Youth Suicide Risk and Sexual Orientation

Article excerpt

Smith and Crawford (1986) studied suicide intent among 313 Midwestern high school students. Of the 62% who reported some degree of suicidal ideation or intent, 8.4% had actually made an attempt. Given the nonclinical sample, this percentage is alarmingly high.

Neiger and Hopkins (1988) explored the relationship between demographics, etiology, and adolescent suicide. They found that depression, low self-esteem, self-dislike, and self-criticism were important predictors of suicidal ideation. Indicators of actual suicidal intent included previous suicide attempts, frequent discussion of death, making plans for death, purchasing or carrying deadly weapons, and certain criminal behavior. Finally, suicidal teenagers also reported external concerns: family violence, loss of a parent through divorce or death, and history of parents or siblings who had either attempted or committed suicide.

Brent and colleagues (1993) studied completed youth suicides by comparing victims with a history of previous psychiatric disturbances to those without such history. Although the latter group had fewer of the personal and familial risk factors associated with completed suicide, they nonetheless exhibited higher rates of familial psychiatric disorder, past suicidal ideation or behavior, legal or disciplinary problems in the past year, and loaded firearms in the home.

According to research conducted in the past two decades, sexual minority youth (gay, lesbian, and bisexual) exhibit more suicidal ideation than do their heterosexual peers. Estimated rates of suicidal ideation range from 50% to 70%, and actual suicide attempt rates range from 30% (Gibson, 1989) to 42% (D'Augelli & Hershberger, 1993), or three times that of heterosexual youth (D'Augelli & Hershberger, 1995; Rotheram-Borus, Reid, Rosario, Van Rossen, & Gillis, 1995). For racial minorities who are also gay or lesbian (Smith & Crawford, 1986), rates of suicidal activity are suspected to be even higher, and may reflect prejudice toward both sexual orientation and race. The youth in these studies were seeking assistance from community mental health centers or refuge at shelters, and they typically exhibit greater pathology than the mainstream gay, lesbian, or bisexual youth, an issue that may present a confound (Savin-Williams, 1990).

Furthermore, studies assessing suicide risk among youth have not included the full spectrum of sexual orientation. Several researchers suggest that bisexual and questioning youth may be at higher risk for suicidal behavior than self-identified homosexual youth (D'Augelli & Hershberger, 1993; D'Augelli, Hershberger, & Pilkington, 1996; Rotheram-Borus, Piacentini, Miller, Graae, & Castro-Blanco, 1994).

The literature on adolescent suicide has increased with the increase in suicidal behaviors, particularly among certain adolescent groups where suicidal ideation and behavior are higher. However, the predictive validity of suicide assessments has received mixed reviews. Several instruments display a high false positive rate, that is, overpredicting suicide risk (Muehrer, 1995). Because previous suicide attempters are at greatest risk for suicidal behavior, assessments are needed that not only produce lower false positive rates, but also identify those who have made attempts or have a suicide plan. This group can then be targeted for prevention and intervention efforts.

Another limitation of adolescent suicide research is that suicidal behavior and suicidal ideation are different constructs (Muehrer, 1995), and cross-study comparison of youth who experience fleeting thoughts of suicide with those who have actually made a suicide attempt and have been hospitalized is problematic. Thus, assessment of youth suicide risk should include the full range of suicide risk: low risk (fleeting suicidal ideation with no plan) to high risk (suicide plan, selection of lethal method, and previous attempt history). …