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Sexual minority youths had a higher risk of attempting suicide than their heterosexual peers, a systematic review and meta-analysis found.

Overall, sexual minorities were 3.5 times more likely to attempt suicide (OR 3.50, 95% CI 2.98-4.12, P<0.001), though there was significant evidence of between-study heterogeneity, reported Ester di Giacomo, MD, of the University of Milano-Bicocca in Monza, Italy, and colleagues.

Bisexual (OR 4.87, 95% CI 4.76-4.98, P<0.001) and homosexual (OR 3.71, 95% CI 3.51-9.82, P=0.001) adolescents had increased odds of attempted suicide, though these analyses also had high heterogeneity, the authors wrote in .

Transgender teens had the highest risk of suicide (OR 5.87, 95% CI 3.51-9.82) compared to heterosexuals, but this was only based on one study, the researchers noted.

Bullying and abuse, particularly prevalent in LGBT communities, are two factors commonly associated with suicide and may cause sexual minority teens to feel increasingly alone and separate from their heterosexual peers, according to the study. However, this study avoided the possible influence of bullying or peer support in order to provide an unbiased evaluation of the rates of attempted suicide among this population, which may suggest that self-acceptance also plays a large role when LGBT teens partake in self-harm, the authors reported.

"Consequently, at least at the beginning of their self-disclosure, non-heterosexual adolescents might perceive themselves as different and isolated," the authors wrote. "Those sensations, often accompanied by discomfort and fear, could contribute to personal difficulties that might exhibit in self-threatening behavior if not adequately managed and supported."

These associations between LGBT youth and suicide have been established in past research. However, studies conducted within LGBT communities may not be generalizable to all non-heterosexual youth since the respondents of such surveys are likely more willing to discuss their sexuality and offer support within those communities, the authors wrote.

This systematic review and meta-analysis exclusively focused on attempted suicide, examining data from previous observational studies that compared suicide rates across heterosexual and non-heterosexual high school students. Di Giacomo and her team searched for these studies via PubMed, Embase, and PsycINFO electronic databases using combinations of the following terms: heterosexual, homosexual, bisexual, transgender, adolescents, teens, and attempted suicide. Studies were included that defined LGBT and attempted suicide according to criteria.

They examined 35 studies with a total sample of 2,378,987 students, including 113,468 sexual minority teens. These students ranged in age from 12 to 20.

The studies were conducted in 10 countries, including Iceland, the U.S., China, and New Zealand. Fourteen studies enrolled participants in the 1990s, 11 studies between 2005 and 2010, and five between 2000 and 2005, the authors wrote.

"Community and in-school surveys provide a reliable representation of adolescent population, producing a trustworthy quantification of self-threatening behaviors," the authors wrote. "The magnitude and importance of being a youth with sexual minority identity justify social attention and effort in supplying preventive strategies."

Researchers also tested for variables that could be potentially associated with heterogeneity across studies. They found that the presence of 12-year-old participants had an effect in the bisexual teen subgroup, explaining 60% of the true variance as a single covariate and 60-72% of the variance when combined with the other covariates (P<0.001). The year of sampling was also associated with variance in the whole group in combination with other covariates, for a true variance of <20% , according to the study.

The authors noted that different sample sizes appear to be the most explanatory factor in these results. However, they also wrote that including very young and older participants may affect the findings, since self-confidence and acceptance tend to evolve with maturity and older youth may therefore feel less isolated than their younger peers. It is also possible that the years in which the studies were conducted had an effect, as global acceptance of LGBT individuals has increased greatly from the 1990s to 2017, they wrote.

"Nevertheless, the high heterogeneity detected would not seem to be a limitation but instead an indication of the trend of self-harming in LGBT people through time and in its possible declination at different ages," they concluded. "The low detection of publication bias, not detectable when a meta analysis included a specific sexual minority group alone, seems to support this interpretation."

Other limitations include that the data may be limited because student responses were self-reported, the researchers said.

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