St. George's University School of Medicine, St. George's, Grenada, West Indies.
Department of Psychiatry, Brookdale University Hospital Medical Center, Brooklyn, NY, United States.
Psychiatry Res. 2022 Aug;314:114635. doi: 10.1016/j.psychres.2022.114635. Epub 2022 May 14.
We aimed to evaluate the prevalence and trend of identifying as a sexual minority among the American adolescent population. Additionally, we aimed to evaluate the prevalence and odds of substance abuse, hopelessness, and suicidality among the sexual minority adolescents compared to their heterosexual peers.
We performed a retrospective cross-sectional study using Youth Risk Behavior Surveillance System (YRBSS) data from 2015 to 2019. YRBSS divides "Sexual identity" into three groups: heterosexuals, sexual minorities (gay or lesbian or bisexual), and unsure. We identified "hopelessness and suicidality" using the survey questions exploring if participants felt sad or hopeless for >2 weeks, considered suicide, made a suicide plan, and attempted suicide requiring medical care. Univariate and multivariable survey logistic regression analyses were performed to establish an association between hopelessness, suicidality, substance abuse, and identifying as a sexual minority.
Out of 41,377 adolescents, 4055 (9.8%) identified as a sexual minority. An increasing percentage of adolescents identified themselves as a sexual minority between 2015 to 2019 (8% to 11.2%) (pTrend<0.0001). The sexual minority had a higher prevalence of feeling sad and hopeless (63.4 vs. 28.6%), considering suicide (46 vs. 14.2%), planning suicide (38.9 vs. 11.5%), attempting suicide, and having injurious suicide attempts compared to heterosexuals. (p<0.0001) Amongst sexual minorities, the prevalence of substance abuse was higher compared to their heterosexual peers, which includes cigarettes (15 vs 7.8%), e-cigarette (27.2 vs 23.2%), inhalants (14.1 vs 5.3%), cocaine (8.4 vs 3.9%), marijuana (31.2 vs 20.2%), alcohol (36.9 vs 30.3%), steroids (6.4 vs 2.2%), heroin (4.4 vs 1.2%), and injectable drugs (4.0 vs 1.1%) (p<0.0001). In regression analysis, the sexual minority had higher odds of substance abuse, feeling sad and hopeless (aOR:4.6; 95%CI:4.0-5.2; p<0.0001), considering suicide (3.2; 2.8-3.7; p<0.0001), planning suicide (2.0; 1.7-2.3; p<0.0001) compared to heterosexual.
Sexual minorities not only have higher prevalence and odds of hopelessness and suicidality but also have higher prevalence and odds of substance abuse like cigarettes, marijuana, cocaine, heroin, inhalants, and steroids. Hence, early identification, risk stratification, and interventions to reduce mental health disparities are needed.
评估美国青少年群体中自认为是性少数群体的流行率和趋势。此外，我们旨在评估与异性恋同龄人相比，性少数群体青少年滥用药物、感到绝望和出现自杀倾向的流行率和几率。
我们使用 2015 年至 2019 年期间的青少年风险行为监测系统（YRBSS）数据进行了回顾性横断面研究。YRBSS 将“性身份”分为三组：异性恋者、性少数群体（同性恋或双性恋）和不确定。我们使用调查问题来确定“绝望和自杀倾向”，这些问题探讨了参与者是否感到悲伤或绝望超过 2 周、是否考虑过自杀、制定过自杀计划以及是否曾试图自杀需要医疗护理。我们进行了单变量和多变量调查逻辑回归分析，以确定绝望、自杀倾向、药物滥用与自我认同为性少数群体之间的关联。
在 41377 名青少年中，有 4055 名（9.8%）自认为是性少数群体。自 2015 年至 2019 年，自我认同为性少数群体的青少年比例呈上升趋势（8%至 11.2%）（p趋势<0.0001）。性少数群体感到悲伤和绝望的比例（63.4%比 28.6%）、考虑自杀的比例（46%比 14.2%）、制定自杀计划的比例（38.9%比 11.5%）、试图自杀以及出现有伤害性自杀企图的比例均高于异性恋者（p<0.0001）。在性少数群体中，与异性恋同龄人相比，药物滥用的流行率更高，包括香烟（15%比 7.8%）、电子烟（27.2%比 23.2%）、吸入剂（14.1%比 5.3%）、可卡因（8.4%比 3.9%）、大麻（31.2%比 20.2%）、酒精（36.9%比 30.3%）、类固醇（6.4%比 2.2%）、海洛因（4.4%比 1.2%）和注射药物（4.0%比 1.1%）（p<0.0001）。在回归分析中，性少数群体与异性恋者相比，药物滥用、感到悲伤和绝望（比值比：4.6；95%置信区间：4.0-5.2；p<0.0001）、考虑自杀（3.2；2.8-3.7；p<0.0001）、制定自杀计划（2.0；1.7-2.3；p<0.0001）的几率更高。
性少数群体不仅绝望和自杀倾向的流行率和几率更高，而且滥用香烟、大麻、可卡因、海洛因、吸入剂和类固醇等药物的流行率和几率也更高。因此，需要早期识别、风险分层和干预措施来减少心理健康方面的差异。
