title: Self-reported suicide ideation and attempts, and medical care for intentional self-harm in lesbians, gays and bisexuals in Sweden.
abstract: Minority sexual orientation is a robust risk indicator for self-reported suicidal ideation and attempts. However, little is known about patterns of medical care for intentional self-harm in this vulnerable population. We investigate sexual orientation-related differences in self-reported lifetime suicide symptoms and medical care for intentional self-harm between 1969 and 2010, including age at initial treatment and recurrence.
  
  
  
  We used data from the Stockholm Public Health Cohort, a population-based sample of 874 lesbians/gays, 841 bisexuals and 67 980 heterosexuals, whose self-administered surveys have been linked to nationwide registers. Estimates of risk for medical care were calculated as incidence rate ratios (IRR) with 95% CIs.
  
  
  
  Both suicidal ideation and attempts were more commonly reported by lesbian/gay and bisexual (LGB) individuals. Adjusting for risk-time and confounding, lesbians (IRR 3.8, 95% CI 2.7 to 5.4) and bisexual women (IRR 5.4, 95% CI 4.4 to 6.6) experienced elevated risk for medical care for intentional self-harm, as compared to heterosexual women. Gay men evidenced higher risk (IRR 2.1, 95% CI 1.3 to 3.4) as compared to heterosexual men. Recurrent medical care was more frequent in LGB individuals, especially in bisexual women and gay men. Lesbian and bisexual women were also younger than heterosexual women when they first received medical care for intentional self-harm.
  
  
  
  Positive histories of suicidal ideation, attempts and medical care for intentional self-harm, including higher levels of recurrence, are more prevalent among LGB individuals in contrast to heterosexuals. Lesbian/bisexual women evidence an earlier age of onset of treatment. Tailored prevention efforts are urgently needed.
authors.affiliation: Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden Department of Sociology, Stockholm University, Stockholm, Sweden.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Björkenstam
authors.affiliation: Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Kyriaki
authors.initials: K
authors.lastname: Kosidou
authors.affiliation: Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden Department of Community Health Sciences, Fielding School of Public Health and California Center for Population Research, University of California Los Angeles, Los Angeles, USA.
authors.forename: Emma
authors.initials: E
authors.lastname: Björkenstam
authors.affiliation: Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Christina
authors.initials: C
authors.lastname: Dalman
authors.affiliation: Department of Sociology, Stockholm University, Stockholm, Sweden.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Andersson
authors.affiliation: Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Cochran
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D057566:Self Report; D016728:Self-Injurious Behavior; D000072339:Sexual and Gender Minorities; D059020:Suicidal Ideation; D013406:Suicide, Attempted; D013548:Sweden
keywords: PUBLIC HEALTH; REGISTERS; SUICIDE