Suicide Among LGBT People: Review and Recommendations

There is a long report in the most recent Journal of Homosexuality on suicide, suicidal behavior and suicidal ideation among lesbian, gay, bisexual and trans people. The report starts by defining the sexual orientation and gender identity minorities described in thsi paper. The authors are aware that gender identity and sexual orientation both run on a fluid continuum, and that hence LGBT is not the right term. However, they use it anyway because it is used overall in the research community. That makes me wonder whether no-one wants to change the terminology used in research papers to more accurately reflect the reality of sexual orientation and gender identity minorities.

The authors follow by examining the rate of suicide, suicide attempts and suicidal ideation among LGB people. It is thought that gay and bisexual males are more likely to commit suicide or to attempt suicide than heterosexual males, whereas lesbian and bisexual females are more likely to have suicidal ideation than straight women do. The fact that gay or bisexual men are more likely to attempt suicide, contrasts with findings in the genral population, where women are more likely to attempt suicide. As for age at suicide attempt, this varies across studies. Some studies say that adolescents are most likely to attempt suicide, while others report that suicide attempts are more evenly distributed over the lifespan. A potential explanation may be that suicide attempts are more linked to the age at which LGB people start to identify and disclose their sexual orientation than to chronological age.

Mental illness is one of the most significant risk factors for suicide attempts in the general population. Indeed, LGB people, particularly adolescents and bisexual men, are more likely to have a mental disorder than straight people. This, however, does not explain fully why LGB people are more likely to attempt suicide: when controlling for mental disorders, one study found that LGB people were still two to three times more likely to attempt suicide than straight people.

Another risk factor for suicde attempts and mental disorders is discrimination. Several studies found a relationship between parental rejection and school bullying or violence because of sexual orientation and suicide attempts among LGB adolescents. IN LGB adults, experiences with discrimination and harrassment were also correlated to suicde attempt. There was, however, an interesting racial disparity between Whites on the one hand and Latinos and Blacks on the other, where White LGB people were more likely to have mental disorders, while Black and especially Latino people were more likely to attempt suicide. The explanation for this might be that Latino/Black people are more likely to attempt suicide because of social stressors rather than mental illness.

Instituttional discrimination is also a factor in the increased rate of mental illness among LGB people. In states which do not provide protections from discrimination based on sexual orientation or that have constitutional amendments prohibiting gay marriage, there are elevated rates of mental disorders as compared to those in states with more equality. Poor health insurance, for example due to the lack of coverage for same-sex partners, may also lead to elevated rates of untreated mental illness.

Lastly, HIV/AIDS is also a possible risk factor for suicde attempts, but data on this are inconclusive. It is suggested that substance abuse and other mental disorders may be more relevant predictors of suicide attempt among HIV-positive men than is the virus itself. However, rates of suicide attempts among HIV-positive persons have decreased since there are better antiretroviral treatments available.

There are several protective factors against suicide among LGB people. Among adolescents, family connectedness, support from other adults, and school safety protect against suicide attempts. In adults, connections to an LGB community help. It is also suggested that intimate relationships protect against suicide attempts, but that has not been studied.

The authors go on to discuss suicide risk among transgendered people. One study reports an alarming 80-fold increase in suicide deaths among trans individuals as compared to the general popluation. Another study found that trans people were more likely than any comparison group – heterosexuals, gay and lesbian people, and cis people matched on age, relationship status and several other variables -, except for lesbian females, to attempt suicide. Several risk factors are being reported among trans people for suicde attempts, among them mental disorders and discrimination, particularly rejection by parents in adolescence and on-the-job discriminination and harrassment in adults.

The researchers make many recommendations to improve mental health services, suicide prevention services, and public policies relevant to LGBT individuals. With regard to mental health programs, they encourage furthering of LGBT-specific programs and interventions in mental health and substance abuse services. There areseveral guides to LGBT care, but none provide specific guidelines on suicide prvention. It is recommended, lastly, that DSM-V be revised to make it clear that sexual and gender identity minorities are not per se mentally ill.

There are very few suicide prevention programsspecifically for LGBT people. The only one mentioned in this study is the Trevor Project. It is recommended that interventions, education and awareness related to suicide among LGBT people be increased.

Lastly, several public policy changes are recommended. It is recommended that LGBT groups and allies advocate for:

• Better access to health and mental health services through non-discriminiation policies;
  
• Explicit protection against school violence and bullying based on sexual orientation or gender identity;
  
• Improvements in discriminatory legislation related to factors contributing to suicde or mental health problems;
  
• Inclusion of sexual orientation and gender identity questions on surveys relevant to health and mental health.
  

The authors conclude that, although many questions related to suicide among LGBT populations are as yet unanswered, there appears to be little doubt that a broad national effort will be needed to encourage and fund the needed research, raise awareness of the problem among LGBT and suicide prevention leaders, and develop
the interventions, prevention strategies, and policy changes through which suicidal behavior and suicide risk in LGBT populations can be reduced./P>

Reference

Haas AP, Eliason M, Mays VM, Mathy RM, Cochran SD, D’Augelli AR, Silverman MM, Fisher PW, Hughes T, Rosario M, Russell ST, Malley E, Reed J, Litts DA, Haller E, Sell RL, Remafedi G, Bradford J, Beautrais AL, Brown GK, Diamond GM, Friedman MS, Garofalo R, Turner MS, Hollibaugh A, Clayton PJ (2011), Suicide and Suicide Risk in Lesbian, Gay, Bisexual, and Transgender Populations: Review and Recommendations. Journal of Homosexuality, 58(1):10-51. DOI: 10.1080/00918369.2011.534038.

Read Full Post »

Sexual Orientation and Gender Identity in People with Developmental Disabilities

Sexuality & Disability is a journal dedicated to the psychological study of sexuality and gender identity in persons with disabilities. In the most recent issue, a study appeared that aimed to examine the presence of sexual orientation and gender identity in people with developmental disabilities. Only a small group of individuals, 32, were surveyed, and it was not a representative group, since all participants had been referred to a clinic for behavioral or emotional problems. However, the study authors still say that their findings may provide insight that can be useful for further research into the sexual and gender identities of people with developmental disabilities.

The main findings of the study were that over 80% of study participants were heterosexual, followed by about 9% bisexual or questioning, and 3% homosexual. There were some discrepancies between the three different measures of sexual orientation – self-reporting, a questionnaire about current sexual fantasiess and desires, and a sexual history questionnaire. Specifically, there was a significant discrepancy between self-identification and current desires on the one hand and sexual history on the other. To me, this could indicate that people had established their sexual identity through experimenting.

Another interesting finding was the high prevalence of gender identity disorder among this group. Four of the 32 people surveyed, could be diagnosed with GID. Two of them were assigned female at birth, which the authors say signals that developmentally disabled persons may be more likely to be trans. Well, in fact, the authors say that GID may be more common among developmentally disabled people, as if that is something different from being trans. I am not sure whether that is Kenneth Zucker’s cissexism or simply the way medical journals word such things.

Of concern to the authors are factors that might influence sexual orientation in people with developmental disabilities, such as poor sex education and abuse. For example, on the sexual history questionnaire, individuals may have included abusive relationships when identifying their sexual encounters. Of course, it is important that abuse be identified and that people be educated adequately, but I am a little concerned about the possibility that it could be a way to influence people’s sexual self-identification, which would be erasing part of their identitities.

Reference

Bedard C, Lan Zhang H, Zucker KJ (2010), Gender Identity and Sexual Orientation in People with Developmental Disabilities. Sexuality & Disability, 28(3):165-175. DOI: 10.1007/s11195-010-9155-7.

Read Full Post »

Bad Advice on When to Out a Trans Person

In the July 5 edition of The New York Times’ The Ethicist, Randy Cohen gets the following question:

I am a straight woman, and I was set up on a date with a man. We got along well initially, but I grew concerned about how evasive he was about his past. I did some sophisticated checking online – I do research professionally – and discovered that he is a female-to-male transgendered individual. I then ended our relationship. He and I live in Orthodox Jewish communities.  (I believe he converted shortly after he became a man.) I think he continues to date women within our group. Should I urge our rabbi to out this person? NAME WITHHELD, N.Y.

Mr. Cohen’s response begins:

There are two questions here: What must close companions reveal to each other?And what may they reveal about each other to outsiders?

Basically, then, he says that the trans man should’ve outed himself before their first kiss, and that it is fine if [name withheld] discusses this incident with her friends, but that she should not urge the rabbi to out the trans man. It is not said whether she can out the trans man to the rabbi himself.

Well, first off, being trans is compared to having an STD, which is already transphobic. Secondly, would you disclose your STD status before your first kiss? I wouldn’t. Anyone can have an STD, whether they are aware of it or not, so the safest course of action here would likely be to get tested if or when the couple becomes intimate enough for there to be a potential risk of transmission.

With regard to being trans, the issue is even less of a potential partner’s business, because it doesn’t put the partner at risk. It would be something I’d want to know about my partner if we were in a serious relationship in which we were confident enough to disclose important details of our past, but it would be a matter of establishing an emotional bond. If my partner didn’t feel comfortable sharing such a sensitive issue with me yet, and I was committed to the relationship, I would give them the room not to disclose. Of course, I’d eventually find out if we were going to be sexually active, but I am assuming here that a trans person would not be sexually active in a relationship without being comfortable that their transness were accepted. Correct me if I’m wrong here.

Cohen goes on to advise that [name withheld] is free to discuss the incident with her friends. Does he mean that she can out her former partner to her friends? I hope not. In a society that is dangerous to trans people, outing a trans person can be that person’s death sentence. No mattter how accepting you think your friends are of trans people, you can never be sure. Besides, judging from the letter, it seems [name withheld] wanted to warn her friends.

One last thing I noticed in the letter, which I want to comment on, is [name withheld]‘s doing an online backgroudn check on her date. This, I would say, is pretty unethical. Of course, in my own case, my relationship started online, so my boyfriend had been able to do a background check on me before we even dated, but when you get to know each other via other venues, it is unethical to use lack of information about a person’s past as an excuse to google them. Again, there was probably a good reason they were hiding this information from you for now.

Read Full Post »

Thoughts on Requirements for Legal Sex Change

As Helen G pointed out on Questioning Transphobia, in the United States, sexual reassignment surgery is no longer required for a sex change on one’s passport. The reasoning behind this change of policy is that some trans travelers have been at risk in countries where changing sex is dangerous. People can also get a temporary passport when they are in the process of transitioning.

This has me thinking about the Dutch situation, where there is no difference between sex on travel documents and on any other legal document. In the Netherlands, one’s legal sex can be changed only if one has completed sexual reassignment surgery, unless it would be medically or psychologically necessary not to perform this surgery. Since non-op transgenderism is hardly recognized in the Netherlands, it’s going to be very hard to get to this status, and pre-op trans people are of course left with their assigned sex on legal documents.

When I learned about the lgal requirements for a sex change on one’s official documents in the Netherlands through my health law handbook, another thing I noticed, was that, in the Netherlands, it is required that one be sterilized before applying for a legal sex change. There is no medical or psychological exception to this requirement. The reasoning, according to the handbook, is that it would be harmful to a future child to be born to a post-transition trans person. I fail to understand this logic, and no arguments were given. It’s probably that society has decided that only those we call “female” can birth children, and, for this reason, a child is very likely to be harmed psychologically by the idea of being born out of a male body. However, isn’t the correct reasoning here that they are harmed by the incogruence between their parent’s body and society’s current norms? In that case, one may question which of these is wrong, in fact. I tend to consider society’s norm of body policing as wrong, but, apparently, the majority thinks differently.

Read Full Post »

Spain: Cis Women Imprison, Torture, Murder Trans Man

This is beyond sickening. I’ve read quite a few horrific reports of abuse of trans people, and people in general, but this is worse than antyhing I’ve read before. I could hardly finish reading the story. In Spain, two cis women imprisoned a trans man, Roberto González Onrubia, for nine months, tortured him, and eventually murdered him, in his own home. They got access to the home by making use of Mr. Onrubia’s generosity, since they were formerly living in impoverished circumstances. Apparently, they felt the need to take advantage of the man’s kindness. We do not know for certain that transphobia was involved, but it is most likely, given that the man’s gender identity was violated. Fortunately, both women were sentenced to eighteen years in prison. Helen G over at Bird of Paradox has the full story. Note that the description of what happened to Mr. Onrubia is very graphic.

Read Full Post »