Sexual minority youths have a significantly higher risk for life-threatening behavior compared with their heterosexual peers, according to a systematic review and meta-analysis published in JAMA Pediatrics.
Investigators searched the electronic PubMed, Embase, and PsychINFO databases from inception through April 30, 2017 for publications comparing suicidality risk in lesbian, gay, bisexual, and transgender (LGBT) and heterosexual youths. To capture a breadth of identities and behaviors, investigators used combinations of the following search terms: “heterosexual,” “homosexual,” “bisexual,” “transgender,” “adolescents,” “teens,” and “attempted suicide.” Studies without an appropriate comparison group were excluded, as were those not published in a peer-reviewed journal.
A panel of 3 investigators independently reviewed studies for data quality and compatibility with inclusion criteria. Pooled analyses were based on odds ratios (ORs), with calculated 95% CIs. Inverse variance models with random effects were utilized to calculate the respective weight of each study. Univariable and multivariable meta-regression analyses were also conducted to assess heterogeneity and the risk for publication bias.
Of the 764 records identified by search terms, 35 studies satisfied inclusion criteria. The pooled study cohort comprised 2,378,987 heterosexual and 113,468 sexual minority adolescents (age range, 12 to 20). Sexual minority youths had an elevated risk for attempted suicide (OR, 3.50; 95% CI, 2.98-4.12; P <.001). Sensitivity analyses, in which the meta-analysis was serially repeated after the exclusion of each study, indicated that most studies affected the pooled OR at a standard deviation of 0.07. Stratified by sexual minority group, the OR was 3.71 (95% CI, 3.14-4.37) for homosexual individuals and 4.87 (95% CI, 4.76-4.98) for bisexual individuals (both P <.001).
Transgender youths were described as an individual group in just 1 study, which reported an OR of 5.87 (95% CI, 3.51-9.82). Per meta-regression analyses according to study weight, the presence of the youngest (12) participant class was associated with heterogeneity in the bisexual group. In the whole group, however, year of sampling was instead associated with heterogeneity when combined with other covariates. Despite high heterogeneity between-studies, the risk for publication bias was only detected when all studies were assessed together. No risk for publication bias was detected in subgroup analyses.
These results underscore the increased need for mental health screening and support among sexual minority youths. In addition to promoting public awareness of the issue, investigators wrote, future research should investigate the clinical effectiveness of supportive strategies, including counseling and efforts to destigmatize sexual minority status.
di Giacomo E, Krausz M, Colmegna F, et al. Estimating the risk of attempted suicide among sexual minority youths [published online October 8, 2018]. JAMA Pediatr. doi:10.1001/jamapediatrics.2018.2731