Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. In a cross-sectional study using national survey data of high schoolers from 2009 to 2017, there was a significant decline in suicide attempts among students with sexual minority identities, though the rate of suicide attempts remained elevated relative to heterosexual students.

2. The proportion of adolescents who identified as sexual minorities and reported same-sex sexual contact significantly rose over time.

Evidence Rating Level: 3 (Average)

Study Rundown:

Adolescents who identify as sexual minorities have been shown to have increased health risks compared to their heterosexual peers, particularly risk of suicide. While previous studies have attempted to estimate the prevalence of sexual minority identity and suicide attempts, less is known about how these have changed over time. In this cross-sectional study, researchers used survey data from the 2009-2017 Youth Risk Behavioral Surveillance Survey to examine trends in reported sexual identity and suicide attempts in the past 12 months among high school students. During the study period, there was a significant increase in the proportion of adolescents who identified as sexual minorities, and in those who reported same-sex sexual contact. There was a significant decline in suicide attempts among adolescents who identified as sexual minorities, though this decline was not as great as the decline among heterosexual adolescents.

These findings are limited by a reliance on self-reported survey data and exclusion of adolescents absent from school. Furthermore, the sample only included states in the northeast, mid-Atlantic, and Midwest that administered the survey, and results may not be generalizable outside these regions. Nonetheless, the study is strengthened by its large, continuous sample. For physicians, these findings highlight the continued importance of supporting sexual minority youth in order to reduce suicide risk.

In-Depth [cross-sectional study]:

Researchers used 2009-2017 survey data from the Youth Risk Behavioral Surveillance Survey encompassing a sample of high school students in the northeast, mid-Atlantic, and Midwest. A total of 156 892 adolescents were included in the final sample. Participants were excluded if they had not had any sexual contact, or if they reported being forced to have sexual contact. Logistic regression analysis were used to examine trends in reported sexual orientation identity, same-sex sexual contacts, and suicide attempts in the past 12 months over time.

Between 2009 and 2017, the proportion of adolescents who identified as sexual minorities increased 96% from 7.3% to 14.3% (marginal effect [ME]: 0.8 percentage points [pp] per year; 95% confidence interval [CI]: 0.6 to 0.9 pp). The proportion of adolescents reporting same-sex sexual contact increased 70% from 7.7% to 13.1% (ME: 0.60 pp per year; 95% CI: 0.39 to 0.80 pp). There was a decline in suicide attempts among students with sexual minority identities over time (ME: -0.8 pp per year; 95% CI: -1.4 to -0.2), though suicide attempts remained elevated relative to heterosexual students in 2017 (ME: 12.6 pp; 95% CI: 10.0 to 15.1). Adolescents with sexual minority identities accounted for an increasing proportion of suicide attempts over the study period.

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