Disparities in suicidal thoughts and behaviors by sexual and gender identity: A national study of high school students in the US, 2023

Introduction: Suicide is the second leading cause of death among youth in the US. Individuals who identify as sexual and gender minorities are at disproportionate risk of suicide. This study aims to quantify disparities in suicidal thoughts and behaviors (STBs) by sexual and gender identity in a nationally representative sample of high school students in the US. Methods: We analyzed data from n = 15,073 US high school students via the 2023 Youth Risk Behavior Surveillance Survey (YRBSS). Four (4) multivariate logistic regressions compared STBs (hopelessness; suicidal ideations; planned attempts; past attempts) by sexual identity and by gender identity. A multivariate ordinal logistic regression examined a composite score (0–4) of STBs. Models controlled for sex, grade, race, ethnicity, and bullying victimization. Results: Youth who identified as transgender had greater odds of reporting hopelessness (aOR: 3.50), suicidal ideations (aOR: 4.23), planned attempt (aOR: 2.96), and past attempts (aOR: 2.96), relative to those who identified as cisgender; similar estimates were observed for youth who reported being unsure of their gender identity. Youth who identified as gay/lesbian (aOR: 3.02), bisexual (aOR: 4.11), questioning (aOR: 3.12), and other (aOR: 5.06) had significantly higher odds of reporting more severe symptoms of STBs relative to heterosexual youth. Conclusion: Youth who identified as transgender had 3 to 4 times greater odds of STBs in a national sample; sexual identity was similarly associated with STBs. Interventions that expand prevention resources and improve social support for youth who identify as sexual and gender minorities are critically needed. Implications and Contribution: Transgender and sexual minority youth are more likely to report each type of STB and to report more severe symptoms of suicidality. These data suggest the need for multifaceted, suicide prevention programs tailored preventing and reduce STBs among youth, particularly transgender and sexual minority youth.