Amy Bischoff, B.S., Steven Lippmann, M.D.

Introduction

Suicide by young people is a serious, widespread problem. It is the second ranked cause of death among people ages 15-24 and the third one between ages 10-24 years (1). Suicide is of greater concern in lesbian, gay, and bisexual (LGB), or sexual minority youth (2). A 2015 study revealed over 29% of surveyed students with LGB identity in grades 9-12 in the United States had attempted suicide, as compared to about 6% of heterosexual participants (2). Nearly 43% of LGB teens contemplated suicide, versus about 15% of heterosexual adolescents (2). Despite this evidence, relatively less consideration is directed towards understanding suicidal risk factors and/or prevention strategies specific to this population (3).

Risk Factors

There are numerous risk factors contributing to more suicidal behavior among LGB youth. Psychiatric disorders comprise one of the main precipitants for suicide attempts in all adolescents (3). Research involving those with LGB persuasion indicates higher frequency of such attempts by those with depression, anxiety, substance abuse, and/or conduct disorder; they were six times more likely to experience several such problems (4). Even after adjusting for mental health conditions, suicide attempts in LGB populations are still 2-3 times more frequent than for heterosexual individuals (3). Adolescents with LGB identities exhibit elevated prevalence of injuries, violence, tobacco smoking, alcohol and/or other drug use, and sexually high-risk behaviors correlated with unintended pregnancy and/or sexually transmitted infections. These behaviors contribute to increased mortality and morbidity (2). 

Prejudice, stigma, and discrimination are unique factors that precipitate increased suicidal feelings by LGB youth. Throughout their lives, these individuals experience rejection, bullying, harassment, and/or violence (3). Rejection by family is an especially troublesome event. Adolescents receiving negative reactions from family members in response to their “coming out” are eight times more likely to attempt suicide, have six-fold more depression, and evidence three times as much drug abuse and engagement in unprotected sex than LGB adolescents who suffer less such rejection (5).

Prevention

Schools that foster a safe and encouraging atmosphere for all students are successful at preventing suicide. Such a positive school environment results in less depression, suicidal ideation, substance use, and/or unexcused school absences among LGB students. Schools should implement policies designed to improve emotional health for LGB youth. These students, when in institutions with gay-straight alliances or similar support groups, are less likely to harm themselves or be absent due to feeling unsafe or experiencing violence, as compared to those without such supports. Educators ought to encourage respect for everyone and overtly restrict harassment and bullying. Curriculums should include information about pregnancy prevention and avoiding sexually transmitted infections (6). 

Good parenting reduces dangerous behaviors in children. Open conversation helps progeny attain better mental and physical health. With regard to LGB youth, parents should provide discussion about sexual orientation, and include information about sex and avoiding risky situations. Dialogue promotes feelings of trust, love, and support. Parents need to be alert for indications that their child is being bullied or victimized, and if so, immediate action at the school is indicated. Parents have the primary role to promote the well-being of their LGB child or adolescent (6). Families together can create common goals at succeeding in school, life, and maintaining good health.

Conclusion

Suicide among LGB youth is a major concern. While many suicidal risk factors are shared by all teens, bullying and harassment are more dangerous to LGB adolescents than their heterosexual peers. With better understanding and actions promoting safety, we expect improved outcomes for sexual minority youth.

References

1. Teen Suicide is Preventable. (2018). Retrieved from http://www.apa.org/research/action/suicide.aspx Last accessed February 11, 2018
2. Kann L, Olsen EO, McManus T, et al. Sexual Identity, Sex of Sexual Contacts, and Health-Related Behaviors Among Students in Grades 9–12 — United States and Selected Sites, 2015. Morb Mort Wk Rep (MMWR) Surveill Summ. 2016 Aug;65(9):1-202.
3. Haas AP, Eliason M, Mays VM, et al. Suicide and Suicide Risk in Lesbian, Gay, Bisexual, and Transgender Populations: Review and Recommendations. J Homosex. 2011 Jan;58(1):10-51. doi:10.1080/00918369.2011.534038.
4. Fergusson DM, Horwood LJ, Beautrais AL. Is sexual orientation related to mental health problems and suicidality in young people? Arch Gen Psychiatry. 1999 Oct;56(10):876-80.
5. Ryan C, Huebner D, Diaz RM, Sanchez J. Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults. Pediatrics. 2009 Jan;123(1):346-52. doi: 10.1542/peds.2007-3524.
6. LGBT Youth. (2017, June 21). Retrieved from https://www.cdc.gov/lgbthealth/youth.htm Last accessed February 11, 2018