Social rejection, minority stress, and suicidal ideation among LGBTQ people in Pakistan and Indonesia: A comparative narrative review

Abstract

Suicidal ideation among lesbian, gay, bisexual, transgender, and queer (LGBTQ) people is well documented in high-income countries, but evidence from Muslim-majority countries in Asia remains scattered. This narrative review examines how social rejection and minority stress relate to suicidal ideation among LGBTQ people in Pakistan and Indonesia, two Muslim-majority countries with contrasting legal configurations. Peer-reviewed studies, institutional reports, and legal and enforcement records published or updated between 2021 and 2026 were identified through structured searches and synthesized by directed qualitative content analysis guided by Minority Stress Theory and the Interpersonal Theory of Suicide. Sixteen country-specific documents met the inclusion criteria, eight of which reported empirical data. In Pakistan, the evidence is concentrated on transgender (khawaja sira) populations and links discrimination, depression, and anxiety with suicide attempts and suicidal ideation, within a context of national criminalization of male same-sex conduct and a 2023 Federal Shariat Court ruling that struck down core provisions of the Transgender Persons (Protection of Rights) Act 2018. In Indonesia, nationally representative survey data show markedly higher odds of suicidal ideation among gender-diverse and sexually diverse adolescents, alongside high psychological distress among transgender women and unmet need for mental-health services, within a context of provincial criminalization and public caning in Aceh. The evidence in both countries is consistent with a pathway from structural and interpersonal rejection, through concealment and expected rejection, to thwarted belongingness and perceived burdensomeness, but no included study measured this pathway directly. Primary studies that assess minority stressors and interpersonal mechanisms with culturally adapted instruments are needed to inform suicide prevention in both countries.