Abstract
The developmental timing of suicide-related disparities between heterosexuals and sexual minorities (i.e., lesbian/gay and bisexual (LGB) people) is an understudied area that has critical prevention implications. In addition to developmentally situated experiences that shape risk for suicidality in the general population, sexual minorities also experience unique social stressors (e.g., anti-LGB stigma) that may alter their risk for suicidal behavior at different ages. Using a nationally representative US sample of adults, we assessed age-varying rates of suicidal behavior among heterosexuals and sexual minorities ages 18 to 60 and the age-varying association between anti-LGB discrimination and suicidal behavior. We also tested whether these age-varying prevalences and associations differed for men and women and for sexual minorities who did and did not endorse a sexual minority identity. Results indicate a critical period for suicide behavior risk for sexual minorities during young adulthood, with the highest rates of risk at age 18 followed by a steady decline until the early 40s. Disparities were particularly robust for sexual minorities who identified as lesbian, gay, or bisexual. This pattern was present for both men and women, though sexual minority women in their 30s were more likely to report suicidal behavior than heterosexuals and sexual minority men. Sexual minorities who experienced anti-LGB discrimination were more likely to report suicidal behavior, but the significance of this association was limited to those under 30. The effect of discrimination on suicidal behavior was stronger among young adult sexual minority men, relative to sexual minority women, but was present for a wider age range for sexual minority women (until age 30) relative to sexual minority men (until age 25).
Similar content being viewed by others
References
Bostwick, W. B., Boyd, C. J., Hughes, T. L., & McCabe, S. E. (2010). Dimensions of sexual orientation and the prevalence of mood and anxiety disorders in the United States. American Journal of Public Health, 100, 468–475.
Bostwick, W. B., Boyd, C. J., Hughes, T. L., West, B. T., & McCabe, S. E. (2014). Discrimination and mental health among lesbian, gay, and bisexual adults in the United States. American Journal of Orthopsychiatry, 84, 35–45.
Bowleg, L. (2008). When black + lesbian + woman ≠ black lesbian woman: The methodological challenges of qualitative and quantitative intersectionality research. Sex Roles, 59, 312–325.
Cahill, S. R., & Makadon, H. J. (2017). If they don’t count us, we don’t count: Trump administration rolls back sexual orientation and gender identity data collection. LGBT Health, 4, 171–173.
Collins, W. A., & Steinberg, L. (2006). Adolescent development in interpersonal context. In N. Eisenberg, W. Damon, & R. Lerner (Eds.), Handbook of child psychology (pp. 1003–1067). New York: John Wiley & Sons, Inc.
Conwell, Y., Van Orden, K., & Caine, E. D. (2011). Suicide in older adults. The Psychiatric Clinics of North America, 34, 451–468.
Curtin, S. C., Warner, M., & Hedegaard, H. (2016). Data from the National Vital Statistics System, Mortality. National Center for Health Statistics. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db241.htm.
D’augelli, A., Grossman, A., Hershberger, S., & O’Connell, T. (2001). Aspects of mental health among older lesbian, gay, and bisexual adults. Aging & Mental Health, 5, 149–158.
Dziak, J. J., Li, R., & Wagner, A. T. (2017). Weighted TVEM SAS macro for accommodating survey weights and clusters. University Park: The Methodology Center, Penn State. Retrieved from http://methodology.psu.edu.
Fergusson, D. M., Horwood, L. J., Ridder, E. M., & Beautrais, A. L. (2005). Sexual orientation and mental health in a birth cohort of young adults. Psychological Medicine, 35, 971–981.
Fish, J. N., & Pasley, K. (2015). Sexual (minority) trajectories, mental health, and alcohol use: A longitudinal study of youth as they transition to adulthood. Journal of Youth and Adolescence, 44, 1508–1527.
Fish, J. N., Rice, C. E., Lanza, S. T., & Russell, S. T. (2017a). Using TVEM to explore social etiology: Sexual minority discrimination and suicide across the lifespan. Paper presented at the Society for Prevention Research 25th annual meeting, Washington, DC.
Fish, J. N., Rice, C. E., Lanza, S. T., & Russell, S. T. (2017b). Age-varying rates of sexual-identity based discrimination from 18 to 65: Findings from a national sample. Paper presented at the annual interdisciplinary population Health Research conferences, Austin.
Fredriksen-Goldsen, K. I., Kim, H.-J., Barkan, S. E., Muraco, A., & Hoy-Ellis, C. P. (2013). Health disparities among lesbian, gay, and bisexual older adults: Results from a population-based study. American Journal of Public Health, 103, 1802–1809.
Goldbach, J. T., Tanner-Smith, E. E., Bagwell, M., & Dunlap, S. (2014). Minority stress and substance use in sexual minority adolescents: A meta-analysis. Prevention Sciences, 15, 350–363.
Grant, B. F., Amsbary, M., Chu, A., Sigman, R., Kali, J., Sugawana, Y., & Goldstein, R. (2014). Source and accuracy statement: National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). Rockville: National Institute on Alcohol Abuse and Alcoholism.
Haas, A. P., Eliason, M., Mays, V. M., Mathy, R. M., Cochran, S. D., D’Augelli, A. R., et al. (2010). Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: Review and recommendations. Journal of Homosexuality, 58, 10–51.
Hammack, P. L., Frost, D. M., Meyer, I. H., & Pletta, D. R. (2018). Gay men’s health and identity: Social change and the life course. Archives of Sexual Behavior, 47, 59–74.
Hatzenbuehler, M. L., Keyes, K. M., & Hasin, D. S. (2009). State-level policies and psychiatric morbidity in lesbian, gay, and bisexual populations. American Journal of Public Health, 99, 2275–2281.
Institute of Medicine. (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington: The National Academies Press.
Kann, L., O’Malley Olsen, E., McManus, T., Harris, W. A., Shanklin, S. L., Flint, K. H., et al. (2016). Sexual identity, sex of sexual contacts and health-related behaviors among students in grades 9-12—United States and selected sites, 2015. MMWR Surveillance Summary, 65, 1–202.
Katz-Wise, S., & Hyde, J. (2012). Victimization experiences of lesbian, gay, and bisexual individuals: A meta-analysis. Journal of Sex Research, 49, 142–167.
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593–602.
King, S. (2008). Journal of GLBT family studies exploring the role of counselor support: gay, lesbian, bisexual, and questioning adolescents struggling with acceptance and disclosure. Journal of GLBT Family Studies, 4, 37–41.
King, M., Semlyen, J., Tai, S. S., Killaspy, H., Osborn, D., Popelyuk, D., & Nazareth, I. (2008). A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry, 8, 1–17.
Krieger, N., & Sidney, S. (1997). Prevalence and health implications of anti-gay discrimination: A study of black and white women and men in the cardia cohort. International Journal of Health Services, 27, 157–176.
Krieger, N., Smith, K., Naishadham, D., Hartman, C., & Barbeau, E. M. (2005). Experiences of discrimination: Validity and reliability of a self-report measure for population health research on racism and health. Social Science & Medicine, 61, 1576–1596.
Lanza, S. T., Vasilenko, S. A., & Russell, M. A. (2016). Time-varying effect modeling to address new questions in behavioral research: Examples in marijuana use. Psychology of Addictive Behaviors, 30, 939.
Lewis, J. A., & Neville, H. A. (2015). Construction and initial validation of the gendered racial microaggressions scale for black women. Journal of Counseling Psychology, 62, 289–302.
Lick, D. J., Durso, L. E., & Johnson, K. L. (2013). Minority stress and physical health among sexual minorities. Perspectives on Psychological Science, 8, 521–548.
Marshal, M. P., Dietz, L. J., Friedman, M. S., Stall, R., Smith, H. A., McGinley, J., et al. (2011). Suicidality and depression disparities between sexual minority and heterosexual youth: A meta-analytic review. Journal of Adolescent Health, 49, 115–123.
McCabe, S. E., Bostwick, W. B., Hughes, T. L., West, B. T., & Boyd, C. J. (2010). The relationship between discrimination and substance use disorders among lesbian, gay, and bisexual adults in the United States. American Journal of Public Health, 100, 1946–1952.
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697.
Meyer, I. H. (2015). Resilience in the study of minority stress and health of sexual and gender minorities. Psychology of Sexual Orientation and Gender Diversity, 2, 209–213.
Nock, M. K., & Kessler, R. C. (2006). Prevalence of and risk factors for suicide attempts versus suicide gestures: Analysis of the National Comorbidity Survey. Journal of Abnormal Psychology, 115, 616–623.
Nock, M. K., Borges, G., Bromet, E. J., Cha, C. B., Kessler, R. C., & Lee, S. (2008). Suicide and suicidal behavior. Epidemiologic Reviews, 30, 133–154.
Nock, M. K., Green, J. G., Hwang, I., McLaughlin, K. A., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2013). Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: Results from the National Comorbidity Survey Replication Adolescent Supplement. JAMA Psychiatry, 70, 300–310.
Phillips, J. (2014). A changing epidemiology of suicide? The influence of birth cohort on suicide rates in the United States. Social Science & Medicine, 114, 151–160.
Plöderl, M., & Tremblay, P. (2015). Mental health of sexual minorities. A systematic review. International Review of Psychiatry, 27, 367–385.
Poteat, V. P., & Russell, S. T. (2013). Understanding homophobic behavior and its implications for policy and practice. Theory Into Practice, 52, 264–271.
Poteat, V. P., Mereish, E. H., DiGiovanni, C. D., & Koenig, B. W. (2011). The effects of general and homophobic victimization on adolescents' psychosocial and educational concerns: The importance of intersecting identities and parent support. Journal of Counseling Psychology, 58, 597–609.
Robinson, J. P., Espelage, D. L., & Rivers, I. (2013). Developmental trends in peer victimization and emotional distress in LGB and heterosexual youth. Pediatrics, 131, 423–430.
Russell, S. T., & Fish, J. N. (2016). Mental health in lesbian, gay, bisexual, and transgender (LGBT) youth. Annual Review of Clinical Psychology, 12, 465–487.
Russell, S. T., & Joyner, K. (2001). Adolescent sexual orientation and suicide risk: Evidence from a national study. American Journal of Public Health, 91, 1276–1281.
Russell, S. T., & Toomey, R. B. (2012). Men’s sexual orientation and suicide: Evidence for US adolescent-specific risk. Social Science & Medicine, 74, 523–529.
Russell, S. T., Sinclair, K. O., Poteat, V. P., & Koenig, B. W. (2012). Adolescent health and harassment based on discriminatory bias. American Journal of Public Health, 102, 493–495.
Russell, S. T., Toomey, R. B., Ryan, C., & Diaz, R. M. (2014). Being out at school: The implications for school victimization and young adult adjustment. American Journal of Orthopsychiatry, 84, 635–643.
Russell, M. A., Vasilenko, S. A., & Lanza, S. T. (2016). Age-varying links between violence exposure and behavioral, mental, and physical health. Journal of Adolescent Health, 59, 189–196.
Ryan, C., Huebner, D., Diaz, R. M., & Sanchez, J. (2009). Family rejection as a predictor of negative health outcomes in White and Latino lesbian, gay, and bisexual young adults. Pediatrics, 123, 346–352.
Tan, X., Shiyko, M. P., Li, R., Li, Y., & Dierker, L. (2012). A time-varying effect model for intensive longitudinal data. Psychological Methods, 17, 61–77.
Toomey, R. B., & Russell, S. T. (2013). The role of sexual orientation in school-based victimization. Youth & Society, 48, 176–201.
Toomey, R. B., Ryan, C., Diaz, R. M., Card, N. A., & Russell, S. T. (2010). Gender-nonconforming lesbian, gay, bisexual, and transgender youth: School victimization and young adult psychosocial adjustment. Developmental Psychology, 46, 1580–1589.
U.S. Department of Health and Human Services (HHS) Office of the Surgeon General and National Action Alliance for Suicide Prevention. (2012). 2012 National Strategy for suicide prevention: Goals and objectives for action. Washington: HHS.
Funding
This study was funded by several grants awarded by the National Institutes of Health, including grant numbers F32AA023138 (awarded to Fish), R24HD042849 (awarded to the Population Research Center at the University of Texas at Austin), P50DA039838 (awarded to The Methodology Center at Penn State), and R01DA039854 (awarded to Lanza). This manuscript was prepared using a limited access dataset obtained from the National Institute on Alcohol Abuse and Alcoholism. The content is solely the responsibility of the authors and does not reflect the official views of the National Institutes of Health.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
The authors report no conflicts.
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Secondary data analysis for the current manuscript was approved by the Pennsylvania State University and the University of Texas at Austin Institutional Review Boards. The NESARC protocol was originally approved by the US Census Bureau and the US Office of Budget and Management.
Informed Consent
The NESARC researchers obtained informed consent from all participants included in the study.
Rights and permissions
About this article
Cite this article
Fish, J.N., Rice, C.E., Lanza, S.T. et al. Is Young Adulthood a Critical Period for Suicidal Behavior among Sexual Minorities? Results from a US National Sample. Prev Sci 20, 353–365 (2019). https://doi.org/10.1007/s11121-018-0878-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11121-018-0878-5