Alcohol Use and Suicidality by Sexual Orientation Among U.S. Youth, 2009–2017


      Alcohol use and suicidality remain serious risks for U.S. youth. Research has established that disparities exist in these outcomes between heterosexual and sexual minority youth. However, research into the associations between alcohol use and suicidality has yet to consider the differential role of sexual orientation.


      Using a pooled, diverse sample from the 2009–2017 Youth Risk Behavior Survey, associations of alcohol use and suicidality by sex and sexual orientation, and changes in these outcomes over time, were investigated. Analyses were conducted in 2019.


      Suicidality was highest among nonheterosexuals, who ranged from twofold to sevenfold higher odds to report suicidality across all time points, with the most striking disparities among male sexual minority youth. Rates among all students remained stable or increased over time; notable exceptions included a decrease in suicide attempts among bisexual students. Among all students, current alcohol use was associated with elevated levels of suicidality. For female students, the association between drinking and suicidality did not significantly differ by sexual identity; for male students, it was significant regardless of sexual identity and most pronounced among not sure youth.


      These results emphasize the need for additional research into the relationship between contemporaneous alcohol use and suicidality, with attention to differences based on sex, sexual orientation, and other factors that may impact these relationships. There is a particular need for research to examine the temporal nature of the association such that evidence-informed, high-impact interventions can be developed to improve suicidality outcomes among sexual minority youth.
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        • Russell ST
        • Joyner K
        Adolescent sexual orientation and suicide risk: evidence from a national study.
        Am J Public Health. 2001; 91: 1276-1281
        • Haas AP
        • Eliason M
        • Mays VM
        • et al.
        Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: review and recommendations.
        J Homosex. 2011; 58: 10-51
        • Fergusson DM
        • Horwood LJ
        • Beautrais AL
        Is sexual orientation related to mental health problems and suicidality in young people?.
        Arch Gen Psychiatry. 1999; 56: 876-880
        • Burns MN
        • Ryan DT
        • Garofalo R
        • Newcomb ME
        • Mustanski B
        Mental health disorders in young urban sexual minority men.
        J Adolesc Health. 2015; 56: 52-58
        • Needham BL
        Sexual attraction and trajectories of mental health and substance use during the transition from adolescence to adulthood.
        J Youth Adolesc. 2012; 41: 179-190
        • Garofalo R
        • Wolf RC
        • Wissow LS
        • Woods ER
        • Goodman E
        Sexual orientation and risk of suicide attempts among a representative sample of youth.
        Arch Pediatr Adolesc Med. 1999; 153: 487-493
        • Kann L
        • Olsen EO
        • McManus T
        • et al.
        Sexual identity, sex of sexual contacts, and health-related behaviors among students in grades 9-12 - United States and selected sites, 2015.
        MMWR Surveill Summ. 2016; 65: 1-202
        • Meyer IH
        Minority stress and mental health in gay men.
        J Health Soc Behav. 1995; 36: 38-56
        • Meyer IH
        Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence.
        Psychol Bull. 2003; 129: 674-697
        • Safren SA
        • Heimberg RG
        Depression, hopelessness, suicidality, and related factors in sexual minority and heterosexual adolescents.
        J Consult Clin Psychol. 1999; 67: 859-866
        • Nguyen TQ
        • Bandeen-Roche K
        • German D
        • Nguyen NT
        • Bass JK
        • Knowlton AR
        Negative treatment by family as a predictor of depressive symptoms, life satisfaction, suicidality, and tobacco/alcohol use in Vietnamese sexual minority women.
        LGBT Health. 2016; 3: 357-365
        • D'Augelli AR
        • Hershberger SL
        • Pilkington NW
        Lesbian, gay, and bisexual youth and their families: disclosure of sexual orientation and its consequences.
        Am J Orthopsychiatry. 1998; 68 (discussion 372–375): 361-371
        • Waldo CR
        • Hesson-McInnis MS
        • D'Augelli AR
        Antecedents and consequences of victimization of lesbian, gay, and bisexual young people: a structural model comparing rural university and urban samples.
        Am J Community Psychol. 1998; 26: 307-334
        • Kuper LE
        • Adams N
        • Mustanski BS
        Exploring cross-sectional predictors of suicide ideation, attempt, and risk in a large online sample of transgender and gender nonconforming youth and young adults.
        LGBT Health. 2018; 5: 391-400
        • Shields JP
        • Whitaker K
        • Glassman J
        • Franks HM
        • Howard K
        Impact of victimization on risk of suicide among lesbian, gay, and bisexual high school students in San Francisco.
        J Adolesc Health. 2012; 50: 418-420
        • D'Augelli AR
        • Pilkington NW
        • Hershberger SL
        Incidence and mental health impact of sexual orientation victimization of lesbian, gay, and bisexual youths in high school.
        Sch Psychol Q. 2002; 17: 148-167
        • Birkett M
        • Espelage DL
        • Koenig B
        LGB and questioning students in schools: the moderating effects of homophobic bullying and school climate on negative outcomes.
        J Youth Adolesc. 2009; 38: 989-1000
        • Hatzenbuehler ML
        • Birkett M
        • Van Wagenen A
        • Meyer IH
        Protective school climates and reduced risk for suicide ideation in sexual minority youths.
        Am J Public Health. 2014; 104: 279-286
        • Duncan DT
        • Hatzenbuehler ML
        • Johnson RM
        Neighborhood-level LGBT hate crimes and current illicit drug use among sexual minority youth.
        Drug Alcohol Depend. 2014; 135: 65-70
        • Savin-Williams RC
        Verbal and physical abuse as stressors in the lives of lesbian, gay male, and bisexual youths: associations with school problems, running away, substance abuse, prostitution, and suicide.
        J Consult Clin Psychol. 1994; 62: 261-269
        • Díaz RM
        • Ayala G
        • Bein E
        • Henne J
        • Marin BV
        The impact of homophobia, poverty, and racism on the mental health of gay and bisexual Latino men: findings from 3 U.S. cities.
        Am J Public Health. 2001; 91: 927-932
      1. HHS, National Institute on Alcohol Abuse and Alcoholism. The scope of the problem. Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism. Published 2004/2005. Accessed November 11, 2019.

        • Blosnich JR
        • Nasuti LJ
        • Mays VM
        • Cochran SD
        Suicidality and sexual orientation: characteristics of symptom severity, disclosure, and timing across the life course.
        Am J Orthopsychiatry. 2016; 86: 69-78
        • Caputi TL
        • Smith D
        • Ayers JW
        Suicide risk behaviors among sexual minority adolescents in the United States, 2015.
        JAMA. 2017; 318: 2349-2351
        • Remafedi G
        • French S
        • Story M
        • Resnick MD
        • Blum R
        The relationship between suicide risk and sexual orientation: results of a population-based study.
        Am J Public Health. 1998; 88: 57-60
        • Marshal MP
        • Dermody SS
        • Cheong J
        • et al.
        Trajectories of depressive symptoms and suicidality among heterosexual and sexual minority youth.
        J Youth Adolesc. 2013; 42: 1243-1256
        • Windle M
        Suicidal behaviors and alcohol use among adolescents: a developmental psychopathology perspective.
        Alcohol Clin Exp Res. 2004; 28: 29S-37S
        • Pompili M
        • Serafini G
        • Innamorati M
        • et al.
        Suicidal behavior and alcohol abuse.
        Int J Environ Res Public Health. 2010; 7: 1392-1431
        • Swahn MH
        • Bossarte RM
        Gender, early alcohol use, and suicide ideation and attempts: findings from the 2005 Youth Risk Behavior Survey.
        J Adolesc Health. 2007; 41: 175-181
        • Kann L
        • McManus T
        • Harris WA
        • et al.
        Youth risk behavior surveillance - United States, 2017.
        MMWR Surveill Summ. 2018; 67: 1-114
        • Corliss HL
        • Rosario M
        • Wypij D
        • Fisher LB
        • Austin SB
        Sexual orientation disparities in longitudinal alcohol use patterns among adolescents: findings from the Growing Up Today Study.
        Arch Pediatr Adolesc Med. 2008; 162: 1071-1078
        • Dermody SS
        • Marshal MP
        • Cheong J
        • et al.
        Longitudinal disparities of hazardous drinking between sexual minority and heterosexual individuals from adolescence to young adulthood.
        J Youth Adolesc. 2014; 43: 30-39
        • Fish JN
        • Baams L
        Trends in alcohol-related disparities between heterosexual and sexual minority youth from 2007 to 2015: findings from the Youth Risk Behavior Survey.
        LGBT Health. 2018; 5: 359-367
        • Mereish EH
        • Bradford JB
        Intersecting identities and substance use problems: sexual orientation, gender, race, and lifetime substance use problems.
        J Stud Alcohol Drugs. 2014; 75: 179-188
        • Phillips 2nd, G
        • Turner B
        • Salamanca P
        • et al.
        Victimization as a mediator of alcohol use disparities between sexual minority subgroups and sexual majority youth using the 2015 National Youth Risk Behavior Survey.
        Drug Alcohol Depend. 2017; 178: 355-362
        • Bouris A
        • Everett BG
        • Heath RD
        • Elsaesser CE
        • Neilands TB
        Effects of victimization and violence on suicidal ideation and behaviors among sexual minority and heterosexual adolescents.
        LGBT Health. 2016; 3: 153-161
        • Talley AE
        • Hughes TL
        • Aranda F
        • Birkett M
        • Marshal MP
        Exploring alcohol-use behaviors among heterosexual and sexual minority adolescents: intersections with sex, age, and race/ethnicity.
        Am J Public Health. 2014; 104: 295-303
        • Pollitt AM
        • Mallory AB
        • Fish JN
        Homophobic bullying and sexual minority youth alcohol use: do sex and race/ethnicity matter?.
        LGBT Health. 2018; 5: 412-420
        • Hughes TL
        • Wilsnack SC
        • Kantor LW
        The influence of gender and sexual orientation on alcohol use and alcohol-related problems: toward a global perspective.
        Alcohol Res. 2016; 38: 121-132
        • Carpenter C
        Heavy alcohol use and youth suicide: evidence from tougher drunk driving laws.
        J Pol Anal Manage. 2004; 23: 831-842
        • Markowitz S
        • Chatterji P
        • Kaestner R
        Estimating the impact of alcohol policies on youth suicides.
        J Ment Health Policy Econ. 2003; 6: 37-46
        Date accessed: November 11, 2019
        • Cash SJ
        • Bridge JA
        Epidemiology of youth suicide and suicidal behavior.
        Curr Opin Pediatr. 2009; 21: 613-619
        • Ruch DA
        • Sheftall AH
        • Schlagbaum P
        • Rausch J
        • Campo JV
        • Bridge JA
        Trends in suicide among youth aged 10 to 19 years in the United States, 1975 to 2016.
        JAMA Netw Open. 2019; 2e193886
        • Raifman J
        • Moscoe E
        • Austin SB
        • McConnell M
        Difference-in-differences analysis of the association between state same-sex marriage policies and adolescent suicide attempts.
        JAMA Pediatr. 2017; 171: 350-356
        • Hatzenbuehler ML
        The social environment and suicide attempts in lesbian, gay, and bisexual youth.
        Pediatrics. 2011; 127: 896-903
        • Phillips Ii G
        • Turner B
        • Felt D
        • Han Y
        • Marro R
        • Beach LB
        Trends in alcohol use behaviors by sexual identity and behavior among high school students, 2007-2017.
        J Adolesc Health. 2019; 65: 760-768
        • Brener ND
        • Kann L
        • et al.
        • CDC
        Methodology of the Youth Risk Behavior Surveillance System—2013.
        MMWR Recomm Rep. 2013; 62: 1-20
      2. CDC. Conducting trend analyses of YRBS data. Atlanta, GA: Published June 2016. Accessed March 24, 2020.

        • Pacek LR
        • Martins SS
        • Crum RM
        The bidirectional relationships between alcohol, cannabis, co-occurring alcohol and cannabis use disorders with major depressive disorder: results from a national sample.
        J Affect Disord. 2013; 148: 188-195
        • Nowotny KM
        • Peterson RL
        • Boardman JD
        Gendered contexts: variation in suicidal ideation by female and male youth across U.S. states.
        J Health Soc Behav. 2015; 56: 114-130
        • Goldbach JT
        • Tanner-Smith EE
        • Bagwell M
        • Dunlap S
        Minority stress and substance use in sexual minority adolescents: a meta-analysis.
        Prev Sci. 2014; 15: 350-363
        • Kosciw JG
        • Palmer NA
        • Kull RM
        Reflecting resiliency: openness about sexual orientation and/or gender identity and its relationship to well-being and educational outcomes for LGBT students.
        Am J Community Psychol. 2015; 55: 167-178
        • Santos CE
        • VanDaalen RA
        The associations of sexual and ethnic-racial identity commitment, conflicts in allegiances, and mental health among lesbian, gay, and bisexual racial and ethnic minority adults.
        J Couns Psychol. 2016; 63: 668-676
        • Shramko M
        • Toomey RB
        • Anhalt K
        Profiles of minority stressors and identity centrality among sexual minority Latinx youth.
        Am J Orthopsychiatry. 2018; 88: 471-482
        • Fredrick E
        Identity as a Buffer Against Negative Outcomes of Public Stigma Among Lesbian, Gay, and Bisexual Individuals.
        Department of Psychology, East Tennessee State University, Johnson City2015 ([dissertation])
        • Han B
        • Compton WM
        • Blanco C
        • Colpe L
        • Huang L
        • McKeon R
        National trends in the prevalence of suicidal ideation and behavior among young adults and receipt of mental health care among suicidal young adults.
        J Am Acad Child Adolesc Psychiatry. 2018; 57: 20-27.e2
        • Plemmons G
        • Hall M
        • Doupnik S
        • et al.
        Hospitalization for suicide ideation or attempt: 2008-2015.
        Pediatrics. 2018; 141e20172426
        • Saewyc EM
        • Skay CL
        • Hynds P
        • et al.
        Suicidal ideation and attempts in North American school-based surveys: are bisexual youth at increasing risk?.
        J LGBT Health Res. 2007; 3: 25-36
        • Peter T
        • Edkins T
        • Watson R
        • Adjei J
        • Homma Y
        • Saewyc E
        Trends in suicidality among sexual minority and heterosexual students in a Canadian population-based cohort study.
        Psychol Sex Orientat Gend Divers. 2017; 4: 115-123
        • Hadland SE
        • Yehia BR
        • Makadon HJ
        Caring for lesbian, gay, bisexual, transgender, and questioning youth in inclusive and affirmative environments.
        Pediatr Clin North Am. 2016; 63: 955-969
        • Marshall A
        Suicide prevention interventions for sexual & gender minority youth: an unmet need.
        Yale J Biol Med. 2016; 89: 205-213
        • Sigfusdottir ID
        • Kristjansson AL
        • Gudmundsdottir ML
        • Allegrante JP
        Substance use prevention through school and community-based health promotion: a transdisciplinary approach from Iceland.
        Glob Health Promot. 2011; 18: 23-26
        • Carney T
        • Myers BJ
        • Louw J
        • Okwundu CI
        Brief school-based interventions and behavioural outcomes for substance-using adolescents.
        Cochrane Database Syst Rev. 2016; CD008969
        • Delgado-Rodríguez M
        • Llorca J.Bias
        J Epidemiol Community Health. 2004; 58: 635-641