Dissertations & Theses (Open Access)

Date of Award

Summer 8-2020

Degree Name

Doctor of Philosophy in Nursing (PhD)


Diane M. Santa Maria, DrPH

Second Advisor

Rebecca Casarez, PhD

Third Advisor

Ryan M. Hill, PhD

Fourth Advisor

Melissa F. Peskin, PhD


Background: Lesbian, gay, and bisexual (LGB) youth face a disproportionate risk of suicidal ideation and attempt compared to their heterosexual counterparts. The Minority Stress Theory and Interpersonal Theory of Suicide posit that chronic stress, which can occur as a result of bullying victimization, can lead to loneliness, self-hate, and suicidal ideation. The escalation from ideation to attempt can occur quickly, and most youth who survive suicide attempts pursue subsequent, riskier attempts. It is crucial to intervene when behaviors are less severe. The primary aim of this study was to compare the magnitudes of association between independent variables (bullying and sexual orientation subtypes) and three progressively worsening suicidal behaviors: suicidal ideation, attempt, and attempt resulting in a medical injury. A secondary aim was to examine potential interactions between (bullying x sexual orientation) and between (bullying x sexual orientation x gender).

Method: A secondary analysis of the 2017 Youth Risk Behavior Survey (N=14,765) was performed. Outcome variables were suicidal ideation, attempt, and attempt resulting in a medical injury. Main independent variables included cyberbullying, in-school bullying, sexual orientation and gender. Race/ethnicity, age, screen time, and sadness were controlled. Outcomes were evaluated through chi-square tests and binomial logistic regressions. Interactions were tested for significance. A cumulative ordinal logistic regression determined which characteristics were associated with progressively worse forms of suicidal behavior.

Results: Bivariate results indicated that bisexual youth experienced suicidal ideation and attempts more often than lesbian, gay, heterosexual, and youth who were unsure of their orientation. However, when an attempt was made, lesbian and gay youth were more likely to sustain a medical injury. With bullying and other covariates controlled, LGB youth were approximately three times as likely to ideate and twice as likely to attempt suicide compared to heterosexual youth. The severity of suicidal behavior was greatest when adolescents were bullied both in school and online. Sexual orientation significantly modified the effect of bullying on suicidal ideation when 1) the bullying occurred at school and the victim identified as bisexual, and 2) when the bullying occurred via cyberspace and the victim identified as lesbian/gay. Gender did not interact with bullying or sexual orientation.

Conclusion: Additional assessment is required to uncover the tipping points that escalate decisions from ideation to attempt, and from less injurious to more lethal forms of attempt. Lesbian and gay youth may face a higher risk of engaging in lethal forms of suicide attempt compared to other sexual minority subtypes. Bullying victimization formats may affect sexual minority subtypes differently, underscoring the need to examine them as distinct groups. Many LGB high school youth were bullied both in school and online, emphasizing the need to create cultures of acceptance at school.


suicidal ideation, suicide attempt, sexual minority, bully, adolescent, youth

Included in

Nursing Commons



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