BROWN, SARAH BLEAM. The Relationship Between Sexual Identity and Suicidal Ideation: The Moderating Effect of Bullying Victimization. (Under the direction of Dr. Eui Kyung Kim).
Sexual minority youth who identify as lesbian, gay, bisexual, or questioning (LGBQ) are at
elevated risk for negative psychological outcomes compared to their heterosexual peers; LGBQ
youth report higher depression, anxiety, suicide risk, discrimination, and victimization than
heterosexual youth, particularly during late adolescence. Bullying victimization can act as a
potential risk factor to negative emotional outcomes in both heterosexual and LGBQ youth.
Thus, the current study examined the moderating effect of bullying victimization on the relation
between sexual identity and suicide risk using the Youth Risk Behavior Survey. Participants
included a sample of 4,053 9th-12th grade students across the United States from public and
private high schools. A hierarchical logistic regression revealed sexual identity as a predictor of
suicide ideation; sexual minority participants (gay and lesbian, bisexual, or questioning) were
more likely to report suicide ideation compared to heterosexual participants when controlling for
demographics. Bullying victimization significantly predicted suicide ideation, but it did not
moderate the relationship between sexual identity and suicide ideation. Discussions of findings,
implications, and future directions for researchers and practitioners are discussed.
© Copyright 2020 by Sarah Bleam Brown
Bullying Victimization
by
Sarah Bleam Brown
A submitted to the Graduate Faculty of North Carolina State University
in partial fulfillment of the requirements for the degree of
Master of Science
Psychology
Raleigh, North Carolina 2020
APPROVED BY:
_______________________________ _______________________________ Dr. Eui Kyung Kim Dr. Kate Norwalk
Committee Chair
_______________________________ Dr. Mary Haskett
DEDICATION
I dedicate this work to my loving husband, Tomo, who inspired me with hope, courage, and
determination to complete this project. Thank you for everything you have done and continue to
BIOGRAPHY
Sarah Bleam Brown received her Bachelor of Arts in Psychology at Western Kentucky
University where she researched bullying victimization and mental health outcomes for youth in
elementary schools. She is currently a second-year doctoral student in the School Psychology
Program at North Carolina State University where she serves as a Student Leader for the
National Association of School Psychologists and member of the Social Justice Task Force. Her
current research interests include mental health screening and resiliency in schools as well as
evidence-based practices for supporting populations of diverse backgrounds. Following the
completion of her doctorate, Sarah hopes to provide clinical mental health assessment services
for at-risk populations in the Southwest region. Sarah currently lives in Raleigh, NC with her
husband and two adorable cats. She and her husband enjoy missions work and spending time
TABLE OF CONTENTS
LIST OF TABLES ... v
Introduction ... 1
Brief Overview ... 1
Sexual Identity and Suicide Risk ... 2
Bullying Victimization ... 4
Proposed Study ... 7
Methods ... 8
Participants ... 8
Measures ... 9
Procedures ... 10
Data Analytic Strategy ... 10
Results ... 11
Descriptive Statistics ... 11
Bullying Victimization ... 11
Suicide Ideation ... 12
Sexual Identity ... 13
Hierarchical Logistic Regression ... 13
Model 1: Demographics ... 13
Model 2: Sexual Identity ... 14
Model 3: Victimization as a Moderator ... 15
Discussion ... 16
Results ... 16
Implications for Researchers and Practitioners ... 17
Limitations ... 20
Conclusions ... 21
LIST OF TABLES
Table 1 Descriptive Statistics and Chi Square Summary ... 30
Introduction Brief Overview
Suicide is the second leading cause of death in adolescents, according to the Centers for
Disease Control and Prevention (CDC, 2017). Suicidal risk, defined by suicidal ideation,
planning, and attempt, has unfortunately been found common in sexual minority populations
(DeCou & Lynch, 2018). Ballard, Jameson, and Martz (2017) investigated the prevalence of risk
behaviors in both heterosexual and lesbian, gay, bisexual, and questioning (LGBQ) youth in rural
high school populations in the southeastern United States using the Youth Risk Behavior Survey.
Risk behaviors included suicide risk, bullying victimization, school violence, drug use, and risky
sex. Results indicated that students who identified as LGBQ reported significantly higher
likelihoods of all risk behaviors than heterosexual students; they were five times as likely to
report suicide risk factors. This was also consistent with a hospitalized, psychiatric sample of
adolescents; LGBQ status was also a significant predictor of attempted suicide – more than three
times as likely compared to heterosexual youth (DeCou & Lynch, 2018).
The formation of one’s sexual identity is a fluid and complex process that involves many
unique steps to create congruence in one’s cognition and behavior, particularly for a child
(Rosario, Schrimshaw, Hunter, & Braun, 2006). Youth who identify as LGBQ may have
difficulty finding acceptance in a community that supports their orientation (Rosario et al.,
2006), and thus, are at higher risk of negative outcomes than youth who identify as heterosexual
(Salomaa & Matsick, 2019). According to the minority stress model, sexual minorities,
henceforth used to describe those who identify as LGBQ, report higher external and internal
stressors related to their minority status that contribute to mental health problems such as anxiety
such as concealing one’s identity to friends and family or internalizing stigma attached to
adopted labels can contribute to emotional difficulties in sexual minority youth (Salomaa &
Matsick, 2019). Likewise, external, social stressors can exacerbate the relationship between
internal stressors and emotional difficulties (Borgogna et al., 2019). Bullying victimization, a
potential external stressor, can serve as a risk factor for negative mental health outcomes with
adolescents (Schneider, O'Donnell, Stueve, & Coulter, 2012). Sexual minority youth typically
experience victimization to bullying at higher rates than heterosexual-identifying youth in the
United States (CDC, 2017).
Recognizing these unique challenges LGBQ youth may face and their impacts on youth
mental health, identifying contributing factors to mental health concerns within LGBQ youth has
become a pressing topic in current research. Previous studies identified discrepancies in
victimization experiences and suicide risk in sexual minority and majority adolescents. In
addition, studies have discussed bullying victimization as a potential mediator between sexual
identity and suicide risk. However, limited research exists discussing the differential impact of
bullying victimization on emotional outcomes depending on a child’s sexual identity with a large
nationally representative sample. The current study will investigate bullying victimization as a
moderator to suicide ideation and sexual identity. The results of this study will elucidate
potential risk factors contributing to emotional outcomes for youth in hopes to support evidence
for bullying and mental health interventions in school settings.
Sexual Identity and Suicidal Risk
Recent trends for suicide risk in high schools indicate significant disparities in the
experiences of heterosexual and sexual minority youth (CDC, 2015). In a national, representative
had seriously considered suicide comparative to 14.8 percent of heterosexual adolescents (CDC,
2015). Sexual minority youth also reported greater frequency of suicide planning and suicide
attempt compared to their heterosexual peers; within the sexual minority population, youth
identifying as bisexual and female reported the greatest suicide risk. Similar findings have been
reported with various sexual minority populations (Decou & Lynch, 2018; Rimes, Shivakumar,
Ussher, Baker, Rahman, & West, 2018).
As previously mentioned, sexual minorities experience greater internal (proximal) and
external (distal) stress that has potential psychological impacts such as suicidality (Meyer, 2013).
Sexual minority youth experience higher rates of anxiety and depression than heterosexual
youth, which is highly comorbid with suicide risk behaviors (Borgogna et al., 2019; Van Orden
at al., 2010). In a recent meta-analytic review of reported depressive symptoms and depressive
disorders in heterosexual and sexual minority youth, sexual minority youth reported higher rates
of both depressive symptoms and depressive disorders compared to heterosexual youth across
population-based samples (Lucassen et al., 2017). In a lifetime, sexual minority individuals are
1.5 times more likely to have anxiety and depression than heterosexual individuals (King et al.,
2008) and are more likely to utilize psychological services (Balsam, Beauchaine, and Rothblum,
2005). Proximal stressors such as internalized heterosexism – discrimination based on the belief
that heterosexual relationships are the norm – and feelings of guilt or shame about one’s sexual
orientation can predict these experiences (Puckett et al., 2017). Likewise, according to the
interpersonal theory of suicide risk, thwarted belongingness, which serves as a proximal and
distal stressor, and perceived burdensomeness serve as primary risk factors to suicide;
they are not needed or wanted are at higher risk of suicide ideation, suicide attempt, low
self-esteem and shame (Van Orden et al., 2010).
Not only are sexual minority youth at increased risk of psychological distress, but they
also experience more social stressors such as peer victimization at school that can serve to
moderate the relationship between their sexual identity and mental health (Ballard et al., 2017).
For example, the number of friends and social support has been found related to decreased risk
of suicide, while by contrast, social isolation – often a result of victimization experiences –
serves as a risk factor (Van Orden et al., 2010). Overall, higher frequency of bullying
victimization experiences is associated with worse mental health outcomes in youth (Evan,
Smokowski, & Cotter, 2014); of the greatest concern, bullying at schools can significantly
moderate suicide risk in youth with greater impact for those identifying as sexual minorities
(Kodish et al., 2016).
Bullying Victimization
Bullying victimization can include verbal harassment, physical aggression, or exclusion
from a group (Olweus, 2017) and is considered a stressful life event that impacts the
vulnerability of a child to negative outcomes (Swearer & Hymel, 2015) such as depression and
anxiety (Evans, Smokowski, & Cotter, 2014; Haltigan & Vaillancourt, 2014) as well as violence
with youth (Kodish et al., 2016). Concomitant with aforementioned outcomes, victimization to
bullying is associated with increased suicide risk in adolescents (Bannink et al., 2014; Kodish et
al., 2016). Kodish et al. (2016) investigated the relationship between bullying victimization,
depression, and sexual identity in a psychiatric sample of 5,429 youth and young adults from
14-24 years old. LGBQ youth reported higher suicide risk with greater victimization and depressive
The social-ecological developmental model provides a theoretical framework to
understand the victimization experiences and increased suicide risk of LGBQ and heterosexual
youth (Bronfenbrenner, 1979; Swearer & Hymel, 2015). According to the model, a child’s
development is composed of individual and environmental factors that reciprocally influence one
another. For sexual minority youth, sexual orientation can serve as an individual factor
explaining the emotional difficulties they may experience (Salomaa & Matsick, 2019), while the
strength of the relationship may be affected by the social interactions they have within their
environments. School is the primary environment for adolescents to experience social
interactions (Olweus, 2017). Both sexual minority and heterosexual students are inevitably
exposed to positive and negative social interactions in school settings such as bullying
victimization (Swearer & Hymel, 2015); nearly 20 percent of all students report victimization to
traditional bullying at school (Olweus, 2017). However, their social interactions may not have
equal impacts on their emotional functioning.
Sexual minority youth report higher frequency of bullying victimization than their
heterosexual peers do (CDC, 2015). Likewise, they report more psychological distress in relation
to these experiences (Schneider et al., 2012), which may be due to individual factors such as
their sexual identity (Swearer & Hymel, 2015). For example, when LGBQ adolescents often
cognitively engage internalized homophobic views, they may perceive their sexual identity as the
basis of their victimization experiences, which can impact their mental health (Ballard, Jameson,
& Martz, 2017; Price-Feeney, Jones, Ybara, & Mitchell, 2018). Previous studies have supported
that perceptions of victimization and discrimination due to sexual orientation can contribute to
suicide risk in adolescents, as sexual minority adolescents are significantly more likely to report
2009). Common themes expressed by young adults have included “not feeling accepted where
one lives” and “bad reactions from the first friend they came out to”; lack of acceptance in peer
and/or community groups due to sexual orientation can contribute to victimization experiences
and mental health risk in students (Ballard, Jameson, & Martz, 2017). As adolescents connect
their victimization experiences to their sexual identity, they may feel more negatively towards
themselves.
These experiences can also be concurrent with violent acts or fear of violence in schools,
which can also predict suicide risk in adolescents (Goodenow, Watson, Adjei, Homma, &
Saewyc, 2016; Rimes et al., 2018). Barnett, Molock, Nieves-Lugo, and Zea (2019) investigated
risk factors associated with suicide risk in predominantly African American high school
populations in the northeastern United States. Sexual minority students self-reported suicide risk
behaviors, such as attempt, ideation, and planning. Sexual orientation, anti-LGBQ victimization,
peer victimization, and fear of violence at school were all significantly related to suicide risk.
Victimization to violence, defined as being threatened or injured by a weapon as well as physical
fighting, is also highly concurrent with bullying victimization, a recurring variable interacting
with these relationships (Goodenow et al., 2016). These experiences can have a synergistic effect
on the emotional difficulties of sexual minority youth.
LGBQ victimization experiences are not always based on their sexual orientation,
however, as victimization to bullying is unfortunately common despite individual factors like
sexual identity (Olweus, 2017). However, when LGBQ youth experience victimization, the
detrimental effects of bullying on their greater suicidal risk may be more severe (Meyer, 2013).
Individuals can perceive their victimization experiences are due to their sexual orientation, which
With LGBQ youth at higher risk of suicide, the disparities of victimization between sexual
minority and majority students in schools are alarming (CDC, 2015). Trends within the past
decade have supported a decrease in overall student bullying victimization and violence with
high school populations (Goodenow et al., 2016); however, there remain disparities with
heterosexual and LGBQ victimization outcomes with LGBQ youth experiencing greater
frequency of victimization and suicide ideation. Therefore, additional research targeting the
moderating effect of bullying victimization on suicide risk with vulnerable populations is
necessary to further support a growing body of literature imploring stakeholders to act on behalf
of victims. Furthermore, limited research examines this relationship in a generalizable sample.
Proposed Study
The objective of the proposed study is to examine the moderating effect of bullying
victimization on the relationships between each sexual minority status (lesbian and gay, bisexual,
and questioning vs. heterosexual) and suicidal ideation after controlling for demographics (race,
grade, and sex). Previous studies have primarily focused on the relationship of bullying
victimization as a potential mediator, in which there have been varying results, therefore this
study hopes to contribute to literature by examining the moderating effect of bullying
victimization. In addition, suicide ideation is a significant component of suicide risk; as this can
be a precursor to more harmful behaviors and evidence for early intervention, examining suicide
ideation is valuable to encourage preventative efforts by parents, schools, and others working
with students. Last, the current study hopes to integrate the rationale of several studies looking at
the aforementioned variables separately and replicate studies investigating the variables by using
RQ1) Is there a significant relationship between sexual identity and suicidal ideation
among high school students after controlling for demographics in a nationally representative
sample?
RQ2) Does campus bullying victimization moderate the relationship between sexual
identity and suicidal ideation among gay/lesbian, bisexual, and/or questioning high school
students after controlling for demographics in a nationally representative sample?
The current hypotheses are as follows:
H1) In a nationally representative sample, there will be a significant relationship between
sexual identity and suicidal ideation after controlling for demographics. Sexual minority (LGBQ)
students will be more likely to report suicidal ideation than heterosexual students. It is expected
that the relationship will be strongest for bisexual students.
H2) In a nationally representative sample, bullying victimization will significantly
moderate the relationship between sexual identity and suicidal ideation after controlling for
demographics. Regardless of race, grade or sex, it is expected that gay/lesbian, bisexual, and
questioning students with victimization will report suicidal ideation more than would
heterosexual youth with victimization.
Methods Participants
Data analyzed in this study were drawn from the 2017 Youth Risk Behavior Survey
(YRBS), a national survey funded by the CDC and administered by local high schools to
students across the United States (CDC, 2017). The 2017 YRBS dataset included all public and
private high school responses, including students from the 9th to 12th grade (N = 14,765), which
Of the total participants in the YRBS dataset, a random sample of 2,096 heterosexual
participants were selected to achieve an equivalent number of sexual majority and minority
participants; all sexual minority participants were included (n = 2,096). Data with missing cases (N = 52) were not included in the analyses, resulting in a final sample of 4,140 participants. Of the final sample, more than half of the students were female (59%). Additionally, 25% were in
9th grade, 26% were in 10th grade, 25% were in 11th grade, and 23% were in 12th grade.
Approximately 42% were white, 20% were black, 10% were Hispanic, 4% were Asian, 1% were
American Indian/Alaska Native, 1% were Native Hawaiian/Pacific Islander, 14% were multiple
race (Hispanic), and 6% were multiple race (non-Hispanic). Furthermore, half of the students
(50%) identified as heterosexual and half identified as LGBQ including gay or lesbian (9%),
bisexual (27%), and questioning (14%).
Measures
Demographics. Participants self-reported race, grade, and sex to determine demographic characteristics.
Sexual Orientation. Sexual orientation was measured using one item asking, “Which of the following best describes you?” Response options were “heterosexual (straight),” “gay or
lesbian,” “bisexual,” and “not sure.” Students who responded, “not sure” were categorized as
‘questioning.’
Suicide Ideation. Suicidal ideation was measured using one item asking, “During the past 12 months, did you ever seriously consider attempting suicide?” Response options were
Bullying Victimization. Bullying victimization was measured using one item representing traditional campus bullying. Participants were asked, “During the past 12 months, have you ever
been bullied on school property”, in which participants responded “yes” or “no.”
Procedure
The Youth Risk Behavior Surveillance System (YRBSS), developed in 1990, monitors
health-risk behaviors that contribute to negative outcomes, such as death and disability, in youth
across the United States. The 2017 YRBSS, including a questionnaire measuring 99
health-related behaviors as well as obesity and asthma, was administered to a national sample of 144
high schools from 50 states and the District of Columbia (CDC, 2017). Data was collected
during May through February of every odd-numbered year from surveys administered to a
three-stage clustered sample of state, territorial, and school districts. Classes or periods within the
schools were randomly selected to participate in the administration of the surveys. Data from
was then weighted to adjust for nonresponse items. For the purpose of this study, data analysis
commenced following approval from North Carolina State University's Institutional Review
Board.
Data Analytic Strategy
Initial descriptive statistics were performed to examine demographic and variables of
interest to this study. Potential multicollinearity was analyzed by utilizing the variance inflation
factor (VIF); no variables in the model increased risk of standard error, therefore all variables
were included in the model. In addition, Chi-Square analyses for demographic variables (sex,
grade, and race including questions regarding Hispanic descent), bullying victimization, sexual
identity, and suicide ideation were performed. Multi-level categorical variables were dummy
with ‘12th grade’ being the control group by which other categories were compared due to
literature linking less victimization experiences with older age (Olweus, 2017). Likewise,
‘White’ served as a dummy variable for race due to majority status. A hierarchical logistic
regression was conducted to test the moderating role of campus bullying victimization in the
relationship between sexual identity and suicidal ideation. Initial demographic variables were
included in Model 1, with sexual identity (Model 2) and bullying victimization (Model 3) added
incrementally. An interaction term for sexual identity and bullying victimization was created to
test for moderation in the third model. Outliers were detected for several variables of interest to
this study. Due to the large sample size and concerns for distortion of natural distribution of the
data, outliers were not removed from the study. All analyses were conducted using SPSS
Statistics (IBM SPSS Statistics 25 for Windows).
Results Descriptive Statistics
Bullying Victimization
Of the participants, 22.3% reported victimization to campus bullying. A Chi-Square test
of independence (outlined in Table 1) revealed that the relation between sex and bullying
victimization was significant, χ2 (1, N= 4,140) = 11.30, p <.001. Females were more likely to report campus bullying victimization (n=597, 24.3%) than males (n=336, 19.91%), while males
reported less victimization than expected (b = -2.3). In addition, the relation between 9th grade identification and bullying victimization, χ2 (1, N= 4,140) = 13.57, p <.001, and 12th grade identification and bullying victimization, χ2 (1, N= 4,140) = 31.73, p <.001, was also significant. Results suggest a significant difference in the proportion of 9th and 12th grade participants
expected (b = -4.4) and is considered a potential outlier. Other grades were not significant. Last, the relations between Asian race, χ2 (1, N= 4,140) = 8.54, p =.003, African American race, χ2 (1, N = 4,140) = 27.52, p <.001, Hispanic race, χ2 (1, N = 4,140) = 11.15, p =.001, and White race, χ2 (1, N = 4,140) = 26.10, p <.001, and campus bullying were significant. White participants reported significantly more bullying victimization than expected (n = 462, b = 3.4), while Asian (n = 24, b = -2.5), African American (n= 127, b = -4.1), and Hispanic (n = 65, b = -2.8)
participants reported significantly less bullying victimization than expected.
Suicide Ideation
Of the participants, 28% of participants reported they had considered suicide. A Chi
Square test of independence (refer to Table 1) revealed that sex was significantly related to
suicide ideation, χ2(1, N=4,071) = 117.27, p <.001. Females were more to likely to report suicide ideation than males (nearly two times more likely); approximately one-third of females (n=837,
34.2%) reported suicide ideation compared to 17.9% of males (n=290). In addition, 12th grade
identification, χ2 (1, N=4,071) = 5.46, p = .02, was significantly related to suicide ideation; twelfth grade participants were less likely to report suicide ideation that 9th grade participants (b = -1.7). Last, participants identifying as Asian, χ2 (1, N= 4,140) = 3.86, p =.05, African
American, χ2 (1, N = 4,140) = 27.41, p <.001, Hispanic, χ2 (1, N = 4,140) = 11.15, p =.001, and White, χ2 (1, N = 4,140) = 12.01, p =.001, and suicide ideation were significant. White
participants reported significantly more suicide ideation than expected (n = 536, b = 2.2), while African American (n= 167, b = -4.0), and Hispanic (n = 65, b = -2.8) participants reported significantly less bullying victimization than expected.
Sexual minority participants reported greater frequency of victimization to bullying
compared to heterosexual participants; while 16.8% of heterosexual participants reported
victimization, 30.7% of gay/lesbian participants (n = 107), 30.6% of bisexual participants (n =
342), and 22.8% (n =135) of questioning participants reported victimization to bullying. Sexual
identity and bullying victimization were significantly related with heterosexual participants, χ2
(1, N= 4,140) = 79.67, p <.001, reporting significantly less victimization than sexual minority participants (b = -5.5). Lesbian/gay participants, χ2 (1, N= 4,140) = 14.41, p <.001; b = 4.6, and bisexual participants, χ2 (1, N= 4,140) = 59.56, p <.001; b = 12.2, reported significantly more campus bullying victimization than heterosexual participants. Likewise, sexual identity also had
a significant relationship with suicide ideation (refer to Table 1); compared to heterosexual
participants, χ2 (1, N= 4,140) = 387.79, p <.001; b = -11.8, lesbian/gay participants, χ2 (1, N= 4,140) = 31.64, p <.001; b = 4.6, bisexual participants, χ2 (1, N= 4,140) = 281.23, p <.001; b = 12.2, and questioning participants, χ2 (1, N= 4,140) = 5.64, p = .02, b = 1.9, reported significantly greater suicide ideation than expected. Approximately 40.9% of gay/lesbian participants (n =
142), 47.2% of bisexual participants (n = 527), and 32.0% (n =188) of questioning participants
reported suicide ideation compared to 14.2% of heterosexual participants.
Hierarchical Logistic Regression Model 1: Demographics
A hierarchical logistic regression analysis was performed using SPSS to assess whether
sexual identity and victimization to campus bullying significantly affected whether or not a
participant reported suicide ideation when controlling for age, grade, sex, and race (refer to Table
2). In the first step, a test of the demographic model against the constant revealed that Model 1
Nagelkerke R2 = .06. With demographic predictors, 72.1% of cases were correctly predicted
(consistent with the constant); for participants who did not report suicide ideation, 99.9% of
cases were correctly predicted, while 0.2% of participants who reported suicide ideation were
accurately predicted. Female sex (OR = 2.35, Wald = 124.18, p <.001, 95% CI [2.03 – 2.74]) as well as African American (OR = .54, Wald = 35.65, p <.001, 95% CI [.44 - .66]), Asian (OR = .62, Wald = 6.35, p = .01, 95% CI [.42 - .90]), and Hispanic (OR = .66, Wald = 10.23, p = .001, 95% CI [.51 - .85]) race were significant predictors.
Model 2: Sexual Identity
When controlling for demographic information and adding sexual identity as a predictor,
the second model was significant with a moderate effect size, χ2 (15) = 544.24, p < .001,
Nagelkerke R2 = .18. Hypothesis 1 was supported; with sexual identity considered as a predictor, 74.4% of cases were correctly predicted. For participants who did not report suicide ideation, the
model correctly predicted 91% of group membership. For participants who reported suicide
ideation, the model accurately predicted 32.2% of cases. Sexual identity significantly enhanced
prediction of suicide ideation, p <.001; identifying as a lesbian/gay (OR = 4.43, Wald= 131.64, p <.001, 95% CI [3.43 – 5.71]), bisexual (OR = 4.78, Wald = 295.94, p <.001, 95% CI [4.0 – 5.71]) or questioning (OR = 2.71, Wald = 80.42, p <.001, 95% CI [2.18 – 3.37]) significantly predicted suicide ideation. Compared to their heterosexual peers, (OR = .23, Wald= 130.24, p <.001, 95% CI [.18 – .29]), participants who identified as bisexual were 4.78 times more likely to
report suicide ideation. Lesbian/gay participants were 4.43 times more likely to report suicide
Model 3: Victimization as a Moderator
Finally, when all predictor variables were considered together including bullying
victimization and its interaction with sexual identity, they significantly predicted whether or not
a participant reported suicide ideation at the time of the study, χ2 (19) = 772.39, p < .001. The model effect size was moderate to large, with Nagelkerke R2 = .25. With all predictors included in the model, 76.3% of cases were correctly predicted; for participants who reported no suicide
ideation, 94.1% of cases were accurately predicted whereas 30.3% of suicide ideation cases were
accurately predicted. When controlling for demographics, sexual identity significantly predicted
suicide ideation, p <.001; identifying as a lesbian/gay (OR = 4.05, Wald= 73.21, p <.001, 95% CI [2.94 – 5.58]), bisexual (OR = 4.63, Wald = 185.89, p <.001, 95% CI [3.72 – 5.78]) or
questioning, (OR = 2.73, Wald = 54.37, p <.001, 95% CI [2.09 – 3.57]) significantly predicted suicide ideation. According to this model, when compared to their heterosexual peers,
participants who identified as bisexual were 4.63 times more likely to report suicide ideation.
Lesbian/gay participants were 4.05 times more likely to report suicide ideation, while
questioning participants were 2.73 times more likely. In addition, bullying victimization
enhanced the prediction of suicide ideation (OR =.35, Wald = 5.28, p =.02, 95% CI [.14 – .86]); however, the interaction between bullying victimization and sexual identity was not significant
for each identification (Bisexual, p = .36; Lesbian/Gay, p = .80; Questioning, p = .77). Bullying victimization did not moderate the relationship, therefore Hypothesis 2 was rejected. Last,
Discussion Results
The present study replicates the findings of previous studies supporting the increased risk for
suicide for sexual minority populations (Decou & Lynch, 2018). Consistent with previous
findings (Rimes et al., 2018), identifying as a sexual minority (lesbian and gay, bisexual, or
questioning) significantly predicted suicide ideation when controlling for potential risk factors
such as female sex and other demographic variables. Unique to this sample, these results were
identified in a nationally representative sample of high school youth across the United States. As
expected, sexual minority youth reported significantly greater suicide ideation compared
heterosexual youth; although all sexual minority groups were significantly more likely to report
suicide ideation, bisexual youth were most likely. Bisexual individuals have previously been
identified to experience greater in-group and out-group rejection and greater negative mental
health outcomes than lesbian and gay individuals (CDC, 2015; Decou & Lynch, 2018); these
findings were mirrored in the current study.
Though no interaction was found between campus bullying victimization and sexual identity
in the final model, bullying victimization uniquely predicted and contributed to the strength of
the complete model’s prediction of suicide ideation. This finding builds off of previous literature
illuminating the significant relationship between bullying victimization and suicide ideation
while also controlling for potential risk factors and demographic variables (Almeida et al., 2009).
It is important to highlight that sexual minority youth were nearly twice as likely to report
bullying victimization experiences compared to heterosexual youth. Though bullying
victimization did not have a moderating effect on the relationship between suicide ideation and
The lack of interaction between bullying victimization and sexual identity in suicide ideation
potentially supports identities, and possibly the intersectionality of identities, as more salient
contributing factors to suicide risk. Victimization to bullying did not strengthen or weaken the
relationship between suicide risk, which could suggest a robust association between sexual
identity and suicide ideation. When looking at sexual identity and bullying victimization as
individual predictors, sexual identity was a stronger predictor comparatively.
Other variables could have influenced this relationship that were not analyzed for
moderation. For example, logistic interactions for sex were not tested for in this analysis;
however, sex was consistently a significant predictor of both bullying victimization and suicide
ideation. Previous scholarship has discussed female sex as a moderator to suicide risk and
discrimination and/or victimization experiences (Van Orden et al., 2010). Current findings
suggest that female sex increased the likelihood of reporting suicide ideation, therefore
supporting previous literature. In addition, compared to white students, African American youth
reported resilience to suicide risk, reflecting previous literature supporting lower rates of African
American suicidality (Utsey, Hook, & Stanard, 2006). Overall, future research should focus on
the intersectionality of identities as potential moderating and mediating variables associated with
suicide risk and bullying victimization.
Implications for Researchers and Practitioners
There are many implications of this study that have particular relevance to schools. Based on
these results, additional research is warranted to explicate the complexities of sexual
identification as they occur in school settings and identify supports and/or resilience factors for
sexual minority students in schools. As previously discussed, the relationship of elevated suicide
study; however, many studies examine this relationship within psychiatric, self-report samples
(Decou & Lynch, 2018; Peters et al., 2019) rather than the context of a school settings. As
schools are transitioning to support students from a preventative, mental health perspective,
recognizing the utility of schools to implement preventative methods (i.e., broad screening
measures) to address suicide risk is critical. Internalizing symptoms related to a child’s mental
health – such as suicide ideation - are best reported by the child themselves and are often
underreported by school staff (Perales, Campbell, & Johnson, 2020); therefore, self-report
screeners to identify students at-risk could ameliorate this disparity. Furthermore, as discussed
earlier in this paper, Van Orden and colleagues (2010) found that thwarted belongingness and
burdensomeness that individuals experience – which is in turn related to low self-esteem and
shame – serve as primary factors contributing suicide risk, and such experiences can especially
occur with sexual minority populations; however, both were identified as malleable when
addressed with intervention and reciprocally-caring relationships. Recent scholarship has
recognized the impact of school staff relationships on student well-being (Breeman et al., 2015;
Løhre, Lydersen, & Vatten, 2010; Sarkova et al., 2014). Future research should examine the
impact of school staffs’ open communication of support and inclusivity of sexual minority
students and implementation of inclusive curricula/events in their classroom, as these supports
positively affect sexual minority outcomes (Kosciw et al2014).
Acknowledging populations at risk of increased negative mental health outcomes and
promoting inclusivity of marginalized groups can be conducive to a positive school climate
(Kosciw et al., 2014). Schools are critical environments in which a child spends the majority of
his or her day throughout their young life. Results from this study specifically address school
minority students, with sexual minority youth at significantly elevated risk of experiencing
victimization. Overall, sexual minority youth are more likely to report feeling unsafe at school
and hear homophobic remarks from their peers (Rosario, et al., 2006). Though results of the
current study did not identify bullying victimization as a moderator of suicide ideation, it was a
predictor of suicide ideation and is associated with a myriad of negative outcomes (Ballard,
Jameson, & Martz, 2017); according to the Gay, Lesbian, and Straight Education Network
(GLSEN), sexual minority students who experienced elevated victimization were more likely to
miss school (more than three times as likely) and have lower grade point averages than their
non-victimized peers (Kosciw et al., 2014). Ultimately, multi-level bullying interventions leveraging
the impact of peer relationships and encouraging student intervention in bullying are critical to
supporting sexual minority youth in schools (Wernick, Kulick, & Inglehart, 2013). Last, bullying
victimization was the primary external factor analyzed in this study; however, other specific
external factors such as isolated incidences of violence at school were not examined (e.g.,
threatened with weapons on school property). Bullying victimization is considered a specific
type of violence that is repeated with the continuous intent to harm an individual; sexual
minority youth can experience both bullying and specific violent incidences at higher frequency
to their heterosexual peers (Goodenow et al., 2016), therefore both should be considered together
as potential risk-factors for future research.
Though sex and race were not primary variables of interest in this study, such identities
warrant further consideration and examination as potential risk/resilience factors in a child’s life.
Females are consistently identified as at higher risk of negative mental health outcomes and
internalizing behaviors, including suicide risk (CDC, 2015), and this was replicated in this
Interestingly, identities such as sex, race, and sexual orientation were stronger predictors of
suicide ideation compared to bullying victimization. Recognizing the influence of identities on
suicidal ideation, even in the absence of the interaction with bullying victimization, is crucial to
investigating risk factors to suicide. For example, male v. female identification, heterosexual v.
sexual minority identification, and White v. racial minority identification have unequal impacts
on mental health (Eaton, 2014; Meyer, 2013). To this author’s knowledge, limited research exists
examining such intersectionality between identities and their synergistic impact on suicide risk.
Future research should aim to elucidate these relationships and identify possible resilience
factors with diverse groups.
Limitations
Though the sample size, external validity, robust control of variables are significant
strengths of this study, the present study is limited in several ways. First, as with self-report,
cross-sectional analyses, the results are associative in nature and more limited to experimental
methods; therefore, the results should not be assumed to suggest causation of any kind. Second,
as this study primarily examined categorical variables, a logistic regression was utilized to
perform analyses; this analysis is less robust than other linear analyses and utilized a pseudo-R2 to argue for prediction. In addition, a binomial distribution was assumed and not tested for,
which implies that the same probability is maintained across the range of predictor values (Peng,
Lee, & Ingersoll, 2002). As mentioned previously, outliers were detected for several variables
and were not removed due to concerns for distortion of the categorical data, large sample size,
and the nature of social science data; however, this author acknowledges that outliers can
Due to focus on applicability to schools, cyberbullying was not analyzed or discussed in
this paper in relation to sexual identity. Cybervictimization is a unique type of bullying
victimization that is experienced concurrently with traditional bullying and can be concomitant
to negative outcomes experienced by youth (Olweus, 2017); it should be recognized that
omitting cyberbullying from these analyses could explain bullying victimization’s lack of
explanatory power. Furthermore, the questions included in these analyses are categorical, with
responses following a ‘yes’ or ‘no’ pattern. The vague nature of the questions limits
comprehensive understanding of the variables. For example, bullying victimization is best
measured in terms of frequencies (Olweus, 2014); however, respondents simply put whether they
had been bullied or not. Likewise, victimization specific to sexual identity was not enumerated in
the questionnaire; Meyer (2013) argues that sexual minority youth experience exponential stress
when victimization experiences (whether actual or perceived) are due to their sexual identity.
This information was not available in this secondary dataset.
Conclusions
This study hoped to contribute to literature by analyzing the impact of bullying
victimization above and beyond the impact of demographics on the expected relationship
between sexual identity and suicide ideation with a nationally representative sample. Sexual
identity, bullying victimization, female sex and African American race significantly predicted
suicide risk; however, bullying victimization did not moderate the relationship between sexual
identity and suicide risk. These findings identified lesbian/gay, bisexual, and questioning youth
as higher risk of suicide and bullying victimization than heterosexual youth. In addition, bisexual
youth had greater suicide ideation and bullying victimization than other sexual minority youth
risk of suicide compared to other sexual minority youth or heterosexual youth. Future research
should aim to acknowledge the impact of minority identification on mental health outcomes and
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Tables Table 1.
Descriptive Statistics and Chi Squares Summary
Variable Bullying Victimization Suicide Ideation
X2 N X2 N
Grade
9th 13.57*** 279 .66 302
10th 1.86 262 .09 299
11th .003 229 1.84 300
12th 31.72*** 148 5.46* 234
Sex (Female) 11.30*** 597 117.27*** 837
Race
American Indian .02 8 .04 9
Asian 8.54** 24 3.86* 38
African American 27.52*** 127 27.41*** 167
Native Hawaiian .01 7 1.17 12
Hispanic 11.15** 65 4.51* 95
White 26.10*** 462 12.01*** 536
Multiple Hispanic 1.43 140 1.85 172
Multiple Non-Hispanic
5.24* 71 5.23* 85
Sexual Identity
Heterosexual 79.67*** 349 387.79*** 295
Lesbian/Gay 14.41*** 107 31.64*** 142
Bisexual 56.60*** 342 281.23*** 527
Questioning .04 135 5.64* 188
Campus Bullying Victimization
355.29*** 484
Table 2.
Summary of Hierarchical Regression Analysis for Variables Predicting Suicide Ideation
Note. *p < .05, ** p < .01, *** p < .001.
Model 1 Model 2 Model 3
Variable B(SE) Wald OR B(SE) Wald OR B (SE) Wald OR
Grade
9th .13 (.10) 1.61 1.14 .18 (.11) 2.73 1.20 .02 (.11) .03 1.02
10th .06 (.10) .35 1.06 .07 (.11) .42 1.07 -.05 (.11) .21 .95
11th .20 (.10) 3.70 .95 .24 (.11) 4.75 1.27* .15 (.11) 1.70 1.16
12th -.18 (.10) 2.83 .84 -.21 (.11) 3.68 .81 -.05 (.11) .21 .95
Sex (Female) .86 (.08) 124.18 2.35*** .55 (.08) 44.32 1.73*** .57 (.09) 44.51 1.78***
Race
American Indian -.23 (.41) .40 .80 -.46 (.42) 1.23 .63 -.39 (.43) .84 .67
Asian -.49 (.19) 6.35 .62* -.41 (.20) 4.09 .67* -.24 (.21) 1.41 .78
African American -.61 (.10) 35.65 .54*** -.74 (.11) 47.98 .48*** -.60 (.11) 29.24 .55***
Native Hawaiian .24 (.38) .38 1.27 .30 (.41) .55 1.35 .39 (.42) .89 1.48
Hispanic -.42 (.13) 10.23 .66*** -.38 (.14) 7.66 .69** -.23 (.14) 2.81 .79
White -.31 (.19). 2.53 .11 -.10 (.20) .23 .91 -.14 (.21) .41 .87
Multiple Hispanic -.03 (.11) .07 .97 -.11 (.11) .88 .90 -.08 (.12) .42 .93
Multiple Non-Hispanic .12 (.15) .71 1.13 .05 (.16) .09 1.05 .05 (.16) .08 1.05
Sexual Identity
Heterosexual -1.48 (.13) 130.24 .23*** -1.39 (.16) 72.71 .25***
Lesbian/Gay 1.49 (.13) 131.64 4.42*** 1.40 (.16) 73.21 4.05***
Bisexual 1.56 (.09) 295.94 4.708*** 1.53 (.11) 73.21 4.63***
Questioning 1.00 (.11) 80.42 2.71*** 1.00 (.14) 54.37 2.73***
Bullying Victimization (BV) -1.05 (.46) 5.28 .35*
Sexual Identity x BV
Heterosexual x BV .08 (.29) .07 1.08
Lesbian/Gay x BV -.08(.29) .07 .93
Bisexual x BV -.18 (.20) .83 .83
Questioning x BV -.07(.25) .08 .93
