• Posted September 30, 2021

LGBQ Teens More Likely to Contemplate Suicide

Kids who are gay, bisexual or questioning their sexuality may be vulnerable to contemplating suicide at a tender age, a new U.S. government study finds.

It has long been known that teenagers who are part of sexual minorities have a higher risk of suicidal thoughts and behaviors, compared to their heterosexual peers. That includes kids who identify as lesbian, gay, bisexual, transgender or questioning.

Experts said the new findings -- published online Sept. 27 in the journal Pediatrics -- add another layer: Those kids also start to grapple with suicidal thoughts at a younger age -- with an increased risk appearing as early as age 10.

What's more, they typically progressed more quickly from the "thinking" stage to actually planning for suicide.

None of that means LGBTQ kids are destined for poor mental well-being, stressed Brian Mustanski, director of the Institute for Sexual and Gender Minority Health and Wellbeing at Northwestern University in Chicago.

"They are at relatively higher risk of suicidality, but the majority of LGBTQ youth do well," said Mustanski, who was not involved in the study.

That said, it's important to recognize the increased risk, and that it begins early, according to Mustanski.

In general, he said, kids first realize their sexual attractions around the age of puberty. For kids attracted to their own sex, or both, those blooming feelings may be accompanied by distress if they have been exposed to "anti-gay" messages during childhood, Mustanski said.

So it's vital that children understand from a young age that those attractions are normal, he said.

"The process of coming out is not easy for LGBQ youth," said Jeremy Luk, lead researcher on the study.

But the "good news," he said, is that based on other research, LGBTQ teenagers who report high levels of acceptance from either their parents or peers have a reduced risk of attempting suicide.

"In other words, acceptance goes a long way," said Luk, a clinical psychologist who was with the U.S. National Institute of Child Health and Human Development at the study's outset.

The findings are based on 1,771 U.S. high school students who were part of a larger project tracking their health and well-being.

Around 6% said they were attracted to their own sex, both sexes or were "questioning." (The survey did not ask about gender identity.)

Overall, 26% of sexual minority teens said they'd thought about suicide -- double the rate of their heterosexual peers. Similarly, almost 17% had made a suicide plan, versus roughly 5% of their peers. In all, 12% had attempted suicide, compared with 5% of heterosexual students.

The students were also asked how old they were when their suicidal thoughts first emerged. And the increased risk among gay, bisexual and questioning kids was already apparent at age 10.

It all underscores the importance of detecting suicidal behavior early, and getting kids the help they need, said Dr. Pamela Murray, from Boston Children's Hospital and Harvard Medical School.

Current guidelines say all teenagers should be screened for depression yearly, starting at age 12.

But depression screening does not always catch increased suicide risk, said Murray, co-author of an editorial published with the study.

"We've come to realize that depression does not tell the whole story, and we may need to specifically ask about suicidality," she said.

There's also the question of when and how to ask kids about their sexual attractions, to help identify those who may be particularly vulnerable. Some doctors already do that, Murray said, but there are no general guidelines on it.

And of course, once kids with suicidal thoughts and behaviors are identified, "we have to be able to offer them help," Murray said.

That can be a challenge for various reasons, including the dearth of mental health providers for kids and teens. The demand has always overwhelmed the supply, Murray said, and the problem has worsened during the pandemic.

Then there's the fact that many kids suffering from suicidality don't have parents who support them.

Murray noted that sexual minority kids are "over-represented" among the homeless population specifically because their families rejected them.

In his own research, Mustanski has found that bullying may increase the risk of suicidal behavior and self-harm among LGBTQ kids. So school anti-bullying programs could be one important part of prevention.

And while parents' support is critical, so is that from the other people in kids' lives, Mustanski said. Support from friends and romantic partners, he noted, can buoy the mental health of LGBTQ young people.

As for families, Murray pointed to resources like PFLAG, a national nonprofit that offers parents education on how to support their LGBTQ children.

More information

The Trevor Project has resources for LGBTQ young people at risk of suicide.

SOURCES: Jeremy Luk, PhD, clinical psychologist, U.S. National Institute on Alcohol Abuse and Alcoholism, Bethesda, Md.; Pamela Murray, MD, MHP, attending physician, adolescent and young adult medicine, Boston Children's Hospital, and associate professor, pediatrics, Harvard Medical School, Boston; Brian Mustanski, PhD, director, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, Chicago; Pediatrics, Sept. 27, 2021, online