Inclusive state legislation and reduced risk of past-year suicide attempts among lesbian, gay, bisexual, and questioning adolescents in the United States

Objective This study examines the relationship between state legislation relevant to equality for sexual minorities and past-year suicide attempts among lesbian, gay, bisexual, and questioning (LGBQ) adolescents in the United States. Methods Data were aggregated from 24 states that participated in the 2017 Youth Risk Behavior Surveillance System (N = 70,599). We utilized multilevel logistic regression to determine whether observed positive associations between sexual minority identity and past-year suicide attempts differ as a function of 2016 State Equality Index (SEI), an objective measure of state laws and policies affecting equality for sexual minorities. Results LGBQ adolescents were significantly more likely to report having made a suicide attempt in the past year than heterosexual youth (adjusted odds ratio [AOR]: 3.82; 95% confidence interval [CI]: 3.29–4.44). The 2016 SEI moderated the positive association between sexual minority identity and suicide attempts, with odds of past-year suicide attempts significantly reduced in states with more inclusive legislation (AOR: 0.91; CI: 0.85–0.97). Among sexual minority subgroups, significant effect modifications were found for bisexual (AOR: 0.88; CI: 0.77–0.99) and questioning (AOR: 0.87; CI: 0.78–0.96) – but not gay or lesbian (AOR: 1.10; CI: 0.97–1.24) – adolescents. The effect modification was strongest for bisexual males (AOR: 0.68; CI: 0.47–0.99). Conclusions State legislation relevant to equality for sexual minorities differentially affected associations between sexual minority identity and suicide attempts, such that past-year suicide attempts were substantially lower in states with more inclusive legislation. Inclusive state legislation may exert a protective effect on risk for suicide attempts among sexual minority youth.