In recent years in the USA, UK, and many other areas around the world, awareness of suicide risk in LGBTQ youth as well as across the lifespan has increased considerably. While these advances are critically important, stigma reduction occurs at different paces, unevenly around the world, and, even within small communities, widely varying attitudes exist. Therefore, while progress has been profound in many places, there is much work still to be done to eradicate discrimination and stigma.

An estimated 4.5% of the population is LGBTQ, likely an underestimate.²

Research shows that lesbian and gay people have several times greater rates of suicidal ideation and attempts compared with heterosexual populations.²

For bisexual and transgender (trans) people, rates of ideation and attempts are even greater. For example, several studies show gay and bisexual males are four times more likely to attempt suicide than heterosexual males, while lesbian and bisexual females are twice as likely to attempt suicide.^{3, 4}

The transgender population is perhaps the most at-risk population, with more than 40% of trans adults attempting suicide at one point in their lives (compared to less than 5% for the general population).⁵ More specific information on trans suicide risk factors and related issues is provided below.

Because the US Standard Certificate of Death does not include sexual orientation or gender identity (SOGI), there is not currently systematic surveillance for rate or number of suicide deaths among lesbian, gay, bisexual, or transgender (LGBT) people anywhere in the world, although some US states’ surveillance is in the early stages of implementation to systematically include SOGI as part of the vital statistics death record. This has been an advocacy and education effort at AFSP and the Johnson Family Foundation.⁶

While culture in many regions is changing, stigma, discrimination, family rejection, bullying, and abuse unfortunately continue to be common experiences among LGBTQ people, leading to increased suicide risk in this population. (Please see more detailed examples of behaviors in the home that impact outcomes for LGBTQ youth based on research by the Family Acceptance Project in Chapter 13 on Youth, p. 221.)

Among LGBTQ people, trans people are likely to have the highest risk for suicide, but gay, lesbian, and bisexual people also have elevated rates of suicidal behavior.

Clinicians can counsel and support LGBTQ patients, provide opportunities to address mental health conditions, and screen for suicidal ideation or past behavior to process prior trauma and to discuss their current concerns. All of these actions accrue toward reducing suicide risk.

Clinicians should counsel parents and families about the recommendations on behavior in the home and the need to provide acceptance and support for their LGBTQ loved one, and this behavioral choice does not need to be reliant on changing their own personal value system.

Clinicians should have a low threshold for providing psychological support and behavioral healthcare referral since the risk-producing effects of discrimination and trauma can be mitigated powerfully through therapy, support, and processing.

The risk factors for LGBTQ people are similar for general populations but with notable differences in rates of discrimination and other forms of duress.

Risk factors include mental health problems, depression, anxiety disorders, and substance abuse. The high rates of stigma and discrimination LGBTQ people suffer are known to increase the likelihood of mental health problems and suicide risk. Perhaps one of the greatest contributors to the deterioration of mental health in LGBTQ people, especially youth, is the experience of being rejected by family.⁷

Research findings demonstrate that LGBTQ youth are three times more likely to attempt suicide than their heterosexual and cisgender peers.

Support and acceptance by the family is a strongly protective factor for LGBTQ youth.⁸ The support of caring adults outside the family and a positive self identity can also contribute to the protection of LGBTQ youth. For more information about the critical importance of family support for LGBTQ youth, please see Family Acceptance Project research, posters, and other resources.⁹

As noted earlier, the transgender population is one of the most at-risk populations, with a 41% lifetime risk of attempting suicide (compared to 4.6% for the general population).¹⁰

As with gay, lesbian, and bisexual people, family rejection is a major risk factor for trans people. One study showed that 57% of trans people who had been rejected by their families had attempted suicide.¹⁰

Another important risk factor is violence or physical or sexual abuse as a result of transgender identity. The more frequent or intense the abuse, according to studies, the more likely the trans person is to attempt suicide.¹¹

The figures for harassment and violence are stark. Studies find:

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  – 50% of trans people who had been harassed or bullied at school had attempted suicide.

  
  
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  – 55% of trans people who had been discriminated against or harassed at work had attempted suicide.

  
  
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  – 65% of trans people who had suffered sexual violence at work and 70% who had suffered sexual violence at school had attempted suicide.¹⁰