This study aimed to explore differences in associations between exposure to interpersonal trauma and suicidality (ideation, planning, and attempts) by sexual orientation in a representative adolescent sample in the U.S. Consistent with past research (e.g., LeBouthillier et al., 2015), we found that exposure to sexual and dating violence was associated with increased probability of experiencing all suicide-related outcomes (i.e., suicidal ideation, planning for suicide, attempting suicide) among both LGB and heterosexual adolescents. In a sensitivity analysis, our results cohered with past research demonstrating sexual dating violence to be associated with suicidality (Holmes & Sher, 2013). However, in a saturated model including adjustment for each of the three forms of violence, sexual dating violence, a subtype of sexual violence, was no longer correlated with suicidality suggesting the other two forms were stronger suicidality determinants or that sexual dating violence is captured by the sexual violence classification. While these findings are relevant to all youth, particularly those who are exposed to violence, they are especially relevant to the experiences of sexual minority youth, who experience higher rates of childhood sexual abuse (Friedman et al., 2011) and dating violence (Semprevivo, 2021) than their heterosexual peers, placing them at increased risk of experiencing suicidality as a result of their disproportionate exposure to such risk factors.
Further, we found that the strength of the trauma-suicidality associations was modified by sexual identity, with LGB adolescents experiencing the strongest effects of trauma on suicidality. Among heterosexual respondents, exposure to any type of sexual violence and physical dating violence were associated with increased probability of experiencing suicidality. We also found that sexual dating violence significantly reduced odds of attempting suicide among heterosexuals. These findings contrast with previous studies (Holmes & Sher, 2013; Olshen et al., 2007), and demonstrate that more research is needed to explore the effects of sexual dating violence on suicidality among heterosexual adolescents.
However, our results indicate that, among survivors of interpersonal trauma, LGB individuals may be particularly vulnerable to experiencing suicidality. For example, we found that for each unit increase in reports of sexual violence, there were approximately eleven excess reports of suicidal ideation for gay or lesbian youth compared to heterosexuals. These results indicate that direct exposure to interpersonal trauma, such as sexual violence, may have a particularly great impact on mechanisms that influence the development of suicidality in this group as compared to heterosexual youth.
One such mechanism in the trauma-suicide connection may be traumatic stress, which can develop following experiences of sexual violence. Traumatic stress has been found to account for the relationship between childhood sexual abuse and suicidality (Bornovalova et al., 2011), and is associated with interpersonal constructs associated with suicidality, such as perceived burdensomeness and thwarted belongingness (Davis et al., 2014; Pennings et al., 2017). Given that LGB youth are already at heightened risk of developing symptoms of traumatic stress following exposure to trauma (Roberts et al., 2012), more research is needed exploring how traumatic stress may impact known individual and interpersonal mechanisms linking trauma and suicidality. Specifically, future studies should investigate how traumatic stress, which is more common among sexual minority youth (Roberts et al., 2012), may influence the development of suicide-related disparities to begin establishing intervention targets at the individual and extra-individual levels.
One such target is discrimination, which may be an important factor influencing traumatic stress as a mechanism in the trauma-suicide connection among LGB populations. While heterosexist discrimination has been demonstrated to be independently associated with suicidality (House et al., 2011), one study with LGBT populations demonstrated that discrimination-related traumatic events elicit greater complex posttraumatic stress symptoms (Keating & Muller, 2019), particularly those more commonly associated with suicidality, such as PTSD symptoms (Selaman et al., 2014) and dissociation (Ford & Gómez, 2015). More research is needed to understand the role of discrimination on mechanisms in the trauma-suicide connection among LGB populations in order to inform the development of potential post-trauma exposure suicide prevention efforts. Interrupting this pathway by addressing discrimination and traumatic stress through a combination of structural and individual interventions may reduce the incidence of suicidality in this subpopulation. Discrimination, an upstream social determinant of population health, will continue to produce health disparities even if prevalent health disparities are addressed with clinical interventions. Both structural and individual interventions are needed to be implemented simultaneously to close trauma-suicide disparities sustainably.
Our findings also indicate that varying types of violence may differentially influence suicidality among LGB adolescents. For example, we found that sexual abuse had the strongest influence on suicidality among gay and lesbian identifying youth, while sexual dating violence had a significant impact on the development of suicidality among bisexual adolescents. These findings contrast with an earlier study using the YRBS dataset that found teen dating violence did not account for the association between biological sex and suicide risk among bisexual adolescents (Smith et al., 2020). However, the items used do not measure the perpetration of dating violence, which is itself associated with increased suicide risk (Swahn et al., 2008) and is more common among boys than girls (Blais et al., 2020). The findings of our study therefore suggest that the interactions of gender, biological sex, dating violence, and suicidality may be even more complex among bisexual youth specifically. More research is needed exploring the processes that link exposure to specific types of interpersonal trauma and suicidality among individual subgroups of LGB youth, such as dating violence and bisexual youth.