Suicidal behaviour in LGBTI populations in Australia

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Dr Delaney Skerrett, Research Fellow & Clinical Interviewer, Australian Institute for Suicide Research & Prevention, Griffith University delivered this presentation at the 2013 LGBTI Aged Care Forum. The two day event offers a platform for discussion on national policy issues, mental and physical health and implementing sensitive quality care and service delivery.

The forum brings together LGBTI community leaders plus senior researchers on LGBTI issues in the aged and health care sectors, to share perspectives on good practice insights for real needs as well as strategies to build community and sector capacity. For more information about the event, please visit the conference website: http://www.informa.com.au//lgbtiagedcare

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Dr Delaney Skerrett, Australian Institute for Suicide Research & Prevention: Suicidal behaviour in LGBTI populations in Australia

  1. 1. Suicidal behaviour in LGBTI populations in Australia Dr Delaney Michael Skerrett Dr Kairi Kõlves Prof. Diego De Leo Australian Institute for Suicide Research and Prevention WHO Collaborating Centre for Research and Training in Suicide Prevention National Centre of Excellence in Suicide Prevention Life Promotion Clinic
  2. 2. Overview • • • • • • • AISRAP Introduction International research Australian research Risk & protective factors Limitations & implications for research Queensland Suicide Register (QSR) study AISRAP, National Centre of Excellence in Suicide Prevention
  3. 3. Australian Institute for Suicide Research and Prevention  The Institute conducts research in all aspects of suicide prevention and manages the Queensland Suicide Register since 1990. AISRAP was officially established in 1997.  AISRAP, located at Griffith University's Mt Gravatt campus, became a World Health Organization Collaborating Centre for Research and Training in Suicide Prevention in July 2005.  Apart from research activities, AISRAP provides education and training for health and allied professionals. Offering postgraduate programs in suicidology in 2001 was a world first for further information contact jacinta.hawgood@griffith.edu.au  In 2004, the Institute opened the Life Promotion Clinic. This was the first outpatient facility in Australia focused on providing specialised treatment to people with a history of suicidal behaviour.  In 2008 AISRAP was established as the National Centre of Excellence in Suicide Prevention, funded by the Commonwealth government’s Department of Health and Ageing.
  4. 4. Introduction • LGBT(IQ) = lesbian, gay, bisexual, transsexual, (intersex, queer/questioning) • Same-sex attraction ubiquitous, however… – Sexuality and gender identity as complex and not stable or essential characteristics • Complicated to study – Little information on actual feelings or practices (usually relies on self-report or common belief) – Especially problematic with older studies and psychological autopsies • One Danish study based on partnership register (still approximate indication only) AISRAP, National Centre of Excellence in Suicide Prevention
  5. 5. Introduction (cont.) • Nothing inherently suicidogenic about sexuality/gender minority status • Continued societal stigma, particularly for adolescents, has led to belief in greater risk of suicidal behaviour – Early research inconsistent and often non-representative (e.g., prisoners, psychiatric inpatients) AISRAP, National Centre of Excellence in Suicide Prevention
  6. 6. Introduction (cont.) • LGBTI recognised as high risk groups by Australian Senate Committee report (2010) – “Targeted approach” to prevention and awareness – Commonwealth Government acknowledged the heightened risk and supported the recommendations for targeted approaches • DoHA’s LIFE framework lists gay and lesbian people as among the “highest risk” groups – MindOUT! project
  7. 7. Aim • In light of international research (to follow) and Australian government agency recommendations, establish the evidence base for heightened risk in the Australian context – No review of the Australian research has so far been published
  8. 8. Method • Scopus, Medline, and Proquest – Articles in English in peer-reviewed academic journals – Title/key words/abstract: suicid* AND gay OR lesbian OR bisexual OR transsexual AND Australia AISRAP, National Centre of Excellence in Suicide Prevention
  9. 9. INTERNATIONAL RESEARCH AISRAP, National Centre of Excellence in Suicide Prevention
  10. 10. Studies on non-fatal suicidal behaviours: North American adults • Paul et al (2002): 2,881 gay and bisexual men (USA) – Lifetime prevalence for suicide plan 21% – Suicide attempt 12% (almost half multiple attempters) • Bolton & Sareen (2011): 34,653 adults, nationallyrepresentative survey (USA) – Males: G 9.8%, B 10%, unsure 8.5%, non-GB 2.1% (lifetime attempt) – Females: L 10.9%, B 24.4%, 9.9% unsure, non-LB 4.2% (lifetime attempt) • Mathy (2002): 38,204 respondents to online survey from 5 continents (93% USA; 83% male) – Lifetime suicidal ideation sig higher for LGB only in Asia, Nth America, Sth America (not Australia or Europe) – Suicide attempt significantly higher on all continents except Europe AISRAP, National Centre of Excellence in Suicide Prevention
  11. 11. Studies on non-fatal suicidal behaviours: North American adolescents • Hatzenbuehler (2011): 31, 852 11th graders in Oregon (4.4% LGB) – 12-month attempt LGB 21.5% vs. 4.2% non-LGB • Eisenberg & Resnick (2006): 83,731 high schoolers from Minnesota – LGB 47.3% males & 72.9% females lifetime suicidal ideation (34.7% & 53% nonLGB) – LGB 29.0% males & 52.4% females lifetime suicide attempt (12.6% & 24.8% nonLGB) – ORs (male & female): 1.60 & 1.92 (ideation); 2.49 & 2.63 (attempt) • Russell & Joyner (2001): 12,000 high schoolers (USA) – ORs (male & female): 2.45 & 2.48 (suicide attempt) • Silenzio et al (2007) nationally-representative longitudinal study of adolescents (USA) – aOR: 2.94 (12-month ideation) • Marshal et al (2012): 527 female 17 yrs. high schoolers in USA – ORs: 2-week suicidal ideation 4.17, 12-month suicidal ideation 4.93, and 12-month self-harm 7.20 AISRAP, National Centre of Excellence in Suicide Prevention
  12. 12. Studies on non-fatal suicidal behaviours: non-North American • Wichstrøm & Hegna (2003): 2,924 high-schoolers (representative; Norway) – Same-sex sexual behaviour predictive of previous attempt (males & females) and future attempt (females) independent of depressed mood, early sexual debut, parental monitoring, social support • Pinhey & Millman (2004): 1,381 high-schoolers (random sample from 95% of population; Guam) – ORs (male & female): 5.0 & 2.6 (12-month attempt) • Plöderl & Fartacek (2005): 358 LGB & 267 non-LGB adults (convenience sample; Austria) – LGB 28%, non- LGB 13% (current ideation) – LGB 14%, non-LGB 1% (lifetime attempt) • Skegg et al (2003): 946 participants in longitudinal study in NZ – Lifetime self-harm: OR 5.5 males, 1.9 females • The greater the degree of same-sex attraction, the greater the likelihood of self-harm – 12 month suicidal ideation: OR 3.1 males, 2.9 females – Lifetime suicide attempt: OR 3.2 males, 1.4 females AISRAP, National Centre of Excellence in Suicide Prevention
  13. 13. Recent research on fatal suicidal behaviour • Mathy et al (2011): nested case-control study using national cross-referencing civil partnership and suicide data (Denmark) – Significant for males only: age-adjusted mortality risk approx. 8-times higher for men in registered partnerships with other men vs. ever married and approx. 2-times higher than never married AISRAP, National Centre of Excellence in Suicide Prevention
  14. 14. Suicidal behaviours and minority gender role • Fitzpatrick et al (2005): 77 UG psych students, cross-gender role uniquely predicted suicidality, accounting for more variance than sexuality • Clements-Nolle (2006): 392 MtFs, 123 FtMs (San Fransisco): – 32% lifetime suicide attempt AISRAP, National Centre of Excellence in Suicide Prevention
  15. 15. AUSTRALIAN RESEARCH AISRAP, National Centre of Excellence in Suicide Prevention
  16. 16. Studies on non-fatal suicidal behaviours: Australia • Buhrich & Loke (2005): first study identified – Greater proportion of GB than non-GB men presenting to Sydney hospital ER for suicidal behaviours (n.s.) • Barbeler (1991): convenience sample 200 Ls aged 14-28 in Sydney – – – – 14-18yrs: 63% suicidal ideation (lifetime); 46% because of sexuality 19-21yrs: 51% (24%) 22-25yrs: 51% (33.5%) Suicide attempt (lifetime; all ages): 47.5% (31%) • Kelly et al (1998): 65 HIV-, 164 HIV+ GB men – Symptomatic HIV+ men significantly higher suicidal ideation than asymptomatic HIV+ and HIV- men – HIV+ 21%, HIV- 29% (lifetime attempt, n.s.) AISRAP, National Centre of Excellence in Suicide Prevention
  17. 17. Studies on non-fatal suicidal behaviours: Australia • Jorm et al (2002): 4,824 from electoral roll 20-24yrs & 40-44yrs (Canberra) – “Suicidality” (measured on 5-pt scale) significantly higher for LG, and higher still for B • Moller et al (2013) from wave three of the same study as Jorm et al (4,160 participants) – Bisexuality predictive of self-harm (12-month): OR 2.65
  18. 18. Studies on non-fatal suicidal behaviours: Australia • Nicholas & Howard (1998): 57 G and 54 non-G men from Sydney (snowball sample) – Higher lifetime suicidal ideation, thoughts of suicide, intrusive thoughts of suicide, thoughts about methods • Rogers et al (2004): 542 G (34% HIV+) from Adelaide – 14% HIV+, 17% HIV- (2-week) suicidal ideation (n.s.) – 25% lifetime attempt (overall) • Hillier et al (2005): 1,749 SSA 14-21yrs – 35% lifetime self-harm due to sexuality: 14-17yrs 41%; 18-21yrs 31%) • Hillier et al (2010): “strong relationship” between homophobic abuse and thoughts about self-harm, self-harm, thoughts about suicide, and suicide attempt AISRAP, National Centre of Excellence in Suicide Prevention
  19. 19. • Pitts et al (2006): 5,476 LGBTI (65% male, 35% female) online, broadly geographically representative of all States and Territories – 15.7% males, 14.6% females, 15.7% overall “better off dead” in previous 2 weeks • Abelson et al (2006): 656 G, 115 B, non-GB men in Sydney & Melbourne, 18-50 yrs. – Frequency of “feeling suicidal” (0 never to 3 often): G .61, B .62, non-GB .31 • Thorpy et al (2008): online 12-20yrs LGB in Qld – – – – 68% “thought about” self-harm (12 months) 59% had self-harmed (12 months) 82% suicidal ideation (12 months) 37% attempt (12 months)
  20. 20. Studies on fatal suicidal behaviours: Australia • There were no studies identified on fatal suicidal behaviours among LGBT people, except: – QSR report 2005-2007 (De Leo & Sveticic, 2012) identified only 12 suicides of same-sex orientation • de Leo et al (2010) note that sexuality is seldom recorded at death in Australia AISRAP, National Centre of Excellence in Suicide Prevention
  21. 21. RISK & PROTECTIVE FACTORS AISRAP, National Centre of Excellence in Suicide Prevention
  22. 22. Common risk factors with non-LGBT • Substance abuse – G more likely to have tried a variety of drugs; L more likely alcohol abuse (McDaniel et al, 2011) AISRAP, National Centre of Excellence in Suicide Prevention
  23. 23. Specific risk factors • Developmental stressors – “Coming out” in adolescence/early adulthood • Prejudice & discrimination (homophobia & heterosexism) – Internalisation of homophobia: shame • Higher risk of being bullied & of sexual assault • Precocious development of minority sexual orientation & subsequent maltreatment (Corliss et al, 2009) • Russel & Joyner (2001): suicide risk mediated by depression, hopelessness, alcohol abuse, recent suicide attempt of family member or friend, victimisation • Clements-Nolle et al (2006): independent predictors of suicide risk in transsexual people are age under 25 yrs, depression, history of substance abuse treatment, history of forced sex, discrimination, & victimisation AISRAP, National Centre of Excellence in Suicide Prevention
  24. 24. Protective factors • Talking about & acceptance of one’s sexuality: – Suicide attempts tend to occur before “coming out” and first same-sex experience (Nicholas & Howard, 1998) • Supportive family, esp. father (Nicholas & Howard, 1998) • Feeling safe at school, having supportive teachers, having a high self-esteem (Saewyc, 2007) • Exposure to media positively portraying gay characters (McKee, 2000) • Tolerant societal environment: rates in US states with antidiscrimination legislation decreased after coming into law AISRAP, National Centre of Excellence in Suicide Prevention
  25. 25. LIMITATIONS & IMPLICATIONS FOR RESEARCH AISRAP, National Centre of Excellence in Suicide Prevention
  26. 26. Limitations • Keyword search limited to article titles given the large amount of international research on the topic AISRAP, National Centre of Excellence in Suicide Prevention
  27. 27. Implications for research • No representative studies have been carried out in Australia – Jorm et al (2002) carried out on 8,824 people from the electoral role did identify elevated risk – Abelson et al (2006) found statistically significant differences in “feeling suicidal” between G, B, and nonG/B men, but control group not matched • No studies on completed suicide among LGBT • Need for representative, controlled studies as well as studies on completed suicide in Australia AISRAP, National Centre of Excellence in Suicide Prevention
  28. 28. QUEENSLAND SUICIDE REGISTER (QSR) STUDY FOR BEYONDBLUE AISRAP, National Centre of Excellence in Suicide Prevention
  29. 29. The Queensland Suicide Register • The QSR is a comprehensive suicide database maintained by the Australian Institute for Suicide Research and Prevention (AISRAP). • The QSR holds records of all suicides in Queensland since 1990 and is currently the only database of suicides in Australia. • Information comes from a variety of sources including – the Queensland Office of State Coroners – the Queensland Health • The QSR provides information on a wide range of demographic, psychosocial, psychiatric, medical, contextual and behavioural aspects of suicide death cases
  30. 30. QSR Causes of death are scrutinised in the QSR following the Suicide Classification Flow Chart, developed by AISRAP All suicide cases in the QSR are classified into one of the following categories: • Beyond reasonable doubt, or • Probable, or • Possible. This method of assessment might lead to a lower threshold for classifying a death as a suicide, since it is based on health research criteria rather than on an assessment from Coroner’s findings as applied by the ABS (De Leo et al., 2006).
  31. 31. Queensland Suicide Register (QSR) study • Part one of two-part study for beyondblue – Part two is a psychological autopsy study with next-of-kin (NOK) of approx. 25 LGBTI suicides, with 2-3 live LGBTI controls (or NOKs) • All cases 2000-2009 were reviewed for mention of LGBTI identification or status – Only “beyond reasonable doubt” and “probable” were included (i.e., “possible” was excluded) • First study on fatal suicidal behaviours in Australia – Likely the first study in some 30 years to explore the characteristics of LGBT completed suicides to determine whether or not LGBT individuals who die by suicide constitute a unique subpopulation of those at risk for suicide
  32. 32. Queensland Suicide Register (QSR) study • 35 cases identified (L=11(10); G=22; B=1(2); T=1; I=0) – Underreporting: sexuality no longer including on “Form 1”; approx. 550 suicides per year in Qld • 3 controls matched for date of suicide (closest possible), age (+/- 2 years), and gender were compared with conditional logistic regression (or Fisher’s exact test for n < 4) for demographic, psychosocial, psychiatric, medical, contextual, and behavioural aspects – T case matched for identified gender (psychosocial vs. biological/medical approach)
  33. 33. Conclusion • Early studies found no significant increased risk of suicide among LGBT but more recent work, including representative studies (US, Canada, Norway, and Denmark), has identified increased risk of suicidal ideation, suicide attempt, and completed suicide. • Outstanding need for methodologically rigorous work on this important topic in Australia – Our work with beyondblue go towards addressing this need AISRAP, National Centre of Excellence in Suicide Prevention
  34. 34. THANK YOU! d.skerrett@griffith.edu.au (07) 3735 3393 Copyright © Australian Institute for Suicide Research and Prevention, 2013 AISRAP, National Centre of Excellence in Suicide Prevention

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