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LGB Review of Mental Disorder, Suicide and Self Harm December 20, 2009

Posted by Geekgirl in Legal and Policies, medical, psychology, social.
Tags: , , ,

A large review of many studies. Since this article is available through  Open Access I have attached the pdf. suicide

For those of you that like to skim and get to the punchline, I have highlighted important information and conclusions in blue.

A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people

Michael King*1,2, Joanna Semlyen1, Sharon See Tai3, Helen Killaspy1,2,David Osborn1,2, Dmitri Popelyuk1 and Irwin Nazareth3,4Address:

1Department of Mental Health Sciences, Royal Free and University College Medical School, Hampstead Campus, University CollegeLondon, London, NW3 2PF, UK, 2Camden and Islington Mental Health and Social Care Trust, St Pancras Hospital, London, NW1, UK,3Department of Primary Care and Population Sciences, Royal Free and University College Medical School, Hampstead Campus, University CollegeLondon, London, NW3 2PF, UK and 4General Practice Research Framework, Medical Research Council, 158-60 North Gower Street, London, NW12ND, UKEmail: Michael King* – m.king@medsch.ucl.ac.uk; Joanna Semlyen – josemlyen@hotmail.com; Sharon See Tai – s.seetai@pcps.ucl.ac.uk; Helen Killaspy – h.killaspy@medsch.ucl.ac.uk; David Osborn – d.osborn@medsch.ucl.ac.uk; Dmitri Popelyuk – d_popelyuk@hotmail.com;Irwin Nazareth – i.nazareth@pcps.ucl.ac.uk* Corresponding author



Lesbian, gay and bisexual (LGB) people may be at higher risk of mental disorders than heterosexual people.


We conducted a systematic review and meta-analysis of the prevalence of mental disorder, substance misuse, suicide, suicidal ideation and deliberate self harm in LGB people. We searched Medline, Embase, PsycInfo, Cinahl, the Cochrane Library Database, the Web of Knowledge, the Applied Social Sciences Index and Abstracts, the International Bibliography of the Social Sciences, Sociological Abstracts, the Campbell Collaboration and grey literature databases forarticles published January 1966 to April 2005. We also used Google and Google Scholar and contacted authors where necessary. We searched all terms related to homosexual, lesbian and bisexual people and all terms related to mental disorders, suicide, and deliberate self harm. We included papers on population based studies which contained concurrent heterosexual comparison groups and valid definition of sexual orientation and mental health outcomes.


Of 13706 papers identified, 476 were initially selected and 28 (25 studies) met inclusion criteria. Only one study met all our four quality criteria and seven met three of these criteria.

Data was extracted on 214,344 heterosexual and11,971 non heterosexual people.

Meta-analyses revealed a two fold excess in suicide attempts in lesbian, gay and bisexualpeople [pooled risk ratio for lifetime risk 2.47 . The risk for depression and anxiety disorders (over aperiod of 12 months or a lifetime) on meta-analyses were at least 1.5 times higher in lesbian, gay and bisexual people  and alcohol and other substance dependence over 12 months was also 1.5 times higher.

Results were similar in both sexes but meta analyses revealed that lesbian and bisexual women were particularly at risk of substance dependence , while lifetime prevalence of suicide attempt was especially high in gay and bisexual men.


LGB people are at higher risk of mental disorder, suicidal ideation, substance misuse, and deliberate self harm than heterosexual people.

Published: 18 August 2008BMC Psychiatry 2008.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.BMC Psychiatry 2008, 8:70 http://www.biomedcentral.com/1471

Explanations for our findings

Our study aimed to determine whether there was unequivocal evidence for a preponderance of mental health problems in LGB people relative to heterosexuals. Thus,circumspection is required when discussing possible mechanisms which generate them [120].

Although our evidence does not specify the nature of such mechanisms,there is no evidence to suggest that homosexuality is itself a disorder that is thereby subject to a higher co-morbiditythan is found in heterosexuals [120].

This review was strictly limited to documenting whether or not there was an excess of mental health problems in LGB people. It will take other, prospective research to investigate the components of this vulnerability. Unfortunately prospective studies were unusual among the 25 reviewed here and thus we cannot say much with certainty about the risk factors for mental disorder in LGB people.

Nevertheless, it is likely that the social hostility, stigma and discrimination that most LGB people experience is at least part of the reason for the higher rates of psychological morbidity observed. This may be aggravated by easy access to alcohol and drugs in gay venues that LGB people frequent both to find the company of others who will accept them less criticallyand to meet potential partners. However, why LB women are at greater risk of substance misuse than GB men is not clear as most LGB commercial venues provide alcohol.

Implications of our findings

It is of considerable concern that sexual minorities such as LGB people suffer so many disadvantages in terms of mental health. Our findings need consideration in planning public health and clinical services, as well as in terms of international human rights. Although we cannot report on whether or not LGB people are at greater risk than heterosexuals for completed suicide, the elevated risks for all forms of mental disorder, DSH and substance misuse would suggest very strongly that this is the case.

Thus, national suicide strategies need to include LGB people as a high risk group now rather than await more evidence on suicide. The hidden nature of sexual orientation makes it very unlikely that we shall be able to show definitely in post-mortem psychological studies that LGB are over-represented among suicide victims.

Conclusion and further research

Besides more qualitative and case-control research, we need prospective studies as these are most likely to reveal the mechanisms involved. Although, in this review we identified four cohorts [15,18,33,34] only one collected prospective data on suicidal risk in lesbian, gay and bisexual people [34]. Prospective studies, however, are difficult to undertake as many people cannot or will not identify themselves as LGB until late adolescence or even young adulthood when the emotional damage may already have occurred. Nevertheless, a cohort of young LGB people who are followed through as they complete education and career training and start relationships and families, would begin to address this difficult issue.

We also need to address the complexities of defining sexual orientation.Most modern conceptions of sexual orientation consider personal identification, sexual behaviour and sexual fantasy[121]. Thus, we chose these parameters as the most pragmatic and commonly used definitions for this review.However, we need more detailed study of the development of sexuality across the spectrum of partner preference, its stability over time and its relationship to other preferences and behaviour.

Competing interests

The authors declare that they have no competing interests



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