Social Environment Key to Reducing Suicide Attempts in Gay Youth

Caroline Cassels

April 21, 2011

April 21, 2011 — An unsupportive social environment significantly increases the risk for attempted suicide in gay, lesbian, and bisexual youth (LGB), new research suggests. However, if there is a positive side to this bleak finding, it is that a supportive social environment may significantly reduce suicidality in this high-risk population.

This study...really challenges the myth that there is something inherent in being gay that puts gay youth at risk of attempting suicide. Instead, what we've shown is that the social environment strongly influences the prevalence of suicide attempts.

A study conducted by researcher Mark Hatzenbuehler, PhD, Mailman School of Public Health at Columbia University in New York, shows LGB youth living in an unsupportive social environment have a 20% greater risk of attempting suicide than their counterparts living in supportive environments.

"This study suggests that we can reduce suicide attempts among LBG youth by improving the social environment and really challenges the myth that there is something inherent in being gay that puts gay youth at risk of attempting suicide. Instead, what we've shown is that the social environment strongly influences the prevalence of suicide attempts," Dr. Hatzenbuehler told Medscape Medical News.

The study was published online April 18 in Pediatrics.

Novel, Objective Measure

Suicide is the third leading cause of death among youth aged 15 to 24 years, and a large body of previous research indicates gay youth are much more likely to attempt suicide than their heterosexual peers.

Dr. Hatzenbuehler notes that the underlying social factors that contribute to this increased risk are not entirely clear, but some studies have shown that family and school connectedness, as well as school safety, play an important role in the mental health status of LGB youth.

Nevertheless, he points out that most of the previous research lacked objective measures of social environment and has largely relied on self-report.

For this study, Dr. Hatzenbuehler developed a "novel and objective" measure of social environment that did not depend on self-report.

The measure was a combination of several different broad aspects of the social climate surrounding LGB youth in 34 Oregon counties. These aspects included the proportion of same sex couples; the proportion of Democrats, and 3 aspects of school climate that Dr. Hatzenbuehler noted are particularly relevant to LGB youth:

  • The proportion of schools with gay-straight alliances (GSAs);

  • The proportion of schools with antibullying policies specifically aimed at protecting gay students; and

  • The proportion of schools with antidiscrimination policies that included sexual orientation.

Informing the Discussion

Pooling data from the 2006 and 2008 Oregon Healthy Teens survey, an annual survey of public school students in Oregon, the study participants were 31852 11th grade students, 1413 of whom were LGB individuals.

The study revealed that LGB youth were 5 times more likely to attempt suicide in the previous 12 months compared with heterosexual youth. In addition, the risk of attempting suicide among LGB youth was 20% greater among those living in an unsupportive environment compared with a supportive environment.

Schools are one of most important environments for these kids, and this study highlights the fact that there are 3 relatively simple and straightforward things that schools can do to improve the overall climate.

Furthermore, the study showed that a more supportive social environment was significantly associated with fewer suicide attempts even after adjusting for sociodemographic variables and other known suicide risk factors, including depressive symptoms, binge drinking, peer victimization, and physical abuse by an adult.

"I think this study provides us with a roadmap as to how we can reduce suicide among LGB youth. Schools are one of most important environments for these kids, and this study highlights the fact that there are 3 relatively simple and straightforward things that schools can do to improve the overall climate. If we care about our youth, [these findings show] we can take some concrete steps that will significantly improve and promote their well-being," said Dr. Hatzenbuehler.

As many school districts around the United States debate the introduction of GSAs and antibullying and antidiscrimination policies in their schools, Dr. Hatzenbuehler said it is his hope that this research, and other studies like it, will help inform the discussion by providing scientific evidence showing the value of such initiatives for all students — gay and straight.

'Groundbreaking' Study

Dr. Michael Marshal

Commenting on the study for Medscape Medical News, Michael Marshal, PhD, a clinical psychologist at University of Pittsburgh School of Medicine in Pennsylvania, who specializes in adolescent mental health, described Dr. Hatzenbuehler's study as "groundbreaking."

"This is one of the first studies to examine the broader social environment and context as a mediator and moderator of the association between sexual orientation and suicidality. The implications of this study are critical in that they emphasize the important role of a negative or hostile social environment on the health and well-being of LGB youth.

"The results suggest that if we are able to improve social policies and culture regarding how the government responds to bullying in schools, the availability of resources for gay youth, and equal rights for LGB individuals, we may be able to prevent LGB youth suicides," said Dr. Marshal.

He added that the study provides empirical support for the value of such policies "that have long been supported only by clinical observation and anecdotal evidence.

The results suggest that if we are able to improve social policies and culture regarding how the government responds to bullying in schools, the availability of resources for gay youth, and equal rights for LGB individuals, we may be able to prevent LGB youth suicides.

"Now the medical community and mental health providers can proceed with more confidence when they factor in these seemingly 'distal' effects when they are working with LGB youth in the clinical setting. It can no longer be assumed that these important contextual factors don't have a direct impact on LGB youth," said Dr. Marshal.

In addition to testing moderation and mediation of suicide disparities among LGB youth, Dr. Marshal added that the study "is important because it takes into account several important variables that are not always included in studies that examine LGB youth suicidality disparities.

"For example, Dr. Hatzenbuehler was able to demonstrate that above and beyond the effects of substance use, a history of peer bullying, and a physical abuse history, there remains a discernable and clinically meaningful impact of the social environment on LGB suicidality.

"Hopefully, future researchers will follow Dr. Hatzenbuehler's lead and conduct sophisticated theoretical and methodological studies like his in order to better inform the medical community and public health policy regarding LGB youth suicide," Dr. Marshal said.

Dr. Hatzenbuehler said his next research steps include trying to replicate these findings in a national sample of LGB youth.

Dr. Hatzenbuehler and Dr. Marshal have disclosed no relevant financial relationships.

Pediatrics. Published online April 18, 2011.

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