Authors' reply

We thank Margaret White for responding to our editorial ¹ and would like to take this opportunity to respond to some of the points she makes. First, she argues that we conflated gender identity and sexual orientation and treated LGBT youth as a ‘monolithic entity’. We agree that LGBT young people are not a ‘monolithic entity’. We stated clearly that we think it is important to understand the experiences of LGBT young people and to identify where risks for engaging in suicidal behaviour differ between groups. We also gave brief illustrative examples of why risk factors may vary between groups.

On the basis of the findings of the Miranda-Mendizábal review ² we stated there was insufficient data to draw firm conclusions on differences in risk of suicidal behaviour among LGB young people. In addition, the Miranda-Mendizábal review did not assess risk factors in transgender young people and therefore we could not draw conclusions from that study on differences in risk factors experienced by transgender young people and other populations. However, it is important to clarify that this does not imply that we think LGBT young people constitute a monolithic entity or that we are conflating sexual orientation with gender identity.

Second, White provides two examples that she considers reflects a conflation of gender identity and sexual orientation. We are sorry for any misunderstanding and acknowledge that wording could have been more precise.

Reading the first paragraph of the background section in context, we thought it was clear that we were not suggesting transgender young people cannot be heterosexual. Reading the two sentences that immediately follow the first sentence cited by White makes clear that the comparative data we refer to are between LGB and heterosexual young people. The data on suicidality in LGBT groups that we cited is non-comparative data.

White is correct there are two toolkits developed by Public Health England and the Royal College of Nursing that are presented together on the same web page as guidance on ‘Preventing suicide: lesbian, gay, bisexual and trans young people’ (www.gov.uk/government/publications/preventing-suicide-lesbian-gay-and-bisexual-young-people). We're sorry for any misunderstanding caused by the article inadvertently using the singular ‘a toolkit’.

Third, as regards risk factors for transgender youth, we agree that there are a number of potential factors that may have an impact on risk of suicidality in transgender young people. When read in context as a suggestion for further research on risk factors for suicidal behaviour in transgender populations, we thought it was clear that we were citing higher rates of stigma as an illustrative example and not intending to provide a comprehensive list of risk or protective factors, as that would be pre-empting what emerges from future research.