The influence of minority stress on indicators of suicidality among lesbian, gay, bisexual and transgender adults in Thailand

Abstract

Accessible summary What is known on the subject? Established research from the United States and other Western countries has found that lesbian, gay, bisexual and transgender (LGBT) populations are at an elevated risk for suicide. Suicidality among LGBT individuals is understudied in Thailand and other Asian countries, warranting additional research to better understand risk factors and to create effective treatment and suicide prevention interventions. What the paper adds to existing knowledge? The study examined rates and predictors of suicidality in Thai LGBT adults. Study findings suggest that general (e.g. stress and loneliness) and minority stressors (e.g. discrimination and victimization) played important roles in predicting lifetime and past‐year suicidal ideation, while socio‐demographic and health‐related factors (e.g. living in high poverty area and having chronic diseases) were associated with suicide attempts among LGBT individuals. What are the implications for practice? Changes in the nursing curriculum and continuing education resources are needed to improve knowledge and core competencies in the mental health and treatment needs of LGBT individuals in Thailand. Among LGBT serving practitioners, routine assessment of suicidality is needed to increase the early identification and treatment of individual at risk for suicidal behaviours. Standardized measures of sexual orientation and gender identity should be included in all patient intake forms. In conducting research on strategies to improve mental health outcomes among LGBT populations, standardized measures of sexual orientation/gender identity and minority‐specific stressors should be used. Suicide prevention interventions aimed at reducing general and minority stress among LGBT populations should be a priority in mental health nursing. Abstract Introduction A large and rigorous body of research in the United States has demonstrated that lesbian, gay, bisexual and transgender (LGBT) populations are at an elevated risk for suicide. However, scant research aimed at understanding the rates and predictors for suicidality among Thai LGBT individuals exists. Aim To examine rates and predictors of suicidality among Thai LGBT adults (N = 411). Method Data collection was conducted via online and in‐person surveys. Guided by the Minority Stress Model, standardized measures of demographics, health‐related factors, general and minority‐specific stressors and suicidality were completed. Results Thirty‐nine per cent of participants reported lifetime suicidal ideation, 19.0% past 12‐month suicidal ideation and 13.1% lifetime suicide attempts. Lifetime suicidal ideation was associated with higher levels of social discrimination, stress, loneliness and chronic disease (OR = 1.12, 1.16, 2.75, and 1.46, p ≤ .05, R2 = 0.327). Past‐year suicidal ideation was associated with victimization, stress, loneliness and being a former smoker (OR = 1.52, 1.20, 2.34, and 4.89, p < .05, R2 = 0.345). Suicide attempts were associated with internalized homophobia, pov...

Disparities in behavioral health and experience of violence between cisgender and transgender Thai adolescents

“…Suicidality was higher among transgender respondents than cisgender respondents, and was higher among transgender boys than transgender girls. Depression and suicidality among Thai transgender youths are associated with victimization and internalized homophobia [ 8 , 9 ], as well as family rejection and social isolation [ 31 ]. The Thai media also contains hetero-sexist narratives, harmful and discriminatory rhetoric, and negative portrayals of LGBTIQ people [ 32 ].…”

“…A previous study found minority stress (i.e., stress faced by members of stigmatized minority groups caused by factors such as lack of social support, low socioeconomic status, interpersonal prejudice, and discrimination) in the Thai homosexual and bisexual men population [ 33 ]. It is possible that minority stress and internalization of rejection, discrimination and violence [ 9 , 34 ] could have accounted for disparities in depression and suicidality between Thai cisgender and transgender adolescents.…”

“…Behavioral health issues affect both transgender and cisgender adolescents, although a previous study has shown disparities in the prevalence of unsafe sexual practices, sexual violence, drug use, and depression [ 5 ]. Transgender people tend to have higher prevalence of high-risk behavior [ 6 , 7 ], depression [ 8 ] and suicidality [ 8 , 9 ].…”

Health Inequities in LGBT People and Nursing Interventions to Reduce Them: A Systematic Review

“…After the search, we obtained a total of 381 records, of which 16 articles were selected: 1 systematic review and meta-analysis [28], 5 systematic reviews [29][30][31][32][33], 1 cross-sectional descriptive study [34], 4 qualitative studies [35][36][37][38], and 5 quasi-experimental pre-testpost-test studies [39][40][41][42][43]. Regarding the variables of the reviews, 6 articles addressed the specific health needs of LGBT people [28,29,[31][32][33][34], 3 focused on LGBT people's experiences and perceptions [35][36][37], and 10 presented nursing interventions in the LGBT community [30][31][32][33][38][39][40][41][42][43].…”

“…In terms of national contexts, 5 studies were conducted in the USA [38,39,[41][42][43], 2 in Canada [36,40], 1 in Ireland [37], 1 in Turkey [35], and 1 in Thailand [34]. According to the classification by the World Bank [44], 8 articles were from high-income economies (the USA, Canada, and Ireland) and 2 were from upper-middle-income economies (Turkey and Thailand).…”