Psychology of Sexual Orientation and Gender Diversity

© 2018 American Psychological Association 2019, Vol. 6, No. 1, 88 –95

2329-0382/19/$12.00 http://dx.doi.org/10.1037/sgd0000309

Anti-LGBT Victimization, Fear of Violence at School, and Suicide Risk

Among Adolescents
Andrew P. Barnett, Sherry Davis Molock, Karen Nieves-Lugo, and Maria Cecilia Zea
The George Washington University

We investigated whether strengths of the relationships between anti–lesbian, gay, bisexual, and trans-
gender (LGBT) victimization, fear of violence at school, and suicide risk differ by sexual orientation
among a predominantly ethnic minority sample of adolescents. Using the 2012 District of Columbia
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Youth Risk Behavior Survey high school data set, we performed a 4-stage, stepwise logistic regression
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for suicide attempts, suicidal ideation, and suicide planning. First, we tested the independent variables,
sexual orientation and anti-LGBT victimization. Second, we added an anti-LGBT victimization by sexual
orientation interaction term. Third, we tested the independent variable, fear of violence at school, in an
additive model. Fourth, we added a fear of violence at school by sexual orientation interaction term. In
Model 1, sexual orientation and anti-LGBT victimization were both significantly associated with each
suicide risk behavior. In Model 2, the anti-LGBT victimization by sexual orientation interaction term was
not significant for any of the dependent variables. In Model 3, fear of violence at school was significantly
associated with each suicide risk behavior. In Model 4, the fear of violence at school by sexual orientation
interaction term was not significant for suicide attempts or suicidal ideation but was significant for
suicide planning in the direction opposite to our hypotheses. Anti-LGBT victimization, sexual orienta-
tion, and fear of violence at school were associated with suicidal ideation, suicide planning, and suicide
attempts. The strength of the association between fear of violence at school and suicide planning was
weaker for sexual minority adolescents than for heterosexual adolescents.

Public Significance Statement

The results of this study suggest that being harassed based on actual or perceived lesbian, gay,
bisexual, or transgender status is associated with suicide risk behaviors among a predominantly
ethnic minority sample of high school students. In addition, we found evidence of a positive
association between fear of future violence at school and suicide risk for this population.

Keywords: sexual minorities, suicide, bullying

Compared with heterosexual peers, sexual minority adolescents
report significantly higher rates of suicide risk behaviors (Kann et
al., 2016; Marshal et al., 2011). Meyer (2013) postulated that
minority stress accounts for such disparities among sexual minor-
ity populations. Two important features of minority stress for
This article was published Online First September 27, 2018.
Andrew P. Barnett, Sherry Davis Molock, Karen Nieves-Lugo, and
Maria Cecilia Zea, Department of Psychology, The George Washington
University.
The authors extend their gratitude to Philip Wirtz and the Latino Health
Research Center for their help in this analysis.
This article was prepared while Karen Nieves-Lugo was employed at
The George Washington University. The opinions expressed in this article
are the author’s own and do not reflect the view of the National Institutes
of Health, the Department of Health and Human Services, or the United
States Government.
Correspondence concerning this article should be addressed to Andrew P.
Barnett, Department of Psychology, The George Washington University, 2125
G Street North West, Washington, DC 20052. E-mail: apbarnett@gwmail
.gwu.edu
88
sexual minorities are that the stresses are (a) unique to these
individuals and thus not experienced by heterosexuals and (b)
additive to general stressors that can impact all individuals. Mey-
er’s minority stress model distinguishes between distal processes,
defined as objective events and conditions, and proximal pro-
cesses, which relate to the effects of external stress on the indi-
viduals’ internal view of themselves and their world. Proximal
minority stress takes three forms: expectations of rejection, con-
cealment, and internalized anti–lesbian, gay, and bisexual (LGB)
stigma.
Anti-LGB bullying and other forms of peer victimization con-
stitute one type of distal minority stress processes for sexual
minority adolescents. Studies have found that sexual minority
adolescents report higher levels of peer victimization and victim-
ization based on their actual or perceived sexual orientation than
their heterosexual peers (Almeida, Johnson, Corliss, Molnar, &
Azrael, 2009; Darwich, Hymel, & Waterhouse, 2012; Espelage,
Aragon, & Birkett, 2008; Friedman et al., 2011; Kann et al., 2016;
Mueller, James, Abrutyn, & Levin, 2015; Russell, Everett, Rosa-
rio, & Birkett, 2014; Shields, Whitaker, Glassman, Franks, &
Howard, 2012). Although not all peer victimization research iden-
 ANTI-LGBT VICTIMIZATION AND SUICIDE RISK
tifies anti-LGB discrimination as the thematic content, the consis-
tent disparity in reported victimization between sexual minority
and heterosexual youth suggests that sexual orientation may play a
role.
Consistent with the minority stress model, peer victimization
has been found to be associated with suicide risk behaviors for
sexual minority youth (Goodenow, Szalacha, & Westheimer,
2006), and the association between victimization and suicidality
has been reported to be stronger for sexual minority than hetero-
sexual youth (Bontempo & D’Augelli, 2002). Research has also
found evidence of an association between tacitly anti-LGB vic-
timization and suicide risk behaviors among sexual minority youth
and young adults (Hightow-Weidman et al., 2011; Liu & Mustan-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
ski, 2012; Russell, Ryan, Toomey, Diaz, & Sanchez, 2011). Fur-
This document is copyrighted by the American Psychological Association or one of its allied publishers.
ther supporting the model, there is evidence that homophobic
teasing moderates the relationship between sexual orientation and
suicidality (Birkett, Espelage, & Koenig, 2009). One study re-
ported differences by race: Anti-LGB victimization was associated
with suicidality for white lesbian, gay, bisexual, transgender, and
questioning (LGBTQ) youth but not LGBTQ youth of color
(Poteat, Mereish, DiGiovanni, & Koenig, 2011). The present study
builds on prior research by investigating the effect of anti–lesbian,
gay, bisexual, and transgender (LGBT) victimization among sex-
ual minority adolescents when accounting for other forms of
bullying in a predominantly ethnic minority population-based sam-
ple.
The extant research on school climate and suicide risk for
sexual minority youth relates to the theorized pathway between
proximal minority stress processes and mental health outcomes.
Sexual minority adolescents’ perception of their school’s ac-
ceptance of sexual minority students directly relates to their
expectations of rejection in that setting. Positive school climate,
living in a jurisdiction with a more protective school climate,
and living in a school district with LGBT-inclusive antibullying
policies have been associated with lower levels of depressive
symptoms or suicidality for sexual minority students (Birkett et
al., 2009; Hatzenbuehler, Birkett, Van Wagenen, & Meyer,
2014; Hatzenbuehler & Keyes, 2013). Conversely, for sexual
minority students, attending a school with a Gay-Straight Alli-
ance was not associated with suicidality when controlling for
victimization (Goodenow et al., 2006), nor was an association
found between Gay-Straight Alliance presence or participation
and suicidality (Toomey, Ryan, Diaz, & Russell, 2011). The
present study seeks to further contribute to the literature by
assessing the relationship between suicidality and individual
LGB students’ perceptions of climate, which would be expected
to vary substantially, even within a particular school.
Using a predominantly ethnic minority sample of adoles-
cents, we investigated the association between sexual orienta-
tion, distal and proximal minority stress processes, and suicide
risk behaviors. Based on the minority stress model and existing
literature, we developed two hypotheses: (a) anti-LGBT victim-
ization is more strongly associated with suicide risk behavior
for sexual minority students than for heterosexual students and
(b) fear of violence at school is more strongly associated with
suicide risk behavior for sexual minority students than for
heterosexual students.
89
Method
The present study was conducted using the 2012 District of
Columbia Youth Risk Behavior Survey (YRBS) for high school
students. The Institutional Review Board of the George Washing-
ton University approved the study. The YRBS is conducted bien-
nially by the Centers for Disease Control and Prevention to assess
health risk behaviors among adolescents (Centers for Disease
Control and Prevention, 2011). The District of Columbia (DC)
YRBS is administered by the DC Office of the State Superinten-
dent for Education in collaboration with the DC Department of
Health (Ost & Maurizi, 2013). Data were collected October 2012
through January 2013. Eligibility criteria required students to be
enrolled in a traditional public or public charter high school
(grades 9 –12). Passive consent was utilized. Participants were able
to discontinue at any time.
Sample
Sampling for the 2012 DC YRBS used a two-stage cluster
methodology at the school and classroom level, and the total
response rate was 68% (Ost & Maurizi, 2013). Inclusion criteria
for the present study required completion of the sexual orien-
tation item, resulting in an analytic sample size of 10,593.
Measures
Demographics. Single items assessed age, grade, sex, race,
and ethnicity. Race and ethnicity were collapsed into one variable
with the following categories: American Indian/Alaska Native,
Asian, Black or African American, Native Hawaiian or other
Pacific Islander, White, Hispanic/Latino, multiracial/Hispanic, and
multiracial/non-Hispanic.
Sexual orientation. Sexual orientation was measured through
a single item with the response options heterosexual (straight), gay
or lesbian, bisexual, or not sure. Participants who selected hetero-
sexual (straight) were classified as heterosexual; any other re-
sponse was classified as lesbian, gay, bisexual, or questioning
(LGBQ).
Peer victimization. Peer victimization was assessed using
two dichotomous items assessing experiences of being bullied
on school property or electronically bullied during the previous
12 months. These items were combined, with participants who
reported experiencing either or both types of bullying coded as
1 and those who responded no to both items coded as 0.
Anti-LGBT harassment was assessed with a single item as-
sessing frequency participants had been harassed on school
property because someone thought they were gay, lesbian,
bisexual, or transgendered. The variable was dichotomized into
participants reporting any anti-LGBT victimization and those
reporting none.
Fear of violence at school was assessed with a single item
assessing frequency participants had been afraid of being beaten
up at school during the previous year. This variable was dichot-
omized into participants reporting having been afraid at least
once and those reporting no such instances.
Suicide risk behaviors were assessed with three items. Partici-
pants were asked about experiencing suicidal ideation, making a
suicide plan, and attempting suicide in the previous year. The
 90 BARNETT, MOLOCK, NIEVES-LUGO, AND ZEA

suicidal ideation and suicide plan items were both dichotomous.
The suicide attempts item assessed frequency of this behavior and
was dichotomized into participants who reported having made any
suicide attempts and those who reported none.
Analytic Plan
Analyses were conducted using SAS version 9.3 (SAS Insti-
tute, Cary, NC) and followed recommendations for YRBS data
(Centers for Disease Control and Prevention, 2016). Descriptive
statistics were obtained using PROC SURVEYFREQ. PROC
SURVEYLOGISTIC was used to test bivariate associations and
the study hypotheses. Separate analyses were run for each suicide
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(three outcome variables by four models) for an adjusted ␣ ⫽
.0042.
Results
Descriptive Statistics
The descriptive statistics of the sample are reported in Table
1. The sample was majority female and Black or African
American. The Rao-Scott ␹2 test was performed to test whether
each demographic characteristic, independent variable, and de-
pendent variable was independent of sexual orientation. Signif-

risk behavior. The variables were entered into a logistic regression icant associations were found for sex, age, race, grade, and each
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in a four-stage, stepwise process. Model 1 included the indepen-
dent variables sexual orientation and anti-LGBT victimization in
an additive model, with peer victimization included as a control. In
Model 2, an anti-LGBT victimization by sexual orientation inter-
action term was added. Model 3 included the independent variable
fear of violence at school in an additive model. In Model 4, a fear
of violence at school by sexual orientation interaction term was
added. For each analysis, list-wise deletion was used for surveys
with missing data, as has been used in previous analyses using
YRBS and similar population-based data (Duncan & Hatzen-
buehler, 2014; Mueller et al., 2015; Russell et al., 2014). A
Bonferroni adjustment was calculated based on 12 hypotheses
of the independent and dependent variables. The majority of
participants reported a heterosexual identity (see Table 2).
To minimize the risk of participant reidentification, cross-
tabulations and analyses for cell sizes of less than 50 are not
reported. For this reason, racial/ethnic groups were collapsed
into Black/African American, White, Hispanic/Latino, multira-
cial, and other race/ethnicity, and the ungraded/other grade
group was not reported. Bivariate associations were tested for
the demographic variables and the independent variables (not
shown). Race/ethnicity, sex, age, and grade were each related to
at least one independent variable and one dependent variable
and were therefore retained in the model for hypothesis tests.

Table 1
Descriptive Statistics of Analytic Sample

Total LGBQ Heterosexual

Statistics n Wt. n Wt. % Wt. n Wt. % Wt. n Wt. % p value

Total sample 10,593 15,874 100.00 2,435 15.34 13,439 84.66 ⬍.0001
Sex
Male 4,778 7,583 48.18 447.24 5.90 7,136 94.10 ⬍.0001
Female 5,733 8,156 51.82 1,925 23.60 6,231 76.40
Age, years
13 or youngera 198 341.39 2.16 93.94 27.52 247.45 72.48 ⬍.0001
14 1,960 3,604 22.78 473.40 13.14 3,130 86.86
15 2,662 4,027 25.46 628.36 15.60 3,399 84.40
16 2,536 3,583 22.65 595.34 16.61 2,988 83.39
17 2,300 3,019 19.08 455.15 15.08 2,564 84.92
18 or older 902 1,246 7.87 182.20 14.63 1,063 85.37
Race
Black or African American 7,091 10,824 70.70 1,606 14.84 9,218 85.16 ⬍.0001
White 518 667.95 4.36 69.84 10.46 598.11 89.54
Hispanic/Latino 882 1,293 8.44 127.81 9.89 1,165 90.11
Multiracial 1,323 1,912 12.49 374.20 19.57 1,538 80.43
Other race/ethnicity 422 613.32 4.01 126.65 20.65 486.67 79.35
Gradeb
9th 2,876 5,622 35.78 816.61 14.52 4,806 85.48 .0020
10th 2,746 3,764 23.95 606.62 16.12 3,157 83.88
11th 2,487 3,328 21.18 531.23 15.96 2,797 84.04
12th 2,336 2,928 18.63 418.73 14.30 2,509 85.70
Peer victimizationc 1,489 2,232 14.56 566.80 24.68 1,665 12.78 ⬍.0001
Anti-LGBT victimizationc 916 1,429 9.10 514.31 21.33 914.42 6.88 ⬍.0001
Fear of violence at schoolc 830 1,324 8.42 372.75 15.45 951.21 7.14 ⬍.0001
Suicide attemptc 1,033 1,608 13.17 520.11 27.47 1,088 10.55 ⬍.0001
Suicidal ideationc 1,527 2,247 14.69 703.44 30.51 1,544 11.88 ⬍.0001
Suicide planningc 1,512 2,236 14.57 644.47 27.84 1,592 12.21 ⬍.0001
a
Participants reporting age 12 years and younger and age 13 years were combined into one group because of small group size. b Participants reporting
ungraded or other grade are not reported because of small cell size (⬎50) to prevent participant reidentification. c Statistics for participants reporting the
type of behavior are presented (i.e. participants responding yes or at least once for each question).
 ANTI-LGBT VICTIMIZATION AND SUICIDE RISK 91

Table 2

<.0001
.1101
.0091
.9153
.0027
<.0001

.0540
.0002
.0009
<.0001
<.0001
<.0001

<.0001
.1297
p value
Sexual Orientation of Participants

Model 4, n ⫽ 7,759
Sexual orientation n Wt. n Wt. %

(1.07–1.63)

(1.07–1.35)
(1.23–1.73)

(2.02–2.90)
(1.38–2.05)
(1.96–3.12)

(1.87–3.32)
(.95–1.63)

(.69–1.51)

(.63–1.00)

(.40–1.12)
95% CI

(.18–.53)

(.39–.74)
(.34–.76)
Heterosexual 8,961 13,439 84.66
Gay or lesbian 374 556.95 3.51
Bisexual 943 1,400 8.82
Not sure 315 477.36 3.01

.31
1.25
1.32
1.02
1.20
1.46

.79
.54
.50
2.42
1.68
2.47

2.49
.67
OR

<.0001
.1014
.0099
.9769
.0029
<.0001

.0565
.0002
.0010
<.0001
<.0001
<.0001

<.0001
p value
Hypotheses Tests

Model 3, n ⫽ 7,759
Hypothesis 1. First, we tested the association between sexual
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orientation, peer victimization, and anti-LGBT victimization and

(1.07–1.62)

(1.06–1.35)
(1.24–1.73)

(1.93–2.70)
(1.37–2.05)
(1.94–3.10)

(1.70–2.86)
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(.96–1.64)

(.67–1.50)

(.63–1.01)
95% CI
each suicide risk behavior in an additive model (see Tables 3, 4,

(.18–.53)

(.39–.75)
(.34–.76)
and 5, Model 1). Each independent variable was significantly
associated with each of the three suicide risk behaviors. Next, we
tested the hypothesis by adding an anti-LGBT victimization by

.31
1.25
1.32
1.01
1.20
1.46

.80
.54
.51
2.28
1.68
2.45

2.21
OR
sexual orientation interaction term (see Tables 3–5, Model 2). For
each dependent variable, the interaction term was not significant.
Hypothesis 2. First, we tested the association between fear of

<.0001
.0828
.0043
.8395
.0012
<.0001

.0443
<.0001
.0004
<.0001
<.0001
<.0001
.3196
p value
violence at school and each suicide risk behavior in an additive

Model 2, n ⫽ 7,797
model that also included sexual orientation, peer victimization, and
anti-LGBT victimization (see Tables 3–5, Model 3). Fear of vio-

(1.10–1.65)

(1.08–1.37)
(1.19–1.66)

(2.03–2.94)
(1.65–2.41)
(2.22–3.85)
(.97–1.65)

(.71–1.54)

(.50–1.25)
95% CI
lence at school was significantly associated with suicide attempts,

(.19–.53)

(.62–.99)
(.37–.72)
(.32–.72)
suicidal ideation, and suicide planning. Sexual minority orienta-
tion, peer victimization, and anti-LGBT victimization remained
significantly associated with each suicide risk behavior. Next, we
.32
1.27
1.35
1.04
1.21
1.41

.79
.52
.48
2.44
1.99
2.93
.79
OR

tested the hypothesis by including a fear of violence at school by

sexual orientation interaction term (see Tables 3⫺5, Model 4). The
interaction term was not significant for suicide attempts or suicidal
<.0001
.0804
.0045
.8498
.0013
<.0001

.0431
<.0001
.0004
<.0001
<.0001
<.0001
p value

Note. OR ⫽ odds ratio; CI ⫽ confidence interval. Bold indicates significance at ␣ ⫽ .0042.

ideation. The fear of violence at school by sexual orientation
interaction term was significant for suicide planning, but not in the
Model 1, n ⫽ 7,797

expected direction.
(1.10–1.65)

(1.08–1.37)
(1.20–1.67)

(1.97–2.75)
(1.65- 2.41)
(2.13–3.38)
(.97–1.65)

(.70–1.54)
(.19–.53)

(.62–.99)
(.37–.72)
(.32–.72)
95% CI

Discussion

Ungraded/other grade not reported because of small cell size (n ⬍ 50).

Anti-LGBT Victimization
Multivariable Logistic Regression Models for Suicide Attempts

We found evidence of an association between anti-LGBT vic-

.31
1.27
1.35
1.04
1.21
1.42

.79
.52
.48
2.33
1.99
2.68
OR

timization and suicide attempts, suicide planning, and suicidal

ideation. This finding is consistent with previous research showing
Anti-LGBT victimization ⫻ Sexual minority orientation

an association between anti-LGBT victimization and suicidality

(Hightow-Weidman et al., 2011; Liu & Mustanski, 2012; Russell
et al., 2011). Importantly, we found evidence that anti-LGBT
Fear of violence ⫻ Sexual minority orientation

victimization was related to all three suicide risk behaviors tested

Sexual orientation (reference ⫽ heterosexual)
Race (reference ⫽ Black/African American)

independent of general peer victimization and sexual orientation.

Among the suicide risk behaviors, the strongest association was
found between anti-LGBT victimization and suicide attempts, with
Variables

participants who reported anti-LGBT victimization being more

than 2.5 times as likely to report a past-year suicide attempt.
Fear of violence at school

Anti-LGBT victimization was more strongly associated with sui-

Anti-LGBT victimization
Grade (reference ⫽ 9th)a
Sex (reference ⫽ male)
Other race/ethnicity

cide attempts than reporting other forms of peer victimization,

suggesting that this type of victimization is particularly harmful.
Hispanic/Latino

Peer victimization

Our hypothesis that the association between anti-LGBT victimiza-

Multiracial

tion and suicide risk behaviors is stronger for sexual minority

students than for heterosexuals was not supported. Although in-
Table 3

White

10th
11th
12th

consistent with the minority stress model, our finding is notable

Age

in adding to the evidence that anti-LGBT victimization has a

a
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Table 4 92
Multivariable Logistic Regression Models for Suicidal Ideation

Model 1, n ⫽ 9,624 Model 2, n ⫽ 9,624 Model 3, n ⫽ 9,574 Model 4, n ⫽ 9,574

Variables OR 95% CI p value OR 95% CI p value OR 95% CI p value OR 95% CI p value

Race (reference ⫽ Black/African American)

White .72 (.52– 1.01) .0604 .73 (.52–1.02) .0650 .73 (.52–1.03) .0721 .73 (.52–1.03) .0729
Hispanic/Latino 1.08 (.87–1.33) .4940 1.08 (.87–1.33) .4990 1.06 (.85–1.31) .6002 1.05 (.84–1.30) .6869
Multiracial 1.60 (1.35- 1.90) <.0001 1.60 (1.35–1.90) <.0001 1.58 (1.33–1.88) <.0001 1.59 (1.34–1.89) <.0001
Other race/ethnicity 1.09 (.78–1.51) .6205 1.09 (.79–1.51) .6043 1.06 (.76–1.49) .7188 1.08 (.78–1.51) .6372
Age .94 (.86–1.02) .1151 .94 (.86–1.02) .1155 .92 (.85–1.01) .0689 .93 (.85–1.01) .0752
Sex (reference ⫽ male) 1.81 (1.60–2.05) <.0001 1.81 (1.59–2.05) <.0001 1.87 (1.65–2.13) <.0001 1.87 (1.64–2.12) <.0001
Grade (reference ⫽ 9th)a
10th 1.19 (.99–1.44) .0670 1.19 (.99–1.44) .0663 1.20 (.99–1.45) .0606 1.20 (.99–1.45) .0614
11th 1.08 (.84–1.38) .5431 1.08 (.84–1.38) .5475 1.12 (.87–1.44) .3795 1.11 (.87–1.42) .4080
12th 1.23 (.89–1.68) .2071 1.23 (.89–1.69) .2066 1.30 (.94–1.79) .1158 1.29 (.94–1.78) .1205
Sexual orientation (reference ⫽ heterosexual) 2.31 (2.00–2.67) <.0001 2.38 (2.03–2.79) <.0001 2.29 (1.98–2.66) <.0001 2.47 (2.13–2.87) <.0001
Peer victimization 3.37 (2.91–3.89) <.0001 3.37 (2.91–3.89) <.0001 3.03 (2.60–3.53) <.0001 3.02 (2.60–3.52) <.0001
Anti-LGBT victimization 1.95 (1.59–2.41) <.0001 2.09 (1.60–2.72) <.0001 1.86 (1.50–2.30) <.0001 1.89 (1.53–2.33) <.0001
Anti-LGBT victimization ⫻ Sexual orientation .83 (.56–1.25) .3774
Fear of violence at school 1.72 (1.37–2.15) <.0001 2.02 (1.56–2.61) <.0001
Fear of violence ⫻ Sexual orientation .57 (.37–87) .0094
Note. OR ⫽ odds ratio; CI ⫽ confidence interval. Bold indicates significant at ␣ ⫽ .0042.
a
Ungraded/other grade not reported because of small cell size (n ⬍ 50).

Table 5
Multivariable Logistic Regression Models for Suicide Planning

Model 1, n ⫽ 9,632 Model 2, n ⫽ 9,632 Model 3, n ⫽ 9,583 Model 4, n ⫽ 9,583

Variables OR 95% CI p value OR 95% CI p value OR 95% CI p value OR 95% CI p value

Race (reference ⫽ Black/African American)

BARNETT, MOLOCK, NIEVES-LUGO, AND ZEA

White .70 (.52–.95) .0233 .71 (.53–.96) .0276 .71 (.53–.96) .0265 .71 (.52–.96) .0238
Hispanic/Latino .90 (.71–1.15) .3997 .90 (.71–1.15) .3898 .89 (.69–1.13) .3371 .87 (.68–1.12) .2832
Multiracial 1.36 (1.13–1.64) .0010 1.37 (1.14–1.64) .0009 1.34 (1.11–1.62) .0019 1.35 (1.12–1.63) .0014
Other race/ethnicity 1.34 (1.00–1.79) .0518 1.34 (1.01–1.80) .0464 1.33 (.99–1.78) .0602 1.35 (1.01–1.81) .0449
Age .99 (.91–1.08) .8686 .99 (.91–1.08) .8709 .99 (.91–1.08) .7600 .99 (.91–1.08) .7858
Sex (reference ⫽ male) 1.66 (1.45–1.90) <.0001 1.65 (1.44–1.89) <.0001 1.69 (1.48–1.94) <.0001 1.69 (1.47–1.93) <.0001
Grade (ref ⫽ 9th)a
10th 1.07 (.89–1.28) .4925 1.07 (.89–1.28) .4790 1.07 (.89–1.28) .4847 1.07 (.89–1.28) .4907
11th .93 (.74–1.16) .5053 .92 (.74–1.16) .4975 .94 (.75–1.19) .6050 .94 (.74–1.18) .5673
12th .88 (.65–1.19) .3970 .88 (.65–1.19) .4007 .91 (.67–1.23) .5200 .90 (.67–1.23) .5118
Sexual orientation (reference ⫽ heterosexual) 1.91 (1.65–2.21) <.0001 2.05 (1.74–2.41) <.0001 1.89 (1.63–2.19) <.0001 2.07 (1.77–2.42) <.0001
Peer victimization 2.44 (2.11–2.82) <.0001 2.44 (2.11–2.82) <.0001 2.27 (1.94–2.65) <.0001 2.27 (1.94–2.65) <.0001
Anti-LGBT victimization 2.16 (1.77–2.64) <.0001 2.48 (1.95–3.16) <.0001 2.09 (1.71–2.55) <.0001 2.13 (1.74–2.60) <.0001
Anti-LGBT victimization ⫻ Sexual orientation .68 (.46–1.00) .0476
Fear of violence at school 1.43 (1.13–1.81) .0031 1.74 (1.34–2.27) <.0001
Fear of violence ⫻ Sexual orientation .51 (.32–.80) .0032
Note. OR ⫽ odds ratio; CI ⫽ confidence interval. Bold indicates significant at ␣ ⫽ .0042.
a
Ungraded/other grade not reported because of small cell size (n ⬍ 50).
 ANTI-LGBT VICTIMIZATION AND SUICIDE RISK
deleterious impact on sexual minority and heterosexual adoles-
cents (Poteat & Espelage, 2007).
Several possible explanations could account for the lack of
support for the hypotheses. First, the measure of anti-LGBT vic-
timization was limited to a single question about harassment; as a
result, other types of anti-LGBT victimization were not assessed.
Second, the differences in size between the sexual minority and
heterosexual subsamples and between the participants who re-
ported anti-LGBT victimization and those who did not may also
have prevented the detection of the moderation effects. Finally, it
is possible that the effect of anti-LGBT harassment on all students
is similarly detrimental for both LGBT and heterosexual adoles-
cents. If true, the mechanism through which this type of discrim-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
ination contributes to negative outcomes may differ for sexual
This document is copyrighted by the American Psychological Association or one of its allied publishers.
minority and heterosexual adolescents, but the end result may be
similar.
Meyer’s minority stress model holds that being subjected to
discrimination and harassment based on one’s sexual orientation
constitutes a unique form of stress for sexual minority adolescents
(Meyer, 2013). Our findings suggest that harassment based on
perceptions that one is a sexual minority or transgender is also a
potent stressor for heterosexual adolescents that has an effect
distinct from other forms of peer victimization. The harm associ-
ated with being targeted based on one’s presumed LGBT status for
heterosexual students may be due to the stigma associated with
being LGBT in contemporary U.S. culture.
The results of the present study are notable because of the
racially diverse and majority African American sample. A previ-
ous study found that homophobic victimization was not associated
with suicidality for LGBTQ and heterosexual youth of color when
controlling for other forms of victimization (Poteat et al., 2011).
Our findings suggest that anti-LGBT victimization is associated
with suicidality among youth of color, even when controlling for
reports of bullying.
Consistent with previous research, sexual minority orientations
(Eisenberg & Resnick, 2006; Hatzenbuehler et al., 2014; Kann et
al., 2016; Shields et al., 2012) and experiences of peer victimiza-
tion (Bontempo & D’Augelli, 2002; Mueller et al., 2015) were
associated with increased odds of reporting suicide attempts, sui-
cide planning, and suicidal ideation. Sexual minority adolescents
were more than twice as likely to report suicide attempts and
suicidal ideation and more than 1.5 times as likely to report suicide
planning than their heterosexual peers. Furthermore, our results
suggest that this disparity is not solely a function of sexual mi-
nority adolescents being more likely to experience peer victimiza-
tion or anti-LGBT victimization.
Fear of Violence at School
We found evidence that students’ expectations concerning their
school environment are related to suicide risk. Fear of violence at
school was associated with each suicide risk behavior independent
of reported direct experiences of bullying and anti-LGBT victim-
ization. This finding suggests that students’ perception that they
will be subjected to violence at school is related to suicide risk,
regardless of whether they have previously been victimized. As
with anti-LGBT victimization, the strongest association was found
between fear of violence at school and suicide attempts.
93
We found evidence that the relationship between fear of vio-
lence at school and suicide planning differed for sexual minority
and heterosexual participants. However, contrary to our hypothe-
sis, the results showed that the relationship was weaker for sexual
minority than for heterosexual participants. Several possible ex-
planations could account for this finding. One, the weaker rela-
tionship may denote a ceiling effect, given the strong associations
between fear of violence at school and a sexual minority orienta-
tion and suicide planning. Another possible explanation relates to
resilience among sexual minority youth. The present study did not
include any measures of resilience, so it is possible that an unob-
served factor such as LGBT community support serves as a buffer.
In contrast, we found that the associations between fear of violence
at school and suicide attempts and suicidal ideation did not differ
between sexual minority and heterosexual participants.
As with our first hypothesis, methodological concerns may have
contributed to our results. The measure of fear of violence at
school did not specifically assess violence based on one’s sexual
orientation. For this reason, participants may have endorsed this
item if they had feared violence in the previous year based on
factors unrelated to sexual orientation, thus obfuscating the unique
effects of minority stressors on sexual minority participants. Fur-
thermore, the use of a single item failed to assess the full domain
of expectations of victimization at school. A more comprehensive
measure would have assessed fear of violence as well as fear of
other forms of rejection such as harassment and bullying. In
addition, the relatively small sexual minority subsample may have
prevented an interaction effect from being detected. A final pos-
sible explanation is that the relationship between fear of violence
at school and suicide risk is the same for sexual minority adoles-
cents as it is for their heterosexual peers. This finding is not
incompatible with the minority stress model, which focuses solely
on expectations of rejection related to sexual minority identity.
The current study included several methodological strengths.
The participants in the sample were predominantly racial minori-
ties (nearly 95% endorsed a racial identity other than White only).
This sample composition differs from other studies examining
suicide risk and sexual minority adolescents with majority White
samples (Birkett et al., 2009; Bontempo & D’Augelli, 2002; Eisen-
berg & Resnick, 2006; Espelage et al., 2008; Hatzenbuehler, 2011;
Poteat & Espelage, 2007). As a result, the findings of the present
analysis contribute to the understanding of the associations among
anti-LGBT victimization, fear of violence, and sexual orientation
and suicide risk behavior among racial minority high school stu-
dents.
An additional strength related to the sample is the inclusion of
regular public high schools and public charter schools. The repre-
sentation of students from both types of schools contributes to the
heterogeneity of the sample. Public and public charter high schools
may differ with respect to school policies regarding bullying,
overall school climate, and acceptance of sexual minority students
and populations. The results therefore may be more generalizable
to students in other large urban school districts. A final strength of
the current study is the use of the Bonferroni correction. As a
result, we can be reasonably certain that the observed results
reflect true relationships among the variables in the population
despite the use of multiple analyses to test the hypotheses.
A number of important limitations should be noted in interpret-
ing the results of the current analysis. The data were cross-
 94 BARNETT, MOLOCK, NIEVES-LUGO, AND ZEA
sectional, which prevents the investigation of causal relationships.
The present analysis assumed temporal relationships between the
constructs of interest, namely that victimization experiences and
fear of violence preceded suicide risk behavior. However, this
assumption could not be tested and may be incorrect for any given
participant. The missing data points in the variables of interest
represent another limitation. In the analysis of the effect of fear of
violence at school on suicide attempts, in which the largest number
of data points were missing, 27% of the observations were ex-
cluded. List-wise deletion requires the assumption that the data are
missing completely at random. It is possible that some of the data
points were missing because of the stigma associated with the
constructs being measured, making the assumption of missing
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
completely at random untenable. However, if participants omitted
This document is copyrighted by the American Psychological Association or one of its allied publishers.
items because of the associated stigma, one can assume that they
did not answer the question because they would have endorsed the
stigmatized response (i.e., having experienced peer victimization
and/or fearing violence at school). If so, excluding these responses
would result in a potential underestimation of effect.
A fourth limitation for the current study is the use of single
items to measure the constructs of interest. Sexual orientation,
anti-LGBT harassment, fear of violence at school, suicide at-
tempts, suicidal ideation, and suicide planning were all operation-
alized with responses to single questions. Only two items were
used to measure experiences of peer victimization. The measure of
sexual orientation presents unique challenges. Responding to this
item as a sexual minority requires that the participant be aware of
their orientation, identify with one of the options presented (e.g.,
gay or lesbian), and be willing to disclose it on a survey admin-
istered at school. Youth who engage in same-sex sexual behavior
and identify as straight may not be included in the sexual minority
subsample in this analysis. It is also possible that a participant who
has not come out at school would not disclose this information,
even on an anonymous survey. For these reasons, the measurement
of sexual orientation may not be accurate. The gender disparity in
sexual minority orientations in the sample is notable and may
reflect inaccurate reporting of sexual minority status.
The final significant limitation for the current study is the
operationalization of minority stress processes. The proximal mi-
nority stress process was operationalized through an item about
fear of violence at school without specifying that it be attributed to
the participant’s sexual orientation. Meyer’s minority stress model
suggests that this process be explicitly connected to the individu-
al’s sexual minority orientation, at least in terms of their percep-
tions (Meyer, 2013). The item used constitutes a limited measure
of the construct described in the model.
Although some of the hypotheses were not supported, the results
of the present study have implications for clinical and educational
practice as well as for future research. The results showed that
sexual orientation was significantly associated with suicide risk
behaviors independent of peer victimization, anti-LGBT harass-
ment, and fears about future violence. For this reason, clinicians
should continue to view sexual minority adolescents as a particu-
larly vulnerable population. Peer victimization and fears about
future violence were also identified as correlates of suicide risk
behaviors, demonstrating that educators and school officials need
to focus on addressing bullying and related behaviors at school and
ensure targets of victimization receive appropriate services.
Anti-LGBT harassment was significantly associated with sui-
cide risk behaviors for both sexual minority and heterosexual
adolescents. These results demonstrate that harassment based on
sexual identity can lead to negative outcomes for all students.
Therefore, educators and school officials should recognize this
form of victimization as particularly destructive and take measures
to prevent it in educational settings for the benefit of all students.
Future research is needed to elucidate the relationships among
sexual orientation, general and LGBT-specific peer victimization,
expectations of victimization, and suicide risk behaviors. Several
specific directions are indicated by the results of this study. Lon-
gitudinal research is needed to explore possible causal relation-
ships between these variables. In addition, more research is needed
to investigate the intersection of sexual and racial minority iden-
tities among adolescents, such as whether the associations between
sexual minority stress processes and suicide risk operate differ-
ently for ethnic minority youth than for white youth. Finally, the
use of more robust measures of these key constructs would lead to
a greater understanding of the specific types of experiences asso-
ciated with suicide risk. For example, anti-LGBT victimization
could be measured through experiences of harassment, violence,
and bullying; different forms of victimization may differ in their
relationships with suicide risk.
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Received April 13, 2018
Revision received August 7, 2018
Accepted August 8, 2018 䡲