Elsevier

Journal of Psychiatric Research

Volume 130, November 2020, Pages 327-332
Journal of Psychiatric Research

Short communication
Prevalence and clinical indices of risk for sexual and gender minority youth in an adolescent inpatient sample

https://doi.org/10.1016/j.jpsychires.2020.08.022Get rights and content

Abstract

Objective

Rates of self-injurious thoughts and behaviors have increased in adolescents over the past two decades. Sexual and gender minority (SGM) youth report elevated rates of self-injurious thoughts and behaviors compared to heterosexual and cisgender youth. Studies of factors influencing suicide risk in SGM youth remain limited, however, and have largely been conducted in community or epidemiological samples.

Method

The present study aimed to address these limitations by examining the prevalence and clinical characteristics of sexual and gender minority youth in a sample of 515 youth admitted to an adolescent inpatient unit. In addition, the present study aimed to compare rates of self-reported self-injurious thoughts and behaviors, adverse early childhood experiences, and rates of rehospitalization in sexual and gender minority compared to non-sexual and gender minority youth.

Results

Results show that nearly 40% of the sample identified as sexual and/or gender minority. Sexual minority youth reported higher rates of suicidal ideation (t = −6.19, p < .001), higher rates of prior suicidal behavior (Chi2 = 27.44, p < .001) and non-suicidal self-injury (Chi2 = 48.09, p < .001), and greater numbers of adverse childhood experiences (t = −3.99, p < .001); gender minority youth reported higher rates of suicidal ideation (t = −3.91 p = .001). There were no group differences for SGM youth in rates of rehospitalization in the 6-months following initial admission. These results held when controlling for sex assigned at birth and current depression status in multi-variate analyses.

Conclusions

The study illuminates the importance of assessing SGM status in clinical care and highlights the need to evaluate sexual and gender minority specific risk factors for self-injurious thoughts and behaviors in youth.

Introduction

Suicide is the second leading cause of death among adolescents in the United States (Heron, 2018). Furthermore, rates of emergency department visits for self-injurious thoughts and behaviors (SITBs) have doubled in the past decade (Plemmons et al., 2018), and psychiatric hospitalizations are on the rise. Sexual and gender minority (SGM) youth experience elevated rates of SITBs compared to non-SGM individuals (Marshal et al., 2013; Marshal et al., 2011; Testa et al., 2012; Testa et al., 2017). Data from a 2017 CDC survey suggests that, in the prior 12 months, 23.0% of gay, lesbian, and bisexual youth attempted suicide, compared with 5.4% of heterosexual youth (Kann et al., 2018). In addition, the 12-month prevalence of suicide attempts (SAs) was 34.6% among transgender youth, compared to 9.1% in cisgender females and 5.5% in cisgender males (Kann et al., 2018). Further, in a recent meta-analytic review, rates of non-suicidal self-injury (NSSI) in SGM were significantly higher than non-SGM youth (Liu et al., 2019).

Research also indicates that SGM individuals experience elevated rates of stigma, victimization, and social isolation, which likely contribute to increased rates of SITBs (Meyer, 2003; Baams et al., 2015). For SGM youth already experiencing mental health symptoms, adverse childhood experiences (ACEs) may further exacerbate risk for SITBs. Studies of factors influencing suicide risk in SGM youth remain limited, however, and have largely been conducted in community or epidemiological samples (Marshal et al., 2011; Peters et al., 2020). This is a notable limitation given that risk for SITBs is most elevated in psychiatric samples, and in light of emerging evidence that indices of suicide risk in community samples may not generalize well to clinically acute populations (Yen et al., 2013). Thus, there is an urgent need to assess and evaluate indices of risk for clinical SGM populations.

The current study had two primary aims. First, we aimed to describe prevalence statistics and clinical characteristics of a sample of adolescents hospitalized on a psychiatric inpatient unit, with a focus on youth identifying as SGM. We provide prevalence statistics, diagnostic information, and symptom measures of SITBs and ACEs in SGM youth. We examined rates of suicidal behavior (i.e. history of SA), and SI and NSSI, which are important clinical phenomena both independently and as indicators of risk for suicidal behavior. Second, we aimed to examine differences between SGM and non-SGM youth on these clinical indicators of risk and re-hospitalization in the 6-months post-discharge. Despite all youth in the sample experiencing elevated psychiatric problems, we hypothesized that SGM youth will report higher levels of SITBs near the time of hospitalization. In addition, we hypothesized that SGM youth will report higher levels of ACEs, and that SGM youth will have higher rates of re-hospitalization in the 6-months following initial hospitalization.

Section snippets

Participants

The current sample included 515 youth who completed an admission assessment on an adolescent psychiatric inpatient unit in the northeastern United States between December 2017 and February 2019. Youth were admitted if they were determined to be an imminent danger to themselves or others. The modal length of stay on the unit was nine days. Youth ranged from 11 to 18 years old (M = 14.65; SD = 1.84) and were largely non-Hispanic (75%). The majority of the sample was white (66.5%); 11.4% of the

Sexual orientation

Sexual orientation was assessed using a single item, “Do you consider your sexual orientation to be …” Response options included: heterosexual, gay/lesbian/homosexual, bisexual, not sure, other, or decline to state.

Gender identity

Gender identity was assessed using a single item, “What is your gender?” Response options included: male, female, transgender (male to female), transgender (female to male), transgender (do not identify as male/female), not sure, other, or decline to state.

Current DSM IV diagnoses

Psychiatric diagnoses were

Descriptive statistics

Approximately half of the sample self-identified as heterosexual (51.7%; n = 266), and approximately one-third of the sample identified as a SM (24.3% identified as bisexual, n = 125; 7.4% identified as gay/lesbian/homosexual, n = 38; 2.9% identified as other, n = 15). The remainder of youth identified as unsure (n = 55; 10.7%) or declined to state (n = 16; 3.1%). A smaller proportion of youth identified as a GM in this sample. The majority of youth self-identified as female (57.5%; n = 296) or

Discussion

The current study's aims were two-fold: to characterize the prevalence and clinical characteristics of SGM identification among psychiatrically hospitalized adolescents and to assess the relation between SGM status and clinical indicators of risk. We found that approximately 40% of psychiatrically hospitalized adolescents identify as SGM. Among these hospitalized adolescents, SGM youth evidenced significantly higher levels of risk, as compared to heterosexual and cisgender youth. Overall, SGM

Conclusion

In summary, even among clinically high-risk youth, SGM youth are at elevated risk for poor clinical outcomes and indices of risk, including SITBs and ACEs. Findings from the current study have direct clinical implications for assessment and clinical training, and results also highlight important directions for future research, including the need to test the effectiveness of evidence-based interventions in adolescent SGM samples.

Author statement

Bettis: Conceptualization; Methodology & formal analysis; Writing – original draft/review & editing; Funding acquisition.

Thompson: Conceptualization; Data curation; Writing – original draft/review & editing.

Burke: Writing – original draft/review & editing.

Nesi: Writing – original draft/review & editing; Funding acquisition.

Liu: Conceptualization; Supervision; Writing –review & editing.

Hunt: Project administration.

Wolff: Conceptualization; Project administration; Supervision; Writing – review &

Funding

This work was supported by the National Institute of Mental Health [T32 MH019927], and in part by grant PDF-010517 from the American Foundation for Suicide Prevention (PI: Nesi). NIMH and AFSP had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not

Declaration of competing interest

The authors have no disclosures or conflicts of interest to declare.

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