Many studies have found elevated levels of suicide ideation and attempts among sexual minority (homosexual and bisexual) individuals as compared to heterosexual individuals. The suicide risk difference has mainly been explained by minority stress models (MSTM), but the application of established suicidological models and testing their interrelations with the MSTM has been lacking so far. Therefore, we have contrasted two established models explaining suicide risk, the Interpersonal Psychological Theory (IPT) (Joiner, 2005) and the Clinical Model (CM) (Mann et al., 1999), with the MSTM (Meyer, 2003) in a Bavarian online-sample of 255 adult sexual minority participants and 183 heterosexual participants. The results suggested that the CM and the IPT model can well explain suicide ideation among sexual minorities according to the factors depression, hopelessness, perceived burdensomeness, and failed belongingness. The CM and the IPT were intertwined with the MSTM via internalized homophobia, social support, and early age of coming out. Early coming out was associated with an increased suicide attempt risk, perhaps through violent experiences that enhanced the capability for suicide; however, coming out likely changed to a protective factor for suicide ideation by enhanced social support and reduced internalized homophobia. These results give more insight into the development of suicide risk among sexual minority individuals and may be helpful to tailor minority-specific suicide prevention strategies.

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.

The results suggest that a group experience of regular monitored mountain hiking, organized as an add-on therapy to usual care, is associated with an improvement of hopelessness, depression, and suicide ideation in patients suffering from high-level suicide risk.