Exploring Suicide Risk From an Intersectionality Framework

Lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ+) people face unique societal stressors while concerning trends in suicidality for communities of color necessitate further examination of how marginalization contributes to suicide risk. From a foundation of minority stress and intersectionality theory, we investigated suicide risk across multiple marginalized identities. The present study explored the associations between marginalized ethnic and cultural backgrounds, genders, and sexual orientations with suicide risk using a three-way interaction term to analyze data from the publicly available Transgender Population Health Study, while accounting for age, assigned sex at birth, household income, distress, and social support. Relative to White-cisgender-heterosexual people, people marginalized based on ethnic and cultural backgrounds, gender, and sexual orientation had the highest associated increase in suicide risk amongst any other group with single or multiple marginalized identities (β = 1.90, RSE = 0.38, t = 5.44, p < 0.001, 95% CI [1.16, 2.64]). However, relative to White-cisgender-heterosexual people, marginalization based on ethnic and cultural background alone and with sexual orientation had no significant association with suicide risk. Providers must be trained in culturally responsive and gender-affirming practices, particularly given multiple marginalization may be associated with higher suicide risk. Future research should continue to explore multiple marginalization and suicide risk, risk assessments, and prevention efforts.