Teenagers with discordant sexual orientation are more likely to experience nonfatal suicidal behaviors, according to results of a study published in the American Journal of Preventative Medicine.

“In this study, discordance refers to reporting sexual contact that is inconsistent with a respondent’s sexual identity. … Discrimination, stigma, prejudice, rejection, and societal norms may put pressure on sexual minorities to present a sexual identity inconsistent with their true sexual identity or to act in a manner inconsistent with their sexual identity,” said Francis Annor, PhD, of the Centers for Disease Control and Prevention, and fellow investigators.

Understanding the link between the stresses of developing sexual identity and risk of suicidal ideation can be a helpful tool when approaching suicide prevention methods, they noted .

“In considering the health and well-being of youth, sexual identity and sexual behavior and their intersection should be considered for their association with the mental health and well-being of adolescents,” according to Dr. Annor and his colleagues. “Some adolescents reporting discordance may have needs that should be considered when developing and implementing suicide prevention programs.”

For this study, investigators analyzed survey questions from 6,790 high school students queried during the 2015 national Youth Risk Behavior Survey.

Sexual discordance was measured by asking students their sexual orientation and the gender of any sexual partners they may have had. Students who responded as being bisexual or who had not experienced sexual contact before were excluded from final analysis.

Students were majority male (56% vs. 44%), white (54.8%), and heterosexual (97.8%), and sexually concordant (96.1%).

When analyzing suicidal tendencies among students, teens who were sexually discordant were 70% more likely to report thinking about, or planning, suicide. High risk for nonfatal suicidal behaviors was significantly more common among discordant students, compared with concordant students (46.3% vs .22.4%, P less than .0001). Students who were gay or lesbian were significantly more likely to report sexual orientation discordance than heterosexual students (32% vs. 3%, P less than .001).

Sexual discordance also was common among students who were female, black, bullied on school property, used marijuana, or physically forced to have sexual intercourse.

Dr. Annor and fellow investigators theorized that the association between discordance and suicidal ideation may stem from self-discrepancy, which can lead to increased anxiety, stress, or depression.

Another theory was that the stress was induced from being a minority, which is supported by the increased number of nonfatal suicidal behaviors in students who were discordant, female, or gay or lesbian, according to investigators. “The minority stress theory suggests that stigma experienced by sexual minorities may cause chronic, cumulative stress that may negatively impact both mental and physical health,” Dr. Francis and associates explained. “Minority stress has been associated with increased depression, overall poor physical health, and increased risk of chronic disease diagnosis.”

To help prevent these suicidal tendencies, Dr. Annor and colleagues suggested using a multipronged public health approach, including using CDC suicide prevention materials , creating safe spaces for kids to understand their developing sexual identities, and further studies to examine risk among discordant teens and nonfatal suicidal behaviors.

The findings of this study are limited by the use of only high school students, which excludes what may be a significant part of the population. Certain aspects of the survey, including no specific definition of sexual contact, as well as the self-reported nature of the information, might have affected findings. Finally, some of those involved in the study may not have been fully aware of their sexual preference at this age and may have experimented with those of the opposite sex as their reported sexual preference, and this may not have been associated with distress, the researchers said.

Dr. Annor and associates reported no relevant financial disclosures.

SOURCE: Annor F et al. Am J Prev Med. 2018. doi: 10.1016/j.amepre.2018.01.013