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Sexual minority status and suicidal behaviour among Chinese adolescents: a nationally representative cross-sectional study
  1. Yeen Huang1,
  2. Pengsheng Li1,
  3. Lan Guo1,
  4. Xue Gao2,
  5. Yan Xu2,
  6. Guoliang Huang2,
  7. Xueqing Deng1,3,
  8. Ciyong Lu1,3
  1. 1 Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
  2. 2 Center for Adverse Drug Reactions Monitoring of Guangdong, Guangzhou, China
  3. 3 Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou, China
  1. Correspondence to Dr Ciyong Lu; luciyong{at}


Objectives Suicidality among sexual minority adolescents has generated worldwide concern in recent decades, and previous Western studies have demonstrated that sexual minority status is associated with adolescent suicidality. However, whether this association exists in Chinese adolescents remains largely unknown. This study aimed to estimate the associations between sexual minority status and suicidal behaviour among Chinese adolescents.

Design Cross-sectional survey.

Setting A total of 506 high schools in 7 provinces of China.

Participants A total of 150 822 students in grades 7–12 who completed the questionnaires (response rate of 95.9%) were included.

Main outcome measures Suicidal ideation and suicide attempts were used to measure suicidal behaviour, and sexual attraction (opposite sex, same sex or both sex) was used as a measure for sexual minority status.

Results Of the 150 822 adolescents analysed, 4.1% self-reported as sexual minorities and 17.3% were unsure. Compared with heterosexual and unsure adolescents, same-sex romantic attraction (SSA) and both-sex romantic attraction (BSA) adolescents reported a higher prevalence of past-year suicidal ideation (SSA: 21.6% for males and 30.4% for females; BSA: 34.7% for males and 42.3% for females) and suicide attempts (SSA: 6.9% for males and 8.9% for females; BSA: 12.2% for males and 10.9% for females). After adjustment for covariates, SSA and BSA adolescents were more likely to have past-year suicidal ideation and suicide attempts than their heterosexual and unsure peers. BSA adolescents reported the highest risk of suicidal ideation (males: adjusted OR (AOR) 2.42, 95% CI 2.03 to 2.88; females: AOR 2.61, 95% CI 2.41 to 2.82) and suicide attempts (males: AOR 3.83, 95% CI 2.85 to 5.14; females: AOR 2.59, 95% CI 2.19 to 3.06).

Conclusions Our study suggested that Chinese sexual minority adolescents were at increased risk of suicidality, and those with BSA had an especially high risk in this population. These findings emphasised the urgent need to develop targeted interventions to effectively address suicide-related problems among Chinese sexual minority adolescents.

  • public health
  • sexual medicine
  • paediatrics

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  • YH and PL contributed equally.

  • Contributors CL conceptualised and designed the study, reviewed and revised the manuscript and approved the final manuscript as submitted. YH and PL conceptualised and designed the study, coordinated and supervised the data collection, carried out the initial analyses, drafted the initial manuscript, and approved the final manuscript as submitted. They contributed equally to this study. LG carried out the analyses and interpreted the data, reviewed and revised the manuscript and approved the final manuscript as submitted. XG, YX, GH and XD designed the data collection instruments, coordinated and supervised the data collection, reviewed and revised the manuscript, and approved the final manuscript as submitted. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

  • Funding This work was supported by the National Natural Science Foundation of China (Grant number 81673252) and the Natural Science Foundation of Guangdong Province, China (Grant number 2014A030313174).

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

  • Ethics approval This study was approved by the Sun Yat-Sen University School of Public Health Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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