Sexual Minority Youth at Increased Risk for Suicide Attempt, With Transgender Youth at Highest Risk

Razor blade
Razor blade
While all the sexual minority groups had an increased risk for suicide attempt compared with heterosexuals, transgender youths were at the highest risk.

Youths with a non-heterosexual identity are at a significantly increased risk for life-threatening behavior compared with heterosexual youths, according to study results published in JAMA Pediatrics.

Suicide is the second-leading cause of death in adolescents. Risk factors include previous suicide attempts, psychiatric illness, bullying, childhood abuse, and trauma. Homosexual, bisexual, and transgender adolescents are at higher risk for isolation, exposure to violence, and stigmatization.

To examine the risk for attempted suicide in non-heterosexual adolescents, Ester di Giacomo, MD, of the School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy, and colleagues conducted a meta-analysis of articles identified using electronic databases, including PubMed,  Embase, and PsycINFO through April 30, 2017. The investigators included observational studies that defined lesbian gay bisexual transgender (LGBT) and attempted suicide according to criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

The investigators included 35 studies with a total population of 2,378,987 heterosexual and 113,468 sexual minority adolescents between age 12 and 20. The studies were conducted in 10 countries: Iceland, the United States, Ireland, Canada, Switzerland, Norway, New Zealand, China, Taiwan, and Korea.

Compared with their heterosexual peers, sexual minority adolescents had an increased risk for suicide attempt with an odds ratio (OR) of 3.50 (P <.001). While all the sexual minority groups had increased odds compared with heterosexuals, transgender youths were at the highest risk for suicide attempt (OR, 5.87), while homosexual youths had an OR of 3.71 and bisexual youths had an OR of 3.69. Of the countries included in the study, New Zealand had the highest odds ratio (11.70) for suicide attempt, but this included a study focused on transgender youths, who are at the highest risk for suicide.

There was a considerable degree of heterogeneity between the studies, with the exception of those from European countries. The meta-analysis was limited by the self-reported nature of the data and the need for self-disclosure.

The investigators called for increased public awareness and careful evaluation of support strategies, including support programs, counseling, and destigmatizing efforts.


Di Giacomo E, Krausz M, Colmegna F, Aspesi F, Clerici M. Estimating the risk of attempted suicide among sexual minority youths: a systematic review and meta-analysis [published online October 8, 2018]. JAMA Pediatr. doi:10.1001/jamapediatrics.2018.2731