title: Lifetime Prevalence of Suicide Attempts Among Sexual Minority Adults by Study Sampling Strategies: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Previous reviews have demonstrated a higher risk of suicide attempts for lesbian, gay, and bisexual (LGB) persons (sexual minorities), compared with heterosexual groups, but these were restricted to general population studies, thereby excluding individuals sampled through LGB community venues. Each sampling strategy, however, has particular methodological strengths and limitations. For instance, general population probability studies have defined sampling frames but are prone to information bias associated with underreporting of LGB identities. By contrast, LGB community surveys may support disclosure of sexuality but overrepresent individuals with strong LGB community attachment.
  
  
  OBJECTIVE
  To reassess the burden of suicide-related behavior among LGB adults, directly comparing estimates derived from population- versus LGB community-based samples.
  
  
  METHODS
  In 2014, we searched MEDLINE, EMBASE, PsycInfo, CINAHL, and Scopus databases for articles addressing suicide-related behavior (ideation, attempts) among sexual minorities.
  
  
  METHODS
  We selected quantitative studies of sexual minority adults conducted in nonclinical settings in the United States, Canada, Europe, Australia, and New Zealand.
  
  
  METHODS
  Random effects meta-analysis and meta-regression assessed for a difference in prevalence of suicide-related behavior by sample type, adjusted for study or sample-level variables, including context (year, country), methods (medium, response rate), and subgroup characteristics (age, gender, sexual minority construct). We examined residual heterogeneity by using τ(2).
  
  
  RESULTS
  We pooled 30 cross-sectional studies, including 21,201 sexual minority adults, generating the following lifetime prevalence estimates of suicide attempts: 4% (95% confidence interval [CI] = 3%, 5%) for heterosexual respondents to population surveys, 11% (95% CI = 8%, 15%) for LGB respondents to population surveys, and 20% (95% CI = 18%, 22%) for LGB respondents to community surveys (Figure 1). The difference in LGB estimates by sample type persisted after we accounted for covariates with meta-regression. Sample type explained 33% of the between-study variability.
  
  
  CONCLUSIONS
  Regardless of sample type examined, sexual minorities had a higher lifetime prevalence of suicide attempts than heterosexual persons; however, the magnitude of this disparity was contingent upon sample type. Community-based surveys of LGB people suggest that 20% of sexual minority adults have attempted suicide.
  
  
  CONCLUSIONS
  Accurate estimates of sexual minority health disparities are necessary for public health monitoring and research. Most data describing these disparities are derived from 2 sample types, which yield different estimates of the lifetime prevalence of suicide attempts. Additional studies should explore the differential effects of selection and information biases on the 2 predominant sampling approaches used to understand sexual minority health.
authors.affiliation: Travis Salway Hottes, Laura Bogaert, and Dionne Gesink are with the Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Anne E. Rhodes is with the Division of Epidemiology, Dalla Lana School of Public Health, and Department of Psychiatry, University of Toronto; and the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario. David J. Brennan is with the Factor-Inwentash Faculty of Social Work, University of Toronto.
authors.forename: Travis Salway
authors.initials: TS
authors.lastname: Hottes
authors.affiliation: Travis Salway Hottes, Laura Bogaert, and Dionne Gesink are with the Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Anne E. Rhodes is with the Division of Epidemiology, Dalla Lana School of Public Health, and Department of Psychiatry, University of Toronto; and the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario. David J. Brennan is with the Factor-Inwentash Faculty of Social Work, University of Toronto.
authors.forename: Laura
authors.initials: L
authors.lastname: Bogaert
authors.affiliation: Travis Salway Hottes, Laura Bogaert, and Dionne Gesink are with the Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Anne E. Rhodes is with the Division of Epidemiology, Dalla Lana School of Public Health, and Department of Psychiatry, University of Toronto; and the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario. David J. Brennan is with the Factor-Inwentash Faculty of Social Work, University of Toronto.
authors.forename: Anne E
authors.initials: AE
authors.lastname: Rhodes
authors.affiliation: Travis Salway Hottes, Laura Bogaert, and Dionne Gesink are with the Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Anne E. Rhodes is with the Division of Epidemiology, Dalla Lana School of Public Health, and Department of Psychiatry, University of Toronto; and the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario. David J. Brennan is with the Factor-Inwentash Faculty of Social Work, University of Toronto.
authors.forename: David J
authors.initials: DJ
authors.lastname: Brennan
authors.affiliation: Travis Salway Hottes, Laura Bogaert, and Dionne Gesink are with the Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Anne E. Rhodes is with the Division of Epidemiology, Dalla Lana School of Public Health, and Department of Psychiatry, University of Toronto; and the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario. David J. Brennan is with the Factor-Inwentash Faculty of Social Work, University of Toronto.
authors.forename: Dionne
authors.initials: D
authors.lastname: Gesink
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data*; D015995:Prevalence; D012111:Residence Characteristics; D012494:Sampling Studies; D019529:Sexuality / Q000706:statistics & numerical data*; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000706:statistics & numerical data*; D014481:United States