(PS9-12) Location Matters: Suicide Risk in Sexual and Gender Minority Youth by Residential Setting

Suicide is a leading cause of death among youth aged 10-24 in the U.S., with sexual and gender minority (SGM) youth at significantly higher risk. SGM youth are almost four times as likely to attempt suicide as their peers, with transgender and nonbinary individuals at especially elevated risk. This disparity is driven by cognitive and behavioral factors, including identity confusion, minority stress, internalized stigma, and maladaptive coping mechanisms, as well as interpersonal stressors like discrimination and rejection. Conversely, protective factors such as family support, peer connections, and inclusive environments are associated with lower suicide risk. Environmental context plays a critical role in shaping these risk and protective factors, yet research on how different settings impact suicidal ideation among SGM youth remains limited. Rural environments pose unique challenges including social isolation, limited access to mental health care, and heightened exposure to stigma, all of which further increase suicide risk for SGM youth.
This study examines whether specific gender and sexual identities are at higher risk for suicidal ideation and whether this risk varies by residential setting—urban (50,000+ residents), micropolitan (10,000-49,999 residents) or rural ( < 10,000 residents). Rates of suicidal ideation were calculated from the 2021-2023 Washington Health Youth Survey at the school district level, using the item “during the past 12 months, did you ever seriously consider attempting suicide?”. We conducted a series of logistic regressions to examine the effect of location, sexual orientation, and gender identity on suicidal ideation. Findings indicate that across all regions, transgender individuals have the highest odds of experiencing suicidal ideation. Urban transgender individuals face the greatest risk (OR = 10.86, 95% CI: 9.14–12.91, p < 0.001), followed by their rural counterparts (OR = 10.28, 95% CI: 6.02–17.57, p < 0.001) and those identifying as 'something else' in rural areas (OR = 9.78, 95% CI: 7.57–12.64, p < 0.001) . Among sexual identities, those identifying as bisexual (OR = 6.15, 95% CI: 5.46–6.93, p < 0.001) and 'something else' (OR = 6.86, 95% CI: 5.78–8.15, p < 0.001) in rural areas had the highest odds of suicidal ideation. In micropolitan areas, those identifying as 'not sure' also face elevated risk (OR = 3.29, 95% CI: 2.63–4.13, p < 0.001). While bisexual individuals in rural areas (OR = 6.15, 95% CI: 5.46–6.93, p < 0.001) show significantly higher suicidal ideation compared to their urban counterparts (OR = 5.39, 95% CI: 5.16–5.64, p < 0.001), no significant differences were observed between rural and urban youth for bisexual individuals and individuals identifying as ‘something else'. The elevated odds of suicidal ideation among both urban and rural transgender teens reflect the widespread need for intervention, particularly in light of current legislation. These findings also highlight that rural bisexual teens face distinct vulnerabilities that warrant specific support strategies.