Structural homophobia and suicidal ideation and behavior among sexual and gender minority adolescents.

Sexual and gender minority (SGM) adolescents have high risk for suicidal behavior, and structural homophobia could contribute to inequities in suicidal ideation and behavior among SGM youth. Limited prior research has examined how comprehensive indicators of structural homophobia are related to suicidal ideation and behavior among SGM adolescents. Anti-gay legislation has been increasing in many states, and studies that enhance our understanding of the associations between structural homophobia and risk for suicidal behavior among SGM youth must be prioritized. We examined associations between structural homophobia at the state level and suicidal thoughts and behaviors in a nationwide sample of SGM adolescents ages 14-18 in the United States (<i>n</i> = 1837) who completed a cross-sectional online survey. Participants were diverse with regard to race, ethnicity, and geographic location. SGM adolescents who lived in states with higher levels of structural homophobia had higher odds of reporting lifetime suicidal ideation (aOR=1.22; <i>p</i>=.047) and suicidal planning (aOR=1.24; <i>p</i>=.013) after adjusting for demographic variables. Lifetime suicide attempt was not related to structural homophobia. Results indicate that SGM youth living in states with more structural homophobia had a higher likelihood of experiencing lifetime suicidal ideation and suicidal planning but not higher suicidal behavior directly. Reducing risk for suicidal behavior among SGM youth is a pressing public health concern. Public policies, societal conditions, and public attitudes that contribute to an affirming and inclusive environment for SGM youth have the potential to reduce suicidal ideation and planning among SGM adolescents.