Sexual Identity–Behavior Profiles and Suicide Outcomes Among Heterosexual, Lesbian, and Gay Sexually Active Adolescents

Objective: Adolescents’ sexual behaviors can be incongruent with those assumed to align with their sexual identity. Identity–behavior profiles permit the characterization of youth who might remain undetected using a single-dimensional assessment of sexual orientation. This study examined suicide risks among four distinct sexual identity–behavior profiles of youth: heterosexual with other-sex partners only, heterosexual with any same-sex partners, lesbian or gay (LG) with same-sex partners only, and LG with any other-sex partners. Method: Data were analyzed from the 2017 National Youth Risk Behavior Survey. Participants’ reported sex, sexual identity, and the sex of their sexual contacts were used to construct the identity–behavior profiles. Multivariate logistic regression was used to examine the relationship between identity–behavior profiles and suicide outcomes. Results: Compared to heterosexual respondents with other-sex partners only, heterosexual respondents with any same-sex partners and LG respondents with same-sex partners only had greater odds of having a suicide plan; LG respondents with any other-sex partners were over seven times more likely to have suicidal thoughts and attempt suicide and 14 times more likely to have a suicide plan. Conclusions: Health and mental health providers can expand the identification of youth at risk for suicide by assessing both sexual identity and behavior.