To the Editors:
Ream’s study [1] focuses on suicide deaths among youth and young adults where lesbian, gay, bisexual, and transgender (LGBT) and heterosexual themes emerged in the course of their investigation. In doing so, he underscores the dearth of data on this important public health issue.
As he notes, studies concordantly find that LGBT populations have greater prevalence of lifetime suicide attempt than heterosexual populations, but there is scant evidence that LGBT people actually die by suicide at higher rates than their non-LGBT peers [2]. Ream’s use of data from the National Violent Death Reporting System (NVDRS) is an attempt to remedy this knowledge gap. Yet, in doing so, his findings and conclusions serve to muddy the waters. Principally, his comparison group is clearly a subsample of heterosexual suicides, thus greatly inflating the paper’s conclusion that “24% of 12- to 14-year-olds who die by suicide in the United States are LGBT” [1,3].
Although the NVDRS currently includes data fields for sexual orientation and transgender status (not gender identity), the overwhelming majority of cases are coded as “unknown.” This is a function of coding rules in the manual. Unless sexual orientation, LGBT or heterosexual, is specifically mentioned in the administrative records, it is not to be coded [4]. Indeed, only 21% of NVDRS suicide cases among 12- to 29-year-olds were actually coded for sexual orientation or transgender status, whether LGBT or otherwise. Most of the missing cases were presumably heterosexual individuals [5]. A further source of bias is that LGBT status might have been more salient to law enforcement and medical examiners than heterosexual status, leading to its more frequent notation in the administrative record. These two factors call into question the assertion that the sample provides “nationally representative” results.
We share Ream’s enthusiasm about seeking data to improve knowledge about risk of suicide death among LGBT communities. However, we believe strong circumspection is necessary when using NVDRS data for LGBT-related analyses to avoid drawing misleading conclusions.
Contributor Information
Kirsty A. Clark, Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
John R. Blosnich, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; U.S. Department of Veterans Affairs, Center for Health Equity Research and Prevention, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia; West Virginia University Injury Control Research Center, Morgantown, West Virginia
Ann P. Haas, Department of Health Sciences, Lehman College, City University of New York, Bronx, New York
Susan D. Cochran, Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
References
- [1].Ream GL. What’s unique about lesbian, gay, bisexual, and transgender (LGBT) youth and young adult suicides? Findings from the National Violent Death Reporting System. J Adolesc Health 2019;64:602–7. [DOI] [PubMed] [Google Scholar]
- [2].Haas AP, Eliason M, Mays VM, et al. Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: Review and recommendations. J Homosex 2010;58:10–51. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [3].Mays VM, Cochran SD. Challenges and opportunities for modernizing the National Violent Death Reporting System. Am J Public Health 2019;109:192–4. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [4].Haas AP, Lane AD, Blosnich JR, et al. Collecting sexual orientation and gender identity information at death. Am J Public Health 2019;109:255–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [5].Gates GJ. How many people are lesbian, gay, bisexual and transgender? Los Angeles, CA: Williams Institute; 2011. [Google Scholar]