Sexual Orientation and Suicide Attempt Disparities Among US Adolescents: 2009-2017

Abstract

Background: Sexual minority adolescents face mental health disparities relative to heterosexual adolescents. We evaluated temporal changes in US adolescent reported sexual orientation and suicide attempts by sexual orientation.

Methods: We used Youth Risk Behavioral Surveillance data from 6 states that collected data on sexual orientation identity and 4 states that collected data on sex of sexual contacts continuously between 2009 and 2017. We estimated odds ratios using logistic regression models to evaluate changes in reported sexual orientation identity, sex of consensual sexual contacts, and suicide attempts over time and calculated marginal effects (MEs).

Results: The proportion of adolescents reporting minority sexual orientation identity nearly doubled, from 7.3% in 2009 to 14.3% in 2017 (ME: 0.8 percentage points [pp] per year; 95% confidence interval [CI]: 0.6 to 0.9 pp). The proportion of adolescents reporting any same-sex sexual contact increased by 70%, from 7.7% in 2009 to 13.1% in 2017 (ME: 0.6 pp per year; 95% CI: 0.4 to 0.8 pp). Although suicide attempts declined among students identifying as sexual minorities (ME: -0.8 pp per year; 95% CI: -1.4 to -0.2 pp), these students remained >3 times more likely to attempt suicide relative to heterosexual students in 2017. Sexual minority adolescents accounted for an increasing proportion of all adolescent suicide attempts.

Conclusions: The proportion of adolescents reporting sexual minority identity and same-sex sexual contacts increased between 2009 and 2017. Disparities in suicide attempts persist. Developing and implementing approaches to reducing sexual minority youth suicide is critically important.

FIGURE 1

Changes in reported sexual minority orientation identity and same-sex sexual contacts over time. A, Sexual minority orientation identity over time. B, Sex of sexual contacts over time. C, Sexual orientation among students with same-sex sexual contacts. D, Sexual orientation among students with opposite-sex sexual contacts. Note that y-axis scales range from 0% to 10% for all graphs except for the bottom left (C), where the scale is from 0% to 60%. Heterosexual sexual orientation identity and opposite-sex sexual contacts are excluded from the graphs, so the graphs can be presented at a scale that improves visualization of temporal changes in sexual minority identity and in same-sex sexual contacts.

FIGURE 2

Changes in the proportion of adolescents reporting ≥1 suicide attempt over time, by sexual orientation identity and sex of sexual contacts. A, Suicide attempts by sexual orientation identity. B, Suicide attempts by sex of sexual contacts.