Examining Impact of Change in Sexual Identity on Suicidality Among Sexual Minority Youth Accessing Crisis Services

Background and Purpose: Youth suicide is a public health crisis in the U.S., with suicide as the second lead cause of death for ages 10-24. Further complicating our understanding of suicidality among sexual minority and gender minority youth (SGMY), is the fact that sexual identities may change over time in particular, during childhood and adolescence. Given the importance of identity formation in healthy adolescent development, there is a concerning lack of research on how changes in sexual identities may influence suicidality among SGMY. This longitudinal study examined characteristics SGMY with stable and unstable identities, and association between change in sexual identity and suicidality outcomes.

Methods: Surveys were administered with youth (aged 12–24, N = 405) recruited from an LGBTQ youth-focused suicide prevention service provider. The data was collected at baseline and 30-days follow-up. Descriptive statistics were conducted to identify change in sexual identities, and patterns of change. Multinomial logistic regression was conducted to examine the association between change in sexual identity and ideation (no change, decrease, and increase in ideation).  

Results: Around 15% of the sample (n=60) reported changing their sexual identity from baseline to 30-days follow-up. Participants identifying with gay/lesbian identity were least likely to report a change in identity (n=15; 9.3%), followed by bisexual (n=8; 11.8%), pansexual (n=13; 20%) and others (n=24; 21.6%). In addition, among those who reported a change, 10% (n=6) reported changing their identity to straight. Those reporting change in sexual identity were significantly more likely to report higher suicidal ideation (17% vs 10.4%). In regression model, youth reporting change in sexual identity had higher odds of increase in suicidal ideation (OR=2.26) and decrease in ideation (OR=2.53) compared to no change in suicidal ideation, after accounting for age, birth-sex, gender, and disclosure to parents compared to their peers. However, change in identity was not significantly associated with likelihood of future suicide attempts.

Conclusions and Implications: SGMY in our sample presented with stable and unstable identities, and however, youth with gay/lesbian or bisexual identities were least likely to report change in identity. Youth reporting change in sexual identity were also more likely to report a change in ideation, however the directionality of change (increase or decrease), needs further investigation. In addition, there is a need for further studies with more time points to examine stability in identities and how they may be associated with changes in health outcomes over a period of time. Crisis service organizations working to reduce suicidality among LGBTQ youth may want to be sensitive to the changes in identities and disparities associated with multiple minority experiences.