Abstract
Sexual and gender minorities experience an elevated burden of suicidality compared with the general population. Still, little is known about that burden and the factors generating it in the context of low- and middle-income countries. The present study assessed the prevalence of suicidal ideation, planned suicide, and attempted suicide among men who have sex with men (MSM) and transgender people (TG) in Nepal, and examined the association of perceived discrimination on the basis of sexual orientation with suicidal ideation and with attempted suicide. Data were obtained from a surveillance survey among MSM and TG in Nepal in 2012. A sample of 400 MSM and TG, recruited using respondent-driven sampling, completed a structured face-to-face interview. Throughout their lifetime, 26.8% of the participants had experienced suicidal ideation, 12.0% had made a suicide plan, and 9.0% had attempted suicide. In particular, more TG than MSM had experienced suicidal ideation (39.8% vs. 21.3%), had made a suicide plan (19.5% vs. 8.9%), and had attempted suicide (15.3% vs. 6.4%). Overall, the odds of having experienced suicidal ideation was significantly higher among the 38.3% of participants who had perceived discrimination based on their sexual orientation (AOR: 3.17; 95% CI: 1.83–5.48). Moreover, the odds of suicidal ideation was significantly higher as the extent of perceived discrimination increased (AOR: 1.35; 95% CI: 1.15–1.60). However, the odds of attempted suicide was not significantly associated with perceived discrimination (AOR: 1.40; 95% CI: 0.62–3.15). The findings highlight perceived discrimination as an independent risk factor for suicidal ideation. Future suicide prevention programs should target sexual and gender minorities and include elements focusing on discrimination.
Highlights
Sexual and gender minorities experience numerous health disparities compared with the general population
The extent to which these findings can be transferred to sexual and gender minorities in low- and middleincome countries remains unknown: while 75% of all global suicides occur in low-and middleincome countries [14], almost all related research has been conducted in high-income countries [15]. To address these gaps in our knowledge, in the present study we examined the lifetime prevalence of suicidal ideation, planned suicide and attempted suicide among men who have sex with men (MSM) and male to female transgender people (TG) in Nepal, a low-income country located in the WHO region of South-East Asia
We explored the association between perceived discrimination on the basis of sexual orientation and suicidality
Summary
Sexual and gender minorities experience numerous health disparities compared with the general population. The wide range of health disparities is well documented, large gaps still exist in our understanding of their formation, and of the contextual factors that influence sexual and gender minorities over their life course [1]. In the past decade there were at least ten times fewer suicide and suicidality related citations compared with HIV related citations in the scientific literature on health among sexual and gender minorities [3]. This indicates the substantial need to scale up research on suicidality among this particular population
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