The Association between State-Level Policies Directed Toward Sexual and Gender Minorities and Suicidal Ideation, Suicide Planning, and Suicide Attempts Among High School Students in the United States

Background and Purpose: Suicide is a leading cause of death among United States (US) adolescents. Marginalization and discrimination based on sexual orientation (SO) and gender identity (GI) increases risk for suicide. In the US there has been an unprecedented increase in the number of oppressive and discriminatory legislation targeting gender and sexual minorities, and such marginalization through policies has only amplified during the current Trump administration. Extant research on the impact of oppressive legislation on suicidal behaviors has primarily focused on adults. As such, understanding of how these policies impact suicide ideation, planning, and attempts among adolescents is limited. The objectives of this study were three-fold: 1) investigate the prevalence of suicidal ideation (SI), suicide planning (SP), and suicide attempts (SA) among a nationally representative sample of US high school students, 2) examine the relationship between state-level policies related to SO and GI on SI, SP, and SA and 3) test if the association between SO and GI state-level policies and SI, SP and SA differed by individual-level SO or GI .

Methods: Individual-level data from the 2023 Youth Risk Behavior Survey (YRBS) were merged with two state-level indices on policies related to SO and GI from the Movement Advancement Project database. The three outcome variables (suicidal ideation, suicide plan, and suicide attempts) were measured dichotomously. The analytic sample contained 15,269 adolescents aged 14-18, nested in 50 states. We conducted logistic regression with robust standard errors clustering by state to assess the association between state-level SO and GI policies and SI, SP and SA controlling for demographic characteristics, school and cyberbullying, and feeling sad or hopeless.

Results: Approximately 20% of participants experienced SI, 16% made a SP, and 9% reported a SA. In crude models, a one unit increase in state-level SO policies was significantly associated with lower odds of SP (p=<0.05), but not SI or SA. Policies related to GI were not associated with SI, SP or SA. However, more protective GI policies were associated with a marginally significantly lower odds of SI among gender minorities relative to their cisgender peers (p= <0.1).

Conclusions and Implications: Results from this study indicate the social environment has implications for SI and SP over and above individual factors. Adolescents living in states with more protective SO-related legislation had lower odds of SP relative to those living in states with more oppressive SO-related legislation. The impact of GI-related policies was more protective of SP among transgender participants compared to their cisgender peers. To our knowledge, this is the first study to assess the impact of state-level SO and GI legislation on the rates of SI, SP, and SA among a nationally representative sample of adolescents. Given the increase in oppressive LGBTQ+ legislation recent years and particularly during the new Trump administration, it is imperative that social workers 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 marginalizing legislation.