Association between Polyvictimization and Multiple Suicide Attempts Among Sexual Minority Adolescents: Findings from the 2015-2021 National Youth Risk Behavior Survey

Background and objectives: Suicide among adolescents in the United States is a major public health concern. Research indicates that compared to their heterosexual peers, sexual minority adolescents are at significant risk of experiencing multiple forms of victimization and engaging in suicidal thoughts and behaviors (STBs). Although studies have examined the association between polyvictimization and STBs among adolescents, few studies have investigated the association between polyvictimization and multiple suicide attempts among sexual minority adolescents using a large and nationally representative sample. Drawing on the interpersonal-psychological theory of suicide—which postulates that the exposure to painful experiences increases the likelihood of suicide attempts (non-lethal and lethal), the objectives of this study were to examine: 1) the prevalence of polyvictimization among sexual minority adolescents, and 2) the cross-sectional association between polyvictimization and multiple suicide attempts among sexual minority adolescents.

Methods: Data for this study came from the 2015-2021 national Youth Risk Behavior Survey. The sample comprised of 10,092 adolescents ages 14-18 who self-identified as gay or lesbian, bisexual, or questioning. The outcome variable investigated was multiple suicide attempts and was measured as no attempt, single attempt, and multiple attempts. The main explanatory variable was polyvictimization, which was measured using five items: school bullying, cyberbullying, forced sexual intercourse, physical fighting, and being threatened with or injured with a weapon. Multinomial logistic regression was conducted to examine the association between polyvictimization and multiple suicide attempts after controlling for demographic factors, feeling sad/hopeless, and substance use.

Results: Of the 10,092 sexual minority adolescents examined, 10.4% attempted suicide once and 12% attempted suicide multiple times during the past 12 months. More than half experienced at least one form of victimization: 14% experienced three or more forms of victimization, 14.5% experienced two forms of victimization, and 24.5% experienced one form of victimization. Controlling for the effects of demographic factors, feeling sad/hopeless, and substance use, the risk of multiple suicide attempts was 10.91 times higher for sexual minority adolescents who experienced three or more forms of victimization (RRR=10.91, 95% CI=7.64-15.56), 3.83 times higher for those who experienced two forms victimization (RRR=3.83, 95% CI=2.62-5.61), and 2.59 times higher for those who experienced one form of victimization (RRR=2.59, 95% CI=1.78-3.76) when compared to their non-victimized sexual minority counterparts. Compared to sexual minority adolescents who self-identified as non-Hispanic White, the risk of multiple suicide attempts was 2.48 times higher for their counterparts who self-identified as non-Hispanic Black (RRR=2.48, 95% CI=1.82-3.39), 1.66 times higher for their counterparts who self-identified as “Other” race/ethnicity (RRR=1.66, 95% CI=1.18-2.35), and 1.47 times higher for their counterparts who self-identified as Hispanic (RRR=1.47, 95% CI=1.17-1.84).

Conclusions: School social workers and counselors working with sexual minority adolescents should be aware that exposure to multiple forms of victimization among sexual minority adolescents significantly increases their risk of multiple suicide attempts over and above known risk factors for suicide attempts. The findings of this study highlight the importance of screening for polivictimization in suicide assessments because the exposure to painful and provocative experiences may increase multiple suicide attempts for sexual minority adolescents.