A new study analyzing data from 48 countries has found that moving from a country with a higher LGBTQ stigma to one that is more tolerant can improve mental health and reduce the risk of suicide.

Although there’s been some progress, the world has a long way to go to truly become accepting of gayness and bisexuality. Despite being a natural phenomenon encountered in hundreds of other species (including giraffes, gorillas, and swans) being gay (or bisexual) comes with a stigma in almost all parts of the world. In some parts, the stigma is greater than in others — and this comes at a great cost.

Previous studies have found that living in intolerant countries can be very taxing on the mental health of members of the LGBTQ community (LGBTQ stands for Lesbian, Gay, Bisexual, Transgender, Queer). Now, a new study finds that moving to a more tolerant country reduces some of that mental burden, and also reduces the risk of suicide.

“Our study found that gay and bisexual men had a lower risk of depression and suicidality when they moved from higher-stigma countries to lower-stigma countries, especially when they had lived in the new country for five years or longer,” said lead study author John Pachankis, PhD, an associate professor of public health and director of the LGBTQ Mental Health Initiative at the Yale School of Public Health.

The survey analyzed data from a 2017-18 online survey of more than 123,000 participants living in countries in Europe and Asia. Most were gay or bisexual men, while a minority (6%) identified as heterosexual men, but had sex with other men on at least one occasion. The survey was designed to assess the participants’ mental health, as well as factors of stress. For instance, they were asked how compelled they felt to hide their sexual orientation, how socially isolated they felt, and how much they internalized negative attitudes.

The researchers then developed an indicator to assess the stigma against gay and bisexual men. The index was compiled from 15 laws and policies relating to LGBTQ rights, as well as social attitudes. Overall, the study included 11,000 participants who moved from higher- to lower-stigma countries. For Pachankis, this is a clear sign that social and political stigma against these men is significantly affecting their mental health.

“The study shows that structural stigma shaped gay and bisexual men’s daily lives and mental health by increasing their risks for social isolation, concealment of their identity, and internalized homonegativity,” he said.

Interestingly, a small number of men moved from lower stigma to higher stigma countries — but they didn’t report any increased negative effects. This is perhaps because growing up in a more tolerant society has long-lasting benefits, the researchers speculate.

The findings of the study, however, are pretty clear. If we want to reduce the risk of suicide and improve the wellbeing of these LGBT members, tolerance is crucial. Men are, in general, much more prone to suicide than women. Worldwide, the rates are about 16 deaths per 100,000 men and 7 deaths per 100,000 women — but in many countries, male suicide has become a sort of silent epidemic. In the UK, for instance, suicide is the single biggest killer of men under the age of 45 in the country. In the US, the annual suicide rate has increased 24% between 1999 and 2014 — a big contributor to the three-year decline of life expectancy in the U.S.

For LGBT men, the risk of suicide is even greater. It’s hard to estimate the exact suicide rate for gay men because sexuality is often hidden and unknown, but it’s estimated that bisexual men are four times more likely to attempt suicide in their lifetime than heterosexual men. This is why it’s important to advocate for changes to laws, policies, and societal stigma directed against LGBTQ people Pachankis concludes.

The study “Structural Stigma and Sexual Minority Men’s Depression and Suicidality: A Multilevel Examination of Mechanisms and Mobility Across 48 Countries” was published in the Journal of Abnormal Psychology.