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Suicide Risk and Sexual Orientation: A Critical Review

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Abstract

Many studies have reported higher rates of suicide attempts among sexual minority individuals compared with their heterosexual counterparts. For suicides, however, it has been argued that there is no sexual orientation risk difference, based on the results of psychological autopsy studies. The purpose of this article was to clarify the reasons for the seemingly discrepant findings for suicide attempts and suicides. First, we reviewed studies that investigated if the increased suicide attempt risk of sexual minorities resulted from biased self-reports or less rigorous assessments of suicide attempts. Second, we reanalyzed the only two available case–control autopsy studies and challenge their original “no difference” conclusion by pointing out problems with the interpretation of significance tests and by applying Bayesian statistics and meta-analytical procedures. Third, we reviewed register based and clinical studies on the association of suicides and sexual orientation. We conclude that studies of both suicide attempts and suicides do, in fact, point to an increased suicide risk among sexual minorities, thus solving the discrepancy. We also discuss methodological challenges inherent in research on sexual minorities and potential ethical issues. The arguments in this article are necessary to judge the weight of the evidence and how the evidence might be translated into practice.

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Notes

  1. Many of the cited studies in this paper would not have been located via a systematic literature search, basically because “homosexuality” or related terms (sexual orientation, bisexuality, gay, lesbian, men who have sex with men etc.) do not appear in the title or the abstract (e.g., Beskow, 1979; Motto, Heilbron, & Juster, 1985; Qin, Agerbo, & Mortensen, 2003; Rothberg, Fagan, & Shaw, 1990).

  2. Fisher’s exact test has been reported to be unnecessarily conservative for the case of two independent binomial distributions (e.g., Lyderson, Fagerland, & Laake, 2009). The application of more powerful tests, such as Barnard’s unconditional test, the mid-p Value, or the Fisher-Boschloo test nearly always produce statistically significant group differences in the Renaud et al. (2010) study (one-sided or two-sided testing), and in most cases of the Shaffer et al. (1995) study for the one-sided tests. Due to limited space, we provided this information online (Footnote 3).

  3. Information can be obtained upon request from the authors. The original submission was accompanied with an additional file that included the R- and BUGS-codes, results for unconditional tests, and further information. It can be retrieved from http://www.pmu.ac.at/de/1367.htm, http://www.youth-suicide.com/, or from http://people.ucalgary.ca/~ramsay/adolescent-gay-lesbian-suicide-risk.htm. The latter webpage includes an in depth analysis of the statistical problems that we address in this article.

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Acknowledgments

We thank Lu Tian, Simon Jackman, and Antonio Martín-Andrés for helping us with statistical issues and we also thank Anthony D’Augelli for his feedback on a draft of the article.

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Authors and Affiliations

  1. Suicide Prevention Research Program, Institute of Public Health, Paracelsus Private Medical University, Salzburg, Austria

    Martin Plöderl, Karl Kralovec, Clemens Fartacek & Reinhold Fartacek

  2. Sonderauftrag für Suizidprävention, Christian-Doppler-Klinik, Ignaz-Harrer Str. 79, 5020, Salzburg, Austria

    Martin Plöderl, Karl Kralovec, Clemens Fartacek & Reinhold Fartacek

  3. University Institute of Clinical Psychology, Christian Doppler Clinic, Salzburg, Austria

    Martin Plöderl & Clemens Fartacek

  4. Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands

    Eric-Jan Wagenmakers

  5. Faculty of Social Work University of Calgary, Calgary, AB, Canada

    Pierre Tremblay & Richard Ramsay

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  1. Martin Plöderl
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Plöderl, M., Wagenmakers, EJ., Tremblay, P. et al. Suicide Risk and Sexual Orientation: A Critical Review. Arch Sex Behav 42, 715–727 (2013). https://doi.org/10.1007/s10508-012-0056-y

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  • DOI: https://doi.org/10.1007/s10508-012-0056-y

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