Inclusive State Legislation and Reduced Risk of Past-Year Suicide Attempts Among Lesbian, Gay, Bisexual, and Questioning Adolescents in the United States

Abstract

Objective

This study examines the relationship between state legislation relevant to equality for sexual minorities and past-year suicide attempts among lesbian, gay, bisexual, and questioning (LGBQ) adolescents in the United States.

Methods

Data were aggregated from 24 states that participated in the 2017 Youth Risk Behavior Surveillance System (N = 70,599). We utilized multilevel logistic regression to determine whether observed positive associations between sexual minority identity and past-year suicide attempts differ as a function of 2016 State Equality Index (SEI), an objective measure of state laws and policies affecting equality for sexual minorities.

Results

LGBQ adolescents were significantly more likely to report having made a suicide attempt in the past year than heterosexual youth (adjusted odds ratio [AOR]: 3.82; 95% confidence interval [CI]: 3.29–4.44). The 2016 SEI moderated the positive association between sexual minority identity and suicide attempts, with odds of past-year suicide attempts significantly reduced in states with more inclusive legislation (AOR: 0.91; CI: 0.85–0.97). Among sexual minority subgroups, significant effect modifications were found for bisexual (AOR: 0.88; CI: 0.77–0.99) and questioning (AOR: 0.87; CI: 0.78–0.96) – but not gay or lesbian (AOR: 1.10; CI: 0.97–1.24) – adolescents. The effect modification was strongest for bisexual males (AOR: 0.68; CI: 0.47–0.99).

Conclusions

State legislation relevant to equality for sexual minorities differentially affected associations between sexual minority identity and suicide attempts, such that past-year suicide attempts were substantially lower in states with more inclusive legislation. Inclusive state legislation may exert a protective effect on risk for suicide attempts among sexual minority youth.

Keywords:

• LGBQ adolescents
• sexual minority youth
• state legislation
• suicide attempt

ACKNOWLEDGMENTS

The authors gratefully acknowledge the Centers for Disease Control and Prevention for designing, organizing, and publishing data collected in the Youth Risk Behavior Surveillance System, all respondents who participated in 2017 state-level surveys, and the Human Rights Campaign for conducting a comprehensive annual review of state laws and policies that affect equality for sexual minorities. We also thank Prudence Fisher and Mark Hatzenbuehler for reviewing and providing expert guidance on this manuscript. The findings and conclusions in this article are those of the authors and do not necessarily represent the views of NIDA or the Columbia School of Social Work.

DISLOSURE STATEMENT

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the National Institute on Drug Abuse (NIDA) under grant number [T32DA037801].

Notes on contributors

Christina Aivadyan

Christina Aivadyan is a Predoctoral Research Fellow in the T32 Training Program in HIV, Substance Abuse, and Criminal Justice at the Columbia School of Social Work, New York, NY, USA.

Melissa N. Slavin

Melissa N. Slavin is a Postdoctoral Research Fellow in the T32 Training Program in HIV, Substance Abuse, and Criminal Justice at the Columbia School of Social Work, New York, NY, USA.

Elwin Wu

Elwin Wu is a Professor at the Columbia School of Social Work, New York, NY, USA.