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

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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, poverty, chronic disease, alcohol use and physical health (OR = 1.44, 1.06, 1.59, 1.45 and 0.95, p ≤ 0.05, R2 = 0.187). Discussion General and minority‐specific stressors negatively impacted suicidality among LGBT participants. Implication for practice Study findings have implications for nursing education, practice and research. Nursing education should include information about the influence of sexual orientation and gender identity on mental health outcomes. Further, systematic screening for suicidality should be conducted by LGBT serving psychiatric and mental health nurses. Finally, research is needed to determine best practices for interventions aimed at reducing suicidality risk among LGBT individuals.

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