School-based factors associated with attempted suicide among united states adolescents, 2015-2019

Purpose: Suicide is the second leading cause of death among adolescents in the United States, ages 15 to 19 years old. Previous research has identified an extensive list of risk factors associated with adolescent suicide and indicates sexual minority youth, who identify as lesbian, gay, bisexual, or unsure, are at increased risk for suicidal behaviors, but limited research examines the contextual factors that may be associated with suicide attempts among these youth. Additional research is warranted into school-based factors and their relationship with suicide among sexual minority youth. The purpose of the present study is to investigate school-based factors associated with suicide and explore differences by sexual minority status among a large, nationally representative sample of U.S. youth over multiple years. Methods: Pooled data from the 2015-2019 Youth Risk Behavior Survey (YRBS) were analyzed. The YRBS is a bi-annual survey conducted in the United States to examine health behaviors among youth in middle and high school. Weighted logistic regression models were conducted to determine conditional associations to past-year suicide attempt ("yes or no"). The conditional associations considered were, sexual orientation ("heterosexual, gay/lesbian, bisexual and not sure"), did not go to school because they felt unsafe ("yes and no"), and grades over the last year ("mostly A's/B's, mostly C's/D's/F's and none of these grades/not sure"). Interactions between sexual orientation and not going to school because they felt unsafe, were built and were mean centered to reduce multi-collinearity and interpretability of findings. Missing data were handled with multiple imputation methods and combined in multivariate analyses using Rubin's rules. The level of significance was set at p < .05 and were two-tailed. Analyses were conducted in Stata. Results: The total sample comprised of 44,066 students in 9th-12th grades, with nearly equal percentages of boys and girls (50.0% vs. 49.2%, respectively). An estimated 3.4% (95% confidence interval (CI): 3.15-3.62) of youth reported past year suicide attempt. Compared to heterosexual youth, bisexual youth (aOR: 1.38, 95%CI 1.24-1.53) were more likely to report attempting suicide. Students who reported feeling unsafe at school (aOR: 1.49, 95%CI 1.34-1.64) were more likely to attempt suicide compared to those who reported feeling safe at school. Sexual orientations and feeling safe at school interactions were not significant- the students who did not feel safe were not those that identified as sexual minorities. Students who reported their grades as C's/D's/F's (aOR: 0.75, 95%CI 0.64-0.86) were less likely than students who reported A's/B's to attempt suicide. Conclusions: These findings indicate that students who do not feel safe in school have an increased risk of suicide attempts, underscoring the importance of programs that promote a safe and supportive school environment. Students who reported lower grades have a decreased risk of suicide attempts, necessitating further research to identify the influence of academic pressures. Understanding school-based factors affecting adolescent suicide risk is important to identify students at greatest risk and develop targeted and effective programs to reduce suicide in this age group.