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Bullying was common among LGBTQ youth who died by suicide between 2003 and 2017, especially among younger children, researchers reported.

Among 9,884 children ages 10-19 who died by suicide, a far greater proportion of LGBTQ youth were bullied compared with their heterosexual peers (20.7% vs 4.4%), and LGBTQ decedents had nearly five times the odds of experiencing bullying after adjusting for depression, mental health problems, and family or relationship problems (odds ratio 4.92, 95% CI 3.58-6.82, P<0.001), reported Kirsty A. Clark, PhD, MPH, of Yale University in New Haven, Connecticut, and colleagues.

Bullying was most prevalent among LGBTQ children ages 10-13 who died by suicide, with 67.6% experiencing bullying compared with 15% of non-LGBTQ children, the team wrote in a research letter in .

"Experiencing bullying is associated with a host of mental health problems including things like depression [and] anxiety that contribute to suicidal thoughts and behavior," Clark told 番茄社区. "For adolescents who are LGBTQ and already navigating the internal psychological process of coming to terms with an LGBTQ identity, that is compounded by things like bullying and social rejection, which can then influence mental health and suicidality."

Among those of high school age, 19% reported being bullied at school and 7.4% had attempted suicide in 2017, according to the . However, lesbian, gay, and bisexual youth reported being bullied at school at nearly twice the rate of their heterosexual peers (33% vs 17.1%), and attempted suicide at more than four times the rate (23% vs 5.4%), according to the survey.

Together, the data shows that bullying and suicidality are rising among LGBTQ youth, and "points to a causal concern," commented Dorothy Espelage, PhD, of the University of North Carolina at Chapel Hill, who was not involved in this study.

"There are still higher suicide rates among LGBTQ youth compared to their straight-identified peers and that is because in society, there are some communities not accepting of gender and sexual minority youth," Espelage told 番茄社区. "There are still families that are not affirming when their kids come out, and those victimized at home are likely to be victimized at school."

Although this study is unable to definitively prove bullying caused these suicides, it is "not much of a logical jump to presume [it] played a substantial role," commented Jack Turban, MD, a clinical fellow in psychiatry at Harvard Medical School in Boston, where he researches the mental health of LGBTQ youth.

Moreover, many LGBTQ youth may not disclose their sexuality due to fear of harassment or discrimination, and many may not disclose their bullying either, meaning that the prevalence of both bullying and sexual minority status may be underreported in this analysis, Turban said.

"Hopefully this data will inspire school officials to continue to combat bullying against LGBTQ youth in schools," Turban told 番茄社区 in an email. "Future research should empirically measure what kinds of school-based policies best mitigate this risk."

In one 2015 study, sexual orientation victimization, along with depression and suicidal ideation, was found to be or the belief that a child's sexuality is a burden to other people in their lives, Espelage said.

Anti-bullying interventions specifically geared towards LGBTQ youth in schools and communities could therefore be targeted to reduce this "perceived burdensomeness," Espelage said.

Importantly, this issue is not going away because of school closures and stay-at-home measures that confine LGBTQ youth to their homes, Clark said. Cyberbullying, in addition to in-school bullying, is elevated among LGBTQ children, and its adverse effects on adolescent mental health may be compounded in homes where parents have rejected a child's sexual identity, she said.

"Supportive parenting, especially during these times of high anxiety when youth are spending a lot of time at home, is particularly important for LGBTQ youth," Clark said.

The researchers used records from the 2003-2017 National Violent Death Reporting System (NVDRS). Clark and co-authors searched records from coroners or law enforcement reports that described adolescent suicide for terms related to bullying. Sexual orientation and transgender status were added to the NVDRS in 2013, but suicides coded before that were also categorized as LGBTQ through text searches in coroner and law enforcement narratives.

In total, 334 children -- mean age of 16.5 years, 53%of whom were male -- were categorized as LGBTQ. Of the 9,550 non-LGBTQ youth, significantly more (76.4%) were male, but their mean age was about the same. In both groups, at least three-quarters of the cohort were white (76%-81%), researchers reported.

Compared with their heterosexual peers, a significantly higher proportion of LGBTQ youth experienced a depressed mood (45.8% vs 35%), mental health problems (49.4% vs 41.7%), a history of suicidal thoughts (37.4% vs 20.9%), family relationship problems (24% vs 19.4%), and intimate partner problems (34.1% vs 27.2%), Clark and co-authors noted.

They added that although a disproportionate number of LGBTQ youth who died by suicide experienced bullying, the majority of bullying-associated deaths were among non–LGBTQ-classified youth (85.9%). Compared with heterosexual peers, there were also higher rates of bullying in LGBTQ youth ages 14-16 (27.8% vs 6.7%) and 17-19 (7.3% vs 1.7%).

If you or someone you know is considering suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255.

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