Sexual orientation and risk of suicide attempts among a representative sample of youth

Objective: To examine whether sexual orientation is an independent risk factor for reported suicide attempts. Design: Data were from the Massachusetts 1995 Centers for Disease Control and Prevention Youth Risk Behavior Survey, which included a question on sexual orientation. Ten drug use, 5 sexual behavior, and 5 violence victimization variables chosen a priori were assessed as possible mediating variables. Hierarchical logistic regression models determined independent predictors of suicide attempts. Setting: Public high schools in Massachusetts. Participants: Representative, population-based sample of high school students. Three thousand three hundred sixty-five (81%) of 4167 responded to both the suicide attempt and sexual orientation questions. Main Outcome Measure: Self-reported suicide attempt in the past year. Results: One hundred twenty-nine students (3.8%) self-identified as gay, lesbian, bisexual, or not sure of their sexual orientation (GLBN). Gender, age, race/ethnicity, sexual orientation, and all 20 health-risk behaviors were associated with suicide attempt (P<.001). Gay, lesbian, bisexual, or not sure youth were 3.41 times more likely to report a suicide attempt. Based on hierarchical logistic regression, female gender (odds ratio [OR],4.43; 95%; confidence interval [CI], 3.30-5.93), GLBN orientation (OR, 2.28; 95% CI, 1.39-3.37), Hispanic ethnicity (OR, 2.21; 95% CI, 1.44-3.99), higher levels of violence/victimization (OR, 2.06; 95% CI, 1.80-2.36), and more drug use (OR, 1.31; 95% CI, 1.22-1.41) were independent predictors of suicide attempt (P<.001). Gender-specific analyses for predicting suicide attempts revealed that among males the OR for GLBN orientation increased (OR, 3.74; 95%;, CI, 1.92-7.28), while among females GLBN orientation was not a significant predictor of suicide. Conclusions: Gay, lesbian, bisexual, or not sure youth report a significantly increased frequency of suicide attempts, Sexual orientation has an independent association with suicide attempts for males, while for females the association of sexual orientation with suicidality may be mediated by drug use and violence/victimization behaviors.