di Giacomo
, et al
Estimating the risk of attempted suicide among sexual minority youths: a systematic review and meta-analysis
JAMA Pediatr.
; doi:

Investigators from multiple institutions in Italy and Canada conducted a meta-analysis to assess the risk of attempted suicide among sexual minority adolescents compared to heterosexual youth. The authors used a systematic search to identify appropriate studies, using the following combination of search terms: heterosexual, homosexual, bisexual, transgender, adolescents, teens and attempted suicide. Studies that compared rates of attempted suicide among sexual minority and heterosexual high school students were eligible for inclusion in the meta-analysis. Only studies that defined attempted suicide according to the DSM-5 criteria were included. Standard and impartial criteria were used to classify sexual orientation. Data on study participants from included studies were combined, and the odds ratio (OR) for attempted suicide among sexual minority youth compared to heterosexual adolescents was calculated using inverse variance models with random effects. Subgroup analyses were conducted to assess risk among homosexual, bisexual, and transgender youth. Multiple analyses that evaluated the effects of potential sources of bias (such as the year when a study was conducted, the country in which it was conducted, and/or publication bias and heterogeneity) were performed to assess the robustness of the results.

Data on 2,387,987 heterosexual and 113,468 sexual minority youth from 35 studies were included in the meta-analysis. The 35 studies were conducted in 10 countries and included youth 12–20 years old. Overall, sexual minority youth were at an increased risk of attempted suicide compared to those who were heterosexual (OR=3.50; 95% CI, 2.98, 4.12). Compared to heterosexual adolescents, the risk of attempted suicide was significantly increased among homosexual youth (OR=3.71; 95% CI, 3.15, 4.37), bisexual youth (OR=3.69; 95% CI, 2.96, 4.61), and transgender youth (OR=5.87; 95% CI, 3.51, 9.82). The results were not qualitatively different when analyzed using multiple statistical approaches.

The authors conclude that sexual minority youth are at significantly higher risk of life-threatening self-injurious behavior than their heterosexual peers.

Dr Wong has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Suicidal behaviors are common among adolescents in the United States, with rates of ideation, plans, and attempts that approach the rates seen in adults. The results of the current meta-analysis reveal substantially increased risk of suicide among sexual minority youth, including those who identify as homosexual, bisexual, and transgender. The studies included represent data from adolescents in 10 countries, indicating the strong association of sexual minority identification and suicidal risk in multiple cultural contexts. The results of the meta-analysis were also robust to several analytic tests. A notable study limitation is that all data on sexual identity and suicidal behaviors were self-reported.

Assessments of reproductive, sexual, and emotional health are recommended in all well teen and young adult...

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