Adolescents who identify as gay, lesbian, bisexual or questioning are much more likely to consider, plan or attempt suicide than their heterosexual peers, according to research from the University of Pennsylvania, the University of California, San Diego, and San Diego State University published this week in the Journal of the American Medical Association.

Specifically, of a nationally representative sample of 15,624 high-school age participants, 40 percent of sexual-minority adolescents seriously considered suicide compared to 15 percent of their heterosexual counterparts. Nearly a quarter attempted suicide compared to approximately 6 percent of those in the sexual majority.

“The most staggering finding, the one that really makes you think, is just how prevalent these suicide-risk behaviors are in the LGBQ adolescent community,” said Theodore L. Caputi, who conducted this work while at Penn’s Wharton School and who is now a pursuing a master’s degree at University College Cork in Ireland. “Research has shown that suicide-risk behaviors are an indicator of extreme distress.”

Caputi’s research focuses mostly on substance-use disorders like the opioid epidemic and teenage drug use. During a fellowship in Wharton’s Summer Program for Undergraduate Research, while investigating the intersection of minority groups, substance use and mental-health disorders, he noticed a gap in the literature.

“The more I researched the connection between suicide risk and teens who identify as sexual minorities, the more interesting it became,” he said. “In particular, these results were so striking it was clear this work could have some real-world impact informing policy.”

He teamed up with Davey Smith, a professor at the UC San Diego School of Medicine, and John Ayers, an adjunct associate professor in the San Diego State Graduate School of Public Health. From there, the trio began digging deep into data from the National Youth Behavioral Risk Survey administered by the Centers for Disease Control and Prevention.

This survey, which began in 1990 and was most recently given in 2015, asks high-school students about their conduct in a range of areas, from smoking to exercise. It gets specific about topics like gun-carrying and electronic bullying, alcohol use and suicide. For this research, that last category proved thought-provoking, particularly questions related to suicidal thoughts and actions.

To analyze the data, Caputi and colleagues used a new methodology focused on risk ratios rather than odds ratios. The researchers showed the probability of a link between sexual-minority groups and suicide risk and then drew a comparison to the relevant heterosexual groups. They also concentrated on adolescents, a subset rarely before explored in this context.

The team noticed several important trends: Though female sexual-minority adolescents, on the whole, show a higher absolute prevalence for suicide-risk behaviors, when the researchers incorporated in statistics from heterosexual counterparts, sexual-minority males were at greater relative risk. For behaviors such as trying to take their own lives, LGBQ males were almost five times as likely to report having done so than heterosexual males in the same age group.

Another trend stuck out, one related to adolescents who identify as bisexual. Nearly one-third of this group reported attempting suicide in the past 12 months, and 46 percent had considered it. Previous research has revealed that bisexual adolescents in particular experience great distress because some people are dismissive of this sexual orientation.

“There are clearly differences in how sexual-minority adolescents experience the world,” Caputi said. “External stressors like stigma and isolation are significant contributing factors, and those weigh on members of these high-risk communities.” 

Though the researchers acknowledge some limitations with the study, for example, a lack of data about transgender people and just a 60-percent response rate to the survey, they hope their results call attention to the severity of this problem and prompt action on the part of policymakers, community members, educators and clinicians.

“If people are thinking about suicide and their attempts are not successful, that does not mean we’ve won,” Caputi said. “The goal is to decrease the stressors that cause LGBQ adolescents to contemplate suicide in the first place. We’re hoping our study will inspire social and policy changes that lead to happier and healthier lives for LGBQ adolescents.”

Funding for the research came from the Joseph Wharton Scholars Program, George J. Mitchell Scholarship Program and National Institutes of Health.