Beyond Risk: Revisiting Suicide Risk and Protective Factors Among LGBTQIA+ Populations and Anticipating Future Directions

Suicide research concerning lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other sexually and gender-diverse (LGBTQIA+) populations has established a consistent pattern of inequity, but it has too often described disparity without adequately specifying how risk is produced, interrupted, or prevented. This Review revisits the evidence through a multilevel, intersectional, and prevention-oriented lens. LGBTQIA+ identities are not intrinsic causes of suicidality. Excess risk is better understood as an outcome of exposure to structural stigma, discrimination, violence, family rejection, conversion practices, socioeconomic exclusion, barriers to affirming care, and the psychological and interpersonal processes through which these conditions are embodied. At the same time, family acceptance, school connectedness, peer and community belonging, identity affirmation, inclusive policies, accessible gender-affirming and culturally responsive care, and timely evidence-based suicide interventions can alter trajectories. Yet the literature remains constrained by cross-sectional designs, inconsistent measurement, aggregation of heterogeneous populations, underrepresentation outside high-income Western settings, and a tendency to label correlates as “protective” without establishing causal or contextual validity. The next phase of the field should combine better population surveillance with longitudinal and quasi-experimental designs; distinguish ideation, self-harm, attempts, and suicide mortality; evaluate structural and service interventions; and govern digital prediction with privacy, fairness, and community accountability. The central task is no longer to document that inequities exist, but to identify which modifiable conditions reduce them, for whom, under what circumstances, and at what level of intervention.