The Impact of State-Level LGBTQ+ Equality Legislation on Suicidal Ideation, Suicide Planning, and Suicide Attempts Among Adolescents in the U.S

Background and Purpose: Suicide is the third leading cause of death among individuals aged 15-24. Adolescents marginalized based on their sexual orientation and/or gender identity are at higher risk for suicide than heterosexual and cisgender adolescents. Over the past decade, there has been an unprecedented increase in the number of anti-LGBTQ+ bills and laws, and in 2022, over 315 anti-LGBTQ+ bills were introduced to the State Legislature across the U.S. Prior research on the impact of anti-LGBTQ+ legislation on suicide has primarily focused on adults, leaving a gap in the literature on how anti-LGBTQ+ legislation affects adolescent suicide. The objectives of this study were to investigate: 1) the prevalence of suicidal ideation (SI), suicide planning (SP), and suicide attempts (SA) among a nationally representative sample of adolescents in U.S., and 2) the effects of state-level LGBTQ+ policies on SI, SP, and SA.

Methods: Individual-level data from the 2021 Youth Risk Behavior Survey (YRBS) were merged with state-level data on LGBTQ+ policies from the Movement Advancement Project. Our analytic sample included 13,351 adolescents aged 14-18 (50.6% male). SI, SP, and SA in the past 12 months were dichotomous outcome variables. The exposure, state-level LGBTQ+ policies, was measured as a continuous variable considering laws and policies that protect or harm LGBTQ+ individuals. Higher scores indicate more protective LGBTQ+ policies. The main analysis involves the use of mixed-effects multilevel logistic regression to ascertain the effects of state-level LGTBQ+ policies on SI, SP, and SA after controlling for demographic characteristics, victim of school and cyberbullying, and feeling sad or hopeless.

Results: Of the 13,351 adolescents, over 20% experienced SI, 17.8% made a SP, and 9.6% had a SA. State-level LGBTQ+ policies ranged from -12 to 42.5, with an average of 20.95 (SE=0.15). In the unadjusted model, a one unit increase in state-level LGBTQ+ policy score was significantly associated with lower odds of SI (p=.030), SP (p=.021), and SA (p=.035). However, when adding the individual level covariates to the models, SA lost its significance. In the fully adjusted models, each additional unit increase in state-level LGTBQ+ policy score was significantly associated with lower odds of SI (aOR=0.99, p=.017) and SP (aOR=0.99, p=.019). The percent of total variance in SI, SP, and SA due to state-level LGBTQ+ policy ranges between 1.3% to 2.4%

Conclusions and Implications: Results from this study indicate the social environment in which adolescents live has implications for SI and SP over and above individual factors. Adolescents living in states with more protective LGBTQ+ legislation had lower odds of SI and SP relative to those living in states with more oppressive LGBTQ+ legislation. To our knowledge, this is the first study to assess the impact of LGBTQ+ legislation on the rates of SI, SP, and SA among adolescents. Given the increase in anti LGBTQ+ legislation put forth in recent years, social workers should advocate for protective LGBTQ+ legislation to support adolescents' mental health. In addition, clinical social workers should be aware of the suicide risk of adolescents in the context of new legislation.