Sexual-minority youth have a two to three times higher risk for suicidal behaviour than their peers. They also have increased mental health risk factors, such as depression and substance abuse, and are often victims of homophobia and discrimination. Available data are unable to provide a clear understanding of the psychosocial factors contributing to these unfavourable mental health indicators. In this Review, we assess current knowledge about the effect of variables, such as acceptance and support, as possible risk factors or protective factors for the development of suicidal behaviour among sexual-minority youth (we consider youth as those aged 13-25 years). 34 articles were eventually included in the review process; and we contextualised their content at three different levels (society, social network, and individual) before integrating the outcomes into a model. This Review shows how negative social environments (such as a non-acceptant school climate), inadequate support within the closest social network, and an absence of lesbian, gay, bisexual, transgender, intersex, queer or questioning support movements in communities contribute to the development of suicidality in young people. Furthermore, the unsupportive reactions of others can be internalised, manifesting as homophobic, biphobic, and transphobic patterns in the individual. To prevent suicidal behaviour, we suggest that all these aspects need to be taken into consideration when planning interventions.
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