Review article
Suicidality and Depression Disparities Between Sexual Minority and Heterosexual Youth: A Meta-Analytic Review

https://doi.org/10.1016/j.jadohealth.2011.02.005Get rights and content

Abstract

Purpose

To examine disparities between sexual minority youth (SMY) and heterosexual youth in rates of suicidality and depression symptoms.

Methods

Separate meta-analyses were conducted to examine suicidality and depression disparities. Studies were included if the average age of the participants was <18 years, and if suicidality or depression symptoms were compared across SMY and heterosexual youth.

Results

SMY reported significantly higher rates of suicidality (odds ratio [OR] = 2.92) and depression symptoms (standardized mean difference, d = .33) as compared with the heterosexual youth. Disparities increased with the increase in the severity of suicidality (ideation [OR = 1.96], intent/plans [OR = 2.20], suicide attempts [OR = 3.18], suicide attempts requiring medical attention [OR = 4.17]). Effects did not vary across gender, recruitment source, and sexual orientation definition.

Conclusions

Disparities in suicidality and depression may be influenced by negative experiences including discrimination and victimization. Clinicians should assess sexual orientation, analyze psychosocial histories to identify associated risk factors, and promote prevention and intervention opportunities for SMY and their families.

Section snippets

Methods

Meta-analysis reporting guidelines [23] developed and recommended by the Centers for Disease Control and Prevention were followed closely for this study.

Suicidality

The literature search yielded 20 suicidality studies with 122 corresponding effect size estimates. Studies reported multiple effect size estimates because of having multiple outcome variables, multiple demographic subgroups, or both. One effect size was over five standard deviations larger than the overall weighted effect size [29], and thus was excluded from the analyses. Furthermore, 16 of the original 122 effects were redundant with other effects within the individual studies (e.g., some

Discussion

This study provides strong evidence that SMY experience significantly higher levels of suicidality and depression symptoms than heterosexual youth. The robust pattern of results, particularly regarding suicidality, highlights the severity and pervasiveness of disparities between SMY and heterosexual youth. For example, on average 28% of SMY reported a history of suicidality as compared with 12% of heterosexual youth. Second, 104 of the 105 individual ORs for the association between sexual

References (56)

  • J.A. Bridge et al.

    Suicide trends among youths aged 10 to 19 years in the United States, 1996–2005

    JAMA

    (2008)
  • D.A. Brent et al.

    Adolescent depression

    N Engl J Med

    (2002)
  • D.A. Brent

    Depression and suicide in children and adolescents

    Pediatr Rev

    (1993)
  • T.R. Goldstein et al.

    Youth suicide

  • M. King et al.

    A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people

    BMC Psychiatry

    (2008)
  • I.H. Meyer

    Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence

    Psychol Bull

    (2003)
  • D.E. Bontempo et al.

    Effects of at-school victimization and sexual orientation on lesbian, gay, or bisexual youths' health risk behavior

    J Adolesc Health

    (2002)
  • R. Garofalo et al.

    The association between health risk behaviors and sexual orientation among a school-based sample of adolescents

    Pediatrics

    (1998)
  • G. Remafedi et al.

    The relationship between suicide risk and sexual orientation: Results of a population-based study

    Am J Public Health

    (1998)
  • S.T. Russell et al.

    Adolescent sexual orientation and suicide risk: Evidence from a national study

    Am J Public Health

    (2001)
  • I. Rivers et al.

    The victimization of lesbian, gay, and bisexual youths: Implications for intervention

  • L.L. Caldwell et al.

    The leisure context of adolescents who are lesbian, gay male, bisexual and questioning their sexual identities: An exploratory study

    J Leis Res

    (1998)
  • R. Garofalo et al.

    Sexual orientation and risk of suicide attempts among a representative sample of youth

    Arch Pediatr Adolesc Med

    (1999)
  • E. Olshen et al.

    Dating violence, sexual assault, and suicide attempts among urban teenagers

    Arch Pediatr Adolesc Med

    (2007)
  • A.H. Faulkner et al.

    Correlates of same-sex sexual behavior in a random sample of Massachusetts high school students

    Am J Public Health

    (1998)
  • S.A. Safren et al.

    Depression, hopelessness, suicidality, and related factors in sexual minority and heterosexual adolescents

    J Consult Clin Psych

    (1999)
  • M.P. Marshal et al.

    Sexual orientation and adolescent substance use: A meta-analysis and methodological review

    Addiction

    (2008)
  • D.F. Stroup et al.

    Meta-analysis of observational studies in epidemiology: A proposal for reporting

    JAMA

    (2000)
  • Cited by (841)

    • The Role of Individual Discrimination and Structural Stigma in the Mental Health of Sexual Minority Youth

      2024, Journal of the American Academy of Child and Adolescent Psychiatry
    View all citing articles on Scopus
    View full text