Risk Factors and Intervention Strategies for Gay, Lesbian, Bisexual and Transgender Youth

July 6, 2007 at 3:00 pm  •  Posted in Suicide Prevention by  •  0 Comments

By Michael Langlois, MSW, LICSW

Risky Behaviors
GLB Youth and Suicide
How Social Workers Can Help GLB Youth
Selected Readings


This article identifies and examines risk factors for suicide, self-harm and substance abuse in gay, lesbian, bisexual and transgendered (GLBT) adolescents. According to research conducted over the last 20 years, these particular risk factors have not decreased over time, not even in the most liberal parts of the nation. The social worker’s interventions when working with this particular client population can make a crucial difference in reducing suicidal thoughts/attempts, self-harming behaviors, and substance abuse while providing support for those navigating one of the most difficult developmental stages of life.


Over the past 15 years, research has suggested that adolescence can continue into the third decade of life. As those of us who work with adolescents and their families can attest, getting there is half the battle. And while adolescence is a period of increased stress and excitement for a majority of youth, some definitely have more of a struggle on their hands than others. Eighty percent of all gay, lesbian, bisexual youth reported feeling severely isolated in a study by Hetrick and Martin in 1987, and of this 80 percent, half reported additional difficulties caused by their parents’ rejection due to their sexual orientation.

As a result of their families’ rejection, as many as 26 percent of gay, lesbian and bisexual (GLB) youth feel forced to leave home.  Up to 50 percent of gay males who leave home early engage in prostitution to support themselves, placing them at much higher risk for rape, assault and infection with HIV and other sexually transmitted diseases (STDs). Those who remain at home are not necessarily in a safer situation: 41percent of GLB youth in a 1990 study reported suffering violence from family, peers, or strangers, and 46 percent of these youth reported that the perpetrators of the violence toward them were members of their own families.

Schools often unwittingly or complicitly reinforce that it is not healthy or safe to be gay, lesbian, or bisexual. As recently as 1991, a study at Lincoln-Sudbury Regional High School in Boston revealed that 97 percent of the student body reported hearing anti-gay comments on campus.  Such disparaging and often prejudicial remarks are often ignored or, even worse, tacitly encouraged by faculty and administration.

Risky Behaviors

Not unlike their peers, GLBT adolescents often cope with the problems they encounter at home, school, or on the streets by using and often abusing alcohol and other drugs. In a study that tracked youth substance use over a three month span, 68 percent of the gay male adolescents reported alcohol use with 26 percent using one or more times weekly. 44 percent reported drug use in addition to alcohol, and 8 percent considered themselves drug dependent. 83 percent of lesbian adolescents reported alcohol use, 56 percent reported drug use, and 11 percent specifically reported crack/cocaine use.

More recent surveys (MA Department of Education, 2003) have not indicated the problem has improved. The anonymous survey conducted statewide in Massachusetts public schools found the following:

Students who described themselves as gay, lesbian, or bisexual were significantly more likely than their peers to report attacks, suicide attempts, and drug and alcohol use. When compared to their heterosexual peers, this group was:

  • over five times more likely to have attempted suicide in the past year
  • over three times more likely to miss school in the past month because of feeling unsafe
  • over three times more likely to have been injured or threatened with a weapon at school

In 2005, the Youth Risk Behavior Survey  reported:

Sexual minority adolescents – those who self-identified as gay, lesbian, or bisexual or who reported any same-sex sexual contact – had suicidality rates nearly double those of their peers. For example, they were more likely to have hurt themselves on purpose (44 percent vs. 17 percent), to have seriously considered suicide (34 percent vs. 11 percent), and to have made a suicide attempt in the past year (21 percent vs. 5 percent).

GLB Youth and Suicide

Perhaps the most dismaying statistics come from a federal study on youth suicide that was conducted 20 years ago during the Reagan administration. Published in 1987, the study reported that gay youth are two to three times more likely to attempt suicide than their peers. Further, it estimated that 30 percent of all completed suicides are GLB youth.  Given Kinsey’s statistic that approximately 10 percent of the population is homosexual, this would suggest that 30 percent of all youth suicides come from only this 10 percent of the population! None of these statistics specifically refer to transgendered youth. This reflects the need for more research with this group.

For some adolescents the above composite picture is a fairly accurate rendition of life. Others have the good fortune to defy all or most of the statistics with the help of supportive families and communities. Still others find their sexual orientation and the stigma it brings them the least of their other problems, such as extreme poverty, witnessing and experiencing traumatic incidents, and persecution due to race. Regardless, to survive and thrive in the face of such isolation, violence, fear and shame deserves singular credit and recognition of personal courage.

How Social Workers Can Help GLB Youth

When addressing issues of sexual orientation, the clinician is in an often uncomfortable and always political situation. As Judith Herman points out, when trauma originates in nature or acts of God, we have no problem in sympathizing with the victim. But, she writes, “When the traumatic events are of human design, those who bear witness are caught between victim and perpetrator. . . forced to take sides. . . [It] is very tempting for us to take the side of the perpetrator. All the perpetrator asks [is that we] do nothing.” The perpetrator does not have to be a person, it can be a school, a community, a society, the nation. The perpetrator can be a peer, a parent, and/or a professional. Gibson remarks in his report to the Secretary’s Task Force on Youth Suicide, “It is a sobering fact to realize that we [those who choose to do nothing] are the greatest risk factors in youth suicide.”

Social workers, no strangers to the fact that the personal is political, must continue to urge and work with the fields of social welfare, mental health and substance abuse to move forward in their efforts to help adolescents. Situated in schools, emergency rooms and outpatient clinics, social workers are uniquely positioned to intervene and make a positive difference. The major stumbling block to successful intervention is, ironically, not specific to GLBT adolescents, but a more broadly defined developmental one. Youngsters, understandably, tend to draw very general conclusions from extremely limited life experiences. GLBT youth may have encountered verbal or physical abuse, diagnoses of psychological pathology, and accusations of moral deficiency from those they have met previously in their lifetimes. They have no reason, and perhaps little hope, that we as social workers and professionals will be any different than those who have come before.

Sensitivity at first contact is crucial. Nothing less is required than the conveyance of empathy, provision of information regarding supportive community resources along with the instillation of hope. All of this occurs within the context of standing alongside the adolescent in a world which at best denies his or her existence and at worst seeks to eradicate it. Clinicians in these situations may feel overhwhelmed, and reexperience feelings common in adolescence themselves! Regardless of the social worker’s own sexual orientation, it is often hard to step back and reflect upon the values and biases that we all live and work in. Continued education can help decrease the worker’s own sense of frustration and confusion, as well as provide a sounding board and basis for practice.

Selected Readings

Gibson, P., LCSW, “Gay Male and Lesbian Youth Suicide,” Report of the Secretary’s Task Force on Youth Suicide, U.S. Department of Health and Human Services, 1989.

Governor’s Commission On Gay and Lesbian Youth, “Making Schools Safe for Gay and Lesbian Youth.” Boston, MA., 1993

Healy, J., Ph.D., Your Child’s Growing Mind., New York: Doubleday Books, 1994.

Herman, Judith, M.D., Trauma and Recovery., New York: Basic Books, 1997

Hetrick, E.S., and Martin, A.D., “Developmental Issues and Their Resolution for Gay and Lesbian Adolescents,” Journal of Homosexuality, 14(1/2): 24-43, 1987.

Kinsey, A.C., Pomeroy, W.B., and Martin, C.E., Sexual Behavior in the Human Male, 1948, and Sexual Behavior in the Human Female, 1953, Philadelphia: W.B. Saunders.

Massachusetts Department of Education Youth Risk Behavior Surveys, 2003, 2005. http://www.doe.mass.edu/cnp/hprograms/yrbs/

Rosario, M., Hunter, J., and Rotheram-Borus, M. J., Unpublished data on lesbian adolescents, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, 1992.


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