Cory Russo, Utah’s lead death investigator, is used to questioning strangers during the most harrowing moments of their lives. When she shows up at the scene of a suicide, murder, or other unexpected death, her job is to question the mourners about how the deceased lived.
How old have you been? What was her race? Did you have a job? Have you ever been hospitalized for psychiatric problems? How had you felt that morning?
In recent years, she’s added new questions to the list: What was your sexual orientation? What was her gender identity?
Russo, who works in the Salt Lake City coroner’s office, is one of the relatively few death investigators nationwide who routinely collect such data, although sexuality or gender identity may be relevant to the circumstances of a person’s death.
She recalled the recent suicide of a young man who died in the home of older adults. During their interviews, Russo learned that the man had been living with them for a year, since his family kicked him out of their home for being gay. He has struggled with emotional upheaval and addiction.
“It was heartbreaking to hear that,” said Russo, a lesbian who lost loved ones to suicide. “In this case, it was very important to understand this piece.”
Studies of LGBTQ people show that they often suffer from suicidal thoughts and attempts, factors that significantly increase the risk of suicide.
However, because most death investigators do not collect data on sexuality or gender identity, no one knows how many gay and transgender people in the United States die by suicide each year. The information vacuum makes it difficult to tailor suicide prevention interventions to the needs of those most at risk and to measure how well the programs are working, researchers said.
The lack of data is particularly unfortunate now, they said, as assumptions about suicide rates among LGBTQ groups often inform important policy debates. Some LGBTQ advocates have warned that bans on gender-based childcare for transgender children, for example, will lead to more suicides, while some Republican lawmakers have claimed deaths from suicide are rare.
Utah, which like many mountain states has a high suicide mortality rate, has spearheaded efforts to collect such data since 2017, when the state legislature passed legislation mandating detailed investigations into suicides.
Lawmakers were “frustrated that they were being asked to respond blindfolded to our state’s suicide crisis,” said Michael Staley, a sociologist hired to lead data collection at the Utah coroner’s office. “It’s a five-alarm fire.”
In the months after investigators like Russo show up at a death scene, Staley’s team of six conduct “psychological autopsies” and contact the families of everyone in the state who dies from suicide or drug overdoses to get detailed information about the people’s lives deceased.
Such data — which includes information on sexual relationships and gender, as well as housing, mental health, drug problems and social media use — can be used to understand the complex array of factors that contribute to people’s decisions to end their lives , contribute, Staley said. He plans to release a report later this year detailing interviews with the families of those who have died by suicide in Utah in the past five years.
In the case of children and young people who die by suicide, the team not only interviews parents and guardians, but also several close friends. In some cases, Staley recalled, friends knew about the deceased’s problems with sexuality, gender, or drug use, but the parents did not.
These conversations can be extremely difficult. John Blosnich, director of a research initiative called the LGBT Mortality Project at the University of Southern California, has taken rideshares to observe death investigators and teach them the importance of data collection on gender and sexuality. His training also helps investigators deal with the distress or stigma surrounding the questions of the deceased’s friends and relatives.
“They speak to families who are in shock, who are angry, who are sometimes catatonic about their loss,” Blosnich said.
So far, Blosnich has trained investigators in Utah, Nevada, Colorado, New York and California, where a 2021 state law started a pilot program to collect sexual orientation and gender identity data. In a recent study of 114 investigators in three states, Blosnich reported that only about 41% asked directly about a deceased person’s sexual orientation and only 25% asked about gender identity before completing the training.
Medical examiners send reports of homicides and suicides to the Centers for Disease Control and Prevention, which maintains a database of violent deaths with comprehensive demographic, medical, and social information, including toxicology tests, mental health diagnoses, and even histories of financial and family hardships. But a study of more than 10,000 suicides among young adults reported to the CDC database found that only 20% included information about the deceased’s sexuality or gender identity.
Another Department of Health agency, the Office of the National Coordinator for Health Information Technology, is attempting to set new standards that would require every hospital receiving federal funding to survey their patients about their sexuality and gender identity.
Death investigators are “limited by the fact that they can’t ask the person the question,” said Dr. John Auerbach, who worked at the CDC from 2021-2022 to standardize questions about sexuality and gender Educating patients about sexuality and gender identity could also help answer other public health questions, such as relative risk of cancer or Diabetes in the LGBTQ community, Auerbach said.
But this approach has its limitations. Patients may not feel comfortable sharing this information with their doctors. And those who don’t interact with the healthcare system may be at particularly high risk of suicide.
LGBTQ advocates said obtaining this data has become increasingly urgent in recent years as states across the country have restricted many aspects of gay and transgender people’s lives.
“With the lack of data, it’s all too easy to reject us,” said Casey Pick, director of law and policy at the Trevor Project, a nonprofit focused on suicide prevention among LGBTQ youth that operates at the state and federal levels used to start collecting this data.
“I’ve heard it too many times: Lawmakers and public witnesses in hearings are suggesting that the LGBTQ community is screaming about suicide because we don’t have that data,” Pick said.
It’s also important to acknowledge the unknowns, Staley said. Although studies report high rates of suicidal ideation and suicide attempts among lesbian, gay and transgender people, this does not necessarily mean a high rate of suicide. He pointed out that while women are more likely to attempt suicide than men, men are far more likely to die by suicide, in part because they have more access to guns.
And Staley, who is gay, warned against political narratives that “normalize suicide as part of the queer experience.”
“I would argue that this life experience rather empowers us to be resilient,” he said. “Our fate is not sealed. Our history is not written.”
If you are having suicidal thoughts, call or text 988 to reach the 988 Suicide and Crisis Lifeline, or go to SpeakingOfSuicide.com/resources for a list of additional resources.
This article originally appeared in The New York Times.
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