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

      , PhD 1 , , PhD 2 , , PhD, MSPH 3 , , MA, MSW, MSt, MSc 4 , , PhD, MS 5 , , PhD 6 , , MD 7 , , PhD 8 , , PhD, RN, FAAN 9 , , PhD 10 , , PhD 11 , , MPA 12 , , PhD, MSW 13 , , OD 14 , , MD 15 , , ScD 16 , , MD, MPH 17 , , PhD 18 , , PhD 19 , , PhD 20 , , PhD 21 , , PhD, MSW, MPA 22 , , MD, MPH 23 , , MD 24 , 25 , , MD 1

      Journal of Homosexuality

      Taylor & Francis

      LGBT, risk factors, suicide, suicide attempts, suicide prevention

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          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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          Most cited references 135

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          Diagnostic and statistical manual of mental disorders.

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            Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence.

             Ilan Meyer (2003)
            In this article the author reviews research evidence on the prevalence of mental disorders in lesbians, gay men, and bisexuals (LGBs) and shows, using meta-analyses, that LGBs have a higher prevalence of mental disorders than heterosexuals. The author offers a conceptual framework for understanding this excess in prevalence of disorder in terms of minority stress--explaining that stigma, prejudice, and discrimination create a hostile and stressful social environment that causes mental health problems. The model describes stress processes, including the experience of prejudice events, expectations of rejection, hiding and concealing, internalized homophobia, and ameliorative coping processes. This conceptual framework is the basis for the review of research evidence, suggestions for future research directions, and exploration of public policy implications.
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              Suicide prevention strategies: a systematic review.

              In 2002, an estimated 877,000 lives were lost worldwide through suicide. Some developed nations have implemented national suicide prevention plans. Although these plans generally propose multiple interventions, their effectiveness is rarely evaluated. To examine evidence for the effectiveness of specific suicide-preventive interventions and to make recommendations for future prevention programs and research. Relevant publications were identified via electronic searches of MEDLINE, the Cochrane Library, and PsychINFO databases using multiple search terms related to suicide prevention. Studies, published between 1966 and June 2005, included those that evaluated preventative interventions in major domains; education and awareness for the general public and for professionals; screening tools for at-risk individuals; treatment of psychiatric disorders; restricting access to lethal means; and responsible media reporting of suicide. Data were extracted on primary outcomes of interest: suicidal behavior (completion, attempt, ideation), intermediary or secondary outcomes (treatment seeking, identification of at-risk individuals, antidepressant prescription/use rates, referrals), or both. Experts from 15 countries reviewed all studies. Included articles were those that reported on completed and attempted suicide and suicidal ideation; or, where applicable, intermediate outcomes, including help-seeking behavior, identification of at-risk individuals, entry into treatment, and antidepressant prescription rates. We included 3 major types of studies for which the research question was clearly defined: systematic reviews and meta-analyses (n = 10); quantitative studies, either randomized controlled trials (n = 18) or cohort studies (n = 24); and ecological, or population- based studies (n = 41). Heterogeneity of study populations and methodology did not permit formal meta-analysis; thus, a narrative synthesis is presented. Education of physicians and restricting access to lethal means were found to prevent suicide. Other methods including public education, screening programs, and media education need more testing. Physician education in depression recognition and treatment and restricting access to lethal methods reduce suicide rates. Other interventions need more evidence of efficacy. Ascertaining which components of suicide prevention programs are effective in reducing rates of suicide and suicide attempt is essential in order to optimize use of limited resources.

                Author and article information

                [1 ] American Foundation for Suicide Prevention, New York, New York, USA
                [2 ] Department of Health Education, San Francisco State University, San Francisco, California, USA
                [3 ] Departments of Psychology and Health Services, University of California, Los Angeles, Los Angeles, California, USA
                [4 ] LifeWise Consulting, Bend, Oregon, USA
                [5 ] Department of Epidemiology, UCLA School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
                [6 ] College of Health and Human Development, Pennsylvania State University, University Park, Pennsylvania, USA
                [7 ] Department of Psychiatry, The University of Colorado at Denver, Denver, Colorado, USA
                [8 ] College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, Columbia University–New York State Psychiatric Institute, Division of Child and Adolescent Psychiatry, New York, New York, USA
                [9 ] Health Systems Science, and UIC National Center of Excellence in Women's Health, University of Illinois at Chicago, College of Nursing, Chicago, Illinois, USA
                [10 ] Department of Psychology, The City University of New York–The City College and Graduate Center, New York, New York, USA
                [11 ] Department of Family Studies and Human Development, University of Arizona, Tucson, Arizona, USA
                [12 ] National Center for the Study and Prevention of Youth Suicide, American Association of Suicidology, Washington, DC, USA
                [13 ] Suicide Prevention Resource Center, Education Development Center, Inc., Washington, DC, USA
                [14 ] Suicide Prevention Resource Center, Education Development Center, Inc., Newton, Massachusetts, USA
                [15 ] Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
                [16 ] Department of Community Health and Prevention, School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
                [17 ] Youth and AIDS Projects, and Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
                [18 ] Center for Population Research in LGBT Health, and The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
                [19 ] Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
                [20 ] Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
                [21 ] Department of Psychology, Ben-Gurion University of the Negev, Beer Sheva, Israel
                [22 ] Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
                [23 ] Adolescent HIV Services, Howard Brown Health Center and Children's Memorial Hospital, Chicago, Illinois, USA
                [24 ] Regional Mental Health Services, The Permanente Medical Group, Inc., and Department of Psychiatry, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
                [25 ] Queers for Economic Justice, New York, New York, USA
                Author notes

                This work has been supported by grants to the American Foundation for Suicide Prevention from the Lilly Foundation and the Johnson Family Foundation.

                The authors gratefully acknowledge the contribution of the following individuals to the 2007 Conference on LGBT Suicide and Suicide Risk: Jane Pearson, PhD, National Institute of Mental Health; Keri Lubell, PhD, Centers for Disease Control and Prevention; Maria Dinger, Substance Abuse and Mental Health Services Agency; Joel Ginsberg, JD, former Executive Director of the Gay and Lesbian Medical Association; Edward Dunne, PhD, former chair of the AFSP Survivor Council; and Edmond Yomtoob, PsyD, Janice Hurtado and Kimberly Gleason who represented the AFSP Chapters. We also thank Charles F. Reynolds, MD, President of the AFSP Board of Directors; Christian York and Lisa Riley, representatives of the AFSP Chapter Advisory Committee on LGBTQ Issues; and Dave Reynolds, MPH, Senior Public Policy and Research Manager at The Trevor Project, who reviewed and critiqued an earlier draft of the manuscript. Leanne Spaulding at AFSP deserves our special thanks for her assistance with the referencing of the paper. Finally, we deeply grateful to Robert Gebbia, AFSP Executive Director, and Andrew Lane, Executive Director of the Johnson Family Foundation, for their support and commitment to this project.

                Address correspondence to Ann P. Haas, Director of Prevention Projects, American Foundation for Suicide Prevention, 120 Wall Street, 22nd Floor, New York, NY 10005, USA. E-mail: ahaas@
                J Homosex
                J Homosex
                Journal of Homosexuality
                Taylor & Francis
                4 January 2011
                January 2011
                : 58
                : 1
                : 10-51
                Copyright © Taylor & Francis Group, LLC

                This is an open access article distributed under the Supplemental Terms and Conditions for iOpenAccess articles published in Taylor & Francis journals , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Research Article

                Sexual medicine

                risk factors, suicide, suicide attempts, lgbt, suicide prevention


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