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Sexual Orientation and Risk of Suicide Attempts Among a Representative Sample of Youth
Robert Garofalo, MD;
R. Cameron Wolf, MS;
Lawrence S. Wissow, MD, MPH;
Elizabeth R. Woods, MD, MPH;
Elizabeth Goodman, MD
Arch Pediatr Adolesc Med. 1999;153:487-493.
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.
From the Divisions of General Pediatrics (Dr Garofalo) and Adolescent/Young Adult Medicine (Drs Woods and Goodman), Children's Hospital/Harvard Medical School, Cambridge, Mass; JRI Health–Sidney Borum Community Health Center, Boston, Mass (Dr Garofalo); and The Johns Hopkins School of Hygiene and Public Health, Baltimore, Md (Mr Wolf and Dr Wissow).
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