Exposure to Suicidal Behavior by Sexual and Gender Minority Status Among Adolescents in the Southeastern United States

To investigate exposure to others' suicidal behavior in explaining the heightened risk for suicidal thoughts and behaviors (STBs) among sexual and gender minority (SGM) adolescents. From December 2022 to May 2023, this cross-sectional survey study recruited 1,128 students from four public high schools (grades 9-12) in one historically segregated county in the southeastern United States. We estimated exposure to others' suicidal behavior and one's own STBs by SGM status. SGM adolescents reported significantly higher levels of STBs and more prevalent exposure to friends' and family members' suicide attempts and deaths (all p < 0.01), with 50.2% of SGM adolescents reporting exposure to friends' suicide attempts. In multivariate mediation models adjusted for confounders, exposure to friends' and family members' suicide attempts accounted for 7%-12% of the disparities in STBs between SGM and cisgender/heterosexual adolescents. Exposure to others' suicidal behavior is prevalent among SGM adolescents and associated with the group's increased risk of STBs. Suicide prevention policies and programs targeting SGM adolescents should enhance school-based screening, increase access to SGM-affirmative mental health resources, and leverage peer-engaged interventions.