LGBTIQ+ Australians: suicidal thoughts and behaviours and self-harm Print this page

LGBTIQ+ communities have been identified as priority populations under The National Mental Health and Suicide Prevention Agreement (Cth of Australia, 2022) and for data development as part of the National Suicide and Self-harm Monitoring System. Under the agreement, governments have a responsibility to support priority populations, who may be at higher risk of mental ill health and suicide due to vulnerability caused by social, economic, and environmental circumstances.

Data on suicide and self-harm among LGBTQ+ people from the Private Lives 3 and Writing Themselves In 4 surveys

The Australian Research Centre in Sex, Health and Society (ARCSHS) at La Trobe University runs Australia’s two largest targeted surveys of LGBTQ+ adults and LGBTQA+ young people, the Private Lives and Writing Themselves In surveys, respectively (Hill et al. 2020, 2021). The most recent iterations of these surveys, Private Lives 3 (PL3) and Writing Themselves In 4 (WTI4) were undertaken in 2019. The PL3 and WTI4 datasets are the largest and most comprehensive available for the LGBTQ+ population in Australia and include a diverse sample of participants from all states and territories and demographic groups (Hill et al. 2020, 2021).

ARCSHS has provided the AIHW with existing data on suicide and self-harm from PL3 and WTI4, aggregated by state/territory, age-group, gender and sexual orientation. In addition, the AIHW has engaged ARCSHS to undertake secondary analysis of the data from PL3 and WTI4, including:

• Types of gender affirmation accessed by trans and gender diverse adults and association with health and wellbeing outcomes (PL3).
• Types of gender affirmation accessed by trans and gender diverse young people and association with mental health outcomes and suicidality (WTI4).
• The role of relationship status and gender of relationship partner in shaping health and wellbeing outcomes among multigender attracted (bisexual+) adults (PL3).

Data on suicidal thoughts and suicide attempt among LGBTQ+ adults from the PL3 survey are presented in the following section. This is the first tranche of data from PL3 and WTI4 to be published on the AIHW Suicide and self-harm monitoring website. Data on suicidal thoughts and attempts and self-harm among young LGBTQA+ young Australians from WTI4 and the results of the secondary analysis of PL3 and WTI4 will be published later in 2023.

The findings of PL3 are consistent with evidence from Australia and overseas, which indicate that LGBTIQ+ communities experience higher levels of mental ill health, suicidality and self-harm, compared with the general population (Hill et al. 2020, 2021, Marchi et al. 2022, Swannell et al. 2016, Zwickl et al. 2021). Within the LGBTQ+ research, trans and gender diverse participants appear to experience a greater risk of suicidal thoughts and behaviours, compared with cis-gendered participants. For instance, among PL3 participants:

• The lifetime prevalence of suicidal thoughts ranged from 64% among cisgender men to 90% among non-binary participants and 91% among trans men.
• More than half of trans men reported having attempted suicide in their lifetimes (53%), in contrast to around one-fifth of cisgender men (22%).

Other Australian studies of trans people have found that a large proportion of participants (ranging from 43 to 48%) have attempted to take their own lives at some point (Zwickl et al. 2021, Bretherton et al. 2021, Strauss et al. 2017).

A limitation of PL3, WTI4 and other targeted, community surveys of LGBTQ+ people is that they tend not to be based on probability sampling and, as a result, it is not possible to conclude that they provide representative data for the LGBTQ+ population. However, these surveys do provide important information about the survey respondents, which can inform the work of LGBTQ+ researchers and advocates, and policy makers.

What other national suicide and self-harm data are available for LGBTIQ+ communities in Australia?

There are currently no reliable national data on rates of suicide and self-harm among LGBTIQ+ communities in Australia. The two key administrative datasets used by the AIHW to report on rates of suicide and hospitalised self-harm, the National Mortality Database (NMD) and the National Hospital Morbidity Database (NHMD) do not include information on LGBTIQ+ status. LGBTIQ+ status is not available in any national linked administrative datasets and has not been enumerated in the Census of Population and Housing. Data gaps could be improved by the broader inclusion of the Standard for Sex, Gender, Variations of Sex Characteristics and Sexual Orientation Variables, 2020 (ABS 2020) in national collections.

State and territory suicide registers include variables on sexual orientation and gender, however, LGBTIQ+ status tends to be underreported in these surveillance systems (CCOV 2022, Leske et al. 2022). To date, the Victorian Suicide Register (VSR) and the Queensland Suicide Register (QSR) are the only state suicide registers to publish data on suicide deaths among LGBTIQ+ people. In each state, the numbers are too small to disaggregate by gender and sexual orientation (CCOV 2022, Leske et al. 2022).

The population representative, National Study of Mental Health and Wellbeing (2020–21 and 2021–22), conducted by the Australian Bureau of Statistics (ABS) collected information on suicidality and self-harm and was the first ABS collection to use the Standard for Sex, Gender, Variations of Sex Characteristics and Sexual Orientation Variables, 2020 (ABS 2020, 2020–21b). So far, only results from the 2020–21 cohort have been published, with the ABS noting that the ‘sample achieved for 2020–21 is insufficient to produce reliable estimates of mental disorders for all items within the Standard’ (ABS 2020–21b). The ABS has advised that further disaggregation of mental health data by items within the Standard may be possible once the results from the 2020–21 and 2021–22 cohorts are combined (ABS 2020–21b). The combined results are scheduled to be released by the ABS on 10 October 2023.

Prevalence of suicidal behaviour and thoughts among LGBTIQ+ adults – data from the 2019 Private Lives 3 (PL3) survey

PL3 is the third iteration of national surveys investigating the health and wellbeing of lesbian, gay, bisexual, trans and gender diverse and queer (LGBTQ) adults in Australia. The PL3 survey is managed by the Australian Research Centre in Sex, Health and Society (ARCSHS) at La Trobe University in Melbourne and was developed by ARCSHS in consultation with an Expert Advisory Group comprising representatives from the states and territories and LGBTIQ+ groups. The sample was recruited via paid advertising on social media and promotion through relevant professional networks and LGBTIQ+ organisations. The survey was open to people aged 18 years and over, from 24 July 2019 until 1 October 2019 and could be completed online or in paper form if requested. A sample of 6,835 participants was achieved, whose ages ranged from 18–88 years. The PL3 survey included questions on suicide attempt and suicidal thoughts in the past 12 months and lifetime. For more information, view the PL3 national report.

People with an intersex variation/s were specifically targeted for participation in PL3 but the sample achieved (n=47) was too small to provide statistically meaningful comparisons. Therefore, data for participants with an intersex variation/s are not reported as a separate group and the acronym ‘LGBTQ+’ is used when discussing the PL3 results below. The data for PL3 participants who reported having intersex variation/s are included in the other categories presented, according to their responses to gender and sexual orientation questions. View the PL3 national report for more information about participants with an intersex variation/s.

The PL3 results relating to suicide attempt and suicidal thoughts are depicted in the visualisations below. As PL3 uses a non-probability convenience sample, the results may not be representative of the Australian LGBTQ+ population and cannot be generalised to this population group. However, they provide valuable insights into the experiences of close to 7000 people from this population group and highlight where further work is needed to obtain better data and improve outcomes for at-risk communities. Importantly, the PL3 sample allows for disaggregation of data by gender and sexual orientation, which illustrates the wide variations in experiences of suicidal thoughts and behaviours between the different gender and sexual orientation groups in the sample. These results are consistent with other studies that show considerable variation in the prevalence of suicidal thoughts and behaviours between sub-groups under the LGBTQ+ umbrella (e.g. Kirakosian et al. 2023, Marchi et al. 2022, Stinchcombe & Hammond 2021, Swannell et al. 2016).

The results of PL3 are not directly comparable with those for the general population from national population surveys, such as the ABS National Study of Mental Health and Wellbeing (2020–21) and the ABS National Survey of Mental Health and Wellbeing (2007). The ABS surveys used probability sample designs as well as different recruitment methods, instruments, and modes of administration (see ABS 2020–21b for information on methodology). Both types of survey designs have limitations regarding sampling LGBTQ+ communities. Targeted surveys, such as PL3, may be biased towards people with stronger attachment to the LGBTQ+ community, while population surveys may underrepresent LGBTIQ+ people (Hottes et al. 2016) and, as is the case in the ABS National Study of Mental Health and Wellbeing (2020–21), obtain insufficient samples to report results by gender and sexual orientation. A meta-analysis of lifetime prevalence of suicide attempt among lesbian, gay and bisexual (LGB) people by Hottes et al. (2016) found that targeted community surveys reported higher prevalence of lifetime suicide attempt among LGB people, compared with results for LGB people from population surveys. Even so, LGB people reported higher prevalence of lifetime suicide attempt compared with heterosexual people, regardless of the survey type (Hottes et al. 2016).

In relation to the PL3 data, the term 'suicidal thoughts' is being used rather than 'suicidal ideation'. This is because suicidal ideation is defined in national population data as 'serious thoughts about taking one’s own life', whereas the PL3 data item is 'thoughts about suicide, wanting to die, or about ending your life'.

As the PL3 was a voluntary online survey, participants could leave questions blank if they wished. In these cases, the PL3 results reported below are the proportions (percentages) of those who answered the relevant question.

Suicide attempts and suicidal thoughts among PL3 participants

The visualisation below includes 4 charts that users can navigate between to view the PL3 data for suicidal thoughts and attempts broken down by either state and territory of residence, gender, sexual orientation or age group.

Nationally, around three-quarters (75%) of PL3 participants had experienced suicidal thoughts and around one third (30%) reported attempting suicide in their lifetimes.

Results by state and territory

The prevalence of suicidal thoughts and attempt among PL3 participants was similar across states and territories.

• Lifetime prevalence of suicidal thoughts ranged from 68% in the Northern Territory (NT) to 80% in the Australian Capital Territory (ACT).
• Recent (past 12 months) prevalence of suicidal thoughts ranged from 35% in the NT to 47% in Tasmania (Tas).
• Participants from Tas and Queensland (Qld) were most likely to report having attempted suicide in their lifetimes (35%), followed by those in South Australia (SA) (33%), Western Australia (WA) (32%), ACT (31%), Vic and New South Wales (NSW) (both 28%) and the NT (21%).
• Recent suicide attempt (past 12 months) was also more likely to be reported by participants from Tas (8%) and Qld (7%), followed by WA and ACT (both 6%), Vic (5%) and SA and NSW (4%).
• Recent suicide attempt is not reported for participants from the NT due to the small cell count (n<3).

Caution should be used in interpreting the results by state and territory, as they may be affected by sampling and recruitment bias, in particular for the NT, where the sample size was only 37. Relative to the general population, PL3 oversampled people from Vic and the ACT, and under-sampled people from NSW and Qld (Hill et al. 2020). There may also be confounding due to differences in the age, gender, and sexual orientation distributions of LGBTQ+ people by state and territory.

Results by age group

The results for age group show a clear gradient by age, with younger age groups more likely to report lifetime and recent (last 12 months) experience of suicidal thoughts and lifetime suicide attempt.

• Lifetime experience of suicidal thoughts ranged from around half of people aged 65 years and over (51%) to 80% of people in the 18–24 and 25–34-year age groups.
• Lifetime suicide attempt ranged from 18% of people aged 65 years and over to 34% of 18–24-year-olds.
• Recent suicide attempt was most likely among participants aged 18–24 years (10%), followed by participants aged 35–44 years (5%), then those aged 25–34 (3%), 45–54 years (2%) and 55–64 years (1%).

The patterns observed in these results are consistent with the general population results from the ABS National Study of Mental Health and Wellbeing (2020–21), which show prevalence of lifetime and recent suicidal ideation and suicide attempt is highest among the youngest age group (16–34 years) and decreases with increasing age (ABS 2020–21a). Ambulance data from the National Ambulance Surveillance System (NASS) also show higher rates of attendances for suicidal ideation and attempt among younger age groups.

The PL3 results for younger people may be influenced by the greater proportions of younger people categorised as trans, gender diverse, bisexual, pansexual and queer, relative to those in the older age groups (Hill et al. 2020). Participants in each of these categories are more likely to experience poor mental health outcomes, as well as discrimination and stigma, when compared with cisgendered, gay and lesbian participants (Hill et al. 2020).

Results by sexual orientation

The PL3 survey asks participants to select which terms best describe their sexual orientation and then asks them to select the term they would use if they had to choose only one. The options provided were developed in consultation with the PL3 Expert Advisory Group and include: ‘lesbian’, ‘gay’, ‘homosexual’, ‘bisexual’, ‘pansexual’, ‘heterosexual’, ‘queer’, ‘asexual’, ‘prefer not to have a label’, ‘prefer not to answer’, ‘don’t know’ and ‘something different’ (with free text option to describe). In the analysis, participants who selected ‘homosexual’ (due to low numbers), ‘prefer not to have a label’ and ‘something different’ as well as trans and gender diverse participants and those with an intersex variation/s who selected ‘heterosexual’ were combined into the category ‘something else’. For more information on sexual orientation in PL3, please see the PL3 national report.

The results for sexual orientation differed across response categories, apart from gay respondents, who were least likely to have experienced suicidal thoughts or attempt, recently or in their lifetimes.

• Pansexual and queer participants reported the highest prevalence of lifetime suicidal thoughts (88% and 87%, respectively), followed by bisexual and asexual participants (80% and 79% respectively), participants categorised as “something else” (75%), lesbian participants (73%) and gay participants (63%).
• A similar pattern was seen for recent suicidal thoughts, which were reported by 55% of both pansexual and queer participants, 50% of bisexual participants, 45% of respondents categorised as “something else”, 43% of asexual participants, 37% of lesbian participants and 31% of gay participants.
• Nearly half (47%) of pansexual participants reported having attempted suicide in their lifetimes, followed by queer participants (37%), “something else” (34%), bisexual (32%), lesbian (30%), asexual (27%) and gay (20%) participants.
• Participants in the “something else” sexual orientation category were most likely to report recent suicide attempt (10% of this group), followed by pansexual (8%), bisexual (6%), queer (5%), asexual and lesbian (4%) and gay (3%) participants.

There is limited research that includes the sexual orientations “pansexual”, “queer” and “asexual” as specific groups with which to compare these results. Studies that have included lesbian, gay and bisexual people as separate groups have generally reported higher levels of suicidal thoughts and behaviour among bisexual and multi-gender attracted people, compared with gay and lesbian people (e.g. Stinchcombe & Hammond 2020, Marchi et al. 2022).

Results by gender

When disaggregated by gender, the results show that trans (trans man and trans woman) and non-binary participants were more likely to have experienced recent and lifetime suicidal thoughts and suicide attempts, compared with cisgendered participants (cisgender man and cisgender woman).

• Lifetime prevalence of suicidal thoughts among PL3 participants ranged from 64% of cisgender men to 90% of non-binary participants and 91% of trans men.
• More than half of trans men reported having attempted suicide in their lifetimes (53%), compared with around one fifth of cisgender men (22%).

The high levels of suicidal thoughts and behaviour among trans participants are consistent with other studies of trans people in Australia. A 2017–2018 survey of Australian trans adults found that 43% of participants had attempted suicide in their lifetimes (Zwickl et al. 2021, Bretherton et al. 2021). The 2016 Trans Pathways survey of Australian trans young people aged 14–25 years reported that 48.1% of participants had ever attempted suicide (Strauss et al. 2017).

Suicide attempt, suicidal thoughts and disability or long-term health conditions in PL3

The PL3 survey asks participants whether they have a disability or long-term health condition (defined as one that has lasted or is expected to last 6 months or longer). If participants answer “yes” to this question, they are then asked a series of questions taken from the AIHW’s Standardised Disability Flag Module (SDFM). The SDFM identifies people who may be living with disability and/or long-term health conditions and the impact these conditions have on their day-to-day living (none, mild, moderate, and severe). For further information about how the SDFM was used and the limitations it may have on the data presented please see the PL3 national report.

The visualisation below includes two charts that users can navigate between. One chart shows the prevalence of suicidal thoughts and attempts among PL3 participants according to their disability status. The other chart shows suicidal thoughts and attempts among PL3 participants who reported having a disability or long-term health condition, according to the impact on their day to day living.

Results by disability or long-term health condition status

PL3 participants who reported they have a disability or were unsure whether they have a disability were most likely to have experienced suicidal thoughts in their lifetimes (85% of participants in both categories), compared with PL3 participants who did not have a disability (64%).

PL3 participants who reported having a disability or being unsure about having a disability also reported the highest prevalence of recent suicidal thoughts (54% and 53%, respectively), compared with those without a disability (29%).

Suicide attempt was more common among PL3 participants who reported having a disability, with 40% having attempted suicide in their lifetimes. This is twice the proportion of PL3 participants without a disability (20%) who reported lifetime suicide attempt.

Results by disability or long-term health condition impact on day-to-day activities

The results for lifetime and recent suicidal ideation and suicide attempt show a clear gradient by the severity of activity limitation.

• Among PL3 participants with a disability or long-term health condition who reported severe limitations, 91% reported having suicidal thoughts in their lifetimes and 50% reported attempting suicide in their lifetimes. More than two thirds (68%) of these participants reported recent (past 12 months) suicidal thoughts.
• For PL3 participants with a disability or long-term health condition who had no activity limitation, 71% reported lifetime suicidal thoughts and 26% reported lifetime suicide attempt.