PURPOSE

While lesbian, gay, bisexual, transgender/nonbinary, and queer/questioning (LGBTQ+) college students are at heightened risk of suicidal ideation and attempt compared to cisgender and heterosexual students, few studies have examined system-level factors to reduce these risks. We investigated associations between state-level policies and suicidal behavior by gender identity (cisgender sexual minority; CSM, and transgender/nonbinary; TNB) among U.S. LGBTQ + young adults attending 135 institutions.

METHODS

State policy tallies, from the Movement Advancement Project, represent a sum of LGBTQ+-related laws, with indices for protective (positive) and discriminatory (negative) legislation for an overall score (range: -23.5 to 42.5). We linked tallies with student survey data from LGBTQ + young adult participants (18-24 years) in the 2022-2023 Healthy Minds Study (n = 15,861). We used multilevel models to calculate odds ratios (OR) and 95% confidence intervals (CI) for associations between 10-point increases in overall, sexual orientation, and gender identity tallies and suicidal behavior.

RESULTS

A 10-point increase in overall policy tally was associated with an 8% reduction in the odds of suicidal ideation in CSM participants (OR = 0.92, 95% CI = 0.87, 0.97) and a 7% reduction in TNB participants (OR = 0.93, 95% CI = 0.87, 1.00). Associations were observed between overall policy tallies and suicide attempt among CSM, but not TNB students. We observed congruent results for sexual orientation- and gender-specific tallies.

CONCLUSION

Protective state policy was associated with lower odds of suicidal ideation among LGBTQ + college students. We build upon evidence demonstrating the importance of system-level protections for LGBTQ + individuals.