Price-Feeney, Myeshia, Amy E. Green, and Samuel H. Dorison. "Suicidality among youth who are questioning, unsure of, or exploring their sexual identity." The Journal of Sex Research (2020): 1-8.
ABSTRACT
Many studies have found that lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth are disproportionately impacted by poor mental health outcomes. However, there remains a gap in understanding factors associated with the mental health of youth who are questioning, unsure of, or exploring (QUE) their sexual identity. Using data from The Trevor Project’s 2019 National Survey on LGBTQ Youth Mental Health, a quantitative cross-sectional survey of LGBTQ youth between 13 and 24, we explored suicidality among 801 QUE youth. Significantly more QUE youth were younger, nonwhite, and transgender and nonbinary compared to other LGBTQ youth. QUE youth reported higher rates of suicidality compared to other LGBTQ youth; however, this increased risk was related to the overrepresentation of younger and transgender and nonbinary youth among QUE youth. In adjusted models, being transgender and nonbinary, hearing parents use religion to say negative things about being LGBTQ, and experiencing physical threat or harm based on sexual orientation or gender identity were significantly related to seriously considering suicide and attempting suicide among QUE youth. Given the intricate relationship between the two, researchers should assess both gender identity and sexual identity when determining the risk of suicidality among LGBTQ youth.
Discussion
LGBTQ youth are disproportionately represented among those who report seriously considering and attempting suicide; however, very little is known about youth who are unsure of, are in the process of exploring, or who are questioning their sexual identity. Our finding of increased rates of suicidality among QUE youth compared to other LGBTQ youth supports the hypothesis that youth who identify that they are QUE are not impervious to the disparities in mental health found in the overall LGBTQ youth population. Similar results have been found in previous studies, though their findings place the rates of suicidality among QUE youth between those of straight youth and LGB youth (Kann et al., 2018). While the rates of suicidality were higher among QUE youth in this study, after adjusting for gender identity, age, family income, and race/ethnicity, the risk for seriously considering and attempting suicide among QUE was comparable to other LGBTQ youth. This suggests that increased rates of suicidality among QUE youth can be explained by these variables. Specifically, the increased representation of transgender and nonbinary youth among those who described their sexual identity as QUE accounts for some of the increased risk of suicidality among QUE youth. Indeed, being transgender and nonbinary doubled the likelihood of reporting having seriously considered and attempted suicide in the past 12 months among QUE youth. Previous studies have also found that transgender and nonbinary youth are over two times more likely to experience these same outcomes even compared to cisgender LGBQ youth (Price-Feeney et al., 2020).
These findings indicate that QUE youth who are cisgender differ from QUE youth who are transgender and nonbinary. Assessing sexual orientation in the absence of a measure of gender identity combines cisgender youth, who are unsure of their sexual identity, and transgender and nonbinary, youth who may select QUE because they do not feel their sexual identity is accurately represented within the available labels. These different experiences could explain why, when examined across gender identity and the risk levels associated with them (Espelage et al., 2008; Kann et al., 2018; Zhao et al., 2010), the rates of poor mental health among QUE average in such a way that they fall between straight youth and LGB youth. This highlights the need to assess both sexual orientation and gender identity in order to accurately assess the risk of youth who are QUE. By failing to include gender identity, it is unclear whether it is the uncertainty of their sexual identity label, their transgender and nonbinary identity, or a combination of both that places them at risk for poor mental health indicators.
The finding that QUE youth reported higher rates of suicidality was also partially explained by the increased representation of younger youth, ages 13–17, among respondents who were QUE. Being in this age range is associated with an increased risk of considering and attempting suicide among LGB youth (Green et al., 2019), and in this study, being younger doubled the odds of a suicide attempt in the past 12 months among QUE youth. QUE youth who were from low-income families and who were youth of color were also at increased risk for attempting suicide, which is similar to other findings among LGBTQ youth, suggesting that youth with multiple oppressed identities are at greater risk for poor mental health indicators (Grollman, 2012).
The finding that QUE youth who hear their parents use religion to say negative things about being LGBTQ were at increased risk for suicidality aligns with previous literature that found that parental anti-homosexual religious beliefs were related to suicidality among LGBTQ youth (Gibbs & Goldbach, 2015). Parental use of religion in this way is a form of rejection for LGBTQ youth, negatively impacting their identity development at a critical stage. Indeed, a previous study found that conflict from religious beliefs appears to be an important contributor to LGBTQ identity challenges, even above and beyond the impact of other types of stressors faced by LGBTQ youth (Page et al., 2013).
Although QUE youth reported lower rates of SOGI-based physical threat or harm in the past 12 months compared to other LGBTQ youth, having experienced this was associated with two times the odds of both considering and attempting suicide, even after controlling for all other factors. A regional study of high school students similarly found that homophobic teasing may affect questioning youth more than LGB youth (Espelage et al., 2008), concluding that this might be due to the lack of social support these youth have compared to LGB youth who can find support among other LGB youth. These findings suggest that QUE youth, either because of their actual or perceived gender identity, sexual identity, or both, are just as, if not more, susceptible to the same negative impact of victimization as other LGBTQ youth.