On August 12, the Centers for Disease Control (CDC) released results from the 2015 Youth Risk Behavior Surveillance Survey (YRBS), a biannual poll designed to monitor high school student health. For the first time ever on the poll's national version, states and schools were given the option to include questions about respondents' sexuality.
Results, predictably, were grim. In almost every facet of their personal health, LGB students fare worse than their peers. Twenty-three percent reported experiencing sexual dating violence, and 18 percent reported experiencing physical dating violence, compared with 9 percent and 8 percent of heterosexual students, respectively. More than 10 percent said they've had to miss school at least once during the past month out of concern for their safety.
Perhaps most shocking was the data pertaining to suicide: Some 29.4 percent of LGB students tried to kill themselves in 2015, almost five times as many as straight students. And 42.8 percent experienced some form of suicidal ideation.
"This is a trend that we've seen in a number of smaller reports using data that's not nationally representative: LGB youth experience negative health outcomes far more than their heterosexual peers," Kristin Holland, a health scientist in the CDC's Division of Violence Prevention, told VICE. "The national data just adds evidence to our understanding."
The CDC report "paints a picture of marginalization" in every aspect of LGB high school students' lives, said Dr. Ann P. Haas, a senior consultant to the American Foundation for Suicide Prevention (AFSP). "It's a question of being marginalized, really, both in terms of young people's inner sense of who they are and how they're treated by others. There's a psychological and emotional component that we see when looking at suicide among all other groups, and it's even more prevalent here."
While the survey's results were revelatory to some, and merely further evidence of conclusions already known to others, it provokes a more alarming series of questions about the ways in which we still fail to fully comprehend the scope of LGBTQ health risks in America.
"We'd expect to see this sort of disturbing trend decline. It's striking that it hasn't—it seems just as likely to occur today as it did in the 1970s, from what we can tell—but we can't be totally sure at the moment." —Dr. Ann P. Haas
While the YRBS is the first national survey of its kind, it still includes a limited patchwork of state and local surveys, conducted with varying methods of data collection and analysis that distort how the government evaluates sexual minorities. And beyond the YRBS, other data collection efforts on LGBTQ suicide and health risks are haphazard at best.
The YRBS may measure suicidal ideation and suicide attempts among LGB youth, but the CDC has minimal data on actual LGBTQ suicide mortality for a simple reason: Death certificates rarely include sexual orientation. And the YRBS, including the upcoming 2017 survey, doesn't collect information about gender orientation, leaving transgender Americans—some 41 percent of whom have attempted suicide, according to the AFSP—effectively invisible to CDC officials. The New York Times reported that the CDC has said a question asking about gender identity "might be ready for a pilot test in 2017."
The best data the CDC has on LGBTQ youth suicide rates might be from their Division of Violence Prevention's National Violent Death Reporting System (NVDRS), which collects data on violent deaths in 32 states. (According to Holland, the agency is hoping to expand such data to all 50 states in the next few years.) But the NVDRS depends on reports from medical examiners and law enforcement, meaning sexual orientation and gender identity isn't consistently or uniformly collected. Instead, researchers depend on "mini-psych autopsies" performed by law enforcement officials, with their own overlapping jurisdictions and reporting systems—and their own sets of incentives and insensitivities when it comes to dealing with marginalized populations.
"The NVDRS collects circumstantial data through reports by coroners, medical examiners, and law enforcement," said Holland. "If a police officer does interviews to understand circumstances around the death, they're usually speaking to next of kin, acquaintances, neighbors, witnesses. Unfortunately, this means we're limited in our qualitative analysis to what those people knew and what they felt comfortable sharing with the police."
The limited nature of such data complicates the work of officials and researchers who deal in public health, and for whom LGBTQ suicides demand an informed policy response. Haas in particular coauthored a 2011 study in the Journal of Homosexuality that found that LGBTQ Americans showed a lifetime propensity for anxiety, mood swings, and mental health disorders well beyond adolescence. But without proper data collection on the part of health agencies, it's hard to understand suicide as a lifelong problem for marginalized communities, or how America's changing attitudes toward homosexuality may be trickling down to the crucible of the schoolyard.
"I wish we had a longitudinal study to draw on," said Haas. "For a while, [researchers] thought that the cultural climate improved and LGBT people weren't facing the same overt limitations and discrimination. We'd expect to see this sort of disturbing trend decline. It's striking that it hasn't—it seems just as likely to occur today as it did in the 1970s, from what we can tell—but we can't be totally sure at the moment."
In the end, it will require a comprehensive, federal-level data collection effort to truly understand the scope of LGBTQ suicide in our rapidly changing country. "There are major regional differences in whether your life has become better or worse," said David Bond, vice president for programs at the Trevor Project, an organization focused on suicide prevention among LGBTQ youth. Bond points out that states have passed more anti-LGBTQ legislation since last year's Supreme Court marriage equality ruling than in any other year. "If you live in a major urban center, things have gotten better, because acceptance is on the rise and protective policies and interventions are going up. But that's not always the case in isolated, conservative communities."
By encouraging school districts and local governments to adopt LGBTQ-inclusive policies and general suicide prevention programs, said Bond, regional officials and organizations like the Trevor Project are working to better the experience of LGBTQ teens. But until the data collection practices of the CDC and other agencies improve, it remains to be seen whether increased national and urban acceptance of LGBTQ Americans has a positive effect where it matters most—in our nation's schools and outside its urban cores.
Correction: An earlier version of this article mistakenly stated that states and schools were given the option to include questions about respondents' sexuality for the first time ever. It was the first time ever on the national Youth Risk Behavior Survey; the option was previously available for state and large urban school district surveys. It also stated the CDC declined to tell VICE which states refused to ask questions on student sexuality; the CDC cannot speak for individual state or school districts regarding their reasons for including or not including certain questions on their state or local Youth Risk Behavior Survey.
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