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. That topic isn't addressed in this study.
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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