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      It is time to mobilize suicide prevention for sexual and gender minorities in Canada

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          Abstract

          Suicide is a significant health issue among sexual and gender minority adults (SGMA); yet, there are no tailored suicide prevention programs for these marginalized populations in Canada. We hosted two world cafés with community leaders, health professionals, policymakers, and researchers to identify recommendations for mobilizing SGMA-focused suicide prevention programs. We identified five priorities: (1) make society safer for sexual and gender minorities; (2) decrease barriers to mental health services; (3) support community-driven and community-based interventions; (4) increase suicide knowledge and reduce stigma; (5) expand the knowledge base on SGMA suicide. In the absence of a national Canadian SGMA suicide prevention policy, these priorities provide a starting point in addressing SGMA suicide inequities by advancing SGMA-tailored interventions.

          Résumé

          Le suicide est un problème de santé important chez les adultes issues des minorités sexuelles et de genre (AIMSG), par contre il n’existe aucun programme de prévention du suicide adapté à cette population au Canada. Nous avons donc organisé deux cafés du monde avec des dirigeants communautaires, des professionnels de la santé, des décideurs politiques et des chercheurs afin d’identifier des recommandations et des pistes de solutions au problème du suicide chez les AIMSG. Cinq priorités ont été identifiées : 1) rendre la société plus sécuritaire pour les AIMSG, 2) réduire les obstacles aux services en santé mentale, 3) soutenir les interventions et les efforts communautaires, 4) promouvoir les connaissances et réduire la stigmatisation liée au suicide chez les AIMSG, et 5) développer de nouvelles connaissances sur le suicide chez les AIMSG par la recherche. En l’absence d’une politique nationale canadienne de prévention du suicide pour les AIMSG, ces priorités fournissent un point de départ pour remédier aux inégalités relatives au suicide auxquelles font face les AIMSG et pour le développement d’interventions de prévention adaptées à cette population.

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          Most cited references21

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          Suicide and Suicide Risk in Lesbian, Gay, Bisexual, and Transgender Populations: Review and Recommendations

          Despite strong indications of elevated risk of suicidal behavior in lesbian, gay, bisexual, and transgender people, limited attention has been given to research, interventions or suicide prevention programs targeting these populations. This article is a culmination of a three-year effort by an expert panel to address the need for better understanding of suicidal behavior and suicide risk in sexual minority populations, and stimulate the development of needed prevention strategies, interventions and policy changes. This article summarizes existing research findings, and makes recommendations for addressing knowledge gaps and applying current knowledge to relevant areas of suicide prevention practice.
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            Intervenable factors associated with suicide risk in transgender persons: a respondent driven sampling study in Ontario, Canada

            Background Across Europe, Canada, and the United States, 22–43 % of transgender (trans) people report a history of suicide attempts. We aimed to identify intervenable factors (related to social inclusion, transphobia, or sex/gender transition) associated with reduced risk of past-year suicide ideation or attempt, and to quantify the potential population health impact. Methods The Trans PULSE respondent-driven sampling (RDS) survey collected data from trans people age 16+ in Ontario, Canada, including 380 who reported on suicide outcomes. Descriptive statistics and multivariable logistic regression models were weighted using RDS II methods. Counterfactual risk ratios and population attributable risks were estimated using model-standardized risks. Results Among trans Ontarians, 35.1 % (95 % CI: 27.6, 42.5) seriously considered, and 11.2 % (95 % CI: 6.0, 16.4) attempted, suicide in the past year. Social support, reduced transphobia, and having any personal identification documents changed to an appropriate sex designation were associated with large relative and absolute reductions in suicide risk, as was completing a medical transition through hormones and/or surgeries (when needed). Parental support for gender identity was associated with reduced ideation. Lower self-reported transphobia (10th versus 90th percentile) was associated with a 66 % reduction in ideation (RR = 0.34, 95 % CI: 0.17, 0.67), and an additional 76 % reduction in attempts among those with ideation (RR = 0.24; 95 % CI: 0.07, 0.82). This corresponds to potential prevention of 160 ideations per 1000 trans persons, and 200 attempts per 1,000 with ideation, based on a hypothetical reduction of transphobia from current levels to the 10th percentile. Conclusions Large effect sizes were observed for this controlled analysis of intervenable factors, suggesting that interventions to increase social inclusion and access to medical transition, and to reduce transphobia, have the potential to contribute to substantial reductions in the extremely high prevalences of suicide ideation and attempts within trans populations. Such interventions at the population level may require policy change.
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              Why we need qualitative research in suicidology.

              Using the differentiation between explanations and understanding from philosophy of science as the point of departure, a critical look at the current mainstream suicidological research was launched. An almost exclusive use of quantitative methodology focusing on explanations is demonstrated. This bias in scope and methodology has to a large extent taken the suicidological field into a dead-end of repetitious research. It is argued that an increased focus on understanding and thus extended use of qualitative methodology is essential in bringing the suicidological field forward.
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                Author and article information

                Contributors
                olivier.ferlatte@umontreal.ca
                Journal
                Can J Public Health
                Can J Public Health
                Canadian Journal of Public Health = Revue Canadienne de Santé Publique
                Springer International Publishing (Cham )
                0008-4263
                1920-7476
                23 April 2020
                23 April 2020
                October 2020
                : 111
                : 5
                : 737-742
                Affiliations
                [1 ]GRID grid.14848.31, ISNI 0000 0001 2292 3357, Department of Social and Preventive Medicine, School of Public Health, , University of Montreal, ; Montreal, Canada
                [2 ]Centre de Recherche en Santé Publique, Montreal, Canada
                [3 ]GRID grid.61971.38, ISNI 0000 0004 1936 7494, Faculty of Health Sciences, , Simon Fraser University, ; Burnaby, Canada
                [4 ]GRID grid.418246.d, ISNI 0000 0001 0352 641X, British Columbia Centre for Disease Control, ; Vancouver, Canada
                [5 ]Centre for Gender and Sexual Health Equity, Vancouver, Canada
                [6 ]GRID grid.17091.3e, ISNI 0000 0001 2288 9830, School of Nursing, , University of British Columbia, ; Vancouver, Canada
                [7 ]GRID grid.1008.9, ISNI 0000 0001 2179 088X, Department of Nursing, , University of Melbourne, ; Melbourne, Victoria Australia
                [8 ]Stigma and Resilience Among Vulnerable Youth Centre (SARAVYC), Vancouver, Canada
                [9 ]McCreary Centre Society, Vancouver, Canada
                [10 ]GRID grid.143640.4, ISNI 0000 0004 1936 9465, School of Social Work, , University of Victoria, ; Victoria, Canada
                [11 ]GRID grid.494154.9, ISNI 0000 0004 0371 5394, Mental Health Commission of Canada, ; Ottawa, Canada
                [12 ]Health Initiative for Men, Vancouver, Canada
                [13 ]GRID grid.468082.0, ISNI 0000 0000 9533 0272, Canadian Mental Health Association, BC Division, ; Vancouver, Canada
                [14 ]GRID grid.421437.7, Community-Based Research Centre, ; Vancouver, Canada
                [15 ]British Columbia Centre on Substance Use, Vancouver, Canada
                [16 ]GRID grid.17091.3e, ISNI 0000 0001 2288 9830, Department of Medicine, , University of British Columbia, ; Vancouver, Canada
                Article
                316
                10.17269/s41997-020-00316-3
                7501336
                32328989
                179b6c55-6abe-433f-ad2e-e4c25e1c86c5
                © The Author(s) 2020

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 22 July 2019
                : 15 March 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100005277, School of Nursing, University of British Columbia;
                Award ID: NA
                Award Recipient :
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                © The Canadian Public Health Association 2020

                suicide,prevention,gay,lesbian,bisexual,transgender,two-spirit,queer,canada,prévention,hommes gais,femmes lesbiennes,personnes bisexuelles,personnes transgenres

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