No one knows how many LGBTQ Americans die by suicide

Cory Russo, the Utah death lead investigator, is used to asking strangers questions in the most excruciating moments of their lives. When she turns up at the scene of a suicide, murder, or other form of unexpected death, her job is to interview the mourners about how the deceased had lived.

How old were they? What was their race? Did they have a job? Were they ever hospitalized for psychiatric problems? How had they felt that morning?

In recent years, she has added new questions to the list: What was their sexual orientation? What was their gender identity?

Ms. Russo, who works in the medical examiner’s office in Salt Lake City, is one of the relatively few death investigators in the country who routinely collect such data, even though sexuality or gender identity may be relevant to the circumstances surrounding a death of a person.

She recalled the recent suicide of a young man who died in the home of older adults. During her interviews, Ms. Russo learned that the man had been living with them for a year, ever since his family kicked him out of the house for being gay. He had struggled with emotional turmoil and addiction.

“It was heartbreaking to hear,” said Ms. Russo, a lesbian who has lost loved ones to suicide. “In that case, it was very relevant to understand that piece.”

Studies of LGBTQ people show that they have high levels of suicidal thoughts and suicide attempts, factors that significantly increase the risk of suicide.

But because most death researchers don’t collect data on sexuality or gender identity, no one knows how many gay and transgender people die by suicide each year in the United States. The information vacuum makes it difficult to tailor suicide prevention efforts to the needs of those most at risk, and to measure how well the programs are working, researchers said.

The absence of data is especially unfortunate now, they said, when assumptions about suicide rates among LGBTQ groups are often thrust into high-stakes political debates. Some LGBTQ advocates have warned that banning gender-affirming care for transgender minors, for example, will lead to more suicides, while some Republican lawmakers have argued that suicide deaths are rare.

Utah, which like many mountain states has a high suicide mortalityhas been at the forefront of efforts to collect such data since 2017, when the state legislature passed a law requiring detailed investigation of suicides.

Lawmakers were “frustrated because they were being asked to respond to our state’s suicide crisis with a blindfold,” said Michael Staley, a sociologist hired to lead the data collection in the Utah medical examiner’s office. “It’s a five-alarm fire.”

In the months since researchers such as Ms. Russo appearing at the crime scene, Dr. Staley’s team of six people perform “psychological autopsies,” contacting relatives of everyone in the state who dies by suicide or drug overdose for detailed information about the deceased’s life.

Such data – including information about sexual relationships and gender, as well as housing, mental health, drug problems and social media use – can be used to understand the complex array of factors that contribute to people’s decisions to end their lives says dr. Staley said. He plans to release a report later this year that includes interviews with the families of those who have committed suicide in recent times in Utah five years.

For children and adolescents who die by suicide, the team not only interviews parents and guardians, but also some close friends. In some cases, Dr. Staley himself, friends knew of the deceased’s struggles with sexuality, gender, or drug use that the parents did not know.

These conversations can be extremely difficult. John Blosnich, head of a research initiative called the LGBT Mortality Project at the University of Southern California, has been doing ride-alongs to observe and train death researchers on the importance of collecting data on gender and sexuality. His training also helps investigators deal with the distress or stigma surrounding questions from friends and relatives of the deceased.

“They talk to families who are in shock, who are furious, who are sometimes catatonic because of their loss,” said Dr. Blosnich.

So far Dr. Blosnich researchers trained in Utah, Nevada, Colorado, New York and California where a 2021 state law initiated a pilot program to collect data on sexual orientation and gender identity. In a recent study of 114 researchers in three states, Dr. Blosnich reported that only about 41 percent had directly asked about a deceased person’s sexual orientation, and only 25 percent had asked about gender identity, before taking the training.

Medical investigators send reports of homicides and suicides to the Centers for Disease Control and Prevention, which maintains a database violent deaths with extensive demographic, medical, and social information, including toxicology tests, mental health diagnoses, and even stories of financial and family problems. But a study of more than 10,000 suicides of young adults reported to the CDC database found that only 20 percent contained information about the deceased’s sexuality or gender identity.

Another health department agency, the Office of the National Coordinator for Health Information Technology, is trying to set new standards that would require any hospital receiving federal money to ask its patients about their sexuality and gender identity.

Death investigators are “limited by the fact that they can’t ask the person the question,” said Dr. John Auerbach, who from 2021 to 2022 worked to standardize questions about sexuality and gender at the CDC. If doctors routinely talk to their patients about sexuality and gender identity, that information could also help answer other public health questions, such as those related to the relative risk of cancer or diabetes in the LGBTQ community, said Dr. Auerbach.

But that approach has its limits. Patients may not feel comfortable disclosing that information to their doctor. And those who don’t interact with the healthcare system may be at particularly high risk of suicide.

LGBTQ advocates said getting that data has become more urgent in recent years as states across the country have placed restrictions on many aspects of gay and transgender people’s lives.

“With a lack of data, it’s all too easy to dismiss us,” said Casey Pick, director of law and policy at the Trevor Project, a nonprofit that focuses on suicide prevention among LGBTQ youth who are involved at the state and federal level. has lobbied to begin collecting that data.

“I’ve heard it too many times: lawmakers and public witnesses in hearings suggest that the LGBTQ community is committing suicide because we don’t have this data to refer to,” Ms Pick said.

It’s also important to acknowledge the unknowns, said Dr. Staley. While studies have reported a high rate of suicidal ideation and suicide attempts among lesbian, gay, and transgender people, that doesn’t necessarily mean a high rate of suicide. He noted that while women have more suicide attempts than men, men are much more likely to die by suicide, in part because they have more access to guns.

And dr. Staley, who is gay, warned against political narratives that “normalize suicide as part of the queer experience.”

“I would say that this life experience at least allows us to be resilient,” he said. “Our fate is not sealed. Our story is not written.”

If you are having suicidal thoughts, call or text 988 to reach the 988 Suicide and Crisis Lifeline or visit SpeakingOfSuicide.com/resources for a list of additional resources.