by Nationwide Children's Hospital

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Researchers from the Center for Injury Research and Policy of the Abigail Wexner Research Institute at Nationwide Children's Hospital analyzed six years of multistate child death review data from the United States and found that 81% of sexual and gender diverse youth in the dataset died by suicide, despite many receiving current or prior mental health services.

In a study published on Nov. 1, in a special issue of Pediatrics called "Insights from Fatality Reviews: Informing Pediatric Practice, Policy, and Research," researchers used six years of multistate data from the National Fatality Review-Case Reporting System to identify deaths among sexual and gender diverse youth—identified in the dataset as not heterosexual, not cisgender, or both—and compared their characteristics to a matched sample of youth from these same data who were not known to be sexual and gender diverse.

The study team identified 176 fatalities among sexual and gender diverse youth in the dataset. Decedents' average age was 15.3 years. A greater proportion of deaths were attributed to suicide among sexual and gender diverse youth (81%) compared to non-sexual and gender diverse youth (54%).

"Suicide is a leading cause of death among teenagers, and sexual and gender diverse teens may experience discrimination, rejection, and other stressors that increase their risk of suicidal thoughts and behaviors. It is crucial that mental health services for these teens recognize and address their specific needs," said study senior author Nichole Michaels, Ph.D., principal investigator in the Center for Injury Research and Policy and Assistant Professor of Pediatrics and Public Health at The Ohio State University.

"This study examines the circumstances of fatalities among sexual and gender diverse youth so we can develop better interventions to prevent future injuries and deaths."

Notably, nearly 70% of sexual and gender diverse youth received mental health services during their lifetime, compared to 50% of non-sexual and gender diverse youth in the dataset. A significantly greater percentage of sexual and gender diverse youth were currently receiving mental health services or had been seen in an emergency department for mental health care within the past 12 months, compared to non-sexual and gender diverse youth (49% vs. 31% and 23% vs. 10%, respectively).

"Although many sexual and gender diverse youth were known to have received mental health services, details about the timing, frequency, and quality of care could not be determined. Future research to understand the types of mental health services sexual and gender diverse youth are accessing and how to make them most effective is imperative," said Michaels.

"In addition, the American Academy of Pediatrics is a proponent for gender-affirming care and pediatric health care environments that are welcoming of sexual and gender diverse youth."

In the current study, gender identity and sexual orientation were reported as known stressors for 24% and 33% of sexual and gender diverse youth, respectively. In addition, more sexual and gender diverse youth were identified as having a prior history of depression or self-harm, compared to non-sexual and gender diverse youth (44% vs. 29% and 56% vs. 36%, respectively).

Consistent with prior research, a significantly greater proportion of sexual and gender diverse youth were known to have been victims of bullying, compared to non-sexual and gender diverse youth (28% vs. 15%).

"We know that many sexual and gender diverse youth experience bullying and harassment, often at school," said Michaels. "Schools are critical locations for implementing anti-bullying interventions and anti-discrimination policies to protect sexual and gender diverse youth, but these efforts are needed throughout communities to foster social safety and acceptance for this high-risk and often stigmatized group."

Data for this study were obtained from the National Fatality Review-Case Reporting System (NFR-CRS) collected in the U.S. The study utilized multistate data from child death reviews conducted in the U.S. In 2005, the NFR-CRS was launched as a web-based standardized data entry tool for local and state child death review programs in the US. The National Center for Fatality Review and Prevention maintains, oversees, and disseminates data from the NFR-CRS and provides support and trainings to CDR teams.

As of June 2023, 47 states (excluding Maine, North Carolina, and Vermont) and the District of Columbia use the NFR-CRS for CDR reporting. The study authors point out that inconsistent data reporting methods over time and variations among how Child Death Review (CDR) programs throughout the U.S. ascertain gender identity and sexual orientation information could introduce bias and may contribute to an underrepresentation of sexual and gender diverse youth deaths reported in the study.

More information: Bridget Duffy et al, Characteristics of Fatalities Among Sexual- and Gender-Diverse Youth in the United States: 2015–2020, Pediatrics (2024). DOI: 10.1542/peds.2024-067043P

Journal information: Pediatrics 

Provided by Nationwide Children's Hospital