Suicidality and Depression Disparities Between Sexual Minority Youth and Heterosexual Youth

                Dr. Edwin Shneidman, considered the father of contemporary suicidology, summarized the act of suicide in five words: Suicide is caused by psychache.  Dr. Shneidman described psych-ache as “hurt, anguish, soreness, aching, psychological pain.”  Dr. Shneidman’s description of psych-ache is eerily similar to a description of depression.  His definition of psych-ache is interesting in that it creates the logic: depression may not always cause suicide, but a suicide is always caused by depression.  Surely, this logic is not historically accurate.  There are countless examples of ‘cultural honor suicides’ and ‘rash suicides’ that were not preceded by depression- though in these examples it could be argued that potential psych-ache was avoided through suicide.  Regardless, there does seem to be corollary validity to Dr. Shneidman’s suicide and psyche-ache description. 

During adolescent years, rates of depression and suicide significantly increase.  However, the increase in depression, suicidal ideation, and suicide disproportionately affect sexual minority youth (SMY) compared to heterosexual youth.  Over one hundred years ago, psychologist Stanley Hall characterized the adolescent years of development as being marked by “Storm and Stress”.  Over the years, this idea has been both supported and scrutinized by psychologists, sociologists, and social workers.  Neither Shneidman’s description of suicide nor Hall’s characterization of adolescent development, however, account for the causality of increased suicide or the disparity between SMY and heterosexual youth.  While some neuroscientists would point to hyperactivity of the amygdale (the emotion-processor of the brain) and the underdeveloped prefrontal cortex, sociologists consider the interrelationships between adolescent and peers, family, and society.  As social workers, we must consider all of these aspects (and more).  The research on suicidality among SMY and heterosexual youth suggests that the disparity between the two groups could be due to victimization, violence, stigma, and discrimination which has been linked with higher rates of substance use and abuse which further exacerbates psych-ache. 

So what can we do?  This entry thus far has seemed fairly bleak.  The researchers suggest that, as a clinician, it is of the utmost importance to know your client.  If we consider the preamble to the NASW code of ethics, we remember that competence, the dignity and worth of a person, as well as the importance of human relationships are defining features of our profession.  This, of course, does not mean that as clinicians we need to dig into the sexuality of our clients; it does, however, mean that we must be aware of the different challenges that each of our clients potentially face and strategies for how to navigate the challenges.  The researchers of this article also suggest stringent zero tolerance policies for SMY bullying as well as advocacy through gay-straight alliances and diversity clubs.  Personally, I am an ardent supporter of any organization that promotes peaceful dialogue and understanding between “in-groups and out-groups”.  I also support projects or activities that require divergent groups to work on community service projects, service-learning projects, or adventure therapy, together- there is strong evidence that this type of programming promotes group togetherness.  There is little evidence, however, that suggests zero-tolerance policies are effective in decreasing stigma or discrimination, and oftentimes this approach has the opposite of the intended effect.  In attempting to decrease adolescent “psych-ache” and breaking down the stereotyped “storm and stress”, it is essential for every social worker to have a keen understanding of evidence based practices and equally important, to develop meaningful relationships with those whom we intend to serve.