Sexual orientation discordance puts adolescents at greater risk for nonfatal suicidal behaviors

Discordant students are 70 percent more likely to have had suicidal ideas or to have made suicide attempts, according to a new study in the American Journal of Preventive Medicine


Ann Arbor, February 20, 2018

Suicide is a major national concern in the US. In 2016, it was the second leading cause of death in adolescents aged 12-18 years, with over 1,900 individuals in this age group dying by suicide. Researchers have now identified sexual orientation discordance – sexual contact that is inconsistent with the individual’s sexual orientation – as a potential risk factor for adolescent suicidal ideation and/or attempts. They found that discordant students were 70 percent more likely to have had suicidal ideas or to have made suicide attempts compared with concordant students, reports the American Journal of Preventive Medicine.

“These findings are a wakeup call that we need to learn more about why teens who engage in sexual activity that is different than their sexual orientation are more likely to think about or attempt suicide,” explained lead investigator Francis B. Annor, PhD, from the Epidemic Intelligence Service and Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia. “A better understanding of the stress that leads to suicidal thoughts or attempts among these young people can help communities identify and implement tailored approaches to help them.”

Investigators examined the association between sexual orientation discordance and suicidal ideation/suicide attempts among a nationally representative sample of US high school students. In 2015 for the first time, CDC’s national Youth Risk Behavior Survey (YRBS) included two measures of sexual orientation – sexual identity and sex of sexual contacts – providing an opportunity to examine discordance and how it relates to nonfatal suicidal behaviors among a nationally representative sample. Data were analyzed on a nationally representative group of close to 6,800 students in ninth to twelfth grades who attend public and private schools, identify as heterosexual or gay/lesbian, and had had sexual contact.

Based on the sex of respondents, sex of sexual contacts was categorized as sexual contact with only the opposite sex, sexual contact with only the same sex, sexual contact with both sexes, or no sexual contact. The sexual identity variable was used as the basis against which the sex of sexual contact variable was compared because most students responded to this question. For students who identified as heterosexual, discordance was established if they had had sexual contact with only the same sex or with both sexes. For students who identified as gay/lesbian, discordance was established if they had had sexual contact with only the opposite sex or with both sexes. Respondents who identified as bisexual or not sure were excluded from this study because authors could not be sure that the sex of their sexual contacts was discordant with their sexual identity.

Respondents were considered as being at low risk for nonfatal suicidal behaviors if they had not seriously considered attempting suicide, made a plan about how they would attempt suicide, or attempted suicide during the past 12 months. Students who either seriously considered attempting suicide, made a plan about how they would attempt suicide, or made at least one suicide attempt during the past 12 months were considered as being at high risk for nonfatal suicidal behaviors.

Most students (98 percent) identified as heterosexual. Approximately 96 percent of students experienced sexual orientation concordance with the remaining 4 percent experiencing discordance. The prevalence of discordance in gay/lesbian students was 32 percent, whereas the prevalence was 3.3 percent among heterosexual students.

Discordant students were 70 percent more likely to have experienced nonfatal suicidal behaviors during the past 12 months compared with concordant students and 60 percent after excluding students who had experienced forced sexual intercourse. Higher risk for nonfatal suicidal behaviors was found for discordant students who were bullied on school property, who experienced forced sexual intercourse, and who self-identified as gay/lesbian than their analogous counterparts.

“This study highlights another potential risk factor for youth suicide,” commented Dr. Annor. “The needs of all youth should be considered when developing and implementing suicide prevention programs. The good news is that suicide is preventable. The Centers for Disease Control and Prevention technical package to prevent suicide can help communities and states prioritize strategies with the best available evidence.”

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Notes for editors
The article is “Sexual Orientation Discordance and Nonfatal Suicidal Behaviors in U.S. High School Students,” by Francis B. Annor, PhD, Heather B. Clayton, PhD, Leah K. Gilbert, MD, Asha Z. Ivey-Stephenson, PhD, Shalon M. Irving, PhD, Corinne David-Ferdon, PhD, and Laura K. Kann, PhD (https://doi.org/10.1016/j.amepre.2018.01.013). It appears in advance of the American Journal of Preventive Medicine, volume 54, issue 4 (April 2018) published by Elsevier.

Full text of this article is available to credentialed journalists upon request; contact Jillian B. Morgan at +1 734 936 1590 or ajpmmedia@elsevier.com. Journalists wishing to interview the authors should contact CDC Media Relations at +1 404 639 3286 or media@cdc.gov.

About the American Journal of Preventive Medicine
The American Journal of Preventive Medicine is the official journal of the American College of Preventive Medicine and the Association for Prevention Teaching and Research. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. The journal features papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women's health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and alcohol and drug abuse. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. The journal also publishes official policy statements from the two co-sponsoring organizations, health services research pertinent to prevention and public health, review articles, media reviews, and editorials. www.ajpmonline.org

About Elsevier
Elsevier is a global information analytics business that helps institutions and professionals advance healthcare, open science and improve performance for the benefit of humanity. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support and professional education, including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, more than 38,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX Group, a global provider of information and analytics for professionals and business customers across industries. www.elsevier.com

Media contact
Jillian B. Morgan, MPH
Managing Editor, AJPM
+1 734 936 1590
ajpmmedia@elsevier.com