The nation has been rocked in recent months by suicides of gay students who were harassed by other students, at Rutgers and elsewhere. But what factors put these students at high risk for suicide, and what policies and interventions can help minimize the risk?
A new study by Mark L. Hatzenbuehler, Ph.D., a Robert Wood Johnson Foundation (RWJF) Health & Society Scholar at Columbia University (2010-2012), helps answer that urgent question. Hatzenbuehler’s study is available online now and will be published in the May 2011 issue of Pediatrics.
Suicide is often analyzed in terms of individual psychological factors including depression, alcohol abuse or peer victimization. But the social environment surrounding a young person—particularly a lesbian, gay or bisexual (LGB) youth—can have a tremendous impact on his or her risk for attempting suicide, Hatzenbuehler said.
It’s long been known that LGB youth have higher rates of suicide and suicide attempts, Hatzenbuehler added, but experts “tend to focus a little more on the factors of the individual without thinking about the social context surrounding these youth.”
The RWJF Health & Society Scholars program trains researchers to investigate the connections among biological, genetic, behavioral, environmental, economic and social determinants of health. A clinical psychologist, Hatzenbuehler said his experience in the program convinced him to look more broadly at population health. So he conducted a study to explore the effect of social environments on LGB suicide.
Through the Oregon Healthy Teens Study, an anonymous survey given to middle and high school students in Oregon each year, Hatzenbuehler gathered information on 11th grade students in 297 schools in 34 counties in the state. The Healthy Teens Study asks students to identify their sexual orientation and how many times they have attempted suicide in the past 12 months. It also asks students about well-established, individual-level risk factors for suicide attempts: level of depression, binge drinking, peer victimization and physical abuse by an adult.
To analyze the social environment surrounding these youth, Hatzenbuehler created an index using five points that previous research has shown to be important to the LGB community. He coded each of the 34 participating counties based on this index, to assess each county’s level of supportiveness or positivity. Counties were analyzed by schools’ anti-bullying policies specifically protecting LGB youth, anti-discrimination policies that included sexual orientation, the proportion of schools with Gay-Straight Alliances, and the proportion of same-sex couples and registered Democrats living in the county. “Research has shown that political ideology is strongly associated with support for gay and lesbian policies and relationships,” Hatzenbuehler explained.
His study found that LGB youth were almost five times more likely to have attempted suicide in the last 12 months than heterosexual youth. Nearly 20 percent of lesbian and gay youth had attempted suicide, as had 22 percent of bisexual youth, compared to only four percent of their heterosexual peers.
Strategic analysis of the student information and the environmental index led Hatzenbuehler to conclude that LGB youths’ risk of attempting suicide greatly increased in a negative environment. They were 20 percent more likely to have attempted suicide in a negative social environment than in a positive one.
After adjusting for demographics, Hatzenbuehler found that the social environment remained significantly associated with suicide attempts for all youth, regardless of sexual orientation. Although still less likely to attempt suicide than their LGB peers, nine percent more heterosexual students in negative environments attempted suicide in the last 12 months than heterosexual students in positive environments.
“The effects of a supportive social environment for gay youth are good for straight students as well,” he said. “Positive environments improve the mental health of all youth.”
Hatzenbuehler hopes his study can be replicated in larger and varying contexts. Although this study only looked at one state, a 20 percent higher rate of suicide attempts is substantial, he notes.
“This data really speaks to the importance of social context in creating risks for mental health and for diverse mental health outcomes,” he said. “I think the results are suggestive of the importance of changing the social context in which youth reside.”
Given how much time youth spend at school, Hatzenbuehler believes school policies on bullying and discrimination are important and are a measure of how seriously schools and communities take these issues. Gay-Straight Alliances are also important for LGB youth, he said. “These organizations are safe spaces for gay youth and their allies to come together and get informal forms of social support.”
“The inclusion of social support in schools is important for reducing disparities in suicide attempts among LGB youth,” Hatzenbuehler said. “This has a lot of implications for policy and community-level interventions.”