Associations Between Sexual Minority Stress and Suicide Rates: An Ecological Study in 20 European Countries

Purpose: Sexual minority and trans individuals are at increased risk of suicidal behaviour comparedwith their heterosexual and cisgender counterparts. A potential explanation for this disparity is theconcept of minority stress. The present study aimed to investigate whether variation in minority stressbetween European countries was associated with rates of suicide.Methods: An ecological design was utilised. Given suicide rates for sexual minorities and trans arenot available, we examined the overall suicide rate for the country. Minority stress was calculated bygenerating a composite measure of self-reported discrimination and violence derived from the 2019European Union LGBTI Survey II.Linear regressions estimated the association between World Health Organisation suicide rates (2015-2019) as the outcome variable and country-level minority stress scores. In addition, multilevel linearregressions were performed on individual minority stress scores (as the outcome variable) andcountry-level suicide rates. Relevant covariates were selected for adjustment.Results: The findings did not support an association between suicide rates and minority stress in eitherthe linear model (adjusted coefficient=5.50, 95% CI=-9.21, 20.20, p=0.434) or the multilevel model(adjusted coefficient=0.015, 95% CI=-0.002, 0.032, p=0.082).Conclusions: We did not find evidence for an association between reported minority stress inEuropean countries and suicide rates. There were, however, several limitations to the study that limitthe conclusions we can draw. Further investigation of the role minority stress might play in the mentalhealth of sexual minorities and trans individuals could provide a means to reduce inequality andimprove mental health.