A Systematic Review and Meta-Analysis of Disparities in the Prevalence of Suicide Ideation and Attempt Among Bisexual Populations

Abstract

Sexual minorities are at increased risk of suicide; however, it is unclear whether there are within-sexual minority differences in risk across specific sexual identities-notably between bisexual and lesbian/gay subgroups. We therefore conducted a systematic review and meta-analysis to quantify associations between bisexual identity and self-reported suicide ideation and attempt and the moderation of these associations by gender/sex, age, sampling strategy, and measurement of sexuality. Abstracts and full texts were independently screened by two reviewers, resulting in a total of 46 studies that met inclusion criteria and reported 12-month or lifetime prevalence estimates for suicide ideation or attempt. A consistent gradient was observed across all four outcomes, whereby bisexual respondents reported the highest proportion of suicide ideation or attempt, lesbian/gay respondents the next highest proportion, and heterosexual respondents the lowest proportion. Random-effects meta-analysis comparing bisexual individuals with lesbian/gay individuals yielded odds ratios (ORs) ranging between 1.22-1.52 across the four outcomes examined. Between-study variability in ORs was large. Thirty-one percent of heterogeneity was explained by sample type (e.g., probability vs. non-probability) and 17% by gender/sex. ORs were consistently larger for women (range: 1.48-1.95, all statistically significant at p < .05) than for men (range: 1.00-1.48, all p > .05), suggesting that gender/sex moderates the association between bisexual identity and suicide risk. Within-sexual minority differences in suicide risk may be attributed to structural and interpersonal experiences of monosexism, bisexual erasure and invisibility, or lack of bisexual-affirming social support, each of which may be experienced differently across gender/sex identities.

Disparities in substance use behaviors and disorders among adult sexual minorities by age, gender, and sexual identity

“…While female gender and older age are robust protective factors for most forms of substance use among heterosexuals, these factors appear to have a diminished, and differential, protective effect among SMs (Green and Feinstein, 2012), as age appears to have a stronger protective effect for gay/lesbian women compared to bisexual women. Overall, our results highlight the importance of examining heterogeneity among SMs, a point emphasized by a recent meta-analysis of SM suicide disparities that found risk to vary with respect to the “three-way intersection” of age, gender, and sexual identity (Salway et al, 2018). …”

“…One review found that half of SM youth who come out to their parents experience rejection (Rosario and Schrimshaw, 2013). Bullying, family rejection and identity formation are experiences that are often most acute for SMs in adolescence and young adulthood; during later adulthood, SM individuals may have fully synthesized their identity and established social connections and their own families (Salway et al, 2018), factors which may attenuate risk for substance use. Notably, SM respondents ages 18–25 were born between 1990 and 1998 and are coming of age in the most tolerant social climate to date.…”

“…Regarding gender differences, Weiss (2003) discusses that there are greater tensions between lesbians and bisexual women than gay and bisexual men, due to the historical influences of lesbian feminism and the lesbian separatist movement, which regarded bisexual women’s relationships with men as a betrayal to the advancement of lesbian rights. This legacy of friction may contribute to greater exclusion from the LGBT community by bisexual women (Salway et al, 2018; Weiss, 2003). Overall, bisexual invisibility, societal skepticism or confusion over the meaning of bisexuality, as well as stigma from the gay and lesbian community are factors that may persist across the lifecourse and may be differentially higher among women, contributing to persistent substance use disparities across adulthood.…”

It is time to mobilize suicide prevention for sexual and gender minorities in Canada

“…While SGMA communities can be a haven for some, many SGMA experience discrimination from other SGMA due to intersecting identities related to gender, sexuality, HIV status, race, Indigeneity, and class. Those who are marginalized within SGMA communities are often at increased risk of suicide (Ferlatte et al 2018;Salway et al 2018b). As such, actions to combat oppression within SGMA communities are urgently needed.…”

Sex/Gender Research and Meta-Analysis

“…1 Not bad. Subsequently, I have had the privilege and good fortune to publish two other meta-analytic studies (Grimbos, Dawood, Burris, Zucker, & Puts, 2010;Lalumière, Blanchard, & Zucker, 2000) with colleagues and another one is in the works (Zucker & Aitken, 2018 Puts, McDaniel, Jordan, & Breedlove, 2008;Rooney, Tulloch, & Blashill, 2018;Salway et al, 2019;Schmidt, Babchishin, & Lehmann, 2017;Van Dongen, 2012;Zou & Fan, 2017) and at least two more are in press (Körner, Schaper, Pause, & Heil, in press; Mori et al, in press).…”