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Original Investigation
December 2018

Estimating the Risk of Attempted Suicide Among Sexual Minority Youths: A Systematic Review and Meta-analysis

Author Affiliations
  • 1School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
  • 2Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
  • 3Department of Neuroscience, Doctorate School of the University of Milano-Bicocca, Monza, Italy
  • 4Institute of Mental Health, University of British Columbia, Vancouver, British Columbia, Canada
JAMA Pediatr. 2018;172(12):1145-1152. doi:10.1001/jamapediatrics.2018.2731
Key Points

Question  Are sexual minority youths at higher risk of attempting suicide?

Findings  In this systematic review and meta-analysis of nearly 2.5 million adolescents, sexual minority youths were found to have greater risk of life-threatening behaviors compared with their heterosexual peers. Transgender youths were the most affected followed by bisexual and homosexual teens.

Meaning  Sexual minority adolescents may have a greater risk of life-threatening behaviors compared with heterosexual peers.


Importance  Suicide is the second-leading cause of death among adolescents. Sexual minority individuals are at a higher risk of suicide and attempted suicide, but a precise and systematic evaluation of this risk among sexual minority youths has not been documented to our knowledge.

Objective  To examine the risk of attempted suicide among sexual minority adolescents, differentiating for each sexual minority group.

Data Sources  Electronic databases (PubMed, Embase, and PsycINFO) were searched for articles published through April 30, 2017, with the following search terms: heterosexual, homosexual, bisexual, transgender, adolescents, teens, and attempted suicide.

Study Selection  Studies that reported attempted suicide in sexual minority adolescents compared with heterosexual peers were included. Thirty-five studies satisfied criteria for inclusion of 764 records identified.

Data Extraction and Synthesis  Pooled analyses were based on odds ratios (ORs), with relevant 95% CIs, weighting each study with inverse variance models with random effects. Risk of publication bias and analysis of heterogeneity through univariable and multivariable meta-regressions were also rated.

Main Outcomes and Measures  The evaluation of increased odds of attempted suicide among sexual minority youths compared with heterosexual peers.

Results  Thirty-five studies reported in 22 articles that involved a total of 2 378 987 heterosexual and 113 468 sexual minority adolescents (age range, 12-20 years) were included in the analysis. Sexual minority youths were generally at higher risk of attempted suicide (OR, 3.50; 95% CI, 2.98-4.12; c2 = 3074.01; P < .001; I2 = 99%). If estimated in each sexual minority group, the OR was 3.71 in the homosexual group (95% CI, 3.15-4.37; c2 = 825.20; P < .001; I2 = 97%) and 4.87 in the bisexual group (95% CI, 4.76-4.98; c2 = 980.02; P < .001; I2 = 98%); transgender youths were described as an individual group in only 1 study, which reported an OR of 5.87 (95% CI, 3.51-9.82). Meta-regressions weighted for the study weight highlighted that the presence of young participants (12 years old) was associated with heterogeneity in the bisexual group, whereas the year of sampling was associated with heterogeneity in the whole group when combined with other covariates.

Conclusions and Relevance  Our findings suggest that youths with nonheterosexual identity have a significantly higher risk of life-threatening behavior compared with their heterosexual peers. Public awareness is important, and a careful evaluation of supportive strategies (eg, support programs, counseling, and destigmatizing efforts) should be part of education and public health planning.