Sexual Identity-Behavior Discordance and Suicidal Behaviors Among Sexually Active Adolescents

 

Background & Purpose: Suicide is a major public health concern among adolescents. In the United States, suicide is the second leading cause of death among all youth age 15-19. Sexual minority youth (SMY) experience elevated rates of psychological distress, depression, and hopelessness, increasing their risk for suicide. Although sexual orientation is a multi-dimensional construct, extant research frequently identifies SMY through a single question related to either behavior or identity. Reported sexual identity, however, might be discordant with sexual behavior assumed to align with this identity—or vice versa. Thus, the full scope of youth at risk for suicide might be misspecified. This study, grounded by Self Discrepancy Theory, examined the relationship between sexual identity-behavior discordance and suicidal thoughts, plans, and behaviors (i.e., attempted suicide) among a nationally representative sample of high school students.

Methods: Data were obtained from the 2015 National Youth Risk Behavior Survey (YRBS). The analytic sample consisted of students who reported having sexual contact (N=7,957). Participants reported on their sexual identity (heterosexual, lesbian/gay, bisexual, not sure) and sex of sexual contacts (females, males, females and males). Along with participant gender, these variables were used to construct four groups of identity-behavior concordance/discordance: heterosexual concordant (heterosexual/opposite sex partners), heterosexual discordant (heterosexual/same-sex partners), lesbian/gay (LG) concordant (LG/same-sex partners), LG discordant (LG/opposite sex partners). Outcomes included suicide thoughts, plans, and attempts. Bivariate analyses were used to compare sexual concordance/discordance on suicide outcomes. Multivariate logistic regression analyses were used to evaluate the relationships between sexual concordance/discordance and suicide outcomes, controlling for demographic variables, sad/hopeless feelings, school bullying, and alcohol/drug use before sexual intercourse. A weight based on student sex, race/ethnicity, and grade was applied to adjust non-response and oversampling.

Results: About 4.5% of youth were identified as discordant, among which 247 (3.52%) were heterosexual discordant, and 65 (1.0%) were LG discordant. Without controlling the demographic, behavioral, and psychological variables, students identified as LG discordant were 3 times more likely to have suicidal thoughts (OR_adj= 3.03, 95% CI=[1.36, 6.75]), 4.7 times more likely to have a suicide plan (OR_adj= 4.74, 95% CI=[1.98, 11.31]), and 9.6 times more likely to have a suicide attempt than the heterosexual concordant group (OR_adj= 3.03, 95% CI=[3.96, 23.50]). Students identified as heterosexual discordant were 2.3 times more likely to have suicidal thoughts (OR_adj= 2.27 95% CI=[1.60, 3.23], 3.0 times more likely to have a suicide plan (OR_adj= 2.99, 95% CI=[2.17, 4.11], and 2.8 times more likely to have a suicide attempt than the heterosexual concordant group (OR_adj= 2.77, 95% CI=[1.70, 4.53]). Holding the controlled variables constant, students identified as LG discordant were still 3.4 times more likely to have a suicide plan (OR_adj= 3.44, 95% CI=[1.20, 9.78], and 5.3 times more likely to attempt suicide (OR_adj= 5.31, 95% CI=[1.70, 16.67]).

Conclusions & Implications: Findings show that youth with identity-behavior discordance experience heightened distress as indicated by greater odds of suicide thoughts, plans and attempts. Health and mental health providers can expand the identification of youth at risk for suicide by asking multiple questions surrounding both identity and behavior.