Higher Risks of Suicide among Lesbian, Gay, Bisexual and Transgender (LGBT) Youth in America
Teela Oxendine-Cummings
CST5334 – Ethnic and Cultural Awareness
Capella University

Abstract
This paper presents an overview of what is known about suicide and suicidal behavior among LGB youth. For the intention of this paper, the term youth is generally defined as people age 15 through 24. In developing this paper, the learner reviewed the relevant literature published from 1996 through 2011; researched suicide prevention and mental health support programs, and researched services for LGBT youth. After summarize research findings about the higher risk of suicidal behavior for LGBT youth, the paper explores risk and protective factors for this group and provides suggestions to the field that is used to reduce suicidal behavior among LGBT youth.

Table of Contents
Research Paper

Title…………………………………………………………1 Higher Risks of Suicide among Lesbian, Gay,
Bisexual and Transgender (LGBT) youth in America…1 Abstract …………………………………………………. 2 Table of Contents………………………………………..3-4 Introduction…..…………………………………………..5 Overview on Suicide ……………………………5
Illustration of the LGBT Youth………….............5-6
Sexual Orientation and Suicide………………...6-7
Scope of the Problem : Suicidal Behaviors ………….7
Suicide Deaths Among LGBT Youth…………...7
Suicide Attempts Among LGBT Youth…………7-8
Suicide Ideation Among LGBT Youth………….8
Conclusion on Suicidal Behaviors of LGBT Youth…9 Scope of Challenges faced by LGBT Youth………….9
Coming Out………………………………………..9
Cultural Differences……………… ………………9-10
Homophobic Behavior………………....................10-11
Factors that Escalate Suicide in LGBT Youth………….11
Social Environment……………………………….11-12
Family Support…………………………………….12-13
Prevention Programs……………………………………..13
Suicide Prevention for LGBT Youth……………..13
Programs Serving the LGBT Youth……………..13-14
Other Considerations for Prevention Programs………..14
Family Connectedness……………………………14-15
Cultural Competency and Sensitivity……………15 Conclusion………………………………………………….15 Overview…………………………………………….15-16 References………………………………………………….17-20 Appendix A…………………………………………………..21 School………………………………………………..21 Health Providers…………………………………….21 Telephone and Email………………………………21 Data and Research………………………………....21-22

Introduction
Overview on Suicide
Every year, suicide claims the lives of more than approximately 800,000 people worldwide and about 32,000 people in the United States alone. Suicide is the third leading cause of death for people 15 to 24 years old, with more than 4,000 youth dying by suicide each year (Centers for Disease Control and Prevention, 2007). Many more youth consider suicide, make plans to kill themselves, or attempt suicide. The MMWR (2004), reports that adolescent suicide is a multi-faceted problem with multiple risk factors. The most commonly identified risk factors are societal beliefs about suicide, social isolation, community disintegration, mental health issues including depression and substance abuse ( Parker,2005).
Although all of these reports identify groups at risk for suicidal behavior, none address in any depth issues relevant to one group generally thought to be at higher risk for suicidal behavior: youth who are lesbian, gay, bisexual or transgender (LGBT).
Illustration of the LGBT Youth
When dealing with such circumstances we must first illustrate the factors that constitute the meaning of being “lesbian, gay , bisexual or transgendered “.The terms lesbian, gay, bisexual, and transgender are often used with minimal concern of the difficulties of sexuality and gender. How and why sexual orientation—affection and/or sexual attraction towards males, females, or both—develops and changes over time remains the subject of both research and debate. The relationships among sexual orientation, gender identity (whether a person identifies as male or female), and gender conformity (whether a person displays the emotional and behavioral characteristics culturally associated with a particular gender) are extremely multifaceted.
However, the term transgender refers to people whose gender identity and/or expression is conflicting with cultural norms about their genetic sex. Transgender is not a sexual orientation; however, transgender people are sometimes included in research on LGB people. Occasionally included in research are young people identified as questioning—that is, those who are in the process of exploring the nature of their sexual orientation or gender identity. Questioning often occurs during adolescence, the developmental stage when many young people struggle with issues of sexuality, gender, and identity. This struggle can be especially complicated and lengthened for people exploring LGBT sexual orientations and gender identities. Also, it’s important to remember the causal cultural conceptions of sexual and gender identity, not just the terms used to describe these identities, change over time. It would appear that with the ease with which sexual orientation is commonly defined, that researchers would have a clear cut ability to determine in which category an individual belongs (Parker,2005).
Sexual Orientation and Suicide
Even controlling for these general risk factors, however, sexual orientation remained an independent predictor of suicidality (DePaul, Walsh & Dam,2009) . This may be due partially to the fact that some risk factors for suicidality accrue uniquely to gay and lesbian youths as a result of environmental stressors such as societal oppression and discrimination (McDaniel ,Purcell, & D'Augelli ,2001). These risk factors include victimization based on sexual identity (D'Augelli et al., 2005), rejection by peers or family because of sexual orientation, internalized homophobia, fear of rejection and ridicule, and actual violence (Bontempo & D'augelli, 2002)
Scope of the Problem : Suicidal Behaviors
Suicide Deaths Among LGBT Youth
Suicide is the eleventh leading cause of death overall in the United States, and the third leading cause of death for youth age 15 through 24, following intentional injuries and homicide. However, data on suicide rates—the number of suicide deaths per 100,000 of population—reveal that the rate for this age group is 10 per 100,000, below the national rate of 11.01 per 100,000 for people of all ages (Centers for Disease Control and Prevention, 2007).
However, little can be understood since most resources do not include sexual orientation on reports such as: death certificates and cause of death reports. Yet, even if this information was included on the reports, the National Vital Statistics System does not include that at the state and federal levels. This is a significant exclusion: the National Vital Statistics System is a primary source of data for public health researchers studying any cause of mortality, including suicide. In addition, media resources such as news papers rarely include the sexual orientation as well. Families and friends may not know—or be willing to discuss—the sexual orientation of a person who died, especially by his or her own hand (Lebson, 2002)
Although hard data on suicide rates for young LGB people are lacking, research has established that the most reliable indicators of suicide risk are suicidal ideation and prior suicide attempts.
Suicide Attempts Among LGBT Youth
A suicide attempt is a “potentially self-injurious behavior with a nonfatal outcome, for which there is evidence that the person intended to kill himself or herself” (U.S. Department of Health and Human Services, 2001, p.203). Moreover, one of the most reliable suicide predictors is one that has had prior suicide attempts.
Likewise, studies that compare the rate of suicide attempts among LGBT youth with those among heterosexual youth show significantly higher rates for LGBT youth. For example, D’Augelli and Hershberger (1995) found that LGB youth were three times as likely to have attempted suicide as heterosexual youth. The majority of literature reviews on LGB suicide attempts conclude that LGB youth have a significantly higher rate of attempting suicide than heterosexual youth. Furthermore, most suicide attempts among LGB people occur during adolescence and young adulthood.
Suicide Ideation Among LGBT Youth Suicidal ideation has been defined as “self-reported thoughts of engaging in suicide-related behavior” (U.S. Department of Health and Human Services, 2001). Ideation can range in severity from passing thoughts about suicide to a detailed plan for attempting suicide. Suicidal ideation is more widespread than either attempts or suicides, and its recognition can provide an opportunity to intervene before more serious suicidal behavior develops.
The Massachusetts Youth Risk Behavior Survey reported that youth who self-identified as gay, lesbian, or bisexual or who reported any same-sex sexual contact were more than three times as likely as their heterosexual peers to have seriously considered suicide in the last year (Massachusetts Department of Education, 2011).

Conclusion on Suicidal Behaviors of LGBT Youth
Research indicates that LGBT youth have significantly higher rates of suicide attempts and suicidal ideation than their heterosexual peers. Moreover, attempts, as well as the seriousness of attempts among LGB youth, make it probable that this group of youth has a higher rate of suicide deaths than their heterosexual counterparts.
Scope of Challenges faced by LGBT Youth
Coming Out
The experience of the “coming out” process can be psychologically difficult for youths that are already struggling with teenager developmental crises and associations surrounding culture and diversity .The experiences connected with being a stigmatized sexual minority while young and vulnerable are likely a element of this risk. Coming to terms with one's sexual minority status can be psychologically challenging. At this vulnerable time, LGBT youths are often rejected by key persons in their life in their lives, including family, teachers, and friends (Cato & Canetto, 2003). For many LGBT youths, coming out, leads to isolation and even homelessness. These types of experiences likely hinder LGBT youths' capacity for coping. As stated earlier, this can cause problems such as depression and substance abuse to emerge. In addition, it has been suggested that the likelihood that someone responds to adversity with suicidal behavior depends, among other things, on cultural factors, including the prevailing social meanings and scripts of suicidal behavior(Valenti & Campbell,2009).

Cultural Differences
The social meanings of suicidal behavior are the social interpretations of the suicidal act. For example, one culture (e.g., the U.S.A.) may view suicidal behavior, especially suicidal behavior in young persons, as a symptom of a mental disorder. Another culture (e.g., India) may idealize suicide among one group of individuals (e.g., widows of all ages) but may condemn it for all other persons. The cultural scripts represent the specific forms that the suicidal behavior typically takes in different cultures. These scripts include actors, scenarios, and method. For example, in one culture, suicide may typically involve the use of guns, as is the case among European Americans, whereas in another culture, firepower may seldom be used in suicide in spite of their accessibility. These meanings and scripts are said to influence the social consequences of the suicidal behavior (e.g., whether the suicidal person is hospitalized, incarcerated, dead, or worshipped).
Homophobic Behavior
People of LGBT (lesbian, gay, bisexual, transgendered) orientations have long been stigmatized. With the increase of the gay political faction in the late 1960s, however, homosexuality's criticism as immoral, unlawful, and appalling came under increasing examination. Society's rethinking of sexual orientation was crystallized in the term homophobia, which heterosexual psychologist George Weinberg coined in the late 1960s. This term is known to many as an irrational fear of homosexuality. Although, this is true, such definitions are broadening to mean “aversion to gay or homosexual people or their lifestyle or culture" and "behavior or an act based on this aversion”. Such scrutiny and definitions have transpired to societal oppression of the LGBT community. Homophobic behavior can add to the emotional stress that contributes to the thoughts and feelings of suicide. Research has correlated homophobic behaviors with externalizing psychosocial symptoms such as poor academic performance, high school drop-out rate, isolation, fighting, excessive absenteeism, loss of confidence, anxiety, hopelessness, frustration, despair, low self-concept, and suicide( O’Higgins-Norman, 2009; Wall et al., 2008).
Factors that Escalate Suicide in LGBT Youth
Social Environment
Although the social environment itself has not been defined as a risk factor for suicide, widespread discrimination against LGBT people, heterosexist attitudes, and gender bias can lead to risk factors such as isolation, family rejection, and lack of access to care providers (Suicide Prevention Resource Center,2008). Therefore, risk factors can interrelate in unhealthy ways. Such as internalized homophobia and victimization which leads to stress. Stress leads to depression and substance abuse, which are two of the main contributing factors related to suicide.
Additionally, in the United States prejudice and discrimination against LGB people are widespread among individuals, and in fact, supported by many religious, social, and government institutions. Homophobia and heterosexism are terms that refer to prejudice against LGB people and reflect prevalent social attitudes that most people have internalized (McDaniel et al., 2001). Heterosexism pervades societal customs and institutions. Moreover, Heterosexism operates through a dual process of invisibility and attack. However, homosexuality usually remains culturally invisible; when people who engage in homosexual behavior or who are identified as homosexual become visible, they are subject to attack by society. Some examples of heterosexism include the continuing ban against lesbian and gay military personnel; widespread lack of legal protection from antigay discrimination in employment, housing, and services; hostility to lesbian and gay committed relationships, recently dramatized by passage of federal and state laws against same-gender marriage; and the existence of sodomy laws in more than one-third of the states. This can be a factor that also leads to suicide and suicidal behavior. Although usage of the two words has not been uniform, homophobia has typically been employed to describe individual anti gay attitudes and behaviors whereas heterosexism has referred to societal-level ideologies and patterns of institutionalized oppression of non-heterosexual people. According to the Suicide Prevention Resource Center(2008), “internalized homophobia and conflict about sexual orientation appear to contribute to suicide risk among LGBT youth”(p.22).
Family Support
Aspects of family dynamics—such as lack of support, conflict, and rejection as well as connectedness —play an important role in suicide risk for LGB youth. Abuse within the family (whether psychological, verbal, physical, or sexual) elevates the risk of suicidal behavior by LGBT young people. Therefore, family support plays an important role for LGB youth during the period in which they identify and “come out,” or disclose their sexual orientation to their families. Most are often rejected by members of their family and threatened. This is particularly true for members whom families are from cultural groups that prohibit homosexuality. For example, research has specified that some ethnic and cultural groups (such as first-generation immigrants from Latin America) are less accommodating of children who do not conform to set gender roles than are families that have been in the United States for several generations.

Prevention Programs
Suicide Prevention for LGBT Youth
The staff members of the Suicide Prevention Resource Center (SPRC) have identified LGBT youth programs that unambiguously include components of suicide prevention as well as suicide prevention programs that particularly focus on LGBT youth by (a) searching the World Wide Web; (b) posting questions to LGBT advocate and provider e-mail lists and to suicide prevention e-mail lists; (c) asking SPRC’s colleagues and outworkers about suicide prevention services for LGBT youth; and (d) analyze the psychological, medical and social science literature. SPRC identified only one program with a primary focus on preventing suicide by LGBT youth. The Trevor Project operates the nation’s only 24-hour toll-free suicide prevention helpline for LGBT and questioning youth (1-866-4-U-TREVOR).
Programs Serving the LGBT Youth
As stated earlier, many programs do not offer services specifically related to LGBT youth suicide. Rather, many organizations offer services that contribute to suicide prevention by strengthening protective factors, even if suicide prevention is not among their explicit organizational goals. Training in life skills, enhancing peer relationships, connecting LGBT young people with supportive adults, and helping parents and teachers provide support to LGBT youth are all activities that contribute to preventing suicide ( Suicide Prevention Resource Center,2008). Similarly, several youth suicide prevention state coalitions include state chapters of Parents, Families, and Friends of Lesbians and Gays (PFLAG) or other organizations serving LGBT people acknowledge the important of suicide prevention and actively work with this issue. Cooperation among these organizations has reciprocal benefits: LGBT organizations can “ ensure that statewide coalitions include LGBT youth in developing public awareness, training, data, and interventions, and statewide coalitions can provide resources and suicide prevention expertise to LGBT organization”(p.28).
A summary of suicide prevention programs for all youth found that most are implemented in three settings—schools, communities, and health care systems—and follow one of two broad goals: case-finding with referral and treatment or reduction of risk factors. Case-finding programs include school-based suicide awareness curricula crisis centers and hotlines. School-based awareness programs are normally designed to increase student understanding of adolescent suicide, increase recognition of signs of and risk factors for suicide, change attitudes about getting help, and expose resource.
Furthermore, risk-factor reduction includes lethal-means control, media instruction, youth life skills preparation, and postvention (interventions that follow suicidal behavior) .
Other Consideration for Prevention Programs
Family Connectedness Family connectedness—including the ability of youth to talk with parents, youth feeling cared about and understood, and the family having fun together—has been 32 shown to reduce the risk of suicidal ideation and suicide attempts for some LGB groups by half (Eisenberg & Resnick, 2006). Thus, any programs that build family support are important. Specifically programs related to LGBT youth. Supporting the development of PFLAG groups, LGBT youth support groups, family agencies that provide culturally sensitive services to families with LGBT youth, and gay-straight alliances may help to “reduce the isolation of LGBT youth and create the social supports that operate as a protective factor against suicidal behavior” (p.32).
Cultural Competency and Sensitivity Cultural competence includes a set of behaviors, attitudes, and policies that allows a system, professional, or agency to work efficiently in cross-cultural situations. Many agencies use multiculturalism to ensure that they use effective services for ethnic and minority groups (Narra, 2009). Given that LGBT youth are a minority dealing with negative social forces, a cultural competence approach for LGBT people can help address service discrepancies such as suicide and suicidal behaviors. Furthermore, competency and sensitivity can be developed through training. Competency training allocates members to rehearse skills and often uses case studies and exercises in which participant groups develop LGBT-inclusive policies and programs. This approach allows for open exploration and discussion. Sensitivity training begins with comprehending the existence of LGBT people, learning and becoming comfortable with LGBT terminology, and developing an initial awareness of one’s own biases and assumptions (Saltzburg, 2007). Values clarification and empathy development is an important part of sensitivity training as well.

Conclusion
Overview
A remarkable body of epidemiological records has accounted for higher risks of suicide among lesbian, gay, or bisexual youths. As indicated, one out of three LGB individuals has engaged in one form of suicidal behavior or the other. The experience of the “coming out” process can be psychologically difficult for youths that are already struggling with teenager adolescence and associations surrounding culture and diversity. In addition, homophobic behavior can add to the emotional stress that contributes to the thoughts and feelings of suicide.
The steps taken to lower suicidal behavior among LGBT youth can have the added advantage of reducing the social stigma and discrimination against LGBT people in families, schools, and communities. The learner found that through various research and literature throughout the course that the ultimate goal is not to simply help lesbian, gay, bisexual, and transgender youth survive, but to support them to prosper as healthy, dynamic, and effervescent youth by providing prevention programs and strategies that can be welcomed and greeted to empower their communities.

References
Bontempo, D. E., & D'augelli, A. R. (2002). Effects of at-school victimization and sexual orientation on lesbian, gay, or bisexual youths' health risk behavior. Journal of Adolescent Health, 30, 364-374.
Cato, J. E., & Canetto, S. S. (2003). Attitudes and beliefs about suicidal behavior when coming out is the precipitant of the suicidal behavior. Sex Roles, 49 (9), 497-505. Retrieved from http://ezproxy.library.capella.edu/login?url=http://search.ebscohost.com.library.capella.e du/login.aspx?direct=true&db=sih&AN=11330246&site=ehost-live&scope=site
Centers for Disease Control and Prevention. (2007). Web-based Injury Statistics Query and Reporting System (WISQARS). Retrieved February 26, 2011 from http://www.cdc.gov/ncipc/wisqars/
D’Augelli, A. R., & Hershberger, S. (1995). A multiyear analysis of changes in
AIDS concerns and homophobia on a university campus. Journal of
American College Health, 44(1), 3-10.
D'Augelli, A. R., Grossman, A., Salter, N. P., Vasey, J.J., Starks, M.T., & Sinclair, K. O. (2005). Predicting the suicide attempts of lesbian, gay, and bisexual youth. Suicide and Life-Threatening Behavior, 36, 646-660.
DePaul, J., Walsh, M. E., & Dam, U. C. (200). The role of school counselors in addressing sexual orientation in schools. Professional School Counseling, 12(4), 300-308. Retrieved from http://ezproxy.library.capella.edu/login?url=http://search.ebscohost.com.library. capella.edu/login.aspx?direct=true&db=aph&AN=37564386&site=ehost-live&scope=site
Eisenberg, M. E., & Resnick, M. D. (2006). Suicidality among gay, lesbian and bisexual youth: The role of protective factors. Journal of Adolescent Health, 39(5), 662-668.
Lebson, M. (2002). Suicide among homosexual youth. Journal of Homosexuality,
42(4), 107-117.
Massachusetts Department of Education. (2011a). Violence-related behaviors and experiences. In Massachusetts Department of Education, 2010 Massachusetts Youth Risk Behavior Survey results. Malden, MA:
Author. Retrieved March 1, 20011, from http://www.doe.mass.edu/cnp/hprograms/yrbs/05/ch5.doc
O’Higgins-Norman, J. (2009). Still catching up: Schools, sexual orientation and homophobia in Ireland. Sexuality & Culture, 13 (1), 1-16. doi: 10.1007/s12119-008-9030-1
McDaniel, J. S., Purcell, D., & D'augelli, A. R. (2001).The relationship between sexual orientation and risk for suicide: Research findings and future directions for research and prevention. Suicide and Life-Threatening
Behavior, 3(1.), 84-105.
McDermott, E.,Roen, K., & Scourfield, J. (2008). Avoiding shame: Young LGBT people, homophobia and self-destructive behaviours. Culture, Health & Sexuality, 10 (8), 815-829, doi: 10.1080/13691050802380974. Narra, P. (2009). Teaching on diversity: The mutual influence of students and instructors. Psychoanalytic Psychology, 26, 322-334. doi 10.1037/a0016444
Parker, R. D. (2005). A review of gay, lesbian, bisexual and transgender adolescent research: depression and suicide. Conference Papers –
American Sociological Association, 1-19. Retrieved from http://ezproxy.library.capella.edu/login?url=http://search.ebscohost.com. library.capella.edu/login.aspx?direct=true&db=sih&AN=18614346
&site=ehost- live&scope=site
Saltzburg, S. (2007). Narrative therapy pathways for re-authoring with parents of adolescents coming-out as lesbian, gay, and bisexual. Contemporary Family Therapy: An International Journal, 29(½),
57-69, doi: 10.1007/s10591-007-9035-1.
Suicide Prevention Resource Center. (2008). Suicide risk and prevention for lesbian, gay, bisexual, and transgender youth. Newton, MA:
Education Development Center, Inc.
U.S. Department of Health and Human Services. (2001). National strategy for suicide prevention: Goals and objectives for action. Rockville, MD:
Author.
Valenti, M., & Campbell, R. (2009). Working with youth on LGBT issues: why Gay–Straight Alliance advisors become involved.
Journal of Community Psychology, 37 (2), 228-248. doi: 10.1002/jcop.20290.
Walls, N. E., Freedenthal, S., & Wisneski, H. (2008). Suicidal ideation and attempts among sexual minority youths receiving social services. Social Work, 53(1), 21-29. Retrieved from http://ezproxy.library.capella.edu/login?url=http://search.ebscohost.com.library.capella.edu/login.aspx?direct=true&db=sih&AN=32061951&site=ehost-live&scope=site
Appendix A :
Appendix A contains items in the following categories: Schools, Health Care Providers Telephone and E-mail Help, Data and Research.
Schools
The Gay, Lesbian, and Straight Education Network (GLSEN) www.glsen.org This organization provides free and economical tools to help launch school Gay-Straight Alliances, including Jump-Start Activity Guides, Safe Schools policies, stickers, do-it-yourself training kits, and results from the National School Climate Survey of LGBT students.
Health Care Providers
Association for Lesbian, Gay, Bisexual, and Transgender Issues in Counseling (ALGBTIC) www.algbtic.org/resources/listing.htm A division of the American Counseling Association, this organization provides a variety of resources about the counseling of LGBT individuals, including a list of therapists.
Healthy People 2010: Companion Document for Lesbian, Gay, Bisexual, and Transgender Health (2001) www.glma.org/_data/n_0001/resources/live/HealthyCompanionDoc3.pdf This document, co-written by the Gay and Lesbian Medical Association and the National Coalition for LGBT Health, contains quantitative and qualitative research and information specific to LGBT health and discusses the overall health status of LGBT people
Telephone and Email
The Trevor Project www.thetrevorproject.org Trevor operates the nation’s only 24-hour toll-free suicide prevention helpline for gay, lesbian, bisexual, transgender, and questioning youth (1-866-4-U-TREVOR).
Data and Research
GayData.org
www.gaydata.org/
This Web site, maintained by Randall L. Sell at Drexel University, provides widespread research summaries and links for data, and promotes the gathering of sexual orientation data and further studies of data sources that have already collected such data.
Parents, Families, and Friends of Lesbians & Gays (PFLAG) www.pflag.org/ This group promotes the health and well-being of gay, lesbian, bisexual, and transgender persons and their families and friends. PFLAG’s Web site contains sections on support, education, and advocacy.