Suicide among LGBT youth

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Research has found that attempted suicide rates and suicidal ideation among lesbian, gay, bisexual, and transgender (LGBT) youth is significantly higher than among the general population. LGBT adolescents have the highest rate of suicide attempts. According to LGBT rights organizations as well as scientific research, this is linked to homophobic attitudes and heterosexist discrimination, including political attacks on the civil rights of LGBT people such as in the contemporary efforts to halt the establish of same-sex marriage.

The passage of laws that discriminate against LGBT people have been shown to have significant negative impacts on the physical and mental health and well-being of LGBT youth; for example, depression and drug use among LGBT people have been shown to increase significantly after the passage of discriminatory laws. By contrast, the passage of laws that recognize LGBT people as equal with regard to civil rights have been shown to have significant positive impacts on the physical and mental health and well-being of LGBT youth; for example, a study of nationwide data from across the United States from January 1999 to December 2015 revealed that the establishment of same-sex marriage is associated with a significant reduction in the rate of attempted suicide among children, with the effect being concentrated among children of a minority sexual orientation (LGB youth), resulting in approximately 134,000 fewer children attempting suicide each year in the United States.

Bullying of LGBT youth has been shown to be a contributing factor in many suicides, even if not all of the attacks have been specifically addressing sexuality or gender. Since a series of suicides in the early 2000s, more attention has been focused on the issues and underlying causes in an effort to reduce suicides among LGBT youth. Research by the Family Acceptance Project has demonstrated that "parental acceptance, and even neutrality, with regard to a child's sexual orientation" can bring down the attempted suicide rate.

The National Action Alliance for Suicide Prevention notes that there is no national data (for the U.S.) regarding suicidal ideation or suicide rates among the LGBT population as a whole or in part, for LGBT youth or LGBT seniors, for example. In part because there is no agreed percentage of the national population that is LGBT, or even identifies as LGBT, also death certificates do not include sexuality information. A 1986 study noted that previous large scale studies of completed suicides did not "consider sexual orientation in their data analyses".

Video Suicide among LGBT youth

Reports and studies

Clinical social worker Caitlin Ryan's Family Acceptance Project (San Francisco State University) conducted the first study of the effect of family acceptance and rejection on the health, mental health and well-being of LGBT youth, including suicide, HIV/AIDS and homelessness. Their research shows that LGBT youths "who experience high levels of rejection from their families during adolescence (when compared with those young people who experienced little or no rejection from parents and caregivers) were more than eight times likely to have attempted suicide, more than six times likely to report high levels of depression, more than three times likely to use illegal drugs and more than three times likely to be at high risk for HIV or other STDs" by the time they reach their early 20s.

Numerous studies have shown that lesbian, gay, and bisexual youth have a higher rate of suicide attempts than do heterosexual youth. The Suicide Prevention Resource Center synthesized these studies and estimated that between 5 and 10% of LGBT youth, depending on age and sex groups, have attempted suicide, a rate 1.5-3 times higher than heterosexual youth. A U.S. government study, titled Report of the Secretary's Task Force on Youth Suicide, published in 1989, found that LGBT youth are four times more likely to attempt suicide than other young people. This higher prevalence of suicidal ideation and overall mental health problems among gay teenagers compared to their heterosexual peers has been attributed to minority stress. "More than 34,000 people die by suicide each year," making it "the third leading cause of death among 15 to 24 year olds with lesbian, gay, and bisexual youth attempting suicide up to four times more than their heterosexual peers."

It is impossible to know the exact suicide rate of LGBT youth because sexuality and gender minorities are often hidden and even unknown, particularly in this age group. Further research is currently being done to explain the prevalence of suicide among LGBT youths.

In terms of school climate, "approximately 25 percent of lesbian, gay and bisexual students and university employees have been harassed due to their sexual orientation, as well as a third of those who identify as transgender, according to the study and reported by the Chronicle of Higher Education." Research has found the presence of gay-straight alliances (GSAs) in schools is associated with decreased suicide attempts; in a study of LGBT youth, ages 13-22, 16.9% of youth who attended schools with GSAs attempted suicide versus 33.1% of students who attended schools without GSAs.

"LGBT students are three times as likely as non-LGBT students to say that they do not feel safe at school (22% vs. 7%) and 90% of LGBT students (vs. 62% of non-LGBT teens) have been harassed or assaulted during the past year." In addition, "LGBQ students were more likely than heterosexual students to have seriously considered leaving their institution as a result of harassment and discrimination." Susan Rankin, a contributing author to the report in Miami, found that "Unequivocally, The 2010 State of Higher Education for LGBT People demonstrates that LGBT students, faculty and staff experience a 'chilly' campus climate of harassment and far less than welcoming campus communities."

The internet is also an important factor for LGBT. An international study found that suicidal LGBT showed important differences with suicidal heterosexuals, in a matched-pairs study. That study found suicidal LGBT were more likely to communicate suicidal intentions, more likely to search for new friends online, and found more support online than did suicidal heterosexuals.

According to a study in Taiwan, 1 in 5 or 20% of Taiwanese gay people have attempted suicide.

The black transgender and gender non-conforming community has been found to face discrimination to a higher degree than the rest of the transgender community, which is due to the intersection of racism and transphobia. Research has found that this community experiences a higher level of poverty, suicide attempts, and harassment, while the effects of HIV and being refused health care due to transphobia and/or racism are greater as well. The National LGBTQ task force conducted a survey to discern these trends among the black transgender non-conforming community in with the overall transgender community.

The survey found that amongst the black respondents 49% reported having attempted suicide. Additional findings were that this group reported that 26% are unemployed and 34% reported an annual income of less than $10,000 per year. 42% of respondents reported homelessness which is five times the rate of the US homelessness rate. Also, the report revealed that the black transgender or gender non-conforming community reported 20.23% were living with HIV. 27% of black transgender youth reported being physically assaulted, 15% were sexually assaulted and 21% left school due to these instances of harassment.

Impact of same-sex marriage

The establishment of same-sex marriage is associated with a significant reduction in the rate of attempted suicide among children, with the effect being concentrated among children of a minority sexual orientation (LGB youth). A study of nationwide data from across the United States from January 1999 to December 2015 revealed that the rate of attempted suicide among all schoolchildren in grades 9-12 declined by 7% and the rate of attempted suicide among schoolchildren of a minority sexual orientation (LGB youth) in grades 9-12 declined by 14% in states which established same-sex marriage, resulting in approximately 134,000 fewer children attempting suicide each year in the United States. The researchers took advantage of the gradual manner in which same-sex marriage was established in the United States (expanding from 1 state in 2004 to all 50 states in 2015) to compare the rate of attempted suicide among children in each state over the time period studied. Once same-sex marriage was established in a particular state, the reduction in the rate of attempted suicide among children in that state became permanent. No reduction in the rate of attempted suicide among children occurred in a particular state until that state recognized same-sex marriage. The lead researcher of the study observed that "laws that have the greatest impact on gay adults may make gay kids feel more hopeful for the future".

Maps Suicide among LGBT youth

Developmental psychology perspectives

The diathesis-stress model suggests that biological vulnerabilities predispose individuals to different conditions such as cancer, heart disease, and mental health conditions like major depression, a risk factor for suicide. Varying amounts of environmental stress increase the probability that these individuals will develop that condition. Minority stress theory suggests that minority status leads to increased discrimination from the social environment which leads to greater stress and health problems. In the presence of poor emotion regulation skills this can lead to poor mental health. Also, the differential susceptibility hypothesis suggests that for some individuals their physical and mental development is highly dependent on their environment in a "for-better-and-for-worse" fashion. That is, individuals who are highly susceptible will have better than average health in highly supportive environments and significantly worse than average health in hostile, violent environments. The model can help explain the unique health problems affecting LGBT populations including increased suicide attempts. For adolescents, the most relevant environments are the family, neighborhood, and school. Adolescent bullying - which is highly prevalent among sexual minority youths - is a chronic stressor that can increase risk for suicide via the diathesis-stress model. In a study of American lesbian, gay, and bisexual adolescents, Mark Hatzenbuehler examined the effect of the county-level social environment. This was indexed by the proportion of same-sex couples and Democrats living in the counties. Also included were the proportions of schools with gay-straight alliances as well as anti-bullying and antidiscrimination policies that include sexual orientation. He found that a more conservative social environment elevated risk in suicidal behavior among all youth and that this effect was stronger for LGB youth. Furthermore, he found that the social environment partially mediated the relation between LGB status and suicidal behaviour. Hatzenbuehler found that even after such social as well as individual factors were controlled for, however, that "LGB status remained a significant predictor of suicide attempts."

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Institutionalized and internalized homophobia

Institutionalized and internalized homophobia may also lead LGBT youth to not accept themselves and have deep internal conflicts about their sexual orientation. Parents may abandon or force children out of home after the child's coming out.

Homophobia arrived at by any means can be a gateway to bullying which can take many forms. Physical bullying is kicking, punching, while emotional bullying is name calling, spreading rumors and other verbal abuse. Cyber bullying involves abusive text messages or messages of the same nature on Facebook, Twitter, and other social media networks. Sexual bullying is inappropriate touching, lewd gestures or jokes.

Bullying may be considered a "rite of passage", but studies have shown it has negative physical and psychological effects. "Sexual minority youth, or teens that identify themselves as gay, lesbian or bisexual, are bullied two to three times more than heterosexuals", and "almost all transgender students have been verbally harassed (e.g., called names or threatened in the past year at school because of their sexual orientation (89%) and gender expression (89%)") according to Gay, Lesbian and Straight Education Network's Harsh Realities, The Experiences of Transgender Youth In Our Nation's Schools.

This issue has been a hot topic for media outlets over the past few years, and even more so in the months of September and October 2010. President Barack Obama has posted an "It Gets Better" video on The White House website as part of the It Gets Better Project. First lady Michelle Obama attributes such behaviors to the examples parents set as, in most cases, children follow their lead.

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Projects

The Trevor Project

"The Trevor Project was founded by director/producer Peggy Rajski, producer Randy Stone and screenwriter James Lecesne, creators of the 1994 Academy Award-winning short film, Trevor, a comedy/drama about a gay 13-year-old boy who, when rejected by friends because of his sexuality, makes an attempt to take his life." They are an American non-profit organization that operates the only nationwide, around-the-clock crisis and suicide prevention helpline for LGBT youth, the project "is determined to end suicide among LGBTQ youth by providing life-saving and life-affirming resources including our nationwide, 24/7 crisis intervention lifeline, digital community and advocacy/educational programs that create a safe, supportive and positive environment for everyone."

It Gets Better Project

It Gets Better Project is an Internet-based campaign founded in the US by Dan Savage and his partner Terry Miller in September 2010, in response to the suicides of teenagers who were bullied because they were gay or because their peers suspected that they were gay. The videos that were posted emphasized the idea that hope is possible despite the bullying that LGBT individuals may face. Its goal is to prevent suicide among LGBT youth by having gay adults convey the message through social media videos that these teens' lives will improve. The project has grown rapidly: over 200 videos were uploaded in the first week, and the project's YouTube channel reached the 650 video limit in the next week. The project is now organized on its own website, the It Gets Better Project, and includes more than 30,000 entries with more than 40 million views from people of all sexual orientations, including many celebrities. A book of essays from the project, It Gets Better: Coming Out, Overcoming Bullying, and Creating a Life Worth Living, was released in March 2011.

In 2017 news emerged of a study that found that asking youth to accept negative experiences as the only coping strategy, potentially exacerbates stress. This study from the University of Arizona, led to claims that the It Gets Better Project may do more harm than good.

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Policy responses

A number of policy options have been repeatedly proposed to address this issue. Some advocate intervention at the stage in which youth are already suicidal (such as crisis hotlines), while others advocate programs directed at increasing LGBT youth access to factors found to be "protective" against suicide (such as social support networks or mentors).

One proposed option is to provide LGBT-sensitivity and anti-bullying training to current middle and high school counselors and teachers. Citing a study by Jordan et al., school psychologist Anastasia Hansen notes that hearing teachers make homophobic remarks or fail to intervene when students make such remarks are both positively correlated with negative feelings about an LGBT identity Conversely, a number of researchers have found the presence of LGBT-supportive school staff to be related to "positive outcomes for LGBT youth". Citing a 2006 Psychology in the Schools report, The Trevor Project notes that "lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth who believe they have just one school staff member with whom they can talk about problems are only 1/3 as likely as those without that support to... report making multiple suicide attempts in the past year."

Another frequently proposed policy option involves providing grant incentives for schools to create and/or support Gay-Straight Alliances, student groups dedicated to providing a social support network for LGBT students. Kosciw and Diaz, researchers for the Gay, Lesbian and Straight Education Network, found in a nationwide survey that "students in schools with a GSA were less likely to feel unsafe, less likely to miss school, and more likely to feel that they belonged at their school than students in schools with no such clubs." Studies have shown that social isolation and marginalization at school are psychologically damaging to LGBT students, and that GSAs and other similar peer-support group can be effective providers of this "psychosocial support".

Early interventions for LGBT youth

Be proactive and understanding

Educators can be proactive in helping adolescents with gender identity and the questions/ issues that sometimes come that can help teens so that they do not resort to suicide, drug abuse, homelessness, and many psychological problems. Van Wormer & McKinney (2003) relate that understanding LBGT students is the first step to suicide prevention. They use a harm reduction approach, which meets students where they are to reduce any continued harm linked with their behaviors. They relate that creating a supportive and culturally diverse environment is crucial to social acceptance in an educational setting.

LGBT role models/resources

It is beneficial to hire LGBT teachers to serve as role models and support LGBT students. Many of the resources in the U.S. are crisis driven not prevention driven which needs to be the other way around in order to prevent suicide for LGBT adolescents. Furthermore, studies show that counselors and teachers need to be trained in self-awareness, sexuality and sexual diversity with themselves and with students. Researchers also suggest inviting gay/lesbian and bisexual panels from colleges or universities to conduct classroom discussions. Education and resources is key to helping LGBT students and families. According to researcher Rob Cover, role models and resources benefit LGBT youth only if they avoid replicating stereotypes and provide diverse visual and narrative representations to allow broad identification.

Having a PFLAG (Parents Families, and Friends of Lesbians and Gays) and GSA Club are possible resources to promote discussions and leadership roles to LGBT students. These resources extend outside of school and in the community. (Greytak, E. A., Kosciw, J. G., & Boesen, M. J. 2013) report that when schools have a GSA or Gay Straight Alliance club or a club promoting social awareness and camaraderie of sorts, supportive educators, inclusive curricula, and comprehensive policies that LGBT students were victimized less and had more positive school experiences. Students will feel positive and want to be in school.

Teach tolerance and examine a school's climate

Examine a school's climate and teach tolerance - Teaching Tolerance is a movement, magazine and website which gives many tools and ideas to help people be tolerant of one another. It demonstrates that the classroom is a reflection of the world around us. Educators can use Teach Tolerance's website and book to download resources and look up creative ways to learn more about LBGT students and teaching tolerance to their students in the classroom. It helps schools get started with anti-bullying training and professional development and resource suggestions. It even relates common roadblocks and tips to starting a GSA club.

Research shows that a collaborative effort must be made in order to prevent LGBT students from being bullied and/or committing suicide. Teachers, administrators, students, families, and communities need to come together to help LGBT students be confident. Each school has its own individuality, its own sense of "self", whether it be the teachers, administrators, students, or the surrounding community. In order to tackle the issue of bullying for LGBT students it needs to start with understanding the student population and demographic where the school lies. Educating students, faculty, staff, and school boards on LGBT issues and eliminating homophobia and trans phobia in schools, training staff on diversity acceptance and bullying prevention, and implementing Gay-Straight Alliances is key to suicide prevention for LGBT students (Bacon, Laura Ann 2011). Adolescents grow and are shaped by many factors including internal and external features (Swearer, Espelage, Vaillancourt, & Hymel, 2010).

The school climate must foster respect. Thus, setting the tone for administration, teachers, professionals who enter the building, parents and most importantly the students. People, in general, need to understand their own misconceptions and stereotypes of what being LGBT is. Unless students and adults are educated on the LGBT community, than stereotypes and negative attitudes will continue to exist (Knotts, G., & Gregorio, D. 2011). The GMCLA (Gay Men's Chorus of Los Angeles) use music and singing as a vehicle for changing the attitudes and hearts of people in schools nationwide. Their goal is to bring music to standards-driven curriculum to youth with the purpose of teaching content in innovative and meaningful ways. They instill in students and staff techniques to foster positive meaning of the social and personal issues dealt with in school and society.

Gay, L. (2009) has generated a guide to helping school safety/climate and fostering positive interpersonal relationships through "The Safe Space Kit". This tool helps teachers create a safe space for LGBT students. One of the most effective ways for an educator to create a safe space is to be a supportive ally to LGBT students. This kit has numerous tools for teachers and schools to utilize, including: a hard copy of "The Safe Space Kit" includes the "Guide to Being an Ally", stickers and two Safe Space posters. Even utilizing something just to promote awareness, such as using "The Safe Space Kit" could be a good first step for schools to promote responsiveness to LGBT students. Providing some supports rather than none at all can benefit LGBT youth tremendously now and in the future (Greytak, et al. 2013).

OBPP (Olweus Bullying Prevention Program)

OBPP is an anti-bullying program designed by psychologist Dan Olweus utilized in schools in Europe, Canada and the U.S. Reductions in bullying were due to parent training, playground supervision, home-school communication, classroom rules, and training videos. Furthermore, Swearer, et al. (2010) discuss a "dosage effect" in which the more positive and consistent elements included in a program, the more the likelihood that bullying would decrease. Success in one school does not guarantee success in another because each school has its own social climate. The OBPP is effective but still needs to be analyzed further, since there are many things to consider when implementing this technique within a large school.

Steps To Respect

Steps To Respect is an anti-bullying campaign which can be beneficial in schools as well - it is a comprehensive guide for teachers, administrators, and students utilizing in class lessons and training helping schools foster positive social-emotional skills and conflict resolution. If schools are able to change peer conduct and norms, increase student communication skills, and maintain adult prevention and intervention efforts, the positive effects of their work will strengthen over time (Frey, Edstrom & Hirschstein 2005) and continue to grow as each class progresses through the school system.

Make curriculum changes

According to Russell, S. T., McGuire, J. K., Laub, C., & Manke, E. (2006), it is imperative for educators to make subject and age appropriate lessons with LGBT issues incorporated into the curriculum on a consistent basis utilizing current events, history, literature, or social sciences. Teachers should be trained each year on new practices to employ in their classrooms and in school in general. They should be taught how to handle situations they may face with LGBT students, so that if a problem should arise, they will be confident in their own understandings of the LGBT community and know how to handle any question or situation professionally and empathetically. Russell, et al. (2006) report that state policy and government officials need to be mindful of the ever-changing culture we live in by enforcing and including material appropriate in schools to educate educators on LGBT people in the world.

Burdge, H., Sinclair, K., Laub, C., Russell, S. T. (2012) relate numerous lessons, which each subject area teacher can teach to enforce LGBT inclusivity and school safety. They report that lessons, which promote LGBT inclusivity, can have the greatest impact on school safety. Physical education, health, history, and social studies teachers can educate all students to have more social awareness and create a positive school climate. They continue to note that inviting parents, teachers, administrators and other key stakeholders to identify and/or participate in the development of age-appropriate LGBT-inclusive lessons that teachers can use in their classrooms is most beneficial.

Educators must continue to try new trends, constantly assessing the environment of their school. The best policies and interventions are those, which show positive growth across grade levels. Research should continue to see which programs suit the needs of different schools over a period of time. Since each school varies in many ways, it may be hard to report positive trends. One technique that works in one school may or may not work for another. Therefore, taking pieces of one technique and making it into something that molds best to each school and environment is key.

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See also

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Notes

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Further reading

• Cover, R. (2012). Queer Youth Suicide, Culture and Identity: Unliveable Lives? Ashgate, ISBN 9781409444473.
• Diamond, L (2003). "Was it a phase? Young women's relinquishment of lesbian/bisexual identities over a 5-year period". Journal of Personality and Social Psychology. 84 (2): 352-364. doi:10.1037/0022-3514.84.2.352. PMID 12585809.
• Diamond, L (2008). "Female Bisexuality From Adolescence to Adulthood: Results From a 10-Year Longitudinal Study". Developmental Psychology. 44 (1): 5-14. doi:10.1037/0012-1649.44.1.5. PMID 18194000.
• Haas, A. P.; Eliason, M.; Mays, V. M.; Mathy, R. M.; Cochran, S. D.; D'Augelli, A. R.; Silverman, M. M.; et al. (2011). "Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: review and recommendations". Journal of Homosexuality. 58 (1): 10-51. doi:10.1080/00918369.2011.534038. PMC 3662085. PMID 21213174.
• Hatzenbuehler, M. L. (2009). "How does sexual minority stigma "get under the skin"? A psychological mediation framework". Psychological Bulletin. 135 (5): 707-730. doi:10.1037/a0016441. PMC 2789474. PMID 19702379.
• Helling, S., Levy, D. S., & Herbst, D. (2010, October). Tormented to Death? People Magazine, 56. New York, NY.
• Kann, L., Olsen, E. O., McManus, T., Kinchen, S., Chyen, D., Harris, W. A., & Wechsler, H. (2011). Sexual identity, sex of sexual contacts, and health-risk behaviors among students in grades 9-12 - youth risk behavior surveillance, selected sites, United States, 2001-2009. * MMWR Surveillance summaries Morbidity and Mortality Weekly Report Surveillance summaries CDC, 60(7), 1-133.
• Marshal, M. P.; Dietz, L. J.; Friedman, M. S.; Stall, R.; Smith, H. A.; McGinley, J.; Thoma, B. C.; et al. (2011). "Suicidality and Depression Disparities Between Sexual Minority and Heterosexual Youth: A Meta-Analytic Review". The Journal of Adolescent Health. 49 (2): 115-23. doi:10.1016/j.jadohealth.2011.02.005. PMC 3649127.
• Mayock, P.; Bryan, A.; Carr, N. & Kitching, K. (2009) "Supporting LGBT Lives: A Study of the Mental Health and Well-Being of Lesbian, Gay, Bisexual and Transgender People" Dublin: BeLonG To Youth Services
• O'Donnell, S.; Meyer, I. H.; Schwartz, S. (2011). "Increased risk of suicide attempts among Black and Latino lesbians, gay men, and bisexuals". American Journal of Public Health. 101 (6): 1055-9. doi:10.2105/ajph.2010.300032. PMC 3093285.
• Russell, S. T.; Clarke, T. J.; Clary, J. (2009). "Are Teens "'Post-Gay'"? Contemporary Adolescents' Sexual Identity Labels". Journal of Youth and Adolescence. 38: 884-90. doi:10.1007/s10964-008-9388-2.
• Savin-Williams, R. (2005). The New Gay Teenager. Cambridge, Massachusetts: Harvard University Press.
• Savin-Williams, R. C. (2008). "Then and Now: Recruitment, Definition, Diversity, and Positive Attributes of Same-Sex Populations". Developmental Psychology. 44 (1): 135-138. doi:10.1037/0012-1649.44.1.135. PMID 18194012.
• Savin-Williams, R. C.; Ream, G. L. (2003). "Suicide attempts among sexual-minority male youth". Journal of Clinical Child and Adolescent Psychology. 32 (4): 509-522. doi:10.1207/s15374424jccp3204_3. PMID 14710459.
• Savin-Williams, R. C.; Ream, G. L. (2007). "Prevalence and stability of sexual orientation components during adolescence and young adulthood". Archives of Sexual Behavior. 36 (3): 385-94. doi:10.1007/s10508-006-9088-5. PMID 17195103.
• Savin-williams, R. C. (2006). "Who' s Gay ? Does It Matter ?". Current Directions in Psychological Science. 15 (1): 40-45. doi:10.1111/j.0963-7214.2006.00403.x.
• Savin-williams, R. C., Cohen, K. M., & Youth, G. (2005). Development of Same-Sex Attracted Youth. Development, 1979(2004).
• Schwartz, S.; Meyer, I. H. (1982). "Mental health disparities research: the impact of within and between group analyses on tests of social stress hypotheses". Social Science & Medicine. 70 (8): 1111-8. doi:10.1016/j.socscimed.2009.11.032. PMC 3828206.
• Selby, E. A.; Anestis, M. D.; Bender, T. W.; Ribeiro, J. D.; Nock, M. K.; Rudd, M. D.; Bryan, C. J.; et al. (2010). "Clinical Psychology Review Overcoming the fear of lethal injury : Evaluating suicidal behavior in the military through the lens of the Interpersonal - Psychological Theory of Suicide". Clinical Psychology Review. 30 (3): 298-307. doi:10.1016/j.cpr.2009.12.004.
• Orden, Van; Witte, T. K.; Cukrowicz, K. C.; Braithwaite, S. R.; Selby; Joiner, T. E. (2010). "The interpersonal theory of suicide". Psychological Review. 117 (2): 575-600. doi:10.1037/a0018697.
• Young, R. M.; Meyer, I. H. (2005). "The trouble with "MSM" and "WSW": erasure of the sexual-minority person in public health discourse". American Journal of Public Health. 95 (7): 1144-9. doi:10.2105/ajph.2004.046714. PMC 1449332. PMID 15961753.
• Best Practices: Creating an LGBT-inclusive School Climate. (n.d.). Retrieved July 24, 2016, from http://www.tolerance.org/lgbt-best-practices

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References

• One of the two most complete Internet Resource on gay and bisexual male suicide problems
• Tabulated basic results of about 150 LGBT suicidality studies from 1970 to 2013

Source of article : Wikipedia