In the quarter century I’ve been practicing as a child and adolescent psychiatrist, I’ve come to appreciate the extent to which early involvement in sexual activity represents a risk factor for anxiety, depression, suicidal thoughts and suicidal acts among the kids served by our practice. From a developmental standpoint, there are lots of teenagers who aren’t remotely equipped to manage the intensity of emotions that accompany a sexual relationship. Buried beneath the headlines of a government-funded study released this past week, there’s lots of evidence that teens who voluntarily engage in sexual activity or are victims of sexual violence are far more likely to experience suicidal thinking or behavior than their peers.
The US Centers for Disease Control (CDC) released a new study this past Friday, Sexual Identity, Sex of Sexual Contacts, and Health-Related Behaviors Among Students in Grades 9-12. The study is based on data from the 2015 National Youth Risk Behavior Survey (YRBS), an ongoing project to monitor six categories of priority health-related behaviors among youth and young adults: 1) behaviors that contribute to unintentional injuries and violence; 2) tobacco use; 3) alcohol and other drug use; 4) sexual behaviors related to unintended pregnancy and sexually transmitted infections, including human immunodeficiency virus infection; 5) unhealthy dietary behaviors; and 6) physical inactivity.
For the first time, the CDC investigators asked questions about sexual orientation, gender identity and the sex of sexual contacts of survey participants. The resulting survey is the first nationally representative study of U.S. lesbian, gay, and bisexual high school students. Not surprisingly, the media coverage thus far (see here and here) has focused upon the data from the LGBTQ participants, who represented 11.2% of a sample in excess of 15,000 teens (2.0% identified as gay or lesbian, 6.0% identified as bisexual, 3.2% identified as “unsure” and 88.8% identified as heterosexual).
What we’re going to look at in this data set is how sexual experiences impact suicide risk across the board for high schoolers of both majority and minority sexual orientations.
Let’s start by looking at the association between sexual orientation in this study of high school students and presence of self-reported “serious” suicidal ideation in the last twelve months.
What we see here is that around 18% of U.S. high schoolers expressed “serious” suicidal thoughts in the past year – 15% among heterosexual students, 43% among LGB students, and 32% among youth identifying as “not sure” of their sexual orientation. Rates are clearly higher among females as opposed to males, in keeping with what we know about the sex rations of suicidal ideation in teens. Two observations…
- The frequency with which high schoolers across the board endorse the presence of serious suicidal thoughts is unacceptably high for kids of all sexual orientations.
- The statistics describing rates of suicidal ideation among LGBQ teens are especially alarming and public health interventions targeted at reducing suicidal ideation and behavior among sexual minority youth are clearly indicated.
One of the responses we’ve seen to the very high rates of reported suicidal ideation among teens from sexual minorities is the implementation of anti-bullying strategies in schools across the country. The CDC made very specific support recommendations to schools for supporting youth from sexual minorities. The President made a video to express his support for anti-bullying initiatives. From the data below, we see that LGBQ kids report significantly more frequent victimization from bullying than heterosexual peers.
In the sample, 20.2% of all students; 18.8% of heterosexual students; 34.2% of LGB students; and 24.9% of “not sure” students had been bullied at school during the twelve months prior to the survey. Put differently, LGB students are about 80% more likely and “Q” students are about 30% more likely to be bullied compared to “straight” peers.
In contrast, let’s go back to the slide on serious suicidal ideation and look at the impact of sexual contact on suicidal ideation in teens.
- Overall, students who experienced sexual contact with the same or both sexes were approximately 225% more likely to experience serious suicidal thoughts than students who had sexual contact with the opposite sex only and 370% more likely to experience serious suicidal thoughts than students with no sexual contact.
- Boys who experienced sexual contact with the opposite sex only were twice as likely to report serious suicidal ideation than those with no sexual contact.
- Girls who experienced sexual contact with the opposite sex only were nearly 60% more likely to report serious suicidal ideation than those with no sexual contact.
Let’s look at the statistics on high schoolers who developed a suicide plan…
- Overall, students who experienced sexual contact with the same or both sexes are approximately 250% more likely to report having developed a suicide plan than students who had sexual contact with the opposite sex only and 390% more likely to report having developed a suicide plan than students with no sexual contact.
- Boys who experienced sexual contact with the opposite sex only were 78% more likely to report having developed a suicide plan than those with no sexual contact.
- Girls who experienced sexual contact with the opposite sex only were 55% more likely to report serious suicidal ideation than those with no sexual contact.
Here’s the data on suicide attempts and sexual contact…
- Overall, students who experienced sexual contact with the same or both sexes are approximately 285% more likely to report having attempted suicide compared to students who had sexual contact with the opposite sex only and 650% more likely to report having attempted suicide than students with no sexual contact.
- Boys who experienced sexual contact with the opposite sex only were 215% more likely to report having attempted suicide compared to those with no sexual contact.
- Girls who experienced sexual contact with the opposite sex only were 300% more likely to report having attempted suicide than those with no sexual contact.
Next, let’s look at kids who received medical intervention as a result of a suicide attempt…
- Overall, students who experienced sexual contact with the same or both sexes are approximately over three times more likely to have been seen by a doctor or nurse following a suicide attempt compared to students who had sexual contact with the opposite sex only and over twelve times more likely to have been seen by a doctor or nurse following a suicide attempt than students with no sexual contact.
- Boys who experienced sexual contact with the opposite sex only were seven times more likely to have been seen by a doctor or nurse following a suicide attempt compared to those with no sexual contact.
- Girls who experienced sexual contact with the opposite sex only were more than three more likely to have been seen by a doctor or nurse following a suicide attempt than those with no sexual contact.
Some thoughts that crossed my mind after reviewing this study…
To what extent is very early exposure to sexual intercourse a contributing factor to higher rates of suicidal thoughts and behavior in LGBTQ youth? Kids who experienced sexual intercourse prior to the age of 13 are more than twice as likely to identify as a member of a sexual minority. Girls with first intercourse prior to age 13 are four times more likely to identify as a member of a sexual minority.
Do all of our kids need “safe spaces” or do they need to learn resilience? When one in twelve high schoolers reports having attempted suicide at least once during the preceding twelve months, we have millions of kids who lack the ability to cope with the day to day challenges of adolescence?
What if sexual contact contributes significantly to the risk of suicide for youth from a subculture defined by sexual orientation and sexual expression? One issue begging to be explored in more depth is the extent to which suicide risk is reduced when kids from sexual minorities refrain from sexual contact.
Finally, how is it still socially acceptable in this day and age for advertisers and social media platforms to promote sexual behavior in youth when a clear association exists between sexual behavior and suicide? Hats off to Abercrombie and Hollister for getting rid of their shirtless models. And how is it OK for parents to facilitate opportunities for their teens to engage in sexual contact with other teens? How are “coed sleepovers” any more acceptable than playing bartender to a basement full of teenagers just before handing them their car keys?
We live in a culture that puts great pressure on teens and adults to define themselves through their sexual behavior and sexual prowess. Many of our teens would be better served through discovering their identity elsewhere.
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I don’t believe it is fair to group participants of voluntary sexual action with victims of unwanted sexual violence. It’s not even similar. To me, it just seems like the point of the post is to teach kids to refrain from sexual activity, but victims have no choice!
As we are taught early on in any study of the social sciences we must beware of mere correlation of data if we do this then we could and would quickly make a number of claims about the causal relationships involved which would in fact be incorrect. Given the relationship to reported suicidal ideation, planning, and sexual activity with another person among teens that you shine light on in this study my first hypothesis was to wonder if we would find similar correlations when it came to things like drug and alcohol use but also access to a car, ease and frequency of social time with peers and outside of the home or parental oversight. I could imagine that all of these behaviors including suicide demands that a teen be able to have enough time unsupervised and observed by adults to be able to plan, prepare and act. It could be that more than the coincidence of increased sexual contact the real causal tie was between suicide and autonomy and privacy. It is a bleek possy.
By contrast the emphasis on LGBT teens and their increased risk makes sense in that it represents a spike in what is seen with other teens and because we have lots of good reasons to associate bullying with suicide from the fact that it holds true that victems of bullying do commit suicide more than those who aren’t. Which leads to a whole other source of evidence that is a bit harder to find and interpret which would be the follow through. It is in what we learn from those that complete a suicide attempt that we could potentially gain the greatest support for what is going on and certainly I think it is the high percentage of kids who take their lives and attribute the reason for their action to bullying about their sexual orientation that adds so much more weight to the concern these numbers arose on behalf of lgbt young people.
Of course the other question to explore if indeed sexual activity where a contributing factor. One that I would have is if it was not just those who had been sexually active who where more inclined but if it was of those students the one who where now no longer active because of a break up or heightened parental restrictions, someone moved and so on? A line of questioning the answers to which would greatly impact how we should act on your proposal since it could suggest a drastically different intervention with students who had already been sexualy active at least in regaurd to seeking to minimize the risks of suicide for said teen.
Thanks for your very thoughtful comments. There’s a lot of interesting and helpful data here that suggests associations, but the design doesn’t help with causation.
There’s a ton of work that needs to be done around this topic from a research standpoint. Looking at this topic from a clinician’s perspective, I’ve found that there’s a significant subgroup of kids in our practice who are vulnerable to suicidal thinking or behavior around the time they enter their first sexual relationship independent of sexual orientation that seems to be related to obsessive thinking or rumination. Kids who tend to think too much or perseverate in their thinking have a really hard time managing the intensity of emotions the first time they get involved sexually. I’d wondered if the LGBQ kids were more likely to be sexually active with more partners than the straight kids, but the differences in sexual activity reported in the study weren’t very large. I think 99.99% of appropriately trained professionals agree that bullying can be a problem…I’d guess that the kids with the profile above (obsessive, ruminative) are probably the ones most negatively impacted by bullying.
While a lot of attention has been paid to the bullying issue, it seems that there has to be a lot more to the story than that. The trauma piece is really interesting and deserves a lot more attention. How does one explain the broad, across the board elevation in risky and impulsive behaviors among the LGBQ youth interviewed in the survey? Trauma could certainly explain some of the difference.
I thought it was pretty striking that the differences in rates of sexual contact were increased as the severity of suicidal behavior increased. When they repeat this study next year, I’d hope they’d break out rates of suicidal thinking/behavior for the looking at sexual contact/no contact for the LGBQ population. I thought it was important to look at this topic because if sexual contact/activity in general exposes teens at an increased risk of suicide, would suicide be a greater concern among a subset of teens for whom sexual expression represents a big piece of identity development?
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Your explanation is helpful in better understanding the report and your suggestions about what it reveals. I absolutely do hope they dig deeper in trying to tease out a more direct correlation on that as well.