Differences in Suicide Risk Among Subgroups of Sexual and Gender Minority College Students
Suicide is the second leading cause of death for people in the U.S. aged 15 to 24. While rates of depression, suicidal thoughts, and suicidal behaviors are high among all college students, research has found rates for these risk factors to be higher among adolescents and young adults identifying as a sexual minority (referring to sexual orientation) or gender minority (referring to gender identity).
There are many subgroups within sexual minority populations (including gay, lesbian, and bisexual) and within gender minority populations (including transgender, genderqueer, and nonbinary). While research has shown a clear distinction in suicide risk between heterosexual and non-heterosexual groups, fewer studies have investigated differences in risk between subgroups of sexual minority populations: for example, comparing risk of those identifying as bisexual with those identifying as pansexual. Within gender minority populations, few studies have directly examined mental health or suicide risk among those identifying as transgender relative to those identifying as genderqueer or nonbinary. Examining differences in suicide risk among many sexual and gender minority subgroups could help researchers determine various subgroup needs, with implications for improved suicide prevention interventions.
To assess differences in suicide risk within sexual and gender minority populations, Adam Horwitz, Ph.D., and colleagues conducted secondary analyses of risk characteristics among a broad range of sexual orientations and gender identities among college students enrolled in a large NIMH-supported trial led by Cheryl King, Ph.D. As a part of that trial, 41,412 college students at four U.S. universities completed a wellness screening survey that screened for four suicide risk factors: depression, heavy alcohol use, suicidal ideation, and history of suicide attempt.
Participants reported age, gender identity, race, ethnicity, and sexual orientation, and were able to “check all that apply” regarding gender identity, race, and sexual orientation. For sexual orientation, the survey included several sexual minority categories that have not typically been included in previous studies, such as mostly heterosexual, pansexual, mostly gay/lesbian, and queer.
The results showed that gender minority students had significantly higher rates of depression, suicidal ideation, and suicide attempts relative to cisgender students, though there were no differences in rates of these risk factors within gender minority subgroups (e.g., transgender relative to genderqueer). Students in any of the sexual minority subgroups were substantially more likely to have two or more suicide risk factors relative to heterosexual students. However, within sexual minority subgroups, those identifying as pansexual, bisexual, queer, or mostly gay/lesbian were more likely to have two or more suicide risk factors relative to students identifying as mostly heterosexual, gay/lesbian, asexual, or “other sexual minority.” Notably, students identifying as pansexual had 33% greater odds of having two or more suicide risk factors relative to students identifying as bisexual.
The significant variation in suicide risk among sexual minority subgroups highlights the need for targeted interventions for subgroups at highest risk, the researchers wrote. The researchers suggest that a more fine-tuned approach to the assessment of sexual orientation in studies is important. For example, in this study, students identifying as “mostly heterosexual” constituted the largest subgroup within the sexual minority population, were shown to be at elevated risk for all four examined suicide risk factors relative to students identifying as strictly heterosexual, and had similar risk patterns to those identifying as gay/lesbian. This finding suggests if standard assessments do not include the “mostly heterosexual” category, many individuals are likely miscategorized, which could mask the elevated risk for suicide.
The researchers indicated that additional prospective research to understand longitudinal trajectories of risk and resilience for sexual minority subgroups is needed. They also suggest that these findings have important implications for health professionals working with gender and sexual minority populations, both for better understanding differential risks for suicide and for the importance of providing LGBTQ-affirming care.
Horwitz, A. G., Berona, J., Busby, D. R., Eisenberg, D., Zheng, K., Pistorello, J., Albucher, R., Coryell, W., Favorite, T., Walloch, J. C., & King, C. A. (2020). Variation in suicide risk among subgroups of sexual and gender minority college students. Suicide and Life-Threatening Behavior. DOI: 10.1111/sltb.12637