Untethered lives: Barriers to societal integration as predictors of the sexual orientation disparity in suicidality

Abstract

Abstract Background Despite increasing legal protections and supportive attitudes toward sexual minorities (e.g., those who identify as lesbian, gay, and bisexual [LGB]) in recent decades, suicidality remains more common among this population than among heterosexuals. While barriers to societal integration have been widely theorized as determinants of suicidality for the general population, they have not been comprehensively explored to explain the sexual orientation disparity in suicidality and/or compared to more established contributors. Methods Data come from the cross-sectional Swedish National Public Health Survey, which randomly collected data from individuals (16-84 years of age) annually from 2010 to 2015 (1,281 (2.2%) self-identified as LGB). Analyses examined sexual orientation differences in suicidality (i.e., past-12-month ideation and attempts), and explored the role of barriers to societal integration (i.e., not living with a partner or children, unemployment, and lack of societal trust) in explaining this disparity over-and-above more commonly explored psychological (e.g., depression, substance use) and interpersonal (e.g., discrimination, victimization, lack of social support) suicidality risk factors. Results Compared to heterosexuals, suicidal ideation and attempts were more common among both gay men/lesbians (AORideation: 2.51; AORattempts: 4.66), and bisexuals (AORideation: 3.76; AORattempts: 6.06). Barriers to societal integration mediated the association between sexual orientation and suicidality even in models adjusting for established risk factors for suicidality. Conclusions The disproportionate barriers to societal integration that LGB individuals experience seem important contributors to the elevated risk of suicidality among sexual minorities. Preventive interventions should consider innovative ways to foster societal integration within sexual minority populations and to adjust hetero-centric social institutions to better include sexual minorities.