As more teens identify as sexual minority, suicide rate remains disproportionately high
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From 2009 to 2017, the proportion of teens who identified as a sexual minority nearly doubled to more than 14%, according to researchers, who found that these teens are still more than three times as likely to attempt suicide compared with heterosexual youths.
“Given that we have increasing numbers of youth identifying as sexual minorities and given that suicide is the second leading cause of death among adolescents, this is important to both clinicians and policymakers alike,” Michelle Forcier, MD, MPH, professor of pediatrics and clinician educator at Brown University, told Healio. Forcier was not involved in the research.
For the study, Julia Raifman, ScD, assistant professor of health law, policy and management at Boston University School of Public Health, and colleagues analyzed data from six states that collected information on sexual orientation identity and four states that collected information on the sex of sexual contacts through the Youth Risk Behavioral Surveillance Survey. They used the data to evaluate changes in reported sexual orientation identity, sex of consensual sexual contacts and suicide attempts over time. Anyone who identified as gay, lesbian, bisexual or not sure of their sexual identity were considered a sexual minority.
Respondents were high school students. The analysis included 110,243 adolescents in the six states that collected data on sexual orientation (sample A), 25,994 adolescents form the four states that collected data on the sex of sexual contacts and on sexual assault (sample B) and 20,655 sexually active adolescents from three states that collected data on sexual orientation, sex of sexual contacts and sexual assault (sample C), Raifman and colleagues explained.
“This study is important and reflects what pediatricians across the United States are seeing in schools and in clinics — that more and more youth are exploring a wider range of sexual activities and identities, and that youth exploring non-heterosexualities may be more at risk for self-harm and suicide attempts than their hetero-normative peers,” Forcier said.
According to data from sample A, the proportion of participants who identified as heterosexual declined from 92.7% in 2009 to 85.7% in 2017, whereas the proportion of youths who identified as a sexual minority increased from 7.3% in 2009 to 14.3% in 2017. Those who identified as gay or lesbian doubled from 1.4% in 2009 to 2.8% in 2017. Those who reported that they were unsure of their sexual orientation more than doubled over the study period, from 2% to 4.3%.
“That more youths are willing to disclose, even in a confidential health care survey, their sexual minoritized identity or activities may be due to some instances of increasingly open and supportive national conversations about sexuality and gender in a young population that accesses and understands social media,” Forcier said.
“It may be due to students feeling safer to explore sexuality and identity in communities and states demonstrating laws and policies that overtly protect LGBTQ+ civil liberties, such as marriage equality or LGBTQ+ protections against discrimination in both school, work and health care settings,” she said.
Data from sample B showed a decline in the proportion of adolescents who reported only opposite sex sexual contact, from 92.3% in 2009 to 86.9% in 2017. Participants who reported any same-sex sexual contact increased from 7.7% to 13.1% over the study period. The trends were consistent among both males and females, although the increase in males who had sexual contact with both sexes was not significant, Raifman and colleagues reported.
According to data from sample C, individuals who had same-sex sexual contact were 48.3 times more likely to report sexual minority orientation identity relative to peers with solely opposite-sex sexual contacts. The proportion of youths reporting that they were heterosexual declined from 41.9% in 2009 to 26.4% in 2017. The proportion size did not change for anyone identifying as gay or lesbian (11.5% in 2009 and 13.8% in 2017), or for those who identified as not being sure of their sexual orientation (12.5% in 2009 and 16% in 2017). The proportion of teens who identified as bisexual rose from 34.1% to 43.7% over the study period.
Raifman and colleagues observed a decline in suicide attempts by sexual minorities over time (marginal effect, –0.8 percentage points per year; 95% CI: –1.4 to –0.2) but not by heterosexual students, although sexual minorities remained more than three times more likely to attempt suicide, they said.
“Interestingly, this study might convince leaders to discourage state and national policies that restrict rights and access or even openly demonize sexual and gender-minoritized persons since it is so clearly linked to suicide attempts and poorer health outcomes for an important and growing group of youths in our communities,” Forcier said.
“Advocating for children and adolescents as a population vulnerable to the harms of bullying, discrimination and isolation can truly, positively impact children and families, and is again proven to be the right thing for our children growing up in a country that claims to be about individual freedoms and the right to live an authentic life.”
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