Suicide risk among LGBTQ+ adolescents in Canada

Suicide is recognised as one of the leading causes of death for young people (WHO, 2021). It is widely recognised that adolescents who identify as LGBTQ+ are at greater risk of self-harm and suicide than cisgender, heterosexual peers (Berona et al., 2020; Garofalo et al., 1999; Hatchel et al., 2019; Jadva et al., 2021; Taliaferro et al., 2019). Research by Miranda-Mendizabal et al., (2017) has indicated that sexual orientation minorities were 2.26 times more likely to struggle with suicide than heterosexual adolescents.

Given the consistent level of suicide risk among LGBTQ+ adolescents globally, it is important for specific countries or regions to understand the risk within their area. For example, a survey conducted in association with a British LGBTQ+ charity (Stonewall) found that high numbers of LGBTQ+ adolescents endorsed self-harm (65.3%), suicidal thoughts (73.8%) and had made a suicide attempt (25.7%) (Jadva et al., 2021). However, in other countries such statistics are unknown.

Therefore, the primary aim of a recent Canadian paper was to assess the risk of suicidal ideation and attempt among LGBTQ+ adolescents aged between 15-17 years, in Canada, using nationally representative data.  It is thought that LGBTQ+ youth are at greater risk of suicide due to minority stressors (Meyer, 1993), with one key stressor being the discrimination that people from a minority group are likely to experience. Therefore, a secondary aim of the study was to explore whether the relationship between suicide and being LGBTQ+ was moderated by experiences of bullying.

Suicide is the second leading cause of adolescent death in Canada, yet the risk of suicidal ideation and attempt among LGBTQ+ youth is not known.

Methods

Data was pulled from the Canadian Health Survey on Children and Youth (2019), which is conducted with all adolescents aged between 12-17 years whose consent or parental consent is received. Following Article 2.2. of the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (TCPS-2); the authors did not seek ethical approval for this study. Under this article, ethical approval is not required if data is publicly available or if the individual of interest has no practical expectation of privacy.

As only adolescents aged between 15-17 years were asked about sexual attraction and suicidality, the authors used an age-stratified sampling method to include only data from those in this age-range. The key measures of interest included two binary variables considering suicidal thoughts in the past 12 months and suicide attempt across lifetime; self-reported sexual attraction (males only; mostly males; equally females and males; mostly females; only females; unsure); and bullying and cyberbullying over the past 12 months. Those who were not attracted to the opposite gender were classified as sexual minorities. Gender diversity was defined by self-reported gender being different to that of sex assigned at birth.

The main analysis consisted of several modified Poison regression analyses to calculate risk of suicidal thoughts and attempts of LGBTQ+ adolescents compared with cisgender, heterosexual peers; controlling for sociodemographic factors and stratifying by sex assigned at birth. Further analysis explored the mediating role of bullying and cyberbullying was explored in these associations.

Results

The final sample for this study was 6,800 adolescents; 99.4% of whom were cisgender and including 0.6% gender diverse young people. Of these adolescents, the majority were heterosexual (78.6%), with 14.7% being attracted to multiple genders, and a further 4.3% being unsure of whom they were attracted to. Only 68 females and 54 males being exclusively attracted to their own respective genders.

Firstly, sexual minority adolescents were more likely to report suicidal thoughts (14%) and attempts (6.8%) than heterosexual peers (10.4%; 4.6% correspondingly). This was even greater for gender diverse adolescents, who were thought to be 5 times more likely to experience suicidal ideation, and 7.6 times more likely to attempt suicide than cisgender counterparts.

It was found that bullying and cyberbullying partially mediated the relationship between suicide and being LGBTQ+. However, this was only associated when adolescents were gender diverse or those who were attracted to multiple genders.

This study suggests that Canadian LGBTQ+ adolescents are more likely to struggle with suicidal thoughts and behaviours than their cisgender, heterosexual peers.

Conclusions

This data suggests that suicide risk is greater in Canadian LGBTQ+ adolescents. This is in line with the existing literature in this area. The authors concluded that:

transgender and gender-nonconforming adolescents were at markedly higher risk of both suicidal ideation and suicide attempt than their cisgender peers.

While bullying and cyberbullying partially mediated this relationship for gender diverse young people and those attracted to multiple genders, the nature of the bullying was not examined. Therefore it remains unclear whether this presents evidence of minority stress within the sample.

It appears that transgender and gender diverse adolescents in Canada are at increased risk of suicide.

Strengths and limitations

Kingsbury and colleagues (2022) produced a valuable study which provides a clear overview of national suicide risk in adolescents aged between 15-17 years. By using data from the Canadian Health Survey on Children and Youth (2019), a high number of LGBTQ+ participants were captured offering a practical representation of suicide risk in this minority group.

While this study captured a large sample, few gender diverse adolescents were identified (0.6%). One issue is that “transgender” was defined by comparing assigned sex at birth and self-reported gender. This may miss those who identify with other gender diverse labels, (e.g. agender, non-binary), or who feel unable to self-report a different gender for whatever reason. It is possible that gender diverse adolescents are unrepresented and a greater understanding of suicide risk in this group could be achieved.

It would have been beneficial if the survey had asked younger participants about their sexual attraction, gender identity, and whether they had experienced any thoughts or behaviours relating to suicide. Previous literature has indicated that sexual attraction can be identified at earlier ages (Calzo et al., 2006), as can gender-incongruence (Sorbara et al., 2020). Similarly, suicide can also occur in younger populations (Soole et al., 2015). If this had been built into the survey design, a much clearer understanding of suicide risk in LGBTQ+ adolescents may have been achieved.

This study had a large sample of adolescents, however only a low number of these were gender diverse.

Implications for practice

A distinct implication of this study is to promote the need of LGBTQ+ tailored suicide prevention strategies in Canada, confirming that LGBTQ+ adolescents are more likely to be at greater risk than cisgender, heterosexual peers. Such programmes could include gender-affirming care for gender diverse adolescents, which has been associated with reductions in suicidality (Sorbara et al., 2020), as well as focus on bullying and cyberbullying risk among LGBTQ+ adolescents.

In Canada, suicide prevention strategies should have a focus on LGBTQ+ youth, which acknowledge additional stressors which these adolescents face.

Statement of interests

None.

Links

Primary paper

Kingsbury, M., Hammond, N. G., Johnstone, F., & Colman, I. (2022). Suicidality among sexual minority and transgender adolescents: a nationally representative population-based study of youth in Canada. CMAJ, 194(22), E767-E774.

Other references

World Health Organisation. (2021) Suicide [fact sheet]. Retrieved from https://www.who.int/news-room/fact-sheets/detail/suicide

Berona, J., Horwitz, A. G., Czyz, E. K., & King, C. A. (2020). Predicting suicidal behavior among lesbian, gay, bisexual, and transgender youth receiving psychiatric emergency services. Journal of psychiatric research, 122, 64-69. https://doi.org/10.1016/j.jpsychires.2019.12.007

Hatchel, T., Polanin, J. R., & Espelage, D. L. (2019). Suicidal thoughts and behaviors among LGBTQ youth: meta-analyses and a systematic review. Archives of suicide research, 25(1), 1-37. https://doi.org/10.1080/13811118.2019.1663329

Garofalo, R., Wolf, R. C., Wissow, L. S., Woods, E. R., & Goodman, E. (1999). Sexual orientation and risk of suicide attempts among a representative sample of youth. Archives of pediatrics & adolescent medicine, 153(5), 487-493. https://doi.org/10.1001/archpedi.153.5.487

Taliaferro, L. A., McMorris, B. J., Rider, G. N., & Eisenberg, M. E. (2019). Risk and protective factors for self-harm in a population-based sample of transgender youth. Archives of suicide research, 23(2), 203-221. https://doi.org/10.1080/13811118.2018.1430639

Jadva, V., Guasp, A., Bradlow, J. H., Bower-Brown, S., & Foley, S. (2021). Predictors of self-harm and suicide in LGBT youth: The role of gender, socio-economic status, bullying and school experience. Journal of public health (Oxford). https://doi.org/10.1093/pubmed/fdab383

Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of health and social behavior, 38-56.

Calzo, J. P., Antonucci, T. C., Mays, V. M., & Cochran, S. D. (2011). Retrospective recall of sexual orientation identity development among gay, lesbian, and bisexual adults. Developmental psychology, 47(6), 1658.

Sorbara, J. C., Chiniara, L. N., Thompson, S., & Palmert, M. R. (2020). Mental health and timing of gender-affirming care. Pediatrics, 146(4).

Soole, R., Kõlves, K., & De Leo, D. (2015). Suicide in children: a systematic review. Archives of suicide research, 19(3), 285-304.

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