Suicide Death among Sexual and Gender Minorities

DR. MICHAEL STALEY is the Suicide Prevention Research Coordinator in the Utah Office of Medical Examiner. He collects and analyzes data on suicides in Utah to better understand risk factors and assist other agencies with improving intervention programs.

It’s such an honor to be here with you today—thank you. I am going to talk about suicide, and specifically suicide death today. Suicide has adversely affected many of you in this room—perhaps it has turned your life upside down. You don’t need my permission, but I’m going to give it to you anyway: please put yourself first and step out if that’s the right decision for you.

I’m a sociologist—the red-headed step-child in the field of social sciences—and a functional epidemiologist, so I tend to approach this problem from a different angle than my peers who I share the platform with today. 

The first step to being a good sociologist is to locate yourself in your social world, and it’s important for me to tell you about some experiences that have shaped my worldview. I’m an openly gay man from a mixed-religious household: my mother’s side of the family are Irish Catholics and my dad’s side of the family are devout Latter-days Saints. Ultimately, my parents chose to be spiritual and leave the religion up to my wonderful grandmothers. Whichever grandma showed up on Sunday morning first determined where my brother and I would go to church. Like any normal middle-schooler, I joined a Pentecostal worship band in 8th grade and stayed there until my freshman year of college when I fell in love with Eucharist and loud organ music, and returned to the Catholic Church. Years later, I came out as gay to a priest, Fr. Peoples. I expected some kind of qualified compassion in response. There was no, “but” or “if” in his reply: “Michael, it sounds like you have an incredible capacity to love, so you should do that.” For the past 10 years, I have been fed and challenged and wonderfully embraced in the Episcopal Church. My partner and I will be married by two Episcopal priests next summer, one lesbian, one straight. 

Hindsight is 20/20, and looking back, I can see myself so desperately wanting to escape or bury who I really was and am. I tell you all of this because I want you to know that I see you, and though I cannot know your pain, specifically, I know what it’s like to crush on a guy and instantly be overcome with shame. I know what it’s like to harbor a secret so big that it results in a double consciousness, a self that says: “you are sinful and a disgrace.” Even though faith is part of the reason I felt that way those years ago, faith is also the reason I am here today and the reason I can do the kind of work I do. My faith and sexuality co-exist and they give me a perspective as a scientist that I consider an asset. Psalm 139 says, “For you yourself created my inmost parts; you knit me together in my mother’s womb. I will thank you because I am marvelously made; your works are wonderful, and I know it well.” 

I have a very complicated, nuanced message today. I’m speaking in generalities, the results of aggregate data. That might mean that your experience, or the experience of someone you know, or you lost to suicide may sound different than what I tell you today. That does not mean your experience or the experience of someone close to you is invalid. You do not need data to validate your experience, neither does your experience invalidate this data. 

When we speak of suicide, we’re really talking about three different groups of people: people who think about suicide, or “ideators,” people who attempt suicide, and people who die by suicide. In the U.S. about 4.3 percent of the general population seriously thought about suicide in the previous year. In the U.S., there are about 25 non-fatal suicide attempts for every suicide death. What’s important here, is that people who seriously think about suicide, people who attempt suicide, and people who die by suicide are different groups of people, with some overlap. 

When you look at attempters and individuals who have died by suicide, these differences come into focus: about three females attempt suicide for every one male, but the opposite is true for suicide death: one female dies for every three males. 

When you examine most research on suicide carefully, you’ll notice that individuals in these studies are people who thought about or attempted suicide, not people who died by suicide. The reason for this disparity in research may be obvious: people who have died by suicide cannot answer surveys or tell their stories. Consequently, learning these stories—which I believe to be critically important—requires unique, intensive, and prolonged research methodologies, most of which exceed grant cycles. In Utah, I’m happy to say that we’re doing this kind of research.

I want to shift gears and narrow our conversation to sexual orientation, gender identity, religion, and suicide. Like I said, this is a complicated topic. Sexual orientation and gender identity are two broad, related, fluid, and intertwined categories. 

Let’s talk about suicide attempts. Most of what we know about LGBTQ+ suicide comes almost entirely from those who think about suicide or who attempt suicide, not from those who die by suicide. It has been very well established that LGBTQ+ people think about and attempt suicide at much higher rates than their heterosexual peers. These findings come from reputable, population based research. Specifically, LGB high schoolers attempt suicide at a rate two to seven times that of their peers. By gender, sexual orientation was a stronger predictor of suicide for young men than young women. That’s especially interesting because we know the opposite to be true in the general population: that women attempt suicide more often than men. In a New Zealand cohort study, individuals who identified as LGB at age 21 were six times more likely to attempt suicide than their heterosexual peers; those odds increased when the cohort was interviewed again at age 25. A study of urban gay men in the U.S. found that 12 percent of their sample had attempted suicide—that’s three times the rate of males in the general U.S. population.

Transgender and gender non-conforming individuals are, not surprisingly, at higher risk of suicide ideation and attempts as well, although the research on gender identity is severely lacking, even compared to the research on sexual orientation. 

A few older studies estimate that between 19 and 25 percent of trans* folk have attempted suicide. An American Foundation for Suicide Prevention and Williams Institute study, which used a convenience sample of 6,456 self-identified trans* and gender non-conforming individuals found that 46 percent of trans women and 42 percent of trans men had attempted suicide. Among those who reported suffering physical or sexual violence at school or work, or those who were victimized or discriminated against by law enforcement, those numbers soared to 60 to 70 percent.

Generally speaking, suicidologists have regarded religion and especially religious participation as a protective factor to suicide attempts. Religion promotes connection, so this makes sense. But, as my colleagues point out, religion is not so cleanly a protective factor, and maybe not a protective factor at all for people who fear rejection or who are rejected by their congregations and religious leaders. A study of 21,247 college students revealed that those students who identified as LGBQ were at a high risk of suicide ideation in the past year and of having a attempt in their lifetime if they reported that religion was very important to them. Suicide ideation and attempt were only a factor when religion was ranked as very important. In other words, identifying as Catholic, Evangelical, Presbyterian, Latter-day Saint, Muslim, or what have you is not what predicted suicide, but the importance of that identity as a religious person. There are a lot of nuances to that study that I don’t have time to get into here today.

We know very little about suicide death among sexual and gender minorities. If you do not remember anything else I say today, please sticky note that last statement: we don’t know the rates of LGBTQ suicide death. Here’s what we do know.

Three psychological autopsy studies, which occurred in 1986, 1995, and 2010, respectively, each concluded that sexual minorities were not overrepresented in their samples. These findings are not generalizable to the population at large, however, and have significant limitations.

A study of demographic components in Danish vital records showed that men who were in domestic partnerships with other men were eight times more likely to die by suicide than men who were in heterosexual marriages, and twice as likely as men who had never been married. Women in domestic partnerships with other women showed no increase in suicide death compared to women who were in heterosexual marriages. This study is limited, however, because it only included LGB people who were currently or formerly in a legally registered domestic partnership. 

There are even fewer studies of trans* and gender non-conforming people and suicide death. One longitudinal cohort study of 1,000 people documented the suicide death of 12 trans* identified persons, which, expressed in terms of rate, is about 800 per 100,000; consider that the current rate of suicide in the U.S. is about 14 per 100,000. That rate is deeply unsettling. But here again, this is one study that cannot be generalized. Despite a dearth of research on trans* people and suicidality, I think we have plenty of evidence to claim that trans* and gender non-conforming community are affected by suicide at alarmingly high levels. We need more research, but we shouldn’t wait around for that research to be published before we act. 

The National Violent Death Reporting System, or NVDRS is the only system that includes all suicide deaths in the United States. NVDRS includes several variables that attempt to measure sexual orientation and gender identity. The problem, until recently, has been sexual orientation or gender identity have not been a routine part of death investigation. So, most of the time, sexual orientation and gender identity components are left unknown in NVDRS. 

Just this past year, one of the first journal articles on sexual orientation and gender identity was released using data from NVDRS. Researchers reported that, of the 123,289 suicide deaths between 2003 through 2014, 621, or a half of a percent identified as LGBTQ. Frankly, I was surprised that this study was published. A careful read of the same study will reveal that the sexual orientation and/or gender identity for 119,394 individuals were unknown and referred to as “not LGBT.” You don’t need a PhD to conclude that when 97, almost 98% of the data is missing, the study is rather weak. These findings are problematic. 

In a Utah-specific study of 10 to 17 year-olds who died by suicide between 2011 and 2015, which also used NVDRS, the sexual orientation of 40 decedents was determined out of the total 147. Of the 40, 6, or 15 percent, were identified as LGBQ. If the estimate of LGBTQ people in the general population is between 7 and 10 percent, then that means that LGBTQ people are at a significantly higher risk of suicide death than their peers. However, the sexual orientation for 73 percent of young people in that study could not be determined. Drawing any empirical conclusions from this study is also shaky.

So, you see, things are complicated. And, really, they boil down to the fact that, if we want answers about sexual orientation and gender identity among those who die by suicide, we have to ask about sexual orientation and gender identity. Utah is currently the only state-wide death investigation system that is asking these questions for every person who dies by suicide. We started about ten months ago, so we’re not ready to release findings, but I’m very proud that we’re leading the nation on this issue. Other states and the CDC are looking to Utah as a model for conducting public health investigations in other medicolegal death jurisdictions.

We’re leaning into these answers. This is not an easy or a fast process, but we’re pushing the limits as we have not done before. I take heart in knowing that in the not too distant future, we’ll have better information so we can inform and target our prevention efforts more effectively. We deserve answers.

Earlier, I mentioned that what I share with you today does not invalidate your experience. I know many of you have lost someone you loved beyond measure to suicide. I’m so sorry and I wish their story and your story were different. I want you to know that you’re not alone, and that what I’m about to say still does not invalidate your experience.

I got a frantic phone call from a colleague during general conference weekend in Spring of 2018. He told me five young Latter-day Saints had taken their lives. Five youth deaths this chronologically close together is extremely alarming, no matter the circumstances. Yet, in reality there were no deaths of anyone under the age of 35—no homicides, accidents, natural, undetermined, or suicide. Meanwhile, on Facebook, this story was picking up steam. Fortunately, someone intervened—something I legally cannot do—and asked for names, or at least some kind of proof of these deaths. That proof could not be produced, because no such deaths had occurred. There is the chance that these deaths occurred out of Utah, but I would have expected that to be evident somewhere in the story. This post, this story, made me angry. These false reports are damaging lies.

I often ask audiences what proportion of all suicide deaths in Utah are individuals who are age 10 to 17. I hear 30! 40! 60 percent! frequently. The real number is 6 percent. I’m not in the business of measuring tragedy, and I know deaths of 10 to 17 year-olds have effects that ripple through families, churches, schools and communities. Reading stories about teen suicide in Utah, I can understand why some may think this number is so high. The largest demographic of Utahans who die by suicide are between the ages of 25 and 45 and are white men. This example illustrates that what seems to be true and what is actually true may be different from one another.

There is so much fear when we talk about suicide, especially suicide among LGBTQ youth. Fear is often motivates us to move in the wrong direction. Sexual and gender minority status may be a significant factor in explaining Utah’s high suicide rate, or it may not. We cannot afford to get this wrong. I can tell you that the pain of a mother who lost her straight son to suicide is a lot like the suffering that the mother of a lesbian daughter feels. Ending suicide is the goal here, and both of these mothers deserve to know and believe that is our central mission. Anna Madrigal, the trans* woman matriarch in Armistead Maupin’s Tales of the City series says it best, “There is only the truth.”

We have enough information to do something now: get training, reduce access to lethal means, work to establish GSAs in schools, inform your Church leadership on things they can do protect queer people in your congregation. 

It is right that we harness our experiences in ways that motivate us to take action. Lives are at stake. It is also right to keep our minds open to whatever we may learn about suicide moving forward.

As I wrap up, I want to emphasize two points: it’s critical that we continue to engage in this conversation and make others aware that discrimination at all levels may have life-and-death consequences, especially for our LGBTQ siblings. It’s also critical that our message be hopeful, maybe even inspirational. When we say that LGBTQ kids are killing themselves left and right because of rejection from family or church or whatever the case may be, we’re inadvertently normalizing that behavior—we’re normalizing suicide. In other words, an LGBTQ person, especially a young LGBTQ person may recognize that the problems and adversities they face are similar or the same to some other person who died by suicide. For that person, suicide may seem like a feasible, realistic option. Keeping the message hopeful tells LGBTQ people and anyone else struggling with suicidal thoughts that living is a better option—that it gets better.

Here’s something that gives me a great deal of hope. Ask me to give you a list of people I know who identify as LGBTQ and who are alive, even happy and well, and then ask me for a count of the people I know who are LGBTQ and who have died by suicide and I am absolutely confident that the first list is much, much longer than the latter. QUEER FRAGILITY IS A MYTH. LGBTQ people face challenges and adversity that their peers do not, and, even in the face of this adversity, queer folks are so strong! It’s important to that all of our stories be told, the bad and the good, but let’s make sure to tell stories of hope to LGBTQ people who are struggling, and tell them often. I am surely confident, hope will carry the day.