Decomposing sexual orientation disparities in suicidal ideation among Chinese adolescents
Zixu Li, Mengni Chen, Paul S.F. YipAbstract
Aims
Sexual minority adolescents consistently exhibit a higher prevalence of suicidality compared with their heterosexual peers. This study aims to decompose the disparity in suicidal ideation by quantifying the extent to which it is attributable to differences in exposure to risk and protective factors between heterosexual and sexual minority adolescents, as opposed to differences in their responses to these factors. In addition, this study addresses the limited evidence from Chinese contexts by examining these mechanisms among adolescents in Hong Kong.
Methods
Data were extracted from a population-based survey conducted among local secondary school students in Hong Kong in 2021, encompassing 6883 adolescents. Logistic regression examined the factors associated with suicidal ideation. Decomposition analysis assessed the contribution of these factors to disparities in suicidal ideation between heterosexual and sexual minority adolescents, as well as disparities between sexual minority boys and girls.
Results
Body dissatisfaction, cyberbullying, sexual harassment, perceptions of family life and academic performance were associated with suicidal ideation among adolescents, irrespective of their sex or sexual orientation. Approximately 31%–45% of the disparities in suicidal ideation were driven by differences in their exposure to risk and protective factors, and 55%–69% were driven by differences in how these factors relate to suicidal ideation and potentially unobserved characteristics. Among these factors, perceptions of family life played the most substantial role. Sex-specific patterns were also observed.
Conclusions
The higher prevalence of suicidal ideation among Chinese sexual minority adolescents appears to reflect both their greater exposure to stress and lower levels of support, as well as their distinct responses to these factors. Family-related factors are crucial for understanding this disparity. The observed sex differences emphasize the necessity for more nuanced approaches to addressing the varied experiences of sexual minority adolescents in Chinese societies.