(PS13-35) Suicidal Ideation, Depressive Symptoms, and Stress Among Psychiatrically Hospitalized Sexual Minority and Heterosexual Adolescents

Although sexual minority (SM) youth report higher rates of suicidal ideation (SI) and depression compared to their heterosexual peers, few studies have examined whether SM identity is related to increased severity of SI or depressive symptoms among psychiatrically hospitalized adolescents, or whether the severity of symptomatology remains elevated in the high-risk period following hospital discharge. Minority stress theory suggests that stress related to minority identity (e.g., peer victimization, family rejection) can increase the risk of multiple stress-related health conditions, including depression and SI. The goal of this study is to compare SI, stress, and depressive symptoms among SM and heterosexual youth, as well as examine SI trajectories and stress over time following hospitalization. We hypothesized that sexual minority-identifying youth would endorse significantly higher levels of SI, depressive symptoms, and stress in comparison to their heterosexual peers across all time points.

Psychiatrically hospitalized adolescents (N=180; 71.7% assigned female at birth [AFAB]) were followed 18 months after being discharged. There were 75 (41.7%; 67 AFAB) participants who self-identified as a sexual minority (i.e., gay, lesbian, bisexual, pansexual, etc.). SI was assessed at baseline, 3, 6, 12, and 18 months. A measure of depressive symptoms and semi-structured interviews assessing family and peer stress were conducted at baseline, 6, and 12 months. SI trajectory classes were derived using semi-parametric group modeling.  

A series of independent sample t-tests revealed that SM status is positively related to depressive symptoms at baseline and 6-month, but not at 12-month follow-up. SM status was positively related to SI at baseline, 3, 6, and 18-months following hospital discharge. We found no significant differences in SI severity at 12-month follow-up. Participants identifying as sexual minority had significantly higher chronic family stress at baseline and 6-month follow-up, but not 12-month follow-up. Sexual orientation was not related to higher chronic peer stress at any time point. SM status was included as a predictor of trajectory class in a polynomial logistic regression model. SM adolescents were more likely to be in the declining SI class (i.e., high SI at baseline that declines over time) relative to the subthreshold class (i.e., subthreshold SI across time points). However, SM adolescents are not more likely to be in the chronic SI class (e.g., high SI across time points) relative to the declining SI class.

Consistent with current literature, we found that even among highly acute adolescents, those identifying as sexual minorities endorse more severe depressive symptoms, family stress, and SI than their heterosexual peers. While sexual orientation is not more likely to predict membership in the chronic SI trajectory class, sexual minority participants were more likely to experience higher SI at baseline that declined over the study period. Surprisingly, we did not find that peer stress was related to sexual orientation. Future research in this area would benefit from a more racially diverse sample to promote better generalizability and allow for the exploration of intersectionality in SM mental health.