Do disparities in suicide-related behaviour across sexual orientations differ by neighbourhood deprivation? A discrete-time survival analysis in Ontario, Canada (2007-2017)

Abstract

Background Prior research on the disparities of suicide-related behaviours (SRB) across sexual orientation has been limited by the use of surveys and self-reported data, leading to possible survival bias. Furthermore, there have been no studies examining how neighbourhood deprivation modifies the effects of sexual minority status on SRB. Sexual minority individuals in deprived areas may face unique challenges and stressors that exacerbate their risk of SRB. This study investigates the association between sexual minority status and clinical SRB, and examines whether the effect of neighbourhood deprivation differs across sexual orientation.

Methods A population-representative survey sample (weighted n= 8,778,120) 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 (ON-Marg) index measure of material deprivation at the dissemination area (DA) 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 males had 2.79 times higher odds of SRB compared to their heterosexual counterparts (95% CI 1.66 to 4.71), while sexual minority females had 2.14 time higher odds (95% CI 1.54 to 2.98). Additionally, neighbourhood deprivation was associated with higher odds of SRB: males 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 females 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 males and females, sexual minority status and neighbourhood deprivation on SRB are independent risk factors for SRB. Despite the lack of effect modification, sexual minorities living in the most deprived neighbourhoods have higher chances of SRB. Future investigations should evaluate interventions and policies to improve sexual minority mental health and address neighbourhood deprivation.