Bisexual Teens Face Highest Suicide Risk, But Exposure to Harm May Explain Why

Adolescent suicide remains one of the most urgent public health challenges in the United States. In 2021, suicide was the third-leading cause of death among Americans aged 14 to 18, with a mortality rate of 9 per 100,000, and decades of research have shown that sexual minority youth consistently report higher rates of suicidal thoughts and behavior than their heterosexual peers. A new analysis of national survey data, published in Archives of Sexual Behavior, takes a fresh and unusually rigorous look at this persistent disparity, asking a question that most previous studies have glossed over: do the well-known risk factors of victimization and hopelessness actually work differently depending on whether a teenager identifies as heterosexual, bisexual, homosexual, or unsure of their orientation?

The study, conducted by Wenyi Wang of the University of Texas at Dallas, drew on the Youth Risk Behavior Survey, a biennial school-based surveillance system run by the Centers for Disease Control and Prevention since 1990. The researcher pooled data from five survey waves spanning 2015 to 2023, an initial sample of 81,401 U.S. high school students. After restricting the analysis to respondents with complete information on the key measures, 20,367 adolescents remained. That substantial attrition was a deliberate trade-off: the author prioritized internal validity, accepting that the final sample disproportionately excluded Black students, younger teens, and those in earlier grades, in exchange for a dataset in which every confounder could be fully accounted for.

What sets this analysis apart technically is its use of overlap propensity score weighting, a statistical technique designed to mimic the balance achieved in a randomized controlled trial. Rather than simply adding covariates to a regression model, the study estimated each adolescent’s probability of belonging to a given sexual orientation group based on more than 40 suicidality-related characteristics, including demographics, sleep and eating patterns, physical activity, substance use, risky sexual behaviors, violence exposure, and risk-seeking behaviors such as texting while driving or carrying weapons. Overlap weights then re-weighted the sample into a pseudo-population in which heterosexual, bisexual, homosexual, and unsure-orientation youth were statistically comparable on all measured variables. Among several weighting schemes tested, overlap weights performed best, driving all absolute standardized differences below the conventional 0.10 threshold for adequate balance.

The descriptive picture that emerged was sobering. In the analysis sample, 24.25 percent of adolescents reported seriously considering suicide in the past 12 months, 16.31 percent had made a suicide plan, 28.78 percent reported at least one attempt, and nearly 29 percent experienced persistent sadness or hopelessness lasting two weeks or more. Before any adjustment, bisexual youth stood out as the highest-risk group across nearly every domain: they reported the highest rates of suicidal ideation, planning, attempts, and sexual victimization, along with elevated substance use and risky sexual behaviors. Homosexual students experienced the highest levels of non-sexual victimization, while adolescents unsure of their orientation also showed elevated risk profiles across multiple domains.

After weighting, the disparities in suicidal thinking remained striking. Bisexual, homosexual, and unsure-orientation youth all showed significantly higher adjusted odds of suicidal ideation and planning compared with heterosexual peers, with odds ratios ranging from 2.06 to 4.19. Homosexual identity was associated with the highest adjusted odds of ideation (3.41) and planning (4.19) once victimization and hopelessness were accounted for. Bisexual youth were 26.7 percent more likely than heterosexual youth to report suicidal ideation even after balancing the full covariate set. Notably, however, the pattern for actual suicide attempts was far less consistent, with adjusted odds ratios ranging from 0.89 to 1.46 across groups, and unsure-orientation youth actually showing lower odds of attempts than heterosexual peers.

The study’s theoretical framing drew on general strain theory and its extension, queer general strain theory, which hold that victimization is the most consequential external strain producing negative emotions and maladaptive coping, including suicidality. This framework, combined with minority stress theory, suggests that sexual minority youth are not inherently prone to suicide; rather, their elevated rates reflect a disproportionate burden of stigma-related stressors. The analysis also confronted a competing explanation: some researchers argue that genetic predispositions, adverse childhood experiences, or developmental vulnerabilities that predate identity formation may partly account for the disparities. By balancing an unusually wide array of observed confounders, the study sought to narrow the space for such alternative accounts, though it acknowledged that unmeasured biological and early-life factors cannot be ruled out.

The central analytical question concerned moderation: does the link between victimization or hopelessness and suicidality differ by orientation? Across all groups, both stressors were robustly associated with suicidal ideation and planning, with odds ratios between 1.73 and 3.32. But the interaction tests told a more complicated story. For bisexual youth, the association between total victimization and suicide outcomes was significantly attenuated compared with heterosexual peers, a buffering pattern that also held for non-sexual victimization among unsure-orientation youth. Yet for homosexual youth, the picture reversed depending on the stressor type: homosexual identity buffered the link between non-sexual victimization and suicide planning, but amplified the association between sexual victimization and all suicide outcomes, and strengthened the link between hopelessness and actual attempts. Sexual victimization appeared particularly toxic for unsure-orientation youth, exacerbating risk for ideation and attempts.

An exploratory supplementary analysis using the 2023 survey, the only year measuring transgender identity, offered preliminary insights into an especially vulnerable population. Among 5,819 complete cases, transgender youth showed dramatically elevated adjusted odds of suicidal ideation (2.73) and planning (5.21) compared with heterosexual youth, yet paradoxically lower odds of attempts (0.34). Victimization showed weaker associations with suicide outcomes among transgender youth, while hopelessness was more strongly correlated with ideation and planning. The author emphasized that these transgender-specific estimates carry wide confidence intervals due to the small subgroup size and limited covariate overlap, and should be interpreted with considerable caution.

Perhaps the most consequential finding is what the interactions did not show. Most interaction terms were statistically non-significant and inconsistent in direction, suggesting that sexual minority youth do not possess a unique or heightened susceptibility to the effects of victimization and hopelessness. Instead, the disparities appear to be driven largely by differential exposure: bisexual, homosexual, and unsure youth simply encounter more victimization and more hopelessness than heterosexual peers. This distinction matters enormously for prevention, because it implies that reducing exposure to bullying, sexual violence, and discrimination could meaningfully narrow the gap, rather than requiring orientation-specific psychological interventions.

The study’s limitations temper these conclusions. The cross-sectional design cannot establish temporal order, and reverse causation remains possible, since chronically suicidal adolescents may be more likely to perceive and report victimization and hopelessness. Overlap weighting balances only measured covariates, leaving residual confounding by genetic liability, family processes, school climate, and structural stressors unaddressed. Sensitive self-reported measures are vulnerable to recall bias, social desirability, and differential nonresponse, with non-response on suicide attempts running higher among homosexual students than heterosexual ones, raising the possibility that the highest-risk respondents go uncounted. Sexual identity was measured by self-identification alone, without capturing attraction or partner gender. Still, sensitivity analyses using multiple imputation across 60,278 cases reproduced the complete-case findings, strengthening confidence in the core results. The author calls for longitudinal research incorporating richer contextual and biological measures to clarify the mechanisms that keep sexual orientation independently associated with suicidal thinking even after more than 40 risk factors have been balanced away.

Subject of Research: Sexual orientation differences in the associations of victimization and hopelessness with adolescent suicidality in U.S. Youth Risk Behavior Survey data

Article Title: Do Victimization and Hopelessness Relate to Suicidality Differently Across Sexual Orientation? Evidence from the 2015–2023 U.S. Youth Risk Behavior Surveys

Article References: Wang, W. (2026). Do Victimization and Hopelessness Relate to Suicidality Differently Across Sexual Orientation? Evidence from the 2015–2023 U.S. Youth Risk Behavior Surveys. Archives of Sexual Behavior. https://doi.org/10.1007/s10508-026-03534-x

Image Credits: AI Generated

DOI: 10.1007/s10508-026-03534-x

Keywords: suicidality, sexual orientation, bisexual youth, victimization, hopelessness, Youth Risk Behavior Survey, adolescent mental health, minority stress, propensity score weighting, transgender youth, suicide prevention, Archives of Sexual Behavior