Overlapping Risk: Suicide Prevention Month, Adoption, Recovery, LGBTQIA2S+, and BIPOC Experience

Sep 1

**A note before we begin:**
This post discusses suicide risk and cites research data, including statistics related to suicide attempts among specific populations. No methods or means are described. If this content feels like too much right now, that's a reasonable thing to notice. Please consider reaching out to one of the resources listed here before reading further.

September is National Suicide Prevention Awareness Month, a time set aside to talk openly about something our culture has spent generations trying not to talk about at all. The goal of this month isn't to alarm anyone. It's the opposite: to replace silence with information, and information with connection, because silence is one of the things that makes suicide risk worse, not better.

This year, I want to spend some time on a harder question than "how do we raise awareness?" I want to ask: whose risk is highest, and why does it cluster the way it does? Because when you actually look at the research, suicide risk isn't evenly distributed. It concentrates in a specific set of overlapping communities: Adoptees, LGBTQIA2S+ young people, and BIPOC communities (especially American Indian and Alaska Native communities here in our own region), and People in recovery from substance use. And when a person belongs to more than one of these groups at once, the research is clear that risk does not simply add together. It compounds.

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A Brief Word on Intersectionality

Where This Lens Comes From

The framework for understanding how overlapping identities compound risk comes from legal scholar Kimberlé Crenshaw, who coined the term intersectionality in a 1989 article examining how antidiscrimination law erased Black women's experiences of discrimination by treating race and sex as separate categories (Crenshaw, 1989). Her central insight: that identities don't stack additively; they interact and compound; is exactly the lens this post needs. A person's risk for suicide is never explained by a single thing. It's explained by the interaction of all ouyr experiences and identities together, within the specific systems that person has to navigate.

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What the Data Actually Shows

Let’s look at the research on each of these populations individually first, honoring that each has its own distinct story, before showing how they overlap.

Adoptees

Research consistently shows elevated suicide risk among adopted individuals compared to their non-adopted peers. A study conducted at the University of Minnesota, drawing on a sample of adopted and non-adopted offspring, found that the odds of a reported suicide attempt were roughly four times greater among adoptees than non-adoptees, even after adjusting for other known risk factors (Keyes et al., 2013). A broader meta-analysis of the existing research confirmed this pattern, finding more than double the rate of suicide attempts among adopted individuals across multiple studies (Campo-Arias et al., 2020).

LGBTQIA2S+ Young People

The Trevor Project's 2025 U.S. National Survey on the Mental Health of LGBTQ+ Young People, which surveyed more than 16,000 LGBTQ+ young people ages 13 to 24, found that 36% seriously considered suicide in the past year, including 40% of transgender and nonbinary young people, and that 1 in 10 LGBTQ+ young people attempted suicide in the past year (Nath et al., 2026). Critically, the research also found that LGBTQ+ young people of color attempted suicide at higher rates than their White peers, and that youth living in accepting communities attempted suicide at less than a third of the rate of those in unaccepting communities. A finding that emphasizes and underscores the risk driven by stigma and rejection, not identity itself (Nath et al., 2026).

BIPOC Communities

National data shows that suicide rates vary meaningfully by race and ethnicity, with non-Hispanic American Indian or Alaska Native individuals experiencing the highest age-adjusted suicide rate of any racial or ethnic group in the country (Stone et al., 2025). This is a particularly urgent statistic for our region: North Dakota is home to five federally recognized tribal nations, and American Indian communities across the Upper Midwest have long carried a disproportionate share of this national crisis; a pattern researchers consistently link to the lasting effects of historical and intergenerational trauma.

People in Recovery

Substance use and suicide risk are deeply intertwined. A 2025 systematic review and meta-analysis of 47 studies across 12 countries found that substance misuse was associated with more than five times greater risk of suicide mortality, with particularly elevated risk associated with alcohol and opioid use specifically (Athey et al., 2025). This is precisely why entering or sustaining recovery is not just a physical health milestone — it is very often a suicide prevention intervention in its own right.

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Where These Circles Overlap

Here is the piece that often gets missed when these populations are discussed separately: they are not separate people. An adoptee can be LGBTQIA2S+. A person of color can be in recovery. An LGBTQIA2S+ young person can also be Native and also be adopted. These identities live inside the same bodies, the same histories, and the same nervous systems; and the research on intersectionality tells us clearly that risk in overlapping populations is not simply cumulative. It compounds in ways that are specific to the combination.

Consider what sits in the overlapping space of that diagram: a transracial adoptee who is also LGBTQIA2S+ and Native, navigating racial identity, adoption-related grief, and family or community rejection all at once. Or a person in recovery who is also a person of color, carrying both the elevated risk associated with substance use and the compounding weight of racial trauma and systemic barriers to culturally responsive care. These are not hypothetical combinations. They are the actual, lived reality of many of the people I sit with in this practice.

The goal of naming this overlap is not to rank whose pain matters more. It's to make sure that when someone shows up carrying more than one of these identities, the support they receive actually accounts for all of it.

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What This Looks Like Here, in North Dakota

National data matters, but it's worth grounding this in our own region. North Dakota's age-adjusted suicide rate reached 19.2 per 100,000 people in 2024 — a 73% increase compared to two decades earlier, and meaningfully higher than the national rate (USAFacts, 2026). This is not an abstract number. It reflects real families across this state, including rural communities where access to mental health care, LGBTQIA2S+-affirming resources, and culturally responsive services for Native and BIPOC residents can be especially limited.

A note on rural risk: Suicide risk is consistently higher in rural areas nationally, driven in part by geographic isolation, limited access to mental health providers, and reduced anonymity that can make seeking help feel riskier in small communities. For LGBTQIA2S+ individuals, adoptees, and people of color living in rural North Dakota and Minnesota, these barriers can compound the identity-specific risks described above.

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If You Need Support Right Now

If any part of this post brought something up for you, please don't carry it alone. Support is available, it works, and reaching out is a sign of strength, not weakness.

Crisis & Support Resources

988 Suicide & Crisis Lifeline — Call or text 988, available 24/7, free and confidential — 988lifeline.org
FirstLink (North Dakota & parts of Minnesota) — Dial 211 or text your zip code to 898-211; also answers 988 for this region and offers a dedicated routing option for LGBTQ+ youth — myfirstlink.org
The Trevor Project — Crisis support for LGBTQIA2S+ young people — call 1-866-488-7386, text START to 678-678, or chat at thetrevorproject.org
Crisis Text Line — Text HOME to 741741
Trans Lifeline — Peer support run by and for transgender people — 1-877-565-8860
SAMHSA National Helpline — Substance use and mental health support — 1-800-662-4357

If you have been thinking about reaching out for ongoing support — for yourself, or for someone you love who's navigating more than one of these identities — I would be honored to walk alongside you.

Whenever you're ready, we’re here.

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References

Athey, A., Shaff, J., Kahn, G., Brodie, K., Ryan, T. C., Sawyer, H., DeVinney, A., Nestadt, P. S., & Wilcox, H. C. (2025). Association of substance use with suicide mortality: An updated systematic review and meta-analysis. Drug and Alcohol Dependence Reports, 14, Article 100310. https://doi.org/10.1016/j.dadr.2024.100310

Campo-Arias, A., Egurrola-Pedraza, J. A., & Herazo, E. (2020). Relationship between adoption and suicide attempts: A meta-analysis. International Journal of High Risk Behaviors & Addiction, 9(4), Article e106880. https://doi.org/10.5812/ijhrba.106880

Crenshaw, K. (1989). Demarginalizing the intersection of race and sex: A Black feminist critique of antidiscrimination doctrine, feminist theory, and antiracist politics. University of Chicago Legal Forum, 1989(1), 139–167.

Keyes, M. A., Malone, S. M., Sharma, A., Iacono, W. G., & McGue, M. (2013). Risk of suicide attempt in adopted and nonadopted offspring. Pediatrics, 132(4), 639–646. https://doi.org/10.1542/peds.2012-3251

Nath, R., Matthews, D. D., Hobaica, S., DeChants, J. P., Eden, T. M., Taylor, A. B., & Suffredini, K. (2026). 2025 U.S. national survey on the mental health of LGBTQ+ young people. The Trevor Project. https://doi.org/10.70226/EKGT3197

Stone, D. M., Cammack, A. L., & Carbone, E. G. (2025). Notes from the field: Differences in suicide rates, by race and ethnicity and age group — United States, 2018–2023. MMWR Morbidity and Mortality Weekly Report, 74(35). https://www.cdc.gov/mmwr/volumes/74/wr/mm7435a2.htm

USAFacts. (2026). How many people die by suicide in North Dakota each year?https://usafacts.org/answers/how-many-people-die-by-suicide/state/north-dakota/