Suicide is the third leading cause of death among adolescents and young adults in the United States, with lifetime prevalence rates ranging from 1-10% in adolescents [1-3]. Following a decade of steady decline, the pediatric suicide rate in this country increased 18% between the years of 2003-2004 , signifying the largest single-year increase since 1990. Preliminary findings from national fatal injury data available for 2004-2005 show a continuation of this alarming trend , and suggest the possibility of youth suicide as an escalating public health crisis. Therefore, it is increasingly important for health care professionals to identify and intervene with youth at high risk for suicide.
Existing research has highlighted characteristics of youths at high risk for suicide. The overwhelming majority of youth who make suicide attempts demonstrate mood psychopathology, with depression being the most prevalent disorder. Adolescent depression, marked by hopelessness, severe and pervasive suicidal ideation, is a significant contributor to suicidal behavior . The risk for suicide among adolescents with bipolar disorder is even higher [7-9]. In addition, adolescent males have higher rates of suicide than do adolescent females, who typically report higher rates of suicidal ideation and have higher rates of suicidal behavior . Consistent with adult studies [9-10], a growing body of research suggests that sexual minority youth (SMY; youth who endorse same-sex attraction, same-sex behavior, or a gay/lesbian identity) are also at increased risk for mood disorders and suicidality [11-14]. The primary aim of this paper was to summarize, describe, and compare rates of suicidality and depression between SMY and heterosexual youth.
Minority stress theory suggests that disparities between sexual minority and heterosexual youth can be attributed in part to stigma, discrimination, and victimization experiences that are a result of a homophobic and violent culture . Among the factors that researchers have found to be associated with psychosocial risks in SMY are others’ negative responses to gender atypical behavior, high-risk sexual behavior, conflicts related to disclosure of sexual orientation to family and its consequences, and mistreatment in community settings, especially schools . One or more of these stressors can promote feelings of helplessness and hopelessness that may develop into depression and suicidality.
Despite the robust empirical and theoretical evidence for higher rates of depression and suicidality among SMY, the size of these disparities varies across studies, warranting a systematic investigation into the potential sources of heterogeneity. For example, evidence suggests that the disparities may vary across: gender [13, 17, 18], bisexuality status [19, 20], and different measures of sexual orientation (e.g., same-sex sexual behavior  versus identity labels such as “gay” and “lesbian” ). Previous research has shown that these and other sample and study characteristics moderate the association between sexual orientation and outcomes such as substance use and abuse . Thus, another goal of this paper is to examine whether or not these variables moderate suicidality and depression outcomes, in order to corroborate and expand on the existing literature.
Suicidality and depression effect sizes may vary as a function of how the constructs are measured. Effect sizes may vary based on whether or not researchers measure depression using well-developed depression scales or single-item depression measures. Furthermore, SMY disparities may vary depending on the severity of the suicidality or how suicidality is operationalized. For example, some studies have examined disparities in suicidal ideation , whereas others have examined a wider range of suicidal behaviors including suicide attempts requiring medical attention [21, 22]. Finally, questions remain regarding whether or not disparities persist after controlling for potential confounding variables. For example, as teenagers get older they are more likely to endorse a same-sex orientation and more likely to endorse depression symptoms, suggesting that age may act as a confounder that accounts for part or all of the disparity.
In sum, the primary goal of this study was to summarize and describe suicidality and depression disparities between SMY and heterosexual youth. The second goal was to determine whether or not methodological characteristics of the original studies and sample characteristics explained variability in the disparities observed across studies including gender, bisexuality status, and how sexual orientation, depression, and suicidality were operationalized. The third goal was to review the methodological qualities of this literature in order to determine how many original studies examined longitudinal patterns of suicidality and depression, as well as mediators, moderators, and potential confounders of the association between sexual orientation and the outcomes.