| Abstract: | Objectives. We examined the relationships among sexual minority status, sex, and mental health and suicidality, in a racially/ethnically diverse sample of adolescents.Methods. Using pooled data from 2005 and 2007 Youth Risk Behavior Surveys within 14 jurisdictions, we used hierarchical linear modeling to examine 6 mental health outcomes across 6 racial/ethnic groups, intersecting with sexual minority status and sex. Based on an omnibus measure of sexual minority status, there were 6245 sexual minority adolescents in the current study. The total sample was n = 72 691.Results. Compared with heterosexual peers, sexual minorities reported higher odds of feeling sad; suicidal ideation, planning and attempts; suicide attempt treated by a doctor or nurse, and self-harm. Among sexual minorities, compared with White youths, Asian and Black youths had lower odds of many outcomes, whereas American Native/Pacific Islander, Latino, and Multiracial youths had higher odds.Conclusions. Although in general, sexual minority youths were at heightened risk for suicidal outcomes, risk varied based on sex and on race/ethnicity. More research is needed to better understand the manner in which sex and race/ethnicity intersect among sexual minorities to influence risk and protective factors, and ultimately, mental health outcomes.Over the past 20 years, research has documented elevated suicidality1—defined as behavior related to contemplating, attempting, or completing suicide2—among sexual minority youths (an umbrella term, generally including those who identify as lesbian, gay, bisexual, or transgender LGBT]; engage in same-sex sexual behavior; or have same-sex attractions). This research has consistently demonstrated substantial sexual orientation disparities in suicidality, with sexual minority youths having higher prevalence of suicidality than their heterosexual peers.3–6 A recent review of the literature indicated that sexual minority youths are at least twice as likely as heterosexual youths to contemplate suicide, and 2 to 7 times as likely to attempt suicide.7 A meta-analysis found that 28% of sexual minority youths had a history of suicidality, compared with 12% of their heterosexual peers.8Despite the development of knowledge about suicidality among sexual minority youths, little is known about suicidality in sexual minority youths of color. To the extent that existing researchers have explored racial/ethnic differences, analyses have rarely gone beyond dichotomous (White vs “youths of color”) or trichotomous (White vs Black vs Latino) comparisons. As a result, there exists scant literature exploring the full spectrum of racial/ethnic differences in suicidality among sexual minority youths.The literature on suicide in the general adolescent population demonstrates racial/ethnic differences in suicide ideation and attempts. For example, prevalence of suicide among Native American and Alaska Native youths is twice that of other youths,9 and Latino youths are more likely than either Black or White youths to have considered and attempted suicide.10 Differences are further moderated by participants’ gender: girls are more likely to consider suicide and attempt suicide than boys,10 although boys are more likely to complete suicide.11Studies that have considered racial/ethnic differences in suicidality among sexual minority youths have found differences, though the patterns have been inconsistent. A study based on Youth Risk Behavior Survey (YRBS) data from Massachusetts, reported that among self-identified lesbian, gay, or bisexual (LGB) youths3 Latinos were significantly more likely than Whites to report past-year suicide attempt. Another study found that same-sex–attracted Black and White youths were more likely than their other-sex–attracted peers to report suicidal ideation, whereas same-sex–attracted Latino and Asian/Pacific Islander youths did not differ from other-sex–attracted peers.12 In a nonprobability sample of urban LGBT youths,13 Black and White youths were more likely to report suicidal ideation than Latinos; however, Latinos reported the highest frequency of suicide attempts. A study of New York City adults found that Latino and Black LGB participants were more likely to report serious suicide attempts than were White LGB participants, with most reported attempts occurring during adolescence and young adulthood.14 These conflicting results suggest that there are important differences in suicidality at the intersections of sexual minority status and race/ethnicity, yet further study requires data of sufficient scale and scope to enable analyses of low-prevalence behaviors across small subgroups of youths.To address the need for information about suicidality among racially/ethnically diverse sexual minority populations, we assess suicidality patterns among youths based on sexual orientation, race/ethnicity, and sex. With this, we respond to calls for public health to utilize minority stress and intersectional frameworks as potential lenses through which to understand health and health disparities among sexual minority populations.15,16 Rather than treating social identities as separate and discrete phenomena, our inquiry allows that co-occurring minority identities operate together. An intersectional approach suggests that sexual identity–race–sex intersections are informed by unique cultural, historical, social, and political factors that differentially influence life experiences, including discrimination based on such identities.17–19 In turn, minority stress theory posits that discriminatory experiences predispose populations to stress and adverse mental health outcomes, including suicidality.20The focus on health differences among sexual minority youths across race/ethnicity and sex is vital to creating effective health interventions and programs. Such a focus is particularly relevant within the context of youth suicide, as risk and protective factors associated with suicidality vary across both racial/ethnic and sexual minority groups, and there is a need to better integrate these bodies of research.21 |
