Authors' reply

We thank Meader & Chan ¹ for their appreciation that our review updated and refined the evidence on risk of suicidal behaviour in LGB youth. We concur with these authors that there is a lack of research about suicidal behaviour among the LGBT population. Moreover, we firmly believe that there is a need for identifying specific risk and protective factors of suicidal behaviour in this population, especially among transgender people, for better prevention. Although some factors may be common for the whole LGBT population, it is likely that different mechanisms may be operating. Longitudinal assessment of mediators such as victimisation, stigmatisation and discrimination might help to identify causal pathways for suicidal behaviours, specifically regarding sexual orientation and gender identity. ²

We agree with White that it is important to distinguish between gender identity and sexual orientation. Considering LGBT as a monolithic identity may not be adequate since sexual orientation is a multidimensional concept referring to an enduring pattern of emotional, romantic and/or sexual attraction to males, females or both genders, ³ whereas gender identity is one's own sense or conviction of maleness or femaleness. ⁴ Therefore, homosexuality or heterosexuality must be understood only as forms of sexual expression, whereas transgenderism corresponds to gender identification. Sexual orientation and gender identity ought to be measured in a homogeneous way, preferably using the same definition by expert consensus, to allow comparisons between studies. ²

Owing to the relatively small number of observations, many research studies assessing health problems among minorities are forced to consider different population groups as a single category. The LGBT population is a clear example of this is. As a previous study showed, individuals see the importance of giving health providers information about their gender identity rather than just their sexual orientation. ⁵ Given the underrepresentation of transgender patients in healthcare and the general population, it is crucial to include LGBT education for healthcare providers, and to provide a safe environment for LGBT individuals. These results can be a starting point for a more specific assessment of the health disparities among the LGBT population, considering that factors may affect these individuals in diverse ways.