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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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          Abstract

          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 141

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          Diagnostic and statistical manual of mental disorders.

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            Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults.

            We examined specific family rejecting reactions to sexual orientation and gender expression during adolescence as predictors of current health problems in a sample of lesbian, gay, and bisexual young adults. On the basis of previously collected in-depth interviews, we developed quantitative scales to assess retrospectively in young adults the frequency of parental and caregiver reactions to a lesbian, gay, or bisexual sexual orientation during adolescence. Our survey instrument also included measures of 9 negative health indicators, including mental health, substance abuse, and sexual risk. The survey was administered to a sample of 224 white and Latino self-identified lesbian, gay, and bisexual young adults, aged 21 to 25, recruited through diverse venues and organizations. Participants completed self-report questionnaires by using either computer-assisted or pencil-and-paper surveys. Higher rates of family rejection were significantly associated with poorer health outcomes. On the basis of odds ratios, lesbian, gay, and bisexual young adults who reported higher levels of family rejection during adolescence were 8.4 times more likely to report having attempted suicide, 5.9 times more likely to report high levels of depression, 3.4 times more likely to use illegal drugs, and 3.4 times more likely to report having engaged in unprotected sexual intercourse compared with peers from families that reported no or low levels of family rejection. Latino men reported the highest number of negative family reactions to their sexual orientation in adolescence. This study establishes a clear link between specific parental and caregiver rejecting behaviors and negative health problems in young lesbian, gay, and bisexual adults. Providers who serve this population should assess and help educate families about the impact of rejecting behaviors. Counseling families, providing anticipatory guidance, and referring families for counseling and support can help make a critical difference in helping decrease risk and increasing well-being for lesbian, gay, and bisexual youth.
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              HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: implications for public health intervention.

              This study described HIV prevalence, risk behaviors, health care use, and mental health status of male-to-female and female-to-male transgender persons and determined factors associated with HIV. We recruited transgender persons through targeted sampling, respondent-driven sampling, and agency referrals; 392 male-to-female and 123 female-to-male transgender persons were interviewed and tested for HIV. HIV prevalence among male-to-female transgender persons was 35%. African American race (adjusted odds ratio [OR] = 5.81; 95% confidence interval [CI] = 2.82, 11.96), a history of injection drug use (OR = 2.69; 95% CI = 1.56, 4.62), multiple sex partners (adjusted OR = 2.64; 95% CI = 1.50, 4.62), and low education (adjusted OR = 2.08; 95% CI = 1.17, 3.68) were independently associated with HIV. Among female-to-male transgender persons, HIV prevalence (2%) and risk behaviors were much lower. Most male-to-female (78%) and female-to-male (83%) transgender persons had seen a medical provider in the past 6 months. Sixty-two percent of the male-to-female and 55% of the female-to-male transgender persons were depressed; 32% of each population had attempted suicide. High HIV prevalence suggests an urgent need for risk reduction interventions for male-to-female transgender persons. Recent contact with medical providers was observed, suggesting that medical providers could provide an important link to needed prevention, health, and social services.
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                Author and article information

                Journal
                J Homosex
                J Homosex
                wjhm
                Journal of Homosexuality
                Taylor & Francis
                0091-8369
                1540-3602
                4 January 2011
                January 2011
                : 58
                : 1
                : 10-51
                Affiliations
                [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@ 123456afsp.org
                Article
                10.1080/00918369.2011.534038
                3662085
                21213174
                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.

                Categories
                Research Article

                Sexual medicine

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

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