Childhood maltreatment and mental disorders as suicide risk pathways in LGBT+ populations

Background

Sexual minorities face disproportionately higher risks of childhood maltreatment, mental disorders, and suicidality compared to heterosexual individuals. However, the mechanisms linking early-life adversities and mental disorders to suicidal thoughts and behaviours (STB) remain poorly understood. This study examines the association between childhood maltreatment, mental disorders, and STB, exploring the causal pathways underlying these relationships.

Methods

Data were drawn from the 2014 Adult Psychiatric Morbidity Survey, a representative sample of adults living in England. Lifetime suicidal ideation and suicide attempts were assessed via the CIS-R. Predictors included childhood maltreatment (physical, verbal, or emotional abuse before age 18) and any mental disorder (depression, generalised anxiety, alcohol/substance dependence). Multivariable logistic regression and KHB mediation models were applied.

Results

Final included sample: 5,057 participants. Gay/lesbian and bisexual individuals showed significantly elevated odds for lifetime suicidal ideation (OR = 2.63, 95%CI 1.62–4.28 and OR = 3.22, 95%CI 1.82–5.68, respectively) and attempts (OR = 3.30, 95%CI 1.77–6.15 and OR = 2.84, 95%CI 1.45–5.59). Mediation analyses showed childhood maltreatment and mental disorders explained 37.4% of ideation risk and 39.4% of attempt risk among bisexual individuals, but only 17.2% and 12.3% among gay/lesbian individuals. Despite the inclusion of these mediators, significant direct effects of sexual orientation persisted for both bisexual (Ideation OR = 2.85, 95%CI 1.67–4.88) and gay/lesbian individuals (Ideation OR = 2.13, 95%CI 1.35–3.38).

Conclusions

Sexual orientation is an independent predictor of STB. Childhood maltreatment and mental disorders act as partial mediators, yet residual vulnerability underscores the need for policies addressing structural discrimination. Trauma-informed, subpopulation-tailored prevention programs are critical to reducing STB disparities.

Key messages

• Childhood maltreatment and mental disorders partially mediate the higher suicidality risk in sexual minorities, highlighting the need for trauma-informed interventions.

• Sexual orientation remains an independent predictor of suicidality even after accounting for known risk factors, underscoring the role of structural discrimination.