Investigating suicide related behaviours across sexual orientation and neighbourhood deprivation levels: A cohort study using linked health administrative data

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Abstract

Background

There have been no studies examining how neighbourhood deprivation modifies the effects of sexual minority status on suicide-related behaviours (SRB). Sexual minority individuals in deprived areas may face unique challenges and stressors that exacerbate their risk of SRB. This study aims to investigate the association between sexual minority status and clinical SRB, and examine whether the effect of neighbourhood deprivation differs across sexual orientation.

Methods

A population-representative survey sample (169,090 respondents weighted to represent 8,778,120 individuals; overall participation rate 75%) was linked to administrative health data in Ontario, Canada to measure SRB-related events (emergency department visits, hospitalizations, and deaths) from 2007 to 2017. Neighbourhood-level deprivation was measured using the Ontario Marginalisation index measure of material deprivation at the dissemination area level. Discrete-time survival analysis models, stratified by sex, tested the effects of neighbourhood deprivation and sexual minority status, while controlling for individual-level covariates.

Results

Sexual minority men had 2.79 times higher odds of SRB compared to their heterosexual counterparts (95% CI 1.66 to 4.71), while sexual minority women had 2.14 times higher odds (95% CI 1.54 to 2.98). Additionally, neighbourhood deprivation was associated with higher odds of SRB: men in the most deprived neighbourhoods (Q5) had 2.01 times higher odds (95% CI 1.38 to 2.92) of SRB compared to those in the least deprived (Q1), while women had 1.75 times higher odds (95% CI 1.28 to 2.40). No significant interactions were observed between sexual minority status and neighbourhood deprivation levels.

Conclusion

In both men and women, sexual minority status and neighbourhood deprivation are independent risk factors for SRB. Despite the lack of effect modification, sexual minorities living in the most deprived neighbourhoods have the highest chances of SRB. Future investigations should evaluate interventions and policies to improve sexual minority mental health and address neighbourhood deprivation.

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Most cited references 78

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Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence.

Ilan Meyer (2003)

In this article the author reviews research evidence on the prevalence of mental disorders in lesbians, gay men, and bisexuals (LGBs) and shows, using meta-analyses, that LGBs have a higher prevalence of mental disorders than heterosexuals. The author offers a conceptual framework for understanding this excess in prevalence of disorder in terms of minority stress--explaining that stigma, prejudice, and discrimination create a hostile and stressful social environment that causes mental health problems. The model describes stress processes, including the experience of prejudice events, expectations of rejection, hiding and concealing, internalized homophobia, and ameliorative coping processes. This conceptual framework is the basis for the review of research evidence, suggestions for future research directions, and exploration of public policy implications.

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Perceived discrimination and health: a meta-analytic review.

Elizabeth A Pascoe, Laura Smart Richman (2009)

Perceived discrimination has been studied with regard to its impact on several types of health effects. This meta-analysis provides a comprehensive account of the relationships between multiple forms of perceived discrimination and both mental and physical health outcomes. In addition, this meta-analysis examines potential mechanisms by which perceiving discrimination may affect health, including through psychological and physiological stress responses and health behaviors. Analysis of 134 samples suggests that when weighting each study's contribution by sample size, perceived discrimination has a significant negative effect on both mental and physical health. Perceived discrimination also produces significantly heightened stress responses and is related to participation in unhealthy and nonparticipation in healthy behaviors. These findings suggest potential pathways linking perceived discrimination to negative health outcomes. Copyright (c) 2009 APA, all rights reserved.

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Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review.

K Pickett, M. Pearl (2001)

Interest in the effects of neighbourhood or local area social characteristics on health has increased in recent years, but to date the existing evidence has not been systematically reviewed. Multilevel or contextual analyses of social factors and health represent a possible reconciliation between two divergent epidemiological paradigms-individual risk factor epidemiology and an ecological approach. Keyword searching of Index Medicus (Medline) and additional references from retrieved articles. All original studies of the effect of local area social characteristics on individual health outcomes, adjusted for individual socioeconomic status, published in English before 1 June 1998 and focused on populations in developed countries. The methodological challenges posed by the design and interpretation of multilevel studies of local area effects are discussed and results summarised with reference to type of health outcome. All but two of the 25 reviewed studies reported a statistically significant association between at least one measure of social environment and a health outcome (contextual effect), after adjusting for individual level socioeconomic status (compositional effect). Contextual effects were generally modest and much smaller than compositional effects. The evidence for modest neighbourhood effects on health is fairly consistent despite heterogeneity of study designs, substitution of local area measures for neighbourhood measures and probable measurement error. By drawing public health attention to the health risks associated with the social structure and ecology of neighbourhoods, innovative approaches to community level interventions may ensue.

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Author and article information

Contributors

Karanpreet Kaur Azra: Role: Formal analysisRole: InvestigationRole: MethodologyRole: Writing – original draftRole: Writing – review & editing

Andrew Nielsen: Role: Formal analysisRole: InvestigationRole: MethodologyRole: ValidationRole: Writing – review & editing

Chungah Kim: Role: ConceptualizationRole: InvestigationRole: MethodologyRole: ResourcesRole: Writing – review & editing

Gabriel John Dusing: Role: Writing – review & editing

Antony Chum:

ORCID: https://orcid.org/0000-0002-6756-7031

Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: SupervisionRole: ValidationRole: Writing – original draftRole: Writing – review & editing

Ghobad Moradi: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS One

Journal ID (publisher-id): plos

Title: PLOS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 29 March 2023

Publication date Collection: 2023

Volume: 18

Issue: 3

Electronic Location Identifier: e0282910

Affiliations

[1 ] Department of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada

[2 ] Canadian Institute for Health Information, Toronto, Ontario, Canada

[3 ] School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada

[4 ] Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

Kurdistan University of Medical Sciences, ISLAMIC REPUBLIC OF IRAN

Author notes

Competing Interests: The authors have declared that no competing interests exist.

* E-mail: chuma@ 123456yorku.ca

Author information

Antony Chum https://orcid.org/0000-0002-6756-7031

Article

Publisher ID: PONE-D-22-23488

DOI: 10.1371/journal.pone.0282910

PMC ID: 10058080

SO-VID: 821a05a7-7c98-4331-92a6-97e3107cb585

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 25 August 2022

Date accepted : 24 February 2023

Page count

Figures: 3, Tables: 3, Pages: 19

Funding

Funded by: funder-id http://dx.doi.org/10.13039/501100000155, Social Sciences and Humanities Research Council of Canada;

Award ID: 435-2020-1086

Award Recipient :

ORCID: https://orcid.org/0000-0002-6756-7031

Antony Chum

Funded by: funder-id http://dx.doi.org/10.13039/501100002784, Canada Excellence Research Chairs, Government of Canada;

Award ID: 2021-00269

Award Recipient :

ORCID: https://orcid.org/0000-0002-6756-7031

Antony Chum

This study received funding from a Social Sciences and Humanities Research Council ( https://www.sshrc-crsh.gc.ca/) insight grant (funding reference number 435-2020-1086, Principal investigator: AC). The principal investigator, AC, is supported by the Canada Research Chair program (CRC-2021-00269, https://www.chairs-chaires.gc.ca/). The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Custom metadata

Data Availability Third party data used in this study is owned by and is considered confidential by Statistics Canada. It can be accessed for research purposes through the Canadian Research Data Centre Network ( https://crdcn.org). The data can be accessed in secure computing environments (inside designated Research Data Centres) upon approval by Statistics Canada of a project proposal. CCHS data is available through the Research Data Centres program administered by Statistics Canada (see link for eligibility and process to request access: https://www.statcan.gc.ca/eng/rdc/index) for researchers who meet the criteria for access to confidential data.

Investigating suicide related behaviours across sexual orientation and neighbourhood deprivation levels: A cohort study using linked health administrative data

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Most cited references 78

Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence.

Perceived discrimination and health: a meta-analytic review.

Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review.

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