A lot has changed for LGBTQ+ teens in the last decade. In 2009, they didn’t know if they would be able to go on to marry a same-sex partner (or receive federal benefits if they did), serve openly in the military, become governor or US senator, see themselves represented in an Oscar-winning Best Picture, or run for president.
In an increasingly accepting America, the proportion of high schoolers identifying as lesbian, gay, bisexual, or questioning (LGBQ) doubled from 2009 to 2017, according to a new School of Public Health study.
But the same study, published in the journal Pediatrics, shows that LGBQ high schoolers’ rate of attempted suicide, while declining, was almost four times higher than their straight peers’ in 2017.
“Large disparities in suicide attempts persisted even as the percent of students identifying as LGBQ increased. In 2017, more than 20 percent of LGBQ teens reported attempting suicide in the past year,” says study lead author Julia Raifman, assistant professor of health law, policy & management.
“It’s critical that health and educational institutions have policies and programs in place to protect and improve LGBQ health, such as medical school curricula and high school health curricula that are inclusive of sexual minority health,” she says.
Raifman says LGBQ rights also play a particularly important role in shaping mental health. In a 2017 study, Raifman found that legalization of same-sex marriage in a state came with a 7-percent decrease in all high school students reporting a suicide attempt within the past year. She notes that other research (including a 2018 study she led) has shown that anti-LGBQ legislation and policies harm the mental health of LGBQ adults and teens.
“Our new paper indicates that an increasing number of teenagers are identifying as LGBQ, and will be affected by anti-LGBQ policies that may elevate these already very high rates of suicide attempts,” she says.
For the new paper, Raifman and her colleagues used data from the Youth Risk Behavioral Surveillance Survey (YRBSS). Each state decides which questions to include on its own version of the YRBSS, and only six states collected sexual orientation data continuously between 2009 and 2017: Delaware, Illinois, Massachusetts, Maine, North Dakota, and Rhode Island. Of these states, only Connecticut, Delaware, Illinois, and Rhode Island collected data on the sex of sexually-active students’ partners, and distinguished between consensual sexual contact and sexual assault. This left the researchers with sexual orientation data for 110,243 high school students, and data on the consensual sexual behavior of 25,994 of these students. (None of the states consistently collected data that would identify transgender students.)
The researchers found that the proportion of high schoolers who identified as LGBQ doubled from 7.3 percent in 2009 to 14.3 percent in 2017, with similar trends for identifying as gay or lesbian (from 1.4 percent to 2.8 percent in 2017), bisexual (3.9 to 7.2 percent), and being unsure of their sexual orientation (2.0 to 4.3 percent). In the four states with sexual behavior data, the proportion of sexually active high schoolers who reported any consensual, same-sex sexual contact increased from 7.7 to 13.1 percent.
The rate of straight-identifying high schoolers reporting attempting suicide in the previous 12 months stayed around six percent in both 2009 and 2017. But the rate for LGBQ-identifying teens decreased from 26.7 percent in 2009 to 20.1 percent in 2017. When the researchers adjusted for other student characteristics, such as age and race, they found that the LGBQ suicide attempt rate went from 5.2 times the heterosexual rate in 2009 to 3.8 times the rate in 2017.
LGBQ high schoolers also accounted for an increasing proportion of suicide attempts, from 24.6 percent of all students who attempted suicide in 2009 to 35.6 percent in 2017.
The researchers did not find significant changes from 2009 to 2017 in the rate of suicide attempts among high schoolers who had had same-sex or only heterosexual sexual contact, although the rate remained about twice as high for those reporting any same-sex sexual contact.
Raifman says that the decline in LGBQ teen suicide attempts likely reflects the cultural and legal changes seen in this country from 2009 to 2017. That this rate was still more than threefold the rate of their straight peers, she says, shows how much more work is left to be done—to say nothing of new anti-LGBQ policies introduced in the years since.
The study was co-authored by Michael Stein, professor and chair of health law, policy & management. The other co-authors were: Brittany M. Charlton and S. Bryn Austin of Boston Children’s Hospital, the Harvard T.H. Chan School of Public Health, and Harvard Medical School; Renata Arrington-Sanders of the Johns Hopkins University School of Medicine; Philip A. Chan of the Mirriam Hospital; Jack Rusley of the Warren Alpert Medical School and School of Public Health at Brown University; Kenneth H. Mayer of the Harvard Chan School, Harvard Medical School, and the Fenway Institute; and Margaret McConnell of the Harvard Chan School.