Associations Between LGBTQ+-Supportive School and Community Resources and Suicide Attempts Among Adolescents in Massachusetts

Supportive school and community resources are associated with reduced risk of suicidality among lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) adolescents as well as their cisgender, heterosexual peers. This study examined whether adolescents attending schools and living in communities with more versus fewer LGBTQ+-supportive resources were at lower risk of a past-year suicide attempt. Data on sexual orientation and past-year suicide attempt were obtained from student surveys administered in 30 Massachusetts public high schools between 2014 and 2017 (N = 20,790). Data on school resources were obtained from a questionnaire administered to school officials, and community resources were assessed through internet searching. Modified Poisson generalized estimating equations tested associations between school and community LGBTQ+-supports and suicide attempt separately by sex/gender, adjusting for student, school, and community covariates. Several school resources and the availability of community-wide LGBTQ+-supportive resources were associated with lower risk of a suicide attempt among several subgroups of students, even after controlling for the presence of multiple school and community resources and covariates. For example, the risk of a suicide attempt among gay, bisexual and questioning boys in schools with a gender-neutral restroom was approximately half compared to gay, bisexual and questioning boys in schools without this resource. Past year suicide attempts were also significantly lower among questioning, RR = 0.56, CI [0.37-0.86], and heterosexual, RR = 0.59, CI [0.50-0.68], girls living in communities with more supportive resources compared to those in communities with fewer resources. LGBTQ+-supportive resources in schools and communities may be beneficial for all adolescents regardless of sexual orientation. Public Policy Relevance Statement Suicide is a significant public health issue for adolescents, especially for lesbian, gay, bisexual, and questioning (LGBQ) adolescents, yet few studies have examined associations between LGBTQ+-supportive resources in both schools and communities and risk for a past-year suicide attempt. This study highlights that the presence of LGBTQ+-supportive resources in schools and communities may be beneficial for adolescents of all sexual orientations as a strategy for suicide prevention. Policies that develop and expand such supportive resources are recommended to advance the well-being of LGBQ y