Temporal Trends and Disparities in Suicidal Behaviors by Sex and Sexual Identity Among Asian American Adolescents

Abstract

This cross-sectional study uses data from the national Youth Risk Behavior Survey to investigate the trends and within-group disparities in 4 suicidal behaviors by sex and sexual identity among Asian American adolescents from 1991 through 2019.

Key Points

Question

What are the trends and within-group disparities in self-reported suicidal behaviors among Asian American adolescents from 1991 through 2019?

Findings

In this cross-sectional study with a nationally representative sample of 7619 Asian American adolescents, increases in the prevalence of suicide attempts and injury by suicide attempt were observed among female adolescents from 2009 to 2019, although these increases were not statistically significant. A statistically significant increase in suicide plan was found among Asian American adolescents with partners of the same sex or both sexes.

Meaning

These findings suggest that suicide disparities among Asian American adolescents warrant attention, and that culturally tailored suicide prevention that reduces racial discrimination and sexual orientation–related stigma may help prevent suicide in this group.

Abstract

Importance

Although suicide is the second leading cause of death among Asian American adolescents, there is a dearth of studies examining overall and possible sex and sexual orientation disparities in the trends in suicidal behaviors among Asian American adolescents. Such information is crucial to inform targeted efforts of suicide prevention among Asian American adolescents.

Objective

To examine temporal trends and sex and sexual orientation disparities in trends of nonfatal suicidal behaviors in Asian American adolescents from 1991 through 2019.

Design, Setting, and Participants

This cross-sectional study used data from the national Youth Risk Behavior Survey from 1991 through 2019, analyzing a representative sample of US adolescents in grades 9 through 12 using a 3-stage cluster-sampling design. Data were analyzed from October through November 2020.

Exposures

Calendar year, sex, sexual identity, sex of sexual contact, and interaction terms of these factors.

Main Outcomes and Measures

Crude prevalence and annual percentage changes (APCs) in self-reported suicidal ideation, suicide plan, suicide attempts, and injury by suicide attempt for the overall sample and by sex, sexual identity, and sex of sexual contacts were calculated. Sexual minorities were defined as individuals whose sexual identity was gay or lesbian, bisexual, or not sure.

Results

Among 7619 Asian Americans who participated in the Youth Risk Behavior Survey from 1991 to 2019 (mean [SD] age, 16.09 [1.29] years; 3760 [47.1%] female adolescents), 1576 individuals completed the sexual identity and behaviors questions after 2015 (mean [SD] age, 15.97 [1.28] years; 810 [49.2%] female adolescents). From 2009 through 2019, there was a 1.3-fold (95% CI, −0.8 to 3.3; P = .22) increase in suicide attempts and a 1.7-fold (95% CI, −2.6 to 5.9; P = .45) increase in injury by suicide attempt among Asian American female adolescents, although these increases were not statistically significant. Among 39 Asian American adolescents who identified as gay, lesbian, or bisexual or who were attracted to and had sexual contact with partners of the same sex or both sexes, compared with 1556 Asian American adolescents who were heterosexual, prevalence was greater for suicidal ideation (24 individuals [68.2%] vs 223 individuals [15.0%]; P < .001), suicide plan (15 individuals [57.7%] vs 179 individuals [11.9%]; P < .001), suicide attempts (14 individuals [41.0%] vs 74 individuals [5.5%]; P < .001), and injury by suicide attempt (5 individuals [17.6%] vs 23 individuals [1.7%]; P < .001) between 2015 and 2019. These sexual minorities identified by sexual identity and sexual contact also had an increasing rate over this period in suicide plan (APC, 10.5%; 95% CI, 4.4% to 16.9%; P < .001).

Conclusions and Relevance

This study found significant increases in rates of suicide plan among Asian American adolescents who were sexual minorities identified by sexual identity and sexual contact together. These findings suggest that suicide screening needs to inquire about sexual minority status in terms of sexual identity and sex of sexual contact when identifying Asian American adolescents who are at risk for suicidal behaviors. Culturally relevant suicide-prevention programs addressing unique risk and protective factors, racial discrimination, and sexual orientation–related stigma may be needed for Asian American adolescents.