title: The social environment and suicide attempts in lesbian, gay, and bisexual youth.
abstract: OBJECTIVE
  To determine whether the social environment surrounding lesbian, gay, and bisexual youth may contribute to their higher rates of suicide attempts, controlling for individual-level risk factors.
  
  
  METHODS
  A total of 31 852 11th grade students (1413 [4.4%] lesbian, gay, and bisexual individuals) in Oregon completed the Oregon Healthy Teens survey in 2006-2008. We created a composite index of the social environment in 34 counties, including (1) the proportion of same-sex couples, (2) the proportion of registered Democrats, (3) the presence of gay-straight alliances in schools, and (4) school policies (nondiscrimination and antibullying) that specifically protected lesbian, gay, and bisexual students.
  
  
  RESULTS
  Lesbian, gay, and bisexual youth were significantly more likely to attempt suicide in the previous 12 months, compared with heterosexuals (21.5% vs 4.2%). Among lesbian, gay, and bisexual youth, the risk of attempting suicide was 20% greater in unsupportive environments compared to supportive environments. A more supportive social environment was significantly associated with fewer suicide attempts, controlling for sociodemographic variables and multiple risk factors for suicide attempts, including depressive symptoms, binge drinking, peer victimization, and physical abuse by an adult (odds ratio: 0.97 [95% confidence interval: 0.96-0.99]).
  
  
  CONCLUSIONS
  This study documents an association between an objective measure of the social environment and suicide attempts among lesbian, gay, and bisexual youth. The social environment appears to confer risk for suicide attempts over and above individual-level risk factors. These results have important implications for the development of policies and interventions to reduce sexual orientation-related disparities in suicide attempts.
authors.affiliation: Mailman School of Public Health, Columbia University, 722 West 168th St, Room 1612, New York, NY 10032, USA. mlh2101@columbia.edu
authors.forename: Mark L
authors.initials: ML
authors.lastname: Hatzenbuehler
mesh_terms: D000293:Adolescent; D001727:Bisexuality / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D005260:Female; D054624:Health Status Disparities; D006306:Health Surveys; D020010:Heterosexuality / Q000706:statistics & numerical data; D018452:Homosexuality, Female / Q000706:statistics & numerical data*; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012725:Sexual Behavior; D012931:Social Environment; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data*; D014481:United States