Socioeconomic inequalities in the risk of suicide attempts among sexual minority adolescents: findings from the UK's Millennium Cohort Study

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Overview

Paper Summary

Conflicts of Interest

Identified Weaknesses

Rating Explanation

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Paper Summary

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Sexual Minority and Financially Struggling Teens Face Higher Suicide Attempt Risk

This UK study found that sexual minority teens experiencing socioeconomic hardship (parental unemployment) have a significantly elevated risk of suicide attempts, more than would be expected from either factor alone. While the cross-sectional nature limits causal conclusions, the study demonstrates an important synergistic interaction between these two risk factors. The study also highlights the urgent need for more support for this double-disadvantaged group.

Possible Conflicts of Interest

None identified.

Identified Weaknesses

Loss to follow-up

Although multiple imputation was utilized along with sample and attrition weights to account for loss to follow up, it is unknown if those who dropped out of the study had significant differences from those who completed it. The missing at random assumption may not hold true.

Lack of granularity with sexual and gender minority status

The study was unable to disentangle gender identity of participants due to sample size restrictions. Participants who had intersectional identities (e.g., sexual minority and gender minority) may have different experiences and risks.

Overestimation of suicide attempts

Because the study relied on self-reported suicide attempts, there may be overestimation of attempts. The study authors admit that some attempts classified in the study may not have been with the intent to die.

Cross-sectional design limits causal inference

The study design is cross-sectional, preventing any determination of causality. Socioeconomic circumstances and/or awareness of sexual identity may have been different for participants when the suicide attempts occurred.

Unemployment data may not fully capture socioeconomic status

Parent unemployment status may not reflect the complete economic situation within the household, and the researchers did not collect data on any other source of income, potentially leading to underestimation of socioeconomic hardship.

Rating Explanation

This is a well-executed study using robust data and methods. The MCS is an excellent data source, and the analysis appropriately used multiple imputation and weighting. The limitations are unavoidable given the sensitive topic and data constraints, but the study highlights an important societal issue. The findings should encourage additional research and the development of support systems for this vulnerable group. No conflicts of interest identified.

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