Life under the rainbow: Self-harm and suicidality among LGBT community in Bangladesh

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The LGBT communities in Bangladesh live in precarious conditions under the legal and social sections against them. This study was carried out in a context where data on suicidality among these sexual minority communities in Bangladesh exist little beyond anecdotal reports. Methods. A countrywide cross-sectional survey was carried out to collect data from LGBT (n = 297) and cisgender (n = 86) participants. Snowball sampling was used for generally secretive LGBT participants. Results. Findings indicated significantly higher prevalences of self-harm (direct and indirect), death wish, suicidal ideation, and suicide attempt among the LGBT communities compared to the cisgender population. The lesbians reported the highest lifetime prevalence for indirect self-harm (62%), direct self-harm (56%), death wish (74%) and suicidal ideation (53%). Reported suicide attempts were most common among gays (41%) closely followed by lesbians (38%) and transgenders (36%). When compared with the cisgender population, the odds of these experiences ranged from 3.97 to 13.17 for lesbians, 2.34 to 9.26 for gays, 1.37 to 2.91 for bisexuals, and 2.21 to 13.41 for transgenders. Conclusion. The findings bring forth a dire picture of the high risk of suicidality among the hidden sexual minority communities in Bangladesh and are expected to contribute to evidence-informed policymaking. Self-harm suicide LGBT lesbian gay bisexual transgender hijra homosexuality mental health policy Bangladesh Background Lesbian, gay, bisexual, and transgender, commonly coined together as LGBT, are sexual minority populations where their sexual interest and activities are considered different and often unacceptable to mainstream society. These differences generally contribute to the othering of these individuals in the eyes of mainstream society. In Bangladesh, the perception of LGBT people being abnormal is so widespread in the general population that the members of the LGBT community themselves often consider them abnormal. The complex interplay of misperception, prejudice, problematisation, and discrimination between mainstream society and LGBT communities causes undue psychological disturbances among them. Research findings around the world have indicated a higher prevalence of psychological disturbances among the LGBT population [ 1 , 2 ]. This can be considered one of the factors contributing to higher rates of self-harm and suicidal behaviour among the LGBT communities [ 3 ]. Systematic reviews and meta-analyses on mental health and suicide consistently presented evidence of higher rates of suicidal behaviour and self-harm among the LGBT population compared to the cisgender population [ 1 , 2 , 4 , 5 ]. The most recent meta-analysis by Marchi, et al. [ 5 ] concluded that LGBTIQ people have a higher risk of reported non-suicidal self-injurious behaviour (OR 4.24), suicidal ideation (OR 3.76), and suicidal attempt (OR 4.36). The bisexual community has been reported to have the highest risk of non-suicidal self-injurious behaviour (OR 5.03), suicidal ideation (OR 5.04), and suicidal attempt (OR 6.71) among all the other subgroups in the LGBTIQ population [ 5 ]. Individual studies also reported at least twofold higher prevalence (both lifetime and 12-month) of self-harm among LGBT adolescents compared to heterosexual adolescents [ 6 ]. Significantly higher rates of lifetime prevalence of self-harm, suicidal ideation, and suicidal attempts have been reported for the bisexual, homosexual, and other sexual minority groups compared to the cisgender population [ 7 ]. Qualitative exploration indicated the contribution of an interplay of internal processes (e.g., struggle with understanding and accepting identity) and external responses (e.g., abusive experience, life stressor) as the underlying process in the self-harm and suicidal behaviour among the LGBTQ youth [ 8 ]. Difficulties in emotional regulation have also been reported to contribute to an increased risk of suicidal behaviour among the LGBTQ + population [ 9 ]. The LGBT population, as sexual minorities, are regarded as vulnerable communities in Bangladesh [ 10 , 11 ]. The exact size of the LGBT population in the country is yet to be known. Latest estimates suggest a population size of 8533 for transgenders and 119,869 for male homosexuals; no estimates are available for lesbians and bisexuals [ 12 ]. Although the four groups are categorised together as sexual minorities, their behaviour, practices, community interaction, and support structures vary considerably [for a detailed discussion see 13]. It may be noted here that Bangladesh is a Muslim-majority country that still carries the legacy of the British colonial thinking in most of its laws. Many sexual behaviours and practices of the LGBT population contradict the religious and sociocultural norms as well as the legal provisions of the country [section 377; 14]. The government recently recognised Hizra as the third gender. However, the definition does not accurately include the transgender population which the term was supposed to denote. Considering their minority status and social unacceptability, it is conceivable that the LGBT population suffer from strong psychosocial consequences in Bangladesh. Unfortunately, published literature on mental health, self-harm, and suicidality among the LGBT population in Bangladesh is almost non-existent. A handful of published studies are available on homosexual males. Mozumder, Jasmine, Haque and Haque [ 15 ] reported an alarmingly high rate of self-harm (40.2%), suicidal ideation (47.1%), and suicidal attempt (32.4%) among gay men in Bangladesh. Hussain and Chowdhury [ 16 ] explored factors affecting suicidality among male homosexuals in Bangladesh and found role conflicts, adverse life experiences, poor coping, lack of protective measures, negative societal perception, and relationship difficulties to be the key contributors. Only anecdotal reports are available regarding information on suicidality for the remaining sexual minority groups [ 17 , 18 ]. This general lack of data called for an exploration of the prevalence of self-harm and suicidal behaviour among the LGBT population in Bangladesh. Methods Study design Cross-sectional survey design was used to collect data from the generally hidden and hard-to-reach LGBT communities in Bangladesh between July to August 2016. Although defining LGBT is challenging, two distinct features, namely sexual orientation and sexual identity, are widely used in the definitions [ 19 ]. The participants interviewed in this study self-identified themselves as lesbian, gay, bisexual, or transgender. Against the backdrop of the recent murders of several LGBT activists by alleged Islamist groups around the time of data collection, widespread fear among the LGBT communities prevented many from participating in the study. Participants The present study collected data from 383 self-identified lesbian (n = 34), gay (n = 85), bisexual (n = 87), transgender (n = 91) and cisgender (n = 86 ) individuals from five randomly selected divisional districts of Bangladesh, namely Dhaka, Khulna, Mymensingh, Rangpur, and Sylhet. Due to the widespread stigma, hostile attitude, religious ostracization, and precarious legal status, the sexual minority population in Bangladesh is highly secretive, and thus, a random selection of participants was not possible. Purposive snowball sampling was used to interview LGBT participants from the selected districts. Lesbians from only Dhaka and Khulna participated. Despite a slightly higher mean age for the transgender and cisgender population, the average age of the participants across the LGBT groups and cisgender population were comparable (lesbian − 28.85 years, gay − 26.84 years, bisexual − 26.87 years, transgender − 30.94 years, and cisgender population − 33 years). Instruments A set of five indicators were used for assessing self-harm and suicidal behaviour. The first among these was indirect self-harm where the participants reported their engagement in risky behaviour (such as unprotected sex, drinking alcohol, and denying prescribed medication) with the intent to cause gradual harm to self. The second was direct self-harm which involves intentional bodily harm through cut injury. The third explored wishes and passive prayer for death to come. The fourth explored suicidal ideation i.e., thoughts of ending life. The fifth indicator explored attempted suicide. The participants reported their experience retrospectively on these five indicators in two timeframes, firstly lifetime experience and secondly recent experience (in the past 3 months). Procedures The data and findings presented in this study were collected as part of a larger countrywide survey on exploring the mental health and psychosocial status of sexual minority communities in Bangladesh. Organisations working with LGBT populations served as the contact points and aided the recruitment of study participants. Detailed explanatory statements coupled with verbal clarification on the nature of the study and the processes involved were provided to the participants. To avoid any potential legal implications and inadvertent disclosure of the identity of participants, verbal understood consent was taken instead of signed written ones [see 20]. A nominal reimbursement of Tk.250 (approximately US $ 3) for the cost of transportation was given to all the invited LGBT participants, irrespective of their decision to participate or not. The cisgender participants were not paid any compensation as the interviews were carried out at their places; no transport costs were incurred by them. Data were collected by thirteen research assistants with bachelor's degrees in psychology under supervision from the lead author and a research officer. The RAs were provided with training to minimise variation in administering the research tool, to sensitise them on LGBT issues, and to ensure ethical standards in data collection. Although not recorded, the response rate with the LGBT participants was seemingly much higher as compared to the cisgender participants. The involvement of the community-based organisations might have played an important role in building trust with the research team. Statistical analysis PASW 18 [ 21 ] software package was used for statistical analysis of the data. Self-reported lifetime and recent experience of self-harm and suicidal behaviour of the LGBT groups were compared with that of the cisgender population using the Chi-square test. The odds ratio (OR) was also calculated to see the difference between each of the LGBT groups and the cisgender population on the five indicators. The self-reported lifetime experience provides a crude assessment of the prevalence of self-harm and suicidal behaviour which is also amenable to recall bias. To get a more precise understanding, data on recent experiences within the last three months were also collected. Results All four sexual minority groups had higher rates of self-harm, death wishes, suicidal ideation, and suicidal attempts compared to the cisgender population (OR up to 13.41). These differences were significant across most of the five indicators for both lifetime (Table 1 ) and 3-month reports (Table 2 ). Among the LGBT groups, bisexuals had the lowest lifetime as well as 3-month prevalence on all five indicators of self-harm and suicidal behaviours (OR 1.37 to 3.29). In several cases, reporting from bisexuals did not differ significantly from that of the cisgender population. Table 1 Lifetime experience of self-harm and suicidal behaviour among LGBT and cisgender population Yes n (%) No n (%) Chi-square OR 95% CI Indirect self-harm Cisgender (n = 86) 19 (22) 67 (78) Reference Lesbian (n = 34) 21 (62) 13 (38) 17.26** 5.7 [2.41, 13.45] Gay (n = 85) 36 (42) 49 (58) 8.04** 2.59 [1.33, 5.05] Bisexual (n = 87) 35 (40) 52 (60) 6.63** 2.37 [1.22, 4.62] Transgender (n = 91) 36 (40) 55 (60) 6.3** 2.31 [1.19, 4.47] Direct self-harm Cisgender (n = 86) 8 (9) 78 (91) Reference Lesbian (n = 34) 19 (56) 15 (44) 30.32** 12.35 [4.57, 33.36] Gay (n = 85) 19 (22) 66 (78) 5.48* 2.81 [1.15, 6.83] Bisexual (n = 87) 16 (18) 71 (82) 2.99 2.2 [0.89, 5.45] Transgender (n = 91) 26 (29) 65 (71) 10.58** 3.9 [1.65, 9.20] Wishing death Cisgender (n = 86) 18 (21) 68 (79) Reference Lesbian (n = 34) 25 (74) 9 (26) 29.32** 10.49 [4.17, 26.39] Gay (n = 85) 54 (64) 31 (36) 31.82** 6.58 [3.33, 13.01] Bisexual (n = 87) 36 (41) 51 (59) 8.42** 2.67 [1.36, 5.22] Transgender (n = 91) 65 (71) 26 (29) 45.28** 9.44 [4.73, 18.84] Suicidal Ideation Cisgender (n = 86) 19 (22) 67 (78) Reference Lesbian (n = 34) 18 (53) 16 (47) 10.87** 3.97 [1.71, 9.23] Gay (n = 84) 42 (50) 42 (50) 14.38** 3.53 [1.81, 6.86] Bisexual (n = 87) 26 (30) 61 (70) 1.36 1.5 [0.76, 2.98] Transgender (n = 91) 47 (52) 44 (48) 16.52** 3.77 [1.96, 7.25] Suicidal Attempt Cisgender (n = 86) 9 (10) 77 (90) Reference Lesbian (n = 34) 13 (38) 21 (62) 12.55** 5.3 [1.99, 14.07] Gay (n = 85) 35 (41) 50 (59) 21.1** 5.99 [2.65, 13.52] Bisexual (n = 87) 15 (17) 72 (83) 1.66 1.78 [0.73, 4.33] Transgender (n = 90) 32 (36) 58 (64) 15.49** 4.72 [2.09, 10.66] Note. OR = odds ratio, CI = confidence interval; * p < 0.05, ** p < 0.01. Compared to the cisgender population, lifetime and recent prevalences of indirect self-harm were significantly higher among all the LGBT groups (OR 2.21 to 5.70). The pattern of differences observed for lifetime exposure between the LGBT groups and the cisgender population was also present for recent experiences of self-harm and suicidal behaviour. However, in the case of direct self-harm, only the lesbians had significant differences from the cisgender population (OR = 13.17). Table 2 Recent (last 3-month) self-harm and suicidal behaviour among the LGBT and the cisgender population Yes n (%) No n (%) Chi-square OR 95% CI Indirect self-harm Cisgender (n = 86) 11 (13) 75 (87) Reference Lesbian (n = 30) 12 (40) 18 (60) 10.36** 4.55 [1.73, 11.95] Gay (n = 85) 21 (25) 64 (75) 3.99* 2.24 [1.00, 4.99] Bisexual (n = 85) 23 (27) 62 (73) 5.46* 2.53 [1.14, 5.59] Transgender (n = 90) 22 (24) 68 (76) 3.92* 2.21 [1.00, 4.88] Direct self-harm Cisgender (n = 86) 3 (3) 83 (97) Reference Lesbian (n = 31) 10 (32) 21 (68) 19.1** 13.17 [3.33, 52.17] Gay (n = 84) 7 (8) 77 (92) 1.8 2.52 [0.63, 10.07] Bisexual (n = 85) 4 (5) 81 (95) 0.16 1.37 [0.30, 6.30] Transgender (n = 89) 9 (10) 80 (90) 3 3.11 [0.81, 11.91] Wishing death Cisgender (n = 86) 11 (13) 75 (87) Reference Lesbian (n = 31) 19 (61) 12 (39) 28.11** 10.8 [4.13, 28.21] Gay (n = 85) 39 (46) 46 (54) 22.63** 5.78 [2.69, 12.40] Bisexual (n = 86) 28 (33) 58 (67) 9.58** 3.29 [1.51, 7.16] Transgender (n = 89) 59 (66) 30 (34) 52.16** 13.41 [6.21, 28.97] Suicidal Ideation Cisgender (n = 85) 7 (8) 78 (92) Reference Lesbian (n = 31) 10 (32) 21 (68) 10.48** 5.31 [1.80, 15.62] Gay (n = 84) 32 (38) 52 (62) 21.22** 6.86 [2.82, 16.70] Bisexual (n = 87) 18 (21) 69 (79) 5.37* 2.91 [1.15, 7.38] Transgender (n = 85) 37 (44) 48 (56) 27.6** 8.59 [3.55, 20.80] Suicidal Attempt Cisgender (n = 86) 2 (2) 84 (98) Reference Lesbian (n = 34) 5 (15) 29 (85) 6.8** 7.24 [1.33, 39.37] Gay (n = 83) 15 (18) 68 (82) 11.58** 9.26 [2.05, 41.92] Bisexual (n = 86) 3 (3) 83 (97) 0.21 1.52 [0.25, 9.32] Transgender (n = 86) 14 (16) 72 (84) 9.92** 8.17 [1.80, 37.14] Note. OR = odds ratio, CI = confidence interval; * p < 0.05, ** p < 0.01. Wishing death (which is generally considered a passive form of suicidality) demonstrated a high lifetime exposure (21%) among the cisgender population and was even higher for the lesbian (74%), gay (64%), bisexual (41%), and transgender (71%) population (OR 2.67 to 10.49 compared with the cisgender population) (Table 1 ). The odds ratio for death wish raised to 13.41 for transgenders when checked for death wish in the last 3-month (see Table 2 ). Similar to death wish, the lifetime exposure to suicidal ideation was high (22%) for the cisgender population. The lesbian participants had the highest reported exposure for lifetime suicidal ideation (OR = 3.97) while the transgenders had the highest rate for recent suicidal ideation (OR = 8.59). Gays had the highest lifetime (OR = 5.99) and recent (OR = 9.26) prevalence of suicidal attempts. Discussion The need for a comprehensive exploration of self-harm and suicide among all categories of LGBT populations in Bangladesh has long been felt. A few articles addressed self-harm and suicide among the gay population. However, there was a major gap in published data on self-harm and suicide among the other sexual minority groups in Bangladesh, namely lesbian, bisexual, and transgender. The present study, therefore, incorporated a cross-sectional survey of self-harm and suicidal behaviour of the four groups of sexual minorities and the cisgender population. Self-reported histories of self-harm and suicidal behaviour were recorded with two different time spans, lifetime (ever) and recent (last 3-month). Determining an experience to be exactly within the last 3-month is understandably difficult, a fact that has been reflected in the appearance of multiple missing values in data under this category across all the groups. Self-harm is often considered a precursor of suicidal behaviour [ 22 ] but due to the perception of low immediate risk, indirect self-harm i.e., engaging in risky behaviour with the intention to facilitate early death, usually goes unnoticed and unexplored. Higher rates of direct and indirect self-harm were observed among the LGBT groups. However, the lesbian participants demonstrated a distinctively high lifetime (OR = 12.35) as well as recent (OR = 13.17) engagement in direct self-harm in contrast to the other sexual minority groups (all OR < 4). Non-suicidal self-injurious behaviours have been generally known to be more prevalent among biological females [ 23 , 24 ], which might also have contributed to its higher prevalence among lesbian participants. Higher odds found on all five indicators of self-defeating behaviours among the LGBT population raised a major concern regarding their suicidality in clear contrast to that of the cisgender population in Bangladesh. Concerns around high rates of self-harm and suicidal behaviour among the gay community of the country are already known [ 15 ]. The present study findings provided further support to that and raised similar concerns about other sexual minority groups, especially lesbians and transgenders. About five to six times higher probability of suicide attempts among the lesbian, transgender, and gay population is alarming. The high rates of self-harm and suicidal behaviour reported in this study resonate with similar studies conducted across the globe [ 5 , 25 ]. Lesbians were found to be the most vulnerable groups among the sexual minorities in terms of self-harm and suicidal behaviour. Previous reports suggested a link between their extreme vulnerability and the existing marginalisation of women in the socio-cultural framework of the country [ 26 ]. Although some services are available for the gay and transgender population through community-based organisations, comprehensive customised services for lesbians are yet to be developed at an organisational level. In contrast to many studies across the globe [ 2 , 5 ], the present study indicated lower rates of suicidal behaviour among bisexuals compared to other sexual minority communities. It might be noted here that the bisexuals, having interests towards the opposite gender, are apparently blended within the cisgender population in Bangladesh. Differences in sociocultural contexts of the bisexuals in Bangladesh might also be the possible reason behind this lower rate. Suicide is thought to be preventable at an individual level with psychological support and intervention. Sadly, for the LGBT population in Bangladesh, service accessibility concerns are understandably high due to widespread stigma, discrimination, and legal provisions. It may be noted here that attempted suicide is a cognisable offence as per the penal code in Bangladesh [section 309; 14] and anyone knowing about it (including the psychosocial service providers) is mandated to report such behaviour to law enforcing authorities. The same also applies to anyone engaged in sodomy [section 377; 14]. These legal provisions further intensify the existing burden due to scarcity of service, feared discrimination, or lack of agency, and further prevent individuals from seeking service or disclosing such history needed to get appropriate service. Thus, sexual practices and suicidality become a double burden for anyone from the LGBT community seeking support. Combating suicidality among the sexual minority population would require the involvement of multiple stakeholders (including government agencies, non-government organisations, and community-based organisations) engaged in an intensive, coordinated, and carefully planned effort. Tackling the problem may require affirmative actions targeted towards increased social acceptance of the sexual minority population. Legal acceptance and protection may also be useful. However, any such attempt, from the government or other key stakeholders to ease the burden of these communities, needs to take into consideration the socio-cultural and political context as well as the sensitivity and sentiments of the larger cisgender population. Hasty, insensitive attempts towards awareness may not only be ineffective but also run the risk of igniting further reactivity towards sexual minority groups. The recent anti-LGBT backlash [ 27 ] in Bangladesh that erupted over the nation after the inclusion of a transgender story in the secondary school textbook can be considered as a classic example of an affirmative action that backfired. It may be noted here that, to avoid further complications from this backlash, the LGBT community-based organisation that aided in collecting data from the LGBT participants expressed preference for not to be named in this research or in the acknowledgement section. The World Health Organization has declared a global target to reduce the suicide rate by one-third by 2030 [ 28 ]. In line with that, the government of Bangladesh aspires to reduce suicide mortality by 5% by 2025. However, recognising the gap in the knowledge of mental health and well-being of the LGBT population, no discussion has been made concerning suicide prevention among these sexual minority groups in the national mental health strategic plan [see 11]. Due to the secretive nature of the LGBT community and a lack of proper estimates of population size, it is difficult, if not impossible, to conduct a methodologically perfect prevalence study on them in Bangladesh. Data from small, non-random samples can best be described as pilot estimates and are understandably far from being generalisable toward actual rates. However, with the inclusion of countrywide sampling in the present study, the findings can be considered representative of the LGBT community in Bangladesh. Therefore, these can be useful for policymakers as well as program implementers and may serve as an impetus to act toward intervention in curbing the self-harm and suicidal behaviour among the sexual minority communities in Bangladesh. Although some risk factors for suicidal behaviour have been reported in an international context, those findings may not be useful for Bangladesh considering the contextual difference. An in-depth analysis of putative causes or risk factors behind such high rates of self-defeating behaviour among the LGBT population in Bangladesh may need to be carried out before designing contextually sensitive interventions. Conclusions Amidst worldwide studies reporting a significantly higher prevalence of self-harm and suicidal behaviour among the LGBT population, policymakers in Bangladesh are faced with a scarcity of data (except for the anecdotal reports in the newspapers) to develop relevant strategies to prevent suicide among the LGBT population. The findings indicated a very high prevalence of self-harm and suicidal behaviour among the LGBT population in Bangladesh. The findings are likely to orient and urge the policymakers in Bangladesh to include concerns regarding the LGBT community in their upcoming initiatives to curb suicide mortality in the country. Being the first study of its type in Bangladesh, the findings contribute to the global knowledge base on self-harm and suicidal behaviour among the LGBT population. Further studies should aim at ascertaining how much of this suicidality results in suicide outcomes and at identifying the protective as well as risk factors contributing towards suicide. Abbreviations CI Confidence Interval LGBT Lesbian, Gay, Bisexual, and Transgender LGBTIQ Lesbian, Gay, Bisexual, Transgender, Intersex, and Queer LGBTQ Lesbian, Gay, Bisexual, Transgender, and Queer LGBTQ+ Lesbian, Gay, Bisexual, Transgender, Intersex, Queer, and more OR Odds Ratio PASW Predictive Analytics Software Declarations Ethics approval and consent to participate This study was conducted in accordance with the core ethical principles namely autonomy, benevolence, non-malfeasance and justice as delineated by ethics guidelines for medical research. It did not violate any clause from the Declaration of Helsinki. This study including the informed consent procedure was approved by the ethics committee of the Department of Clinical Psychology, University of Dhaka, Bangladesh on 12 November, 2015 bearing project ID # IR151101. Consent for publication Not applicable. Availability of data and material Complete data used in this article including participants’ characteristics, self-harm and suicidal behaviour will be, upon request, made available to anyone interested to use the data for future research and further analyses. Competing interests The authors declare no competing interests. Funding This study was carried out as part of a bigger study funded by Royal Tropical Institute (KIT), Netherlands. The funding supported conduction of the study, collection of data, and preparation of original study report. No funding was available for writing manuscript or publishing article. Authors' contributions Single author, 100% contribution. 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Bresin K, Schoenleber M: Gender differences in the prevalence of nonsuicidal self-injury: a meta-analysis . Clinical Psychology Review 2015, 38 :55-64. Mustanski B, Liu RT: A Longitudinal Study of Predictors of Suicide Attempts Among Lesbian, Gay, Bisexual, and Transgender Youth . Archives of Sexual Behavior 2013, 42 (3):437-448. Bondyopadhyay A, Ahmed S: Same-sex love in a difficult climate: A study into the life situation of sexual minority: lesbian, gay, bisexual, kothi and transgender persons in Bangladesh . Dhaka: Bandhu Social Welfare Society; 2011. Rita S: Now activists are targeted over 'Sharifa’s Story' . In: Dhaka Tribune. 2024. World Health Organization: Comprehensive mental health action plan 2013–2030 . Geneva: World Health Organization; 2021. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4688367","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":325357930,"identity":"15db860d-f96e-460b-a9d6-feb3853fb4f2","order_by":0,"name":"Muhammad Kamruzzaman Mozumder","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAuUlEQVRIiWNgGAWjYNACNgYGfoYEMDOB4QCxWiQbSNZicIBYLbrt7c+kbpTZ5BsfzzFg+FHDkMdHSIvZmQNp0jnn0iy3nXljwNhzjKFYkqCWGwnHpHPbDhuY3QDawtvAkLiBsJbENqCW/wbGM3IMGP8SpyWZDajlgIGBRI4BM3G2nDnGbJ1zLtlA4syzgsMyxySI8Mvx9oe3c8rsDPjbkzc+fFNjQzjEUABQsQQp6kfBKBgFo2AU4AIAUsxDxviuz74AAAAASUVORK5CYII=","orcid":"","institution":"University of Dhaka","correspondingAuthor":true,"prefix":"","firstName":"Muhammad","middleName":"Kamruzzaman","lastName":"Mozumder","suffix":""}],"badges":[],"createdAt":"2024-07-04 19:44:40","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4688367/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4688367/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":67629075,"identity":"a6459afa-ec17-4df9-975c-2b6dd1c5eccf","added_by":"auto","created_at":"2024-10-28 08:24:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1154692,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4688367/v1/99fb5e57-566a-4abf-ad75-b6caf52805a0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Life under the rainbow: Self-harm and suicidality among LGBT community in Bangladesh","fulltext":[{"header":"Background","content":"\u003cp\u003eLesbian, gay, bisexual, and transgender, commonly coined together as LGBT, are sexual minority populations where their sexual interest and activities are considered different and often unacceptable to mainstream society. These differences generally contribute to the othering of these individuals in the eyes of mainstream society. In Bangladesh, the perception of LGBT people being abnormal is so widespread in the general population that the members of the LGBT community themselves often consider them abnormal. The complex interplay of misperception, prejudice, problematisation, and discrimination between mainstream society and LGBT communities causes undue psychological disturbances among them. Research findings around the world have indicated a higher prevalence of psychological disturbances among the LGBT population [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This can be considered one of the factors contributing to higher rates of self-harm and suicidal behaviour among the LGBT communities [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSystematic reviews and meta-analyses on mental health and suicide consistently presented evidence of higher rates of suicidal behaviour and self-harm among the LGBT population compared to the cisgender population [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The most recent meta-analysis by Marchi, et al. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] concluded that LGBTIQ people have a higher risk of reported non-suicidal self-injurious behaviour (OR 4.24), suicidal ideation (OR 3.76), and suicidal attempt (OR 4.36). The bisexual community has been reported to have the highest risk of non-suicidal self-injurious behaviour (OR 5.03), suicidal ideation (OR 5.04), and suicidal attempt (OR 6.71) among all the other subgroups in the LGBTIQ population [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Individual studies also reported at least twofold higher prevalence (both lifetime and 12-month) of self-harm among LGBT adolescents compared to heterosexual adolescents [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Significantly higher rates of lifetime prevalence of self-harm, suicidal ideation, and suicidal attempts have been reported for the bisexual, homosexual, and other sexual minority groups compared to the cisgender population [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Qualitative exploration indicated the contribution of an interplay of internal processes (e.g., struggle with understanding and accepting identity) and external responses (e.g., abusive experience, life stressor) as the underlying process in the self-harm and suicidal behaviour among the LGBTQ youth [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Difficulties in emotional regulation have also been reported to contribute to an increased risk of suicidal behaviour among the LGBTQ\u0026thinsp;+\u0026thinsp;population [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe LGBT population, as sexual minorities, are regarded as vulnerable communities in Bangladesh [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The exact size of the LGBT population in the country is yet to be known. Latest estimates suggest a population size of 8533 for transgenders and 119,869 for male homosexuals; no estimates are available for lesbians and bisexuals [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Although the four groups are categorised together as sexual minorities, their behaviour, practices, community interaction, and support structures vary considerably [for a detailed discussion see 13]. It may be noted here that Bangladesh is a Muslim-majority country that still carries the legacy of the British colonial thinking in most of its laws. Many sexual behaviours and practices of the LGBT population contradict the religious and sociocultural norms as well as the legal provisions of the country [section 377; 14]. The government recently recognised Hizra as the third gender. However, the definition does not accurately include the transgender population which the term was supposed to denote. Considering their minority status and social unacceptability, it is conceivable that the LGBT population suffer from strong psychosocial consequences in Bangladesh. Unfortunately, published literature on mental health, self-harm, and suicidality among the LGBT population in Bangladesh is almost non-existent. A handful of published studies are available on homosexual males. Mozumder, Jasmine, Haque and Haque [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] reported an alarmingly high rate of self-harm (40.2%), suicidal ideation (47.1%), and suicidal attempt (32.4%) among gay men in Bangladesh. Hussain and Chowdhury [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] explored factors affecting suicidality among male homosexuals in Bangladesh and found role conflicts, adverse life experiences, poor coping, lack of protective measures, negative societal perception, and relationship difficulties to be the key contributors. Only anecdotal reports are available regarding information on suicidality for the remaining sexual minority groups [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. This general lack of data called for an exploration of the prevalence of self-harm and suicidal behaviour among the LGBT population in Bangladesh.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eStudy design\u003c/p\u003e \u003cp\u003eCross-sectional survey design was used to collect data from the generally hidden and hard-to-reach LGBT communities in Bangladesh between July to August 2016. Although defining LGBT is challenging, two distinct features, namely sexual orientation and sexual identity, are widely used in the definitions [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The participants interviewed in this study self-identified themselves as lesbian, gay, bisexual, or transgender. Against the backdrop of the recent murders of several LGBT activists by alleged Islamist groups around the time of data collection, widespread fear among the LGBT communities prevented many from participating in the study.\u003c/p\u003e \u003cp\u003eParticipants\u003c/p\u003e \u003cp\u003eThe present study collected data from 383 self-identified lesbian (n\u0026thinsp;=\u0026thinsp;34), gay (n\u0026thinsp;=\u0026thinsp;85), bisexual (n\u0026thinsp;=\u0026thinsp;87), transgender (n\u0026thinsp;=\u0026thinsp;91) and cisgender (n\u0026thinsp;=\u0026thinsp;86 ) individuals from five randomly selected divisional districts of Bangladesh, namely Dhaka, Khulna, Mymensingh, Rangpur, and Sylhet. Due to the widespread stigma, hostile attitude, religious ostracization, and precarious legal status, the sexual minority population in Bangladesh is highly secretive, and thus, a random selection of participants was not possible. Purposive snowball sampling was used to interview LGBT participants from the selected districts. Lesbians from only Dhaka and Khulna participated. Despite a slightly higher mean age for the transgender and cisgender population, the average age of the participants across the LGBT groups and cisgender population were comparable (lesbian \u0026minus;\u0026thinsp;28.85 years, gay \u0026minus;\u0026thinsp;26.84 years, bisexual \u0026minus;\u0026thinsp;26.87 years, transgender \u0026minus;\u0026thinsp;30.94 years, and cisgender population \u0026minus;\u0026thinsp;33 years).\u003c/p\u003e \u003cp\u003eInstruments\u003c/p\u003e \u003cp\u003eA set of five indicators were used for assessing self-harm and suicidal behaviour. The first among these was indirect self-harm where the participants reported their engagement in risky behaviour (such as unprotected sex, drinking alcohol, and denying prescribed medication) with the intent to cause gradual harm to self. The second was direct self-harm which involves intentional bodily harm through cut injury. The third explored wishes and passive prayer for death to come. The fourth explored suicidal ideation i.e., thoughts of ending life. The fifth indicator explored attempted suicide. The participants reported their experience retrospectively on these five indicators in two timeframes, firstly lifetime experience and secondly recent experience (in the past 3 months).\u003c/p\u003e \u003cp\u003eProcedures\u003c/p\u003e \u003cp\u003eThe data and findings presented in this study were collected as part of a larger countrywide survey on exploring the mental health and psychosocial status of sexual minority communities in Bangladesh. Organisations working with LGBT populations served as the contact points and aided the recruitment of study participants. Detailed explanatory statements coupled with verbal clarification on the nature of the study and the processes involved were provided to the participants. To avoid any potential legal implications and inadvertent disclosure of the identity of participants, verbal understood consent was taken instead of signed written ones [see 20]. A nominal reimbursement of Tk.250 (approximately US\u003cspan\u003e$\u003c/span\u003e3) for the cost of transportation was given to all the invited LGBT participants, irrespective of their decision to participate or not. The cisgender participants were not paid any compensation as the interviews were carried out at their places; no transport costs were incurred by them.\u003c/p\u003e \u003cp\u003eData were collected by thirteen research assistants with bachelor's degrees in psychology under supervision from the lead author and a research officer. The RAs were provided with training to minimise variation in administering the research tool, to sensitise them on LGBT issues, and to ensure ethical standards in data collection. Although not recorded, the response rate with the LGBT participants was seemingly much higher as compared to the cisgender participants. The involvement of the community-based organisations might have played an important role in building trust with the research team.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003ePASW 18 [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] software package was used for statistical analysis of the data. Self-reported lifetime and recent experience of self-harm and suicidal behaviour of the LGBT groups were compared with that of the cisgender population using the Chi-square test. The odds ratio (OR) was also calculated to see the difference between each of the LGBT groups and the cisgender population on the five indicators. The self-reported lifetime experience provides a crude assessment of the prevalence of self-harm and suicidal behaviour which is also amenable to recall bias. To get a more precise understanding, data on recent experiences within the last three months were also collected.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eAll four sexual minority groups had higher rates of self-harm, death wishes, suicidal ideation, and suicidal attempts compared to the cisgender population (OR up to 13.41). These differences were significant across most of the five indicators for both lifetime (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) and 3-month reports (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Among the LGBT groups, bisexuals had the lowest lifetime as well as 3-month prevalence on all five indicators of self-harm and suicidal behaviours (OR 1.37 to 3.29). In several cases, reporting from bisexuals did not differ significantly from that of the cisgender population.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLifetime experience of self-harm and suicidal behaviour among LGBT and cisgender population\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChi-square\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndirect self-harm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCisgender (n\u0026thinsp;=\u0026thinsp;86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67 (78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLesbian (n\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.26**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[2.41, 13.45]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGay (n\u0026thinsp;=\u0026thinsp;85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.04**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[1.33, 5.05]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBisexual (n\u0026thinsp;=\u0026thinsp;87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 (40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52 (60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.63**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[1.22, 4.62]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransgender (n\u0026thinsp;=\u0026thinsp;91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55 (60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.3**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[1.19, 4.47]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDirect self-harm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCisgender (n\u0026thinsp;=\u0026thinsp;86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78 (91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLesbian (n\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.32**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[4.57, 33.36]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGay (n\u0026thinsp;=\u0026thinsp;85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66 (78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.48*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[1.15, 6.83]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBisexual (n\u0026thinsp;=\u0026thinsp;87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71 (82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[0.89, 5.45]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransgender (n\u0026thinsp;=\u0026thinsp;91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65 (71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.58**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[1.65, 9.20]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWishing death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCisgender (n\u0026thinsp;=\u0026thinsp;86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68 (79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLesbian (n\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29.32**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[4.17, 26.39]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGay (n\u0026thinsp;=\u0026thinsp;85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54 (64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31.82**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[3.33, 13.01]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBisexual (n\u0026thinsp;=\u0026thinsp;87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51 (59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.42**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[1.36, 5.22]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransgender (n\u0026thinsp;=\u0026thinsp;91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65 (71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45.28**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[4.73, 18.84]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuicidal Ideation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCisgender (n\u0026thinsp;=\u0026thinsp;86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67 (78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLesbian (n\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.87**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[1.71, 9.23]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGay (n\u0026thinsp;=\u0026thinsp;84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.38**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[1.81, 6.86]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBisexual (n\u0026thinsp;=\u0026thinsp;87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61 (70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[0.76, 2.98]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransgender (n\u0026thinsp;=\u0026thinsp;91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47 (52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.52**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[1.96, 7.25]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuicidal Attempt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCisgender (n\u0026thinsp;=\u0026thinsp;86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77 (90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLesbian (n\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.55**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[1.99, 14.07]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGay (n\u0026thinsp;=\u0026thinsp;85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 (41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50 (59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21.1**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[2.65, 13.52]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBisexual (n\u0026thinsp;=\u0026thinsp;87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72 (83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[0.73, 4.33]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransgender (n\u0026thinsp;=\u0026thinsp;90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.49**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[2.09, 10.66]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cem\u003eNote.\u003c/em\u003e OR\u0026thinsp;=\u0026thinsp;odds ratio, CI\u0026thinsp;=\u0026thinsp;confidence interval; * p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, ** p\u0026thinsp;\u0026lt;\u0026thinsp;0.01.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eCompared to the cisgender population, lifetime and recent prevalences of indirect self-harm were significantly higher among all the LGBT groups (OR 2.21 to 5.70). The pattern of differences observed for lifetime exposure between the LGBT groups and the cisgender population was also present for recent experiences of self-harm and suicidal behaviour. However, in the case of direct self-harm, only the lesbians had significant differences from the cisgender population (OR\u0026thinsp;=\u0026thinsp;13.17).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRecent (last 3-month) self-harm and suicidal behaviour among the LGBT and the cisgender population\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChi-square\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndirect self-harm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCisgender (n\u0026thinsp;=\u0026thinsp;86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75 (87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLesbian (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.36**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[1.73, 11.95]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGay (n\u0026thinsp;=\u0026thinsp;85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 (75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.99*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[1.00, 4.99]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBisexual (n\u0026thinsp;=\u0026thinsp;85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62 (73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.46*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[1.14, 5.59]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransgender (n\u0026thinsp;=\u0026thinsp;90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68 (76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.92*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[1.00, 4.88]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDirect self-harm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCisgender (n\u0026thinsp;=\u0026thinsp;86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83 (97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLesbian (n\u0026thinsp;=\u0026thinsp;31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.1**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[3.33, 52.17]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGay (n\u0026thinsp;=\u0026thinsp;84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77 (92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[0.63, 10.07]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBisexual (n\u0026thinsp;=\u0026thinsp;85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81 (95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[0.30, 6.30]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransgender (n\u0026thinsp;=\u0026thinsp;89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80 (90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[0.81, 11.91]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWishing death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCisgender (n\u0026thinsp;=\u0026thinsp;86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75 (87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLesbian (n\u0026thinsp;=\u0026thinsp;31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.11**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[4.13, 28.21]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGay (n\u0026thinsp;=\u0026thinsp;85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39 (46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.63**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[2.69, 12.40]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBisexual (n\u0026thinsp;=\u0026thinsp;86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.58**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[1.51, 7.16]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransgender (n\u0026thinsp;=\u0026thinsp;89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59 (66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52.16**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[6.21, 28.97]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuicidal Ideation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCisgender (n\u0026thinsp;=\u0026thinsp;85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78 (92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLesbian (n\u0026thinsp;=\u0026thinsp;31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.48**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[1.80, 15.62]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGay (n\u0026thinsp;=\u0026thinsp;84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52 (62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.22**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[2.82, 16.70]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBisexual (n\u0026thinsp;=\u0026thinsp;87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69 (79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.37*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[1.15, 7.38]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransgender (n\u0026thinsp;=\u0026thinsp;85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37 (44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48 (56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.6**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[3.55, 20.80]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuicidal Attempt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCisgender (n\u0026thinsp;=\u0026thinsp;86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84 (98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLesbian (n\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.8**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[1.33, 39.37]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGay (n\u0026thinsp;=\u0026thinsp;83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68 (82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.58**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[2.05, 41.92]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBisexual (n\u0026thinsp;=\u0026thinsp;86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83 (97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[0.25, 9.32]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransgender (n\u0026thinsp;=\u0026thinsp;86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72 (84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.92**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[1.80, 37.14]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cem\u003eNote. OR\u0026thinsp;=\u0026thinsp;odds ratio, CI\u0026thinsp;=\u0026thinsp;confidence interval; * p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, ** p\u0026thinsp;\u0026lt;\u0026thinsp;0.01.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWishing death (which is generally considered a passive form of suicidality) demonstrated a high lifetime exposure (21%) among the cisgender population and was even higher for the lesbian (74%), gay (64%), bisexual (41%), and transgender (71%) population (OR 2.67 to 10.49 compared with the cisgender population) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The odds ratio for death wish raised to 13.41 for transgenders when checked for death wish in the last 3-month (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Similar to death wish, the lifetime exposure to suicidal ideation was high (22%) for the cisgender population. The lesbian participants had the highest reported exposure for lifetime suicidal ideation (OR\u0026thinsp;=\u0026thinsp;3.97) while the transgenders had the highest rate for recent suicidal ideation (OR\u0026thinsp;=\u0026thinsp;8.59). Gays had the highest lifetime (OR\u0026thinsp;=\u0026thinsp;5.99) and recent (OR\u0026thinsp;=\u0026thinsp;9.26) prevalence of suicidal attempts.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe need for a comprehensive exploration of self-harm and suicide among all categories of LGBT populations in Bangladesh has long been felt. A few articles addressed self-harm and suicide among the gay population. However, there was a major gap in published data on self-harm and suicide among the other sexual minority groups in Bangladesh, namely lesbian, bisexual, and transgender. The present study, therefore, incorporated a cross-sectional survey of self-harm and suicidal behaviour of the four groups of sexual minorities and the cisgender population. Self-reported histories of self-harm and suicidal behaviour were recorded with two different time spans, lifetime (ever) and recent (last 3-month). Determining an experience to be exactly within the last 3-month is understandably difficult, a fact that has been reflected in the appearance of multiple missing values in data under this category across all the groups.\u003c/p\u003e \u003cp\u003eSelf-harm is often considered a precursor of suicidal behaviour [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] but due to the perception of low immediate risk, indirect self-harm i.e., engaging in risky behaviour with the intention to facilitate early death, usually goes unnoticed and unexplored. Higher rates of direct and indirect self-harm were observed among the LGBT groups. However, the lesbian participants demonstrated a distinctively high lifetime (OR\u0026thinsp;=\u0026thinsp;12.35) as well as recent (OR\u0026thinsp;=\u0026thinsp;13.17) engagement in direct self-harm in contrast to the other sexual minority groups (all OR\u0026thinsp;\u0026lt;\u0026thinsp;4). Non-suicidal self-injurious behaviours have been generally known to be more prevalent among biological females [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], which might also have contributed to its higher prevalence among lesbian participants.\u003c/p\u003e \u003cp\u003eHigher odds found on all five indicators of self-defeating behaviours among the LGBT population raised a major concern regarding their suicidality in clear contrast to that of the cisgender population in Bangladesh. Concerns around high rates of self-harm and suicidal behaviour among the gay community of the country are already known [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The present study findings provided further support to that and raised similar concerns about other sexual minority groups, especially lesbians and transgenders. About five to six times higher probability of suicide attempts among the lesbian, transgender, and gay population is alarming. The high rates of self-harm and suicidal behaviour reported in this study resonate with similar studies conducted across the globe [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLesbians were found to be the most vulnerable groups among the sexual minorities in terms of self-harm and suicidal behaviour. Previous reports suggested a link between their extreme vulnerability and the existing marginalisation of women in the socio-cultural framework of the country [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Although some services are available for the gay and transgender population through community-based organisations, comprehensive customised services for lesbians are yet to be developed at an organisational level. In contrast to many studies across the globe [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], the present study indicated lower rates of suicidal behaviour among bisexuals compared to other sexual minority communities. It might be noted here that the bisexuals, having interests towards the opposite gender, are apparently blended within the cisgender population in Bangladesh. Differences in sociocultural contexts of the bisexuals in Bangladesh might also be the possible reason behind this lower rate.\u003c/p\u003e \u003cp\u003eSuicide is thought to be preventable at an individual level with psychological support and intervention. Sadly, for the LGBT population in Bangladesh, service accessibility concerns are understandably high due to widespread stigma, discrimination, and legal provisions. It may be noted here that attempted suicide is a cognisable offence as per the penal code in Bangladesh [section 309; 14] and anyone knowing about it (including the psychosocial service providers) is mandated to report such behaviour to law enforcing authorities. The same also applies to anyone engaged in sodomy [section 377; 14]. These legal provisions further intensify the existing burden due to scarcity of service, feared discrimination, or lack of agency, and further prevent individuals from seeking service or disclosing such history needed to get appropriate service. Thus, sexual practices and suicidality become a double burden for anyone from the LGBT community seeking support.\u003c/p\u003e \u003cp\u003eCombating suicidality among the sexual minority population would require the involvement of multiple stakeholders (including government agencies, non-government organisations, and community-based organisations) engaged in an intensive, coordinated, and carefully planned effort. Tackling the problem may require affirmative actions targeted towards increased social acceptance of the sexual minority population. Legal acceptance and protection may also be useful. However, any such attempt, from the government or other key stakeholders to ease the burden of these communities, needs to take into consideration the socio-cultural and political context as well as the sensitivity and sentiments of the larger cisgender population. Hasty, insensitive attempts towards awareness may not only be ineffective but also run the risk of igniting further reactivity towards sexual minority groups. The recent anti-LGBT backlash [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] in Bangladesh that erupted over the nation after the inclusion of a transgender story in the secondary school textbook can be considered as a classic example of an affirmative action that backfired. It may be noted here that, to avoid further complications from this backlash, the LGBT community-based organisation that aided in collecting data from the LGBT participants expressed preference for not to be named in this research or in the acknowledgement section.\u003c/p\u003e \u003cp\u003eThe World Health Organization has declared a global target to reduce the suicide rate by one-third by 2030 [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. In line with that, the government of Bangladesh aspires to reduce suicide mortality by 5% by 2025. However, recognising the gap in the knowledge of mental health and well-being of the LGBT population, no discussion has been made concerning suicide prevention among these sexual minority groups in the national mental health strategic plan [see 11]. Due to the secretive nature of the LGBT community and a lack of proper estimates of population size, it is difficult, if not impossible, to conduct a methodologically perfect prevalence study on them in Bangladesh. Data from small, non-random samples can best be described as pilot estimates and are understandably far from being generalisable toward actual rates. However, with the inclusion of countrywide sampling in the present study, the findings can be considered representative of the LGBT community in Bangladesh. Therefore, these can be useful for policymakers as well as program implementers and may serve as an impetus to act toward intervention in curbing the self-harm and suicidal behaviour among the sexual minority communities in Bangladesh. Although some risk factors for suicidal behaviour have been reported in an international context, those findings may not be useful for Bangladesh considering the contextual difference. An in-depth analysis of putative causes or risk factors behind such high rates of self-defeating behaviour among the LGBT population in Bangladesh may need to be carried out before designing contextually sensitive interventions.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eAmidst worldwide studies reporting a significantly higher prevalence of self-harm and suicidal behaviour among the LGBT population, policymakers in Bangladesh are faced with a scarcity of data (except for the anecdotal reports in the newspapers) to develop relevant strategies to prevent suicide among the LGBT population. The findings indicated a very high prevalence of self-harm and suicidal behaviour among the LGBT population in Bangladesh. The findings are likely to orient and urge the policymakers in Bangladesh to include concerns regarding the LGBT community in their upcoming initiatives to curb suicide mortality in the country. Being the first study of its type in Bangladesh, the findings contribute to the global knowledge base on self-harm and suicidal behaviour among the LGBT population. Further studies should aim at ascertaining how much of this suicidality results in suicide outcomes and at identifying the protective as well as risk factors contributing towards suicide.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence Interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLGBT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLesbian, Gay, Bisexual, and Transgender\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLGBTIQ\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLesbian, Gay, Bisexual, Transgender, Intersex, and Queer\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLGBTQ\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLesbian, Gay, Bisexual, Transgender, and Queer\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLGBTQ+\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLesbian, Gay, Bisexual, Transgender, Intersex, Queer, and more\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOdds Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePASW\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePredictive Analytics Software\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the core ethical principles namely autonomy, benevolence, non-malfeasance and justice as delineated by ethics guidelines for medical research. It did not violate any clause from the Declaration of Helsinki. This study including the informed consent procedure was approved by the ethics committee of the Department of Clinical Psychology, University of Dhaka, Bangladesh on 12 November, 2015 bearing project ID # IR151101.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eComplete data used in this article including participants\u0026rsquo; characteristics, self-harm and suicidal behaviour will be, upon request, made available to anyone interested to use the data for future research and further analyses.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was carried out as part of a bigger study funded by Royal Tropical Institute (KIT), Netherlands. The funding supported conduction of the study, collection of data, and preparation of original study report. No funding was available for writing manuscript or publishing article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSingle author, 100% contribution.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author is in debt to an anonymous LGBT community-based organisation that supported the collection of data from LGBT participants. The author also acknowledges the contribution of Basma Zaman for her editorial support in the first draft of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWittgens C, Fischer MM, Buspavanich P, Theobald S, Schweizer K, Trautmann S: \u003cstrong\u003eMental health in people with minority sexual orientations: A meta-analysis of population-based studies\u003c/strong\u003e. \u003cem\u003eActa Psychiatrica Scandinavica \u003c/em\u003e2022, \u003cstrong\u003e145\u003c/strong\u003e(4):357-372.\u003c/li\u003e\n\u003cli\u003ePl\u0026ouml;derl M, Tremblay P: \u003cstrong\u003eMental health of sexual minorities. 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Dhaka: Bandhu Social Welfare Society; 2011.\u003c/li\u003e\n\u003cli\u003eRita S: \u003cstrong\u003eNow activists are targeted over \u0026apos;Sharifa\u0026rsquo;s Story\u0026apos;\u003c/strong\u003e. In: \u003cem\u003eDhaka Tribune.\u003c/em\u003e 2024.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization: \u003cstrong\u003eComprehensive mental health action plan 2013\u0026ndash;2030\u003c/strong\u003e. Geneva: World Health Organization; 2021.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Self-harm, suicide, LGBT, lesbian, gay, bisexual, transgender, hijra, homosexuality, mental health, policy, Bangladesh","lastPublishedDoi":"10.21203/rs.3.rs-4688367/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4688367/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground.\u003c/h2\u003e \u003cp\u003eThe LGBT communities in Bangladesh live in precarious conditions under the legal and social sections against them. This study was carried out in a context where data on suicidality among these sexual minority communities in Bangladesh exist little beyond anecdotal reports.\u003c/p\u003e\u003ch2\u003eMethods.\u003c/h2\u003e \u003cp\u003eA countrywide cross-sectional survey was carried out to collect data from LGBT (n\u0026thinsp;=\u0026thinsp;297) and cisgender (n\u0026thinsp;=\u0026thinsp;86) participants. Snowball sampling was used for generally secretive LGBT participants.\u003c/p\u003e\u003ch2\u003eResults.\u003c/h2\u003e \u003cp\u003eFindings indicated significantly higher prevalences of self-harm (direct and indirect), death wish, suicidal ideation, and suicide attempt among the LGBT communities compared to the cisgender population. The lesbians reported the highest lifetime prevalence for indirect self-harm (62%), direct self-harm (56%), death wish (74%) and suicidal ideation (53%). Reported suicide attempts were most common among gays (41%) closely followed by lesbians (38%) and transgenders (36%). When compared with the cisgender population, the odds of these experiences ranged from 3.97 to 13.17 for lesbians, 2.34 to 9.26 for gays, 1.37 to 2.91 for bisexuals, and 2.21 to 13.41 for transgenders.\u003c/p\u003e\u003ch2\u003eConclusion.\u003c/h2\u003e \u003cp\u003eThe findings bring forth a dire picture of the high risk of suicidality among the hidden sexual minority communities in Bangladesh and are expected to contribute to evidence-informed policymaking.\u003c/p\u003e","manuscriptTitle":"Life under the rainbow: Self-harm and suicidality among LGBT community in Bangladesh","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-31 05:04:14","doi":"10.21203/rs.3.rs-4688367/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7e439b52-3ea4-4a00-975a-3c31359b2ab4","owner":[],"postedDate":"July 31st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-10-28T08:23:48+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-31 05:04:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4688367","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4688367","identity":"rs-4688367","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}