The Association of Body Image Discrepancy with Suicidal Ideation in Sexual Minority and Gender Nonconforming Youth

Background and Purpose:

Sexual minority and gender nonconforming adolescents are at an increased risk of attempting suicide in high school (Grossman & D'Augeli, 2007; Russel, 2003). Additionally, this community is more likely to have negative body image perception (e.g., body dissatisfaction, weight control, and gender dissociation) compared to their heterosexual peers (Hadland et al., 2014; McGuire et al., 2016). The purpose of this study is to examine if negative body image is associated with increased suicidal ideation in sexual minority and gender nonconforming youth in high school by examining data collected from the Youth Risk Behavior Surveillance System (YRBSS).

Methods:

A secondary analysis of the YRBSS data set explored the variables of suicidal ideation, body image, gender nonconformity, and sexual identity. A nationally representative sample of over 100,000 high school students across 12 states were asked about gender nonconformity, an optional question in the YRBS (2013-2017). Bivariate analyses were utilized to explore the intersectionality of these variables, followed by multiple regressions.

Results:

Eighty-two percent of the sample identified as heterosexual (n=84,442), 3.2% identified as gay or lesbian, 8.1% as bisexual, and 6.4% as not sure. Eighty-two percent of the females selected that other people would identify them as very feminine, mostly feminine or somewhat feminine (n=43,543), 13.7% as equally feminine and masculine, and 4.4% as somewhat masculine, mostly masculine, and very masculine. Among males, 77.7% selected that others would identify them as very masculine, mostly masculine, or somewhat masculine (n=38,703), 9.7% as equally feminine and masculine, and 12.4% as somewhat feminine, mostly feminine, and very feminine.

Fifty-six percent of the sample reported that they did not have incongruent perceptions of body image (n=40,580) and 43.7% reported a weight discrepancy. Approximately 19.2% of these students have considered suicide (n=5,941) and 16.2% made a suicide plan. A chi-square analysis revealed a significant association between sexual identity and GNC (Females: X²(18)=2547.04, p<0.001; Males: X²(18)=2705.34, p<0.001, eta=0.24).

Students with a weight discrepancy are overrepresented by GNC individuals (Females: X²(6)=35.24, p<0.001; Males: X² (6)=106.39, p<0.001). Although the significant relationship is weaker, those students with a weight discrepancy are overrepresented by those who have considered suicide (X² (1)=44.42, p<0.001, eta=5%) and by those who have made a suicide plan (X² (1)=25.37, p<0.001, eta=4%).

Conclusions and Implications:

The primary implication of this paper is the recommendation that the question regarding gender nonconformity should move from a recommended question to a required question in all future YRBS studies. The question about gender nonconformity among high school students revealed a strong association with suicidal ideation and must be researched in future studies. Body image must also be explored more thoroughly in future research. The conceptualization of body image, due to the limited questions in the survey, provided a starting point for exploring the significance of this intersection of identities among SMGNC high school students. These findings are also important for the development of suicide prevention programs specifically designed for unique challenges that sexual minority and gender nonconforming youth experience related to body image.