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Self-reported suicide ideation and attempts, and medical care for intentional self-harm in lesbians, gays and bisexuals in Sweden
  1. Charlotte Björkenstam1,2,3,
  2. Kyriaki Kosidou4,
  3. Emma Björkenstam4,5,
  4. Christina Dalman4,
  5. Gunnar Andersson3,
  6. Susan Cochran1
  1. 1Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA
  2. 2Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
  3. 3Department of Sociology, Stockholm University, Stockholm, Sweden
  4. 4Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
  5. 5Department of Community Health Sciences, Fielding School of Public Health and California Center for Population Research, University of California Los Angeles, Los Angeles, USA
  1. Correspondence to Dr Charlotte Björkenstam, UCLA, Department of Epidemiology, Fielding School of Public Health, Los Angeles, California 171 77, USA; charlotte.bjorkenstam{at}ki.se

Abstract

Background Minority sexual orientation is a robust risk indicator for self-reported suicidal ideation and attempts. However, little is known about patterns of medical care for intentional self-harm in this vulnerable population. We investigate sexual orientation-related differences in self-reported lifetime suicide symptoms and medical care for intentional self-harm between 1969 and 2010, including age at initial treatment and recurrence.

Methods We used data from the Stockholm Public Health Cohort, a population-based sample of 874 lesbians/gays, 841 bisexuals and 67 980 heterosexuals, whose self-administered surveys have been linked to nationwide registers. Estimates of risk for medical care were calculated as incidence rate ratios (IRR) with 95% CIs.

Results Both suicidal ideation and attempts were more commonly reported by lesbian/gay and bisexual (LGB) individuals. Adjusting for risk-time and confounding, lesbians (IRR 3.8, 95% CI 2.7 to 5.4) and bisexual women (IRR 5.4, 95% CI 4.4 to 6.6) experienced elevated risk for medical care for intentional self-harm, as compared to heterosexual women. Gay men evidenced higher risk (IRR 2.1, 95% CI 1.3 to 3.4) as compared to heterosexual men. Recurrent medical care was more frequent in LGB individuals, especially in bisexual women and gay men. Lesbian and bisexual women were also younger than heterosexual women when they first received medical care for intentional self-harm.

Conclusions Positive histories of suicidal ideation, attempts and medical care for intentional self-harm, including higher levels of recurrence, are more prevalent among LGB individuals in contrast to heterosexuals. Lesbian/bisexual women evidence an earlier age of onset of treatment. Tailored prevention efforts are urgently needed.

  • SUICIDE
  • PUBLIC HEALTH
  • REGISTERS

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