Suicidal thoughts and behaviours in adolescents and young adultsdisentangling the role of gender and sexual orientation

Resumen

Suicide is the second leading cause of death among 15- to 29-year-olds. Male youths have higher risk for suicide compared to females, whereas females are at greater risk for suicidal ideation and suicide attempts. Mental disorders have been identified as one of the strongest predictors of suicidal thoughts and behaviours (STB). Among youth, sexual minority (LGB) individuals are a high-risk subpopulation because they face specific stressors (e.g. discrimination, victimisation) that further increase the probability of STB. Evidence about suicide risk and whether there are possible mechanisms by which some factors increase or diminish the risk according to gender or sexual orientation is scarce. The general aim of this doctoral thesis is to provide new evidence about the risk for STB and potential risk and protective factors associated with STB among adolescents and young adults; and how these vary according to gender and sexual orientation. To achieve this aim we carried out a systematic review of the literature, followed by a meta-analysis, and we analysed empirical data from a cohort study (UNIVERSAL: University and Mental Health) of Spanish university students. The results show that female adolescents and young adults are at greater risk for suicide attempts compared to males. As already well known through information provided by vital statistics registries, males are at higher risk for suicide. Risk and protective factors for STB differ by gender. Internalising disorders and interpersonal difficulties increase the risk among females, while externalising disorders, hopelessness and some stressful life events (e.g. death of any of the parents) are found to be related to STB among males. In addition, family and peer support are found to be protective factors for suicidal ideation, but only among females. LGB youth have higher risk for STB compared to heterosexuals. This risk is mediated by childhood maltreatment, bullying and a previous history of any mental disorders. Perceived sexual orientation discrimination increases the risk for any mental disorder, which, in turn, carries risk for suicidal ideation. There is a need to better understand the mechanisms underlying gender differences in the association between STB and anxiety, violence between parents, hopelessness and family support. In addition, a knowledge gap remains in terms of the protective factors of STB for adolescents and young adults. Further research in this regard is definitively needed. This thesis has provided new evidence on a wide range of individual and community risk and protective factors for STB among adolescents and young adults, and has detected important differences across gender and sexual orientation with regard to STB risk. These results suggest that there is a need to combine preventive strategies focusing on individual risk factors (e.g. early diagnosis and treatment of mental disorders) with those with a public health population-level risk prevention approach (e.g. reinforcing community protective factors), as well as to consider the specific needs of high-risk groups.