Suicide and specific populations

Intersectionality recognises that people’s experiences of distress and suicide risk are shaped by the overlap of multiple identities and social conditions, not by any single factor alone.

For example, someone who is LGBTQIA+, living with HIV and residing in a rural area may face compounded stigma, confidentiality concerns, limited access to culturally safe and specialised services, and social isolation, all of which can intensify vulnerability.

Similarly, an intersex person who is also a refugee may experience the combined impacts of trauma, displacement, barriers to healthcare, language and legal challenges, and discrimination related to their sex characteristics.

Suicide prevention responses must therefore consider how these intersecting factors interact in a person’s life and ensure care is inclusive, trauma-informed, culturally safe, and tailored to each individual’s lived experience.

A GP’s role is to listen openly and non-judgmentally, validate the person’s lived experience, and create a safe space where complexity is acknowledged rather than minimised.

Statistics

• Aboriginal and Torres Strait Islander peoples continue to demonstrate strong cultural resilience and community leadership in suicide prevention. Despite this, ongoing structural inequities contributed to the 2023 suicide rate for Aboriginal and Torres Strait Islander people across six of the seven states and territories being the highest since recording began in 2018 (30.8 deaths per 100,000)²⁰.
• In 2023, suicide accounted for 5.2% of all deaths among First Nations people, with men experiencing suicide at 3.5 times the rate of First Nations women (48.5 cf 13.8 per 100,000)²¹.

Why

• The impacts of colonisation (including dispossession, forced child removals and systemic discrimination) continue to affect Social and Emotional Wellbeing²². These impacts occur alongside enduring cultural strengths, such as community connectedness, identity, kinship and spirituality.
• Many Aboriginal and Torres Strait Islander peoples are also survivors, or descendants of the Stolen Generations. The impacts of historical, intergenerational and ongoing trauma including influence trust in services, disclosure, and help-seeking.
• Structural inequities in housing, employment and access to culturally safe care can create barriers to wellbeing, despite strong community and cultural strengths²³.
• Ongoing structural inequities in justice and child protection systems increase First Nations peoples’ exposure to traumatic events such as incarceration and child removal, both of which are linked to increased suicide risk²⁴.
• While Aboriginal Community Controlled Health Organisations (ACCHOs) provide strong, culturally grounded care, gaps remain where Social and Emotional Wellbeing (SEWB) frameworks are not adequately supported or funded.

What GPs need to know

Suicide risk amongst First Nations people is shaped by systemic, social and historical factors. Cultural strengths, such as connection to Country, kinship, identity, community governance and spirituality, are powerful protective factors and central to care.

• SEWB encompasses mind, body, community, culture, and connection to Country, which need to be key considerations when conducting a clinical assessment
• GPs need to conduct conversations with First Nations peoples with cultural humility, acknowledging the person’s strengths, community supports and resilience.
• Some First Nations people and young people may be late to engage with health services because of past experiences of racism, exclusion or system harm, reinforcing the importance of culturally safe, trust-building care²⁵.

How to provide trauma-informed care for this group

• Use SEWB frameworks when assessing risk, and explore the patient’s connections to culture, family, land, language, and spirituality.
• Engage with local community organisations and people:
  • partner with Aboriginal Community Controlled Health Organisations (ACCHOs) and refer to community-led supports
  • engage with Indigenous mental health workers, Elders, and liaison officers, where appropriate²⁶.
• Adopt culturally appropriate practices and language:
  • provide longer appointments and continuity of care, allowing for culturally appropriate pacing
  • acknowledge colonisation and systemic racism, social, cultural, behavioural and economic factors that impact individual and community health, while recognising the resilience, leadership and cultural continuity of Aboriginal and Torres Strait Islander peoples
  • use strengths-based language and validate the patient’s cultural context and lived experiences. For example, instead of saying, ‘You’re not following your care plan properly”, try something like: ‘You’ve shown a lot of resilience managing your health while balancing cultural and family responsibilities. Many people in your community stay strong through cultural practices, time on Country, and support from Elders. If you’d like, we can build your care plan around the strengths you already have.”
• When assessing risk:
  • use SEWB frameworks
  • explore and validate the patient’s connections to culture, family, land, language, spirituality
  • avoid assumptions, ask about cultural identity and experiences of racism, discrimination, or trauma.

Statistics

• Self-harm among LGBTQIA+ Australians occurs at almost six times the rate of non-LGBTQIA+ people (41.2% compared to 7.4%)²⁷.
• 74.5% of LGBTQIA+ people experience a mental disorder in their lifetime compared to 41.7% of non-LGBTQIA+ people²⁷.
• LGBTQIA+ people experience disproportionately high rates of siucide attempts²⁸ and suicidal thoughts (nearly 48% of LGBTQIA+ Australians have seriously thought about taking their own life at some point²⁷).
• 85% of non-binary people, and 70% of transgender people have experienced a mental disorder at some point in their life²⁹

Why

• Stigma, discrimination, bullying, violence, exclusion, and minority stress are key drivers²⁷, along with issues such as family rejection, homelessness, and relationship strain experienced by this population, especially trans and gender-diverse youth³⁰, all of which contribute to higher rates of psychological distress and mental illness.
• LGBTQIA+ people face a range of barriers to safe and inclusive healthcare, including past negative experiences²⁹.
• Lack of protective social environments and a sense of belonging to the community in some regions³¹.

What GPs need to know

• Sexuality and gender are expressions of human diversity and strength, therefore assessment should focus on experiences of harm, stress, and social determinants, as well as stressors that are unique to this population, such as gender affirmation barriers and unsafe housing.
• LGBTQIA+ people often show strong resilience despite past experiences of discrimination, GPs can build on this by prioritising trust, safety, and respect.
• This population carries significant strengths and community connections, while also facing higher rates of psychological distress due to social determinants and minority stress.
• Trans and gender-diverse people may benefit from supported access to gender-affirming pathways that uphold autonomy, safety, and self-determination³².

How to provide trauma-informed care for this group

• Demonstrate acceptance:
  • use inclusive language, and ask for their preferred pronouns
  • ensure clinical spaces visibly affirm LGBTIQA+ identities
  • validate their experiences of discrimination and minority stress.
• Provide informed and compassionate care
  • ensure confidentiality, especially for young people who may not have not disclosed their sexual orientation their family
  • provide affirming referral pathways (gender clinics, LGBTQIA+ mental health services, QLife).
  • screen regularly for mental health concerns, self-harm, and suicidal ideation.
  • incorporate strengths-based narratives (for example, drawing on their community connections and resilience), build community connectedness and adopt protective factors listed in Table 2.

Statistics

• In 2024, 2,529 men died by suicide, accounting for 75–76% of all suicide deaths in Australia³³.
• On average, 7 men die by suicide every day³³.
• The population of working-age men is experiencing a rising suicide trend³³.

Why

• Social norms around masculinity discourage expression of emotions and vulnerability, which leads to a reluctance to seek help³⁴, and a tendency to present later in crisis.
• Men may use more lethal means to attempt a suicide.

What GPs need to know

• Men may downplay symptoms, so you need to be proactive in screening for distress and remember that presentations may be somatic (eg sleep issues, pain).
• There are numerous adverse circumstances linked to suicide in men, including legal issues, substance misuse, economic hardship, relationship breakdown, job loss, financial pressure, and isolation.
• A single recent stressor (eg separation, job loss) can greatly elevate risk – especially if coupled with social isolation and/or difficulties regulating emotional pain³⁵.
• Men aged 40–59 are the highest-risk age group in Australia, with suicide rates peaking at 30.9 per 100,000 in men aged 55–59³⁶. This reflects in part the clustering of major life stressors around this life stage - such as family breakdown, job loss and financial hardship.
• Men’s depression can manifest as a mix of internalising (i.e., persistent sadness, loss of interest or pleasure in previously enjoyable activities) and externalising (i.e., anger, substance misuse, risk-taking) symptoms. Mood disorders are the leading risk factor for suicide in men³⁷. It is therefore important to screen for depression in men using tools that capture both externalising symptoms (e.g., the Male Depression Risk Scale³⁸) and internalising symptoms (e.g., the Patient Health Questionnaire).

How to provide trauma informed care for this group

• Create a supportive environment:
  • create a safe, non-judgmental environment where expressing distress is acceptable
  • normalise help-seeking, validate emotional experiences, and avoid reinforcing stoicism
  • explore recent adverse events (eg legal, financial, relationship) that strongly correlate with suicide in men.
• When offering advice and support:
  • remember that some men can prefer practical, action-oriented conversations
  • offer structured follow-up, safety planning, and practical support (eg referral to financial counselling, men’s support programs)
  • provide information on male-specific services (eg MensLine, men’s wellbeing groups).