Suicidality among sexual minority individuals: A preregistered systematic umbrella review of 20 years of research

Purpose: This preregistered (PROSPERO CRD42022384378) inclusive systematic umbrella review (adhering to the PRISMA-Equity extension guidelines) aimed to exhaustively synthesize suicidality (encompassing suicidal ideations, suicidal behaviors, suicide attempts, and death by suicide) among sexual minority individuals. Methods: A systematic umbrella review was conducted, with eligible studies identified through databases and cited-reference searches. Systematic reviews, meta-analyses, or scoping reviews addressing suicidality in sexual minority individuals (lesbian, gay, bisexual individuals) were included. Quality of reviews was assessed, using AMSTAR-2. Qualitative evidence synthesis and study overlap analysis across reviews were conducted. Results: 53 reviews, published 2006-24, were eligible, encompassing 570 primary studies. Most reviews strongly indicated increased risks of suicidality among sexual minority individuals. For suicidal ideation, reported odds ratios ranged from 1.56 to 5.04, and for suicide attempts from 1.13 to 8.36. There was broad evidence for increased suicide risk among various sexual minority subgroups, including men who have sex with men, bisexual individuals, and those from ethnic minority backgrounds. Quality among included reviews varied considerably (on average, 58%, range: 16.7-87.7%, expressed as POMP [percent of maximum possible] scores of applicable AMSTAR-2 quality features). Overlap of primary literature across all 53 reviews was low, indicating substantial diversity in the reviews’ inclusion criteria and research aims and a need for more comprehensive research syntheses. Conclusions: Future research on this topic should adopt intersectional sampling, utilize longitudinal studies for deeper understanding, and improve reporting. Mental health professionals need specialized training, support organizations should provide safe spaces, and policymakers must prioritize mental health and anti-discrimination laws.