Structural Factors Associated with Suicide Attempts Among LGBTQ Youth Contacting Crisis Services

Background and Purpose: LGBTQ youth experience increased risks of mental health disorder symptoms and suicidality, and structural factors – such as socioeconomic status (SES), experiences of homelessness, conflict between religion and LGBTQ identity, and political equality for LGBTQ persons – may complicate this risk for youth in certain familial, political, and economic climates. Utilizing data from LGBTQ youth contacting a suicide crisis services organization, this study examined whether these structural characteristics were associated with lifetime and recent suicide attempts. Methods: A nationwide sample of LGBTQ youth (ages 12-24) was recruited for a confidential online survey from an LGBTQ-focused crisis services hotline. Regression analyses (linear and logistic, depending on the outcome) adjusting for demographic characteristics assessed for relationships between structural factors and lifetime and recent suicide attempts. The self-administered survey assessed structural factors by asking whether the youth had ever been eligible for a free or reduced lunch at school (indicator of low SES), whether they had ever experienced homelessness, and whether they felt conflicted about being LGBTQ and also being a member of their family’s religion. Youth were asked for their current zip code, and were coded as living in a state with better/worse LGBTQ political climate based on the 2016 Human Rights Campaign’s State Equality Index. The survey also assessed recent and lifetime suicide attempts. Results: Overall, 33% of youth contacting the crisis services hotline reported a lifetime suicide attempt and 5% reported an attempt within the prior two weeks. 31% of youth had experienced lifetime homelessness, 32% had been eligible for free or reduced lunch in school, 40% felt conflicted about being LGBTQ and a member of their family’s religion, and 58% lived in states with a poor political climate for LGBTQ people. Both lifetime and recent suicide attempts were more common among those who felt conflicted about being LGBTQ in their religion (lifetime: OR=1.12: 95% CI: 1.01-1.25; recent: OR=1.73; 95% CI:1.32-2.27) and those who had ever experienced homelessness (lifetime: OR=3.56; 95% CI: 2.27-5.35; recent: OR=3.27; 95% CI: 1.23-8.72). There was a marginally significant (p<0.10) relationship between lifetime suicide attempts and both having a lower SES and living in states with poorer LGBTQ political equality records. Conclusions and Implications: Social workers and other providers working with young LGBTQ persons may consider the implications of structural influences for mental health and suicide outcomes. Utilizing treatment interactions as a space to assess for economic disadvantage and homelessness experiences may help providers to identify LGBTQ youth at highest risk for suicide, and who may also be in need of other services to address their immediate subsistence needs. Similarly, understanding the context of personal religious conflict may help inform treatment plans for LGBTQ youth and their families. Finally, advocacy aimed at improving nationwide political climate around LGBTQ issues may be an area where social work can have a widespread and lasting impact on the mental health of LGBTQ youth.