New research on mental health and suicide attempts in lesbian, gay, bisexual, and transgender youth

Our new study on mental health of LGBT youth.

Posted Dec 15, 2010

6% of lesbian, gay, bisexual and transgender (LGBT) youth attempted suicide in the past year – an alarming rate, but one that is comparable to other urban, minority youth.  This is one of the findings from a study our research team published in the current issue of the American Journal of Public Health.

Previous studies have suggested that LGBT adults and youth are more likely to experience mental health problems than heterosexuals [1-6].  These studies have played an important role in characterizing and calling attention to the mental health needs of the LGB population across development.

How do we explain these findings that LGBT people may be more likely to experience mental health problems?  The dominant theory among researchers is that internal and external manifestation of prejudice, victimization, and social stigma underlie differences [7, 8].    We know LGBT people can experience overt and covert forms of discrimination, oppression, and victimization and we know that these experiences are stressful and affect mental health.   This is called the “minority stress” explanation.

Our study sought to address some of the gaps in past research by conducting structured diagnostic interviews in a community-sample of 246 LGBT youth.  Previous studies have primarily relied on questionnaire measures, which may overestimate mental disorders in some groups.  Participants in our study were very diverse in terms of ethnicity and were between the ages of 16-20 years old, with an average age of 18.

We found that nearly 10% of study participants met criteria for post-traumatic stress disorder (PTSD) and about 15% met criteria for major depression. About 70% of LGBT youth did not meet criteria for any mental disorders.   One of the most important findings from our work is that most of these youth are not experiencing mental health problems.  These findings bring up the question of if whether the prevalence of mental illness is elevated in this group.  The answer to that question depends on what sample is used for comparison and such contrasts must always be done cautiously due to differences in study methodologies.  Most comparable in terms of urbanicity, racial diversity, and age, is representative data reported from a large sample of emerging adults in South Florida [9].  Overall, and in demographic sub-groups, rates of Major Depression, PTSD, and Conduct Disorder were very similar, with the exception of Major Depression in males higher in our sample.  However, in comparison to national data on young adults (ages 18-29), our rates are much higher [10].   This suggests that sample and demographic differences are very important to consider.

We found that a third of our participants had made a suicide attempt at some point in their life, and about 6 % had made a suicide attempt in the last year.  Is this higher than other groups?  Representative data from CDC’s Youth Risk Behavior Surveillance (YRBS) study of high school students in Chicago indicates that 10% made a suicide attempt in the past year, which is slightly higher than we found in our sample of 16-20 year old LGBT youth in Chicago.  However in the YRBS, reports were made using anonymous paper-and-pencil surveys and in our study we had interviewers ask questions face-to-face.  Anonymous studies tend to find a higher rate of reported suicide attempt, so there are difficulties in making these comparisons.

While the frequencies of mental disorders and suicidality in our LGBT sample may have been comparable to similar representative studies of urban heterosexual youth, we emphasize that the prevalence of mental disorders and suicidal behaviors are sufficiently high to warrant special attention to the needs of LGBT youth.  31% of LGBT youth making a suicide attempt at some point in their life is too high no matter what the rate is in heterosexual youth.

As is probably obvious from my discussion above, there is still a lot for us to learn about the mental health of LGBT young people.  I encourage the assessment of sexual orientation in future population-based studies of mental health in order to more fully characterize mental health disparities experienced by this group.     In fact, collecting this information is part of the governments new plan for the health of the U.S. Population (Health People 2020). Our team is also conducting another study of gay and bisexual young men that will help us understand health in that group.

I also strongly encourage the development and testing of new programs that help prevent suicidal feelings and attempts in LGBT youth.  These can range from programs that reduce bullying in schools to teaching youth how to cope with difficult times.  These new programs can join some of the fantastic existing programs, like the Trevor hotline.

You can listed to an interview with me talking about our project findings at the IMPACT Program.

Acknowledgment: The study was supported by a grant from the American Foundation for Suicide Prevention.

The full reference is:  Mustanski, B. S., Garofalo, R., & Emerson, E. M. (2010). Mental health disorders, psychological distress, and suicidality in a diverse sample of lesbian, gay, bisexual, and transgender youths. Am J Public Health, 100, 2426-2432.

Dr. Mustanski is the Director of the IMPACT LGBT Health and Development Program at the University of Illinois at Chicago. You can follow the Sexual Continuum blog by becoming a fan on Facebook.

References cited

1.            Cochran SD, Mays VM. Relation between psychiatric syndromes and behaviorally defined sexual orientation in a sample of the U.S. population. American Journal of Epidemiology. 2000;151(5):516-23.

2.            Cochran SD, Sullivan JG, Mays VM. Prevalence of mental disorders, psychological distress, and mental health services use among LGB adults in the United States. Journal of Consulting & Clinical Psychology. 2003;71(1):53-61.

3.            Bos HM, Sandfort TG, de Bruyn EH, Hakvoort EM. Same-sex attraction, social relationships, psychosocial functioning, and school performance in early adolescence. Dev Psychol. 2008;44(1):59-68.

4.            Fergusson DM, Horwood LJ, Beautrais AL. Is sexual orientation related to mental health problems and suicidality in young people? Archives of General Psychiatry. 1999;56(10):876-80.

5.            Hatzenbuehler ML, McLaughlin KA, Nolen-Hoeksema S. Emotion regulation and internalizing symptoms in a longitudinal study of sexual minority and heterosexual adolescents. Journal of Child Psychology and Psychiatry. 2008;49(12):1270-8.

6.            Galliher RV, Rostosky SS, Hughes HK. School belonging, self-esteem, and depressive symptoms in adolescents: An examination of sex, sexual attraction status, and urbanicity. Journal of Youth and Adolescence. 2004;33:235-45.

7.            Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129(5):674-97.

8.            Hatzenbuehler ML. How does sexual minority stigma “get under the skin”? A psychological mediation framework. Psychol Bull. 2009;135(5):707-30.

9.            Turner RJ, Gil AG. Psychiatric and substance use disorders in South Florida: racial/ethnic and gender contrasts in a young adult cohort. Arch Gen Psychiatry. 2002;59(1):43-50.

10.         Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):617-27.