Depression and Suicide Risk at the Cross-Section of Sexual Orientation and Gender Identity for High School Youth

Background

Negative mental health outcomes for sexual and gender minority adolescents are a considerable public health challenge. Scholarship on adolescent mental health reflects higher rates of depression symptoms and suicidality amongst sexual and gender minority adolescents when compared to their heteronormative and cisgender peers. This prevalence of depression and suicidality may be explained by minority stress theory, which links the presence of oppressive structures to mental health outcomes.

Methods

Using statewide representative data from the 2017 Healthy Kids Colorado Survey conducted with public high school students, we examined the likelihood of experiencing of depression and suicidality by sexual orientation and gender identity. Three dichotomous dependent variables were used: past year depressive symptoms, past year suicide plan, and past year suicide attempt. The independent variable examining the cross-section of sexual orientation and gender identity was created from the results of 2 multiple choice items exploring sexual and gender identity. First descriptive statistics were analyzed, then three logistic regression models were used to predict depression, suicide attempt and suicide plan.

Results

The final sample was 45,918 youth with a mean age of 15.6. Results indicated that all sexual and gender minority identities were at heightened risk for depression symptoms, suicide plan, and suicide attempts compared to cisgender heterosexual youth. Specifically, cisgender youth who identified as LGB were three times more likely (AOR = 3.44, 95% CI [3.20, 3.70]) to have experienced symptoms of depression within the past year, while cisgender youth questioning their sexual orientation were twice as likely (AOR = 1.91, 95% CI [1.71, 2.13]). Transgender heterosexual (AOR = 2.65, 95% CI [1.77, 3.97]), transgender LGB (AOR = 6.37, 95% CI [4.93, 8.22]), and transgender questioning (AOR = 4.02, 95% CI [2.57, 6.30]) youth were between 2.5 and 6 times as likely to have experienced past year symptoms of depression. Regarding suicide plans, transgender LGB (AOR = 7.42, 95% CI [5.93, 9.28]), transgender questioning (AOR = 7.85, 95% CI [5.02, 12.28]), and LGB youth who did not know if they were transgender (AOR = 6.54, 95% CI [5.12, 8.35]) had the highest levels of risk. Finally, suicide attempt was particularly heightened among transgender heterosexual (AOR = 8.11, 95% CI [5.32, 12.37]), transgender LGB (AOR = 9.56, 95% CI [7.58, 12.07]), and transgender questioning (AOR = 8.35, 95% CI [5.34, 13.08]) adolescents, who were between eight and nine times more likely to report a suicide attempt in the past year when compared to cisgender heterosexual youth.

Conclusion

The findings of the presented proposal illuminate how the intersection of sexual orientation and gender identity impact mental health experiences of youth. LGBQ and transgender youth tend to be combined under the umbrella of LGBTQ youth when examining mental health outcomes. However, the identities of sexuality and gender are both separate and intersecting, resulting in unique trajectories of minority stress and resilience. This proposal strengthens the existing body of scholarship advocating for the mental health of sexual and gender minority youth to become educational and public health priorities.