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Risk and Protective Factors for Suicide Among Adolescents: A Look at Gender Identity and Sexual Orientation

December 13, 2019 – 5 min read


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While the rate of suicide in young people is relatively low as compared to older age groups, suicide is currently the second leading cause of death among adolescents in the United States. We have learned from research that there is never a single cause for suicide, various factors may increase a person’s risk. These include mental and physical health factors such as depression or chronic pain, environmental factors such as stressful life events, and historical factors such as a family history of suicide. Research has also shown that just as these factors may contribute differently to suicide risk in different age groups, suicide risk varies among different gender identity groups, races, ethnicities, and sexual orientations.

According to data from the CDC’s 2017 Youth Risk Behavior Survey, 7.4% of high school students reported having attempted suicide in the previous year. While this survey does not distinguish between transgender individuals (those who identify as a gender different from the one they were assigned at birth) and cisgender individuals (those who identify as the same gender they were assigned at birth), prior studies have estimated that 25 – 52% of transgender adolescents have attempted suicide within their lifetime, suggesting that transgender adolescents may be more likely to attempt suicide than cisgender adolescents. Additionally, researchers have reported that those who identify with a sexual orientation other than heterosexual are at greater risk for suicide. Previous research has not explored the differences in suicide risk that may exist among different subgroups of the transgender population (e.g., transgender, transsexual), or among different sexual orientations.

There are protective factors which may help to prevent an individual from engaging in suicidal behavior, such as the “developmental assets” identified by the Search Institute’s framework. Developmental assets are positive qualities or skills an individual may possess (such as a commitment to learning and a sense of responsibility), or those assets that may be offered to the individual by their community (such as a feeling of support from one’s family). These assets may assist youth in their development and aid them in engaging in healthy behaviors.


Do risk and protective factors for suicide differ among adolescents depending on their gender identity and sexual orientation?


Dr. Russell Toomey and his team at the University of Arizona performed statistical analyses on data from the Search Institute’s Profiles of Student Life: Attitudes and Behaviors survey in order to explore the differences in suicide risk among six different gender identities within the transgender (male-to-female, female-to-male, nonbinary/not exclusively male or female), cisgender (male, female), and questioning (not sure) populations, as well as to explore a relationship between developmental assets and suicidal behavior among sexual orientations (only heterosexual, mostly heterosexual, bisexual, mostly lesbian or gay, only lesbian or gay).

This survey was given to more than 120,000 middle school and high school students between the ages of 11 and 19 over a three-year period, from June 2012 to May 2015. It asks questions relating to both healthy and unhealthy social, emotional, and sexual behaviors, developmental assets, and history of suicide attempts.

Developmental assets in this survey included seven internal assets, such as social, emotional, decision-making and planning skills, academic engagement, and positive values. Eleven external assets, including support, feelings of mattering and belonging, extracurricular activity participation, and family, school, and neighborhood boundaries (rules or consequences), were also assessed.

Additional questions related to sociodemographic characteristics such as gender identity, sexual orientation, age, race/ethnicity, parental level of education, and residence area (i.e., “urbanicity;” living in a small city, farm, or a medium-large city).


Transgender identities represented 0.6%, or about 700 adolescents of the total adolescent population surveyed, with an additional 0.9%, or about 1,000 adolescents, representing those who identified as questioning. Within the entire group of adolescents studied, researchers found that 14.1%, or about 17,000 adolescents, expressed they had tried to kill themselves one or more times within their lifetime.

Researchers reported that differences in suicide attempt rates existed between all gender identity groups with the following reported attempt rates: transgender female-to-males (50.8%) and nonbinary (41.8%) adolescents, transgender male-to-females (29.9%) and questioning (27.9%) adolescents, respectively. Consistent with previous research, these findings demonstrated that of the adolescents who identified as transgender, 29.9 – 50.8% had attempted suicide in their lifetime.

Of cisgender adolescents who identified as female, 17.6% expressed they had attempted suicide, as compared to 9.8% of cisgender males, suggesting that females (as well as transgender and questioning adolescents) are more likely to attempt suicide than males.

Similarly, researchers found that adolescents with a sexual orientation other than heterosexual were more likely to attempt suicide than those who identified as heterosexual. Dr. Toomey and his team found that among a smaller sample of 116,925 adolescents, the 9.8% who identified as a sexual orientation other than only heterosexual (i.e., mostly heterosexual, bisexual, mostly lesbian or gay, only lesbian or gay; percentages not available), reported higher rates of suicidal behavior, with the highest rates among bisexual individuals.

Results indicate that adolescents who lived in larger cities and those whose parents had higher levels of education were less likely to attempt suicide. It is, however, important to note that over 75% of the sample surveyed resided in rural areas or small cities, indicating the sample may not be representative of the overall population.

For only heterosexual adolescents, higher rates of suicidal behavior were found among racial/ethnic minorities when compared with white students. With regard to developmental assets —  positive qualities or skills an individual may possess or those instilled in a person through their community relationships — those who reported a sexual orientation other than only heterosexual had lower levels of all developmental assets except for social justice values and extracurricular activity participation, where there were no group differences.

Lastly, researchers found that more effective decision-making and planning skills were the only developmental assets associated with lower risk for suicide in this sample.


- There are notable group differences between those who attempt suicide and those who do not, based on age, gender identity, sexual orientation, race, and ethnicity

- Many factors influence suicide risk and this study adds to the literature by confirming that more sexual minority (i.e., non-heterosexual) and gender minority (i.e., transgender) adolescents reported a suicide attempt than heterosexual and cisgender adolescents.

- In terms of skills and traits that may protect from suicide risk, most sexual minority youth reported fewer internal and external developmental assets; however, only decision-making skills and planning skills were found to be associated with lower risk for suicidal behavior.

- Given the differences identified, it is important to develop interventions that are sensitive to individual and group differences, and seek to improve problem solving and planning skills

Russell Toomey, Ph.D.

Russell Toomey, Ph.D.
University of Arizona
2015 Standard Research Grant
Grant Title: Strengths and Supports in the Lives of LGBT Youth: An Examination of Suicide Attempts and Thriving


Syvertsen, A.K., Scales, P.C., & Toomey, R.B. (2019). Developmental Assets framework revisited:             Confirmatory analysis and invariance testing to create a new generation of assets measures for            applied research, Applied Developmental Science, DOI: 10.1080/10888691.2019.1613155
Toomey, R.B., Syvertsen, A.K., & Flores, M. (2019). Are Developmental Assets Protective Against Suicidal                  Behavior? Differential Associations by Sexual Orientation. Journal of Youth and Adolescence,     48:788–801.
Toomey, R. B., Syvertsen, A. K., & Shramko, M. (2018). Transgender Adolescent Suicide Behavior.            Pediatrics, 142(4).