Next Article in Journal
Is More Always Merrier? Intersectionality as an Antecedent of Job Insecurity
Next Article in Special Issue
The Association between Low Body Weight and Scoliosis among Korean Elementary School Students
Previous Article in Journal
Degradation of Triclosan and Carbamazepine in Two Agricultural and Garden Soils with Different Textures Amended with Composted Sewage Sludge
Previous Article in Special Issue
“In my day…”- Parents’ Views on Children’s Physical Activity and Screen Viewing in Relation to Their Own Childhood
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
IJERPH
Volume 15
Issue 11
10.3390/ijerph15112558
ijerph-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Chinese Sexual Minority Male Adolescents’ Suicidality and Body Mass Index

by
Yeen Huang
1,†,
Pengsheng Li
1,†,
Zhisheng Lai
2,
Xiaofei Jia
3,
Di Xiao
1,
Tian Wang
1,
Lan Guo
1,† and
Ciyong Lu
1,4,*,†
1
Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
2
Yuexiu District Center for Disease Control and Prevention, Guangzhou 510080, China
3
Tianhe District Center for Disease Control and Prevention, Guangzhou 510655, China
4
Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou 510080, China
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Int. J. Environ. Res. Public Health 2018, 15(11), 2558; https://doi.org/10.3390/ijerph15112558
Submission received: 10 October 2018 / Revised: 2 November 2018 / Accepted: 9 November 2018 / Published: 15 November 2018
(This article belongs to the Special Issue Recent Advances of Adolescents and Children Health Research)
Versions Notes

Abstract

:
Excess weight status may increase the risk of suicidality among sexual minority females, but few studies have examined this suicidality disparity in sexual minority males. This study examined the association between sexual minority status and suicide attempts in Chinese male adolescents and tested whether body mass index (BMI) had a moderating effect on that association. Data were collected from 7th to 12th graders from seven randomly selected provinces of China in the 2015 School-Based Chinese Adolescents Health Survey. In total, 72,409 male students completed the questionnaires regarding sexual attraction, self-reported weight and height, and suicide attempts. After adjustment for covariates, sexual minority status was associated with suicide attempts among male students (AOR = 1.74, 95% CI = 1.57–1.93). Stratification analyses showed that BMI category moderated this association; compared with the results before stratification analyses, sexual minority males who were obese had increased risk of suicide attempts (AOR = 2.15, 95% CI = 1.09–4.24), sexual minority males who were overweight had reduced odds of suicide attempts (AOR = 1.40, 95% CI = 1.01–1.92), and no significant association change was found in sexual minority males who were underweight (AOR = 1.82, 95% CI = 1.43–2.33). Our study indicated that BMI moderated the risk of suicide attempts in sexual minority males. Suicide prevention targeting sexual minority males should be focused on weight status disparity and the creation of a positive climate to reduce minority stressors due to body image.

1. Introduction

Suicide is a leading cause of death among adolescents and youth adults, and suicide attempts are an important marker of suicidality [1,2]. A previous study showed that suicide attempts are currently a serious problem among adolescents in developing countries [3]. China is the largest developing country, with a high rate of suicidality, and the suicide patterns stratified by sex in China are different from those in Western countries [4,5]. Previously, in China, females had a consistently higher risk of suicide attempts than males [5]; however, this pattern reversed in 2008 [6]. Therefore, because male adolescents may be at increased risk of suicide attempts in China, an understanding of the risk factors and causes of suicide attempts is imperative to prevent suicidality among this group.
Sexual minority status (e.g., individuals who experience same-sex attraction, engage in same-sex sexual behavior, or self-identify as gay, lesbian, or bisexual) is a well-known risk factor for suicide attempts in male adolescents due to their difficulties in dealing with minority stressors [7]. A previous health survey of adolescents from the United States reported that 5.0–28.1% of sexual minority males had past-year suicide attempts and that the rate of suicide attempts was nearly two to seven times higher for sexual minority males than for heterosexual males [8,9]. It is well known that the cultural background of Western countries is different from that of Asian countries, especially China. Research in China showed that 4.6–12.6% of sexual minority males had a lifetime prevalence of suicide attempts, which was a proportion that was approximately 5.8 times higher than that in the general male population [10,11]. There is evidence of a strong association between sexual minority status and suicide attempts in Chinese male adolescents.
It is well-known that physical abuse and school victimization may increase the likelihood of suicidality for sexual minority adolescents [12], and anti-discrimination policy will contribute to the prevention of their suicide attempts [13]. Moreover, overweight (AOR = 1.40, 95% CI = 1.32–1.49) and obesity (AOR = 1.91, 95% CI = 1.71–2.14) have been showed to be important reasons for adolescents to be bullied at school [14]. Therefore, weight status might associate with suicidality for sexual minority adolescents. Previous research has showed a clear relationship between weight status and suicide attempts among male adolescents [15]; however, whether this association also exits in sexual minority males and how does weight status affect suicide attempts in this group are still unclear. One previous longitudinal study demonstrated that sexual orientation may be associated with body mass index (BMI) among male adolescents [16] and that sexual minority males had higher BMI in early adolescence than their heterosexual peers [17]. Moreover, a prior study in Dutch adolescents reported that obese boys were more likely to have lifetime suicide attempts than their normal weight peers [15]. Two large-scale cohort studies found an inverse association between BMI and suicide attempts among male adults [18,19]. Therefore, BMI may play a moderating role in the association between sexual minority status and suicide attempts among male adolescents. However, no previous study has examined this moderating role. Therefore, the objectives of this study were to estimate the association between sexual minority status and suicide attempts in Chinese male adolescents and to test whether BMI had a moderating effect on this association.

2. Materials and Methods

2.1. Study Design and Participants

We utilized data from the 2015 School-Based Chinese Adolescents Health Survey (SCAHS) [20,21], an ongoing, large-scale health-related behavior survey among Chinese adolescents (grades 7–12). The SCAHS has been conducted every two years since 2007, and the 2015 survey was the most recent version conducted in seven Chinese provinces [22]. In the 2015 SCAHS, students were selected via a 4-stage, stratified-cluster, random-sampling method. In total, 150,822 students completed the questionnaires (response rate of 95.9%), and 72,409 of those students were males. Therefore, in total, 72,409 male students were included in the analysis.

2.2. Data Collection

All students from the chosen classes were given a standardized self-administered questionnaire on the day of the survey to complete in the classroom during a normal class period (40 or 45 min). To protect students’ privacy, the questionnaire was completed by each student participant anonymously under the guidance of investigators and without the presence of teachers or other school personnel (to avoid any potential information bias). After collecting the questionnaires, investigators checked them carefully and contacted the students in a timely manner when they found important missing data. Investigators received standardized training by the research team, and quality control was implemented during data collection. All data were collected from November 2014 to January 2015.

2.3. Ethical Statement

This study was conducted in accordance with the Declaration of Helsinki, and was approved by the Institutional Review Board (ethic code: L2014063) of School of Public Health, Sun Yat-sen University. Written informed consent was obtained from each participating student who was at least 18 years old or from one of the student’s parents (or legal guardians) if the student was under 18 years old.

2.4. Measures

2.4.1. Sexual Minority Status

Sexual minority status was measured by asking students the following question regarding sexual attraction: “In a romantic relationship, which kind of person are you attracted to?” Responses options included the following: ‘opposite sex’, ‘same sex’, ‘equally opposite sex and same sex’, and ‘unsure’ [9,23,24]. Students who reported ‘same sex’, ‘equally opposite sex and same sex’, or ‘unsure’ attraction were classified as sexual minorities. A similar question has been used in other studies of Chinese adolescents [24,25].

2.4.2. Suicide Attempts

Suicide attempts were measured by asking the question “During the past 12 months, how many times did you actually attempt suicide?” and the students were asked to rate on a scale of zero or once or more [26,27].

2.4.3. Body Mass Index Category

BMI (kg/m2) was used as a measure of relative body weight and was calculated from self-reported weight (kg) and height (m) [28,29]; self-reported weight and height and the BMI calculated from these values have been showed to correlate strongly and reliably with measured values [30] and are reliable for predicting obesity status in adolescents [31,32]. Students were classified as underweight, normal weight, overweight, and obesity based on their BMI, and the classification criteria were as follows:
For male students ≤18 years, underweight was defined as a BMI ≤the referent age- and sex-specific percentiles in the national screening standard for underweight in Chinese school-aged children and adolescents (WS/T456-2014) [33]; normal weight was defined as a BMI greater than the referent age- and sex-specific percentiles of underweight and less than the referent age- and sex-specific percentiles of overweight; overweight was defined as a BMI ≥the referent age- and sex-specific 85th percentile but less than the 95th percentile according to the reference for adolescents developed by the Working Group on Obesity in China (WGOC) [34]; obesity was defined as a BMI ≥the referent age- and sex-specific 95th percentile according to the reference for adolescents developed by the WGOC. For male adolescents >18 years, the cut-off points for BMI for underweight, overweight, and obese were 18.5, 24, and 28, respectively, according to the reference for adults developed by the WGOC [35,36].

2.4.4. Covariates

Covariates included age, academic pressure, cigarette smoking, alcohol consumption, school victimization, and depressive symptoms, which have previously been reported to be associated with suicidality among sexual minority adolescents [8,9,37,38].
Academic pressure was assessed by asking about the student’s personal appraisal of academic stress of the school year. The responses included “none”, “less”, and “medium or great”. Cigarette smoking was measured by asking the following question: “During the past 30 days, on how many days did you smoke cigarettes?” Students who selected answers indicating 1 or more days were classified as smokers [39]. Alcohol consumption was assessed with the following question: “During the past 30 days, on how many days did you drink alcohol?” Students who selected answers indicating 1 or more days were classified as alcohol consumers [40]. School victimization was assessed according to the definition of bullying from the Olweus Bully/Victim Questionnaire [41]; students were asked the following question: “Have you been bulled at school in the previous month?” The responses included “no”, “1–2 days”, “3–5 days”, “6–9 days”, “1–19 days”, and “more than 20 days”. Students who reported being bulled with a frequency of 3 days or more were classified as having experienced school victimization [25,42]. The Chinese version of the Depression Self-Rating Scale for Children (DSRSC) was used to identify whether individuals had depressive symptoms [43,44]. The score range of the DSRSC was 0-54, and scores greater than 15 points indicated depressive symptoms. This scale has been demonstrated to be valid and reliable in the Chinese adolescent population.

2.5. Statistical Analysis

First, descriptive analyses were conducted to describe demographic characteristics, prevalence of BMI categories, and suicide attempts in sexual minority males and heterosexual males; Rao-Scott χ2 tests were used to compare the differences between groups. Second, univariate logistic regression models were performed to explore the association between sexual minority status and suicide attempts among male adolescents. The variables that were significant at the 0.10 level in univariate analyses or that had been widely reported in previous studies were simultaneously included in the multivariate logistic regression models to evaluate the independent association between sexual minority status and suicide attempts. Odds ratios (OR) and 95% confidence intervals (CI) were obtained from the logistic regression models. Third, to investigate whether the association between sexual minority status and suicide attempts was moderated by BMI category, we tested the interaction between sexual minority status and BMI category. If the interaction was significantly associated with suicide attempts, we performed stratification analyses to measure the association between sexual minority status and suicide attempts in male adolescents with normal weight, underweight, overweight, and obesity. Missing data accounted for less than 3.1% of all relevant variables, and observations with missing data were eliminated in the statistical analyses. In prevalence estimates and logistic regression analyses, appropriate sampling weights and estimation procedures that accounted for the complex sampling design were used. All statistical analyses were conducted using SAS 9.3 (SAS Institute, Inc., Cary, NC, USA). A two-tailed p-value of less than 0.05 was considered statistically significant.

3. Results

3.1. Characteristics of Participants and the Prevalence of BMI Categories and Suicide Attempts

As shown in Table 1, of the 72,409 male students analyzed, 80.1% self-reported as heterosexuals and 19.9% self-reported as sexual minorities (same-sex attraction: 1.4%, both-sex attraction: 1.9%, and unsure: 16.6%). The male students ranged in age from 12 to 20 years, and the proportion of male students who ranged in age from 12 to 13 and from 14 to 15 years was higher among sexual minority males than heterosexual males (p < 0.001). Compared with their heterosexual peers, sexual minority males were more likely to report school victimization and depressive symptoms (p < 0.001).
The weighted prevalence of having past-year suicide attempts was significantly greater in sexual minority males than in heterosexual males (4.2% vs. 2.2%, p < 0.001). Compared with their heterosexual peers, sexual minority males were more likely to fall outside of the normative BMI categories (p < 0.001).

3.2. Association of Sexual Minority Status, BMI Category, and Their Interaction with Suicide Attempts

In the unadjusted models (Model 1 in Table 2), sexual minority status, BMI category, and their interaction were significantly associated with past-year suicide attempts (p < 0.05). Furthermore, after adjustment for age, academic pressure, cigarette smoking, alcohol consumption, school victimization, and depressive symptoms (Model 2 in Table 2), the above associations remained statistically significant (p < 0.05). Sexual minority status was associated with past-year suicide attempts (adjusted odds ratios (AOR) = 1.74, 95% CI = 1.57–1.93). Male students with obesity (AOR = 1.35, 95% CI = 1.11–1.64) were more likely to have past-year suicide attempts than those with normal weight, underweight, or overweight. The interaction of sexual minority status and BMI category was statistically significant in the adjusted models for past-year suicide attempts (p-interaction = 0.025).

3.3. Association between Sexual Minority Status and Suicide Attempts Stratified by BMI Category

Stratification analyses were conducted separately for male students with normal weight, underweight, overweight, and obesity (Table 3). After stratification analyses, the association between sexual minority status and past-year suicide attempts was moderated by BMI category; compared with the results before stratification analyses, sexual minority males who were obese had a greater risk of past-year suicide attempts (AOR = 2.15, 95% CI = 1.09–4.24), sexual minority males who were overweight had reduced odds of past-year suicide attempts (AOR = 1.40, 95% CI = 1.01–1.92), and no significant association change was found in sexual minority males who were underweight (AOR = 1.82, 95% CI = 1.43–2.33).

4. Discussion

Using data from the 2015 SCAHS, we found that BMI moderated the risk of suicide attempts in Chinese sexual minority males, and those with obesity had increased odds of suicide attempts. To our knowledge, this is the first nationally large-scale study to explore the potential moderating effect of BMI on the relationship between sexual minority status and suicide attempts among male adolescents.
Consistent with previous studies [8,9], our results demonstrated that sexual minority males experienced a higher prevalence of past-year suicide attempts than their heterosexual peers. Moreover, after adjustment for covariates, sexual minority males still had a higher risk of past-year suicide attempts than their heterosexual peers. These results might be related to sexual minority stress associated with same-sex orientation [7]. Our findings support those of previous studies showing a ubiquitously elevated suicidality risk in sexual minorities, and suggest that Chinese sexual minority males remain particularly vulnerable to suicide attempts in comparison with their heterosexual peers.
Furthermore, previous studies found that BMI was an important factor influencing suicide attempts among males [18,45]. Similarly, our study demonstrated that there was a significant association between BMI category and past-year suicide attempts in Chinese male adolescents. Individuals with obesity were at greater risk for past-year suicide attempts than those with normal weight, underweight, or overweight. More importantly, our stratification analyses were conducted separately for normal weight, underweight, overweight, and obese male adolescents, and the results illustrated that the risk of past-year suicide attempts was increased in sexual minority males who were obese and was reduced in those who were overweight compared with the results before stratification analyses, suggesting that BMI category might have a moderating effect on the association between sexual minority status and suicide attempts. A prior study based on the Youth Risk Behavior Survey (YRBS) in the United States showed that sexual minority females who perceived themselves to be overweight had greater odds of past-year suicide attempts than all other sexual minority or perceived weight groups [46]. Moreover, previous cohort studies have showed that higher BMI is associated with a lower risk of suicide in male adults [18,19]. In contrast to previous findings, our results showed that sexual minority males might have a unique suicide pattern moderated by their weight status, which was different from that of sexual minority females and heterosexual males. Similar to previous studies which showed school victimization [47], anti-discrimination policy [13] and Gay-Straight Alliance [48] targeted sexual minority adolescents might have mediating or moderating effects on suicide risk in sexual minorities. Our study showed that weight status might also be one of the important influence factors of suicidality in sexual minority males, excess weight status were associated with higher risk of suicide attempts.
The mechanisms underlying suicidal behavior in sexual minorities are not entirely clear, and the increased suicide risk in obese sexual minority males might be related to their doubled level of minority stressors due to their sexual minority status and their excess weight status. The minority stress theory suggests that individuals may experience multiple minority stressors (e.g., prejudice and violence) if they are defined by stigmatized characteristics such as those of sexual minorities [7], overweight or obese people [49]. Adolescents who are sexually attracted to the same sex and are identified as obese may experience ridicule and are at substantial risk for bullying victimization; victimization in school environments is associated with negative individual outcomes such as depression and suicidal behavior [50]. In addition, our study also found that sexual minority males who were overweight had reduced risk of suicide attempts compared with those with normal weight or underweight. One possible explanation is that sexual minority males may desire to be thinner or more muscular than their heterosexual peers and show greater body dissatisfaction [51] and eating disorder symptomatology [52,53]. Such negative attitudes and behavior toward body image may cause sexual minority males to be more vulnerable to psychological and physical health issues (e.g., suicidal behavior) [54] even if their body image matches normative standards (e.g., weight status is in the normal range or underweight) of their current social environment. Therefore, sexual minority males might be a minority group with a unique suicide risk that is moderated by their weight status. Further studies are needed to understand the potential mechanisms underlying the association between sexual minority status and suicidality and to test whether weight status or other influential factors could strengthen or weaken these associations, such that suicidality intervention and prevention efforts could be more effectively targeted to these high-risk individuals.
Based on our results, the following interventions to prevent suicidality among Chinese sexual minority males are recommended. First, schools and related public health organizations should create a friendly environment and atmosphere to reduce minority stressors against sexual minority males and those with obesity (e.g., supportive and positive regard from classmates and teachers). Second, families and communities should help sexual minority males accept their sexual orientation [55] and body appearance [56] to reduce pressures from sexual minority stressors (e.g., internalized homophobia) and body dissatisfaction (e.g., not comparing oneself unfavorably to another on the basis of appearance). Third, effective prevention and treatment of obesity should also be focused on to help sexual minority males reduce the physical and psychological issues related to suicidality.
Several limitations of our study should be noted when interpreting the results. First, the cross-sectional design of this study limited our ability to make causal inferences. Second, our study used a structured self-reported questionnaire to collect data, and we could not completely rule out the possibility of recall bias. Third, in our national large-scale study, the proportion of male students who responded “unsure” (16.6%) to the sexual minority status question was greater than in previous studies; those “unsure” students probably included not only individuals who were still unsure of their sexual orientation but also heterosexual students who were unwilling to disclose their sexual orientation or did not understand the question because of their younger age, which might result in an underestimation of the suicidality disparities in our study. Fourth, our study sample included students attending school but did not include adolescents who had dropped out of school or were absent from school on the day the survey was administered; suicidality may be more common among students who were absent, and this might lead to an underestimation of the suicidality disparities. Despite these limitations, the primary strengths of our study were that it included a nationally large-scale sample of Chinese male adolescents, which provided sufficient statistical power especially for the stratification analyses, and a representative sample could avoid the oversampling of sexual minorities. Moreover, our study is the first to explore the moderating effect of BMI on the association between sexual minority status and suicide attempts among male adolescents.

5. Conclusions

In China, obese individuals would suffer more stress from cultural preferences around the aesthetics and health of slim body, and such negative pressure might strengthen their association with suicidality especially for obese sexual minorities. Using a nationally large-scale sample of Chinese adolescents, our study indicated that BMI moderated the association between sexual minority status and suicide attempts in male adolescents, and this association was increased in sexual minority males who were obese and was reduced in those with overweight. These findings suggest that suicide prevention efforts targeting sexual minority males should be made, with close attention to disparity in weight status and the promotion of a positive climate to reduce minority stressors due to body image.

Author Contributions

Conceptualization, Y.H., P.L., L.G. and C.L.; Data curation, Z.L., X.J., D.X. and T.W.; Formal analysis, Y.H. and P.L.; Investigation, Z.L., X.J., D.X. and T.W.; Supervision, X.J., L.G. and C.L.; Writing—original draft, Y.H. and P.L.; Writing—review & editing, Z.L., X.J., D.X., T.W., L.G. and C.L.

Funding

This work was supported by the National Natural Science Foundation of China (grant number 81673252) and the Natural Science Foundation of Guangdong Province, China (grant number 2014A030313174).

Acknowledgments

We thank the local health professionals, Department of Education, and participating schools for their assistance and support. In addition, we also express our gratitude to the participating investigators (Ming Li, Siyuan Pan, and Wuquan Li) for assisting data collection and Qiaohong Chen for providing language help.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. World Health Organization. Suicide Data. 2015. Available online: http://www.who.int/mental_health/suicide-prevent ion/en/ (accessed on 1 July 2018).
  2. Cluver, L.; Orkin, M.; Boyes, M.E.; Sherr, L. Child and adolescent suicide attempts, suicidal behavior, and adverse childhood experiences in South Africa: A prospective study. J. Adolesc. Health 2015, 57, 52–59. [Google Scholar] [CrossRef] [PubMed]
  3. Kõlves, K.; De, L.D. Adolescent suicide rates between 1990 and 2009: Analysis of age group 15–19 years worldwide. J. Adolesc. Health 2016, 58, 69–77. [Google Scholar] [CrossRef] [PubMed]
  4. Phillips, M.R.; Li, X.; Zhang, Y. Suicide rates in China, 1995–1999. Lancet 2002, 359, 835–840. [Google Scholar] [CrossRef]
  5. Li, Y.; Li, Y.; Cao, J. Factors associated with suicidal behaviors in mainland China: A meta-analysis. BMC Public Health 2012, 12, 524. [Google Scholar] [CrossRef] [PubMed]
  6. Jie, Z.; Jing, J. A sociological analysis of the decline in the suicide rate in China. Soc. Sci. China 2011, 5, 97–113. [Google Scholar]
  7. Meyer, I.H. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychol. Bull. 2003, 129, 674–697. [Google Scholar] [CrossRef] [PubMed]
  8. Remafedi, G.; French, S.; Story, M.; Resnick, M.D.; Blum, R. The relationship between suicide risk and sexual orientation: Results of a population-based study. Am. J. Public Health 1998, 88, 57–60. [Google Scholar] [CrossRef] [PubMed]
  9. Russell, S.T.; Joyner, K. Adolescent sexual orientation and suicide risk: Evidence from a national study. Am. J. Public Health 2001, 91, 1276–1281. [Google Scholar] [CrossRef] [PubMed]
  10. Mu, H.; Li, Y.; Liu, L.; Na, J.; Yu, L.; Bi, X.; An, X.; Gu, Y.; Zhou, Y.; Li, S.; et al. Prevalence and risk factors for lifetime suicide ideation, plan and attempt in Chinese men who have sex with men. BMC Psychiatry 2016, 16, 117. [Google Scholar] [CrossRef] [PubMed]
  11. Chen, H.; Li, Y.; Wang, L.; Zhang, B. Causes of suicidal behaviors in men who have sex with men in China: A national questionnaire survey. BMC Public Health 2015, 15, 91. [Google Scholar] [CrossRef] [PubMed]
  12. Hillier, L.; Harrison, L.; Dempsey, D. Whatever happened to duty of care? Same-sex attracted young people’s stories of schooling and violence. Melb. Stud. Educ. 1999, 40, 59–74. [Google Scholar] [CrossRef]
  13. Andrew, Y. Policy and Gay, Lesbian, Bisexual, Transgender and Intersex Students; Springer: Cham, Switzerland; Heidelberg, Germany; New York, NY, USA; Dordrecht, The Netherlands; London, UK, 2015. [Google Scholar]
  14. Lian, Q.; Su, Q.; Li, R.; Elqar, F.J.; Liu, Z.; Zheng, D. The association between chronic bullying victimization with weight status and body self-image: A cross-national study in 39 countries. Peer J. 2018, 6, e4330. [Google Scholar] [CrossRef] [PubMed]
  15. van Wijnen, L.G.; Boluijt, P.R.; Hoeven-Mulder, H.B.; Bemelmans, W.J.; Wendel-Vos, G.C. Weight status, psychological health, suicidal thoughts, and suicide attempts in Dutch adolescents: Results from the 2003 E-MOVO project. Obesity (Silver Spring) 2010, 18, 1059–1061. [Google Scholar] [CrossRef] [PubMed]
  16. Katz-Wise, S.L.; Blood, E.A.; Milliren, C.E.; Calzo, J.P.; Richmond, T.K.; Gooding, H.C.; Austin, S.B. Sexual orientation disparities in BMI among U.S. adolescents and young adults in three race/ethnicity groups. J. Obes. 2014, 2014, 537242. [Google Scholar] [CrossRef] [PubMed]
  17. Austin, S.B.; Ziyadeh, N.J.; Corliss, H.L.; Haines, J.; Rockett, H.R.; Wypij, D.; Field, A.E. Sexual orientation disparities in weight status in adolescence: Findings from a prospective study. Obesity (Silver Spring) 2009, 17, 1776–1782. [Google Scholar] [CrossRef] [PubMed]
  18. Gao, S.; Juhaeri, J.; Reshef, S.; Dai, W.S. Association between body mass index and suicide, and suicide attempt among British adults: The health improvement network database. Obesity (Silver Spring) 2013, 21, E334–E342. [Google Scholar] [CrossRef] [PubMed]
  19. Magnusson, P.K.; Rasmussen, F.; Lawlor, D.A.; Tynelius, P.; Gunnell, D. Association of body mass index with suicide mortality: A prospective cohort study of more than one million men. Am. J. Epidemiol. 2006, 163, 1–8. [Google Scholar] [CrossRef] [PubMed]
  20. Wang, H.; Deng, J.; Zhou, X.; Lu, C.; Huang, J.; Huang, G.; Gao, X.; He, Y. The nonmedical use of prescription medicines among high school students: A cross-sectional study in Southern China. Drug Alcohol. Depend. 2014, 141, 9–15. [Google Scholar] [CrossRef] [PubMed]
  21. Guo, L.; Xu, Y.; Deng, J.; He, Y.; Gao, X.; Li, P.; Wu, H.; Zhou, J.; Lu, C. Non-medical use of prescription pain relievers among high school students in China: A multilevel analysis. BMJ Open 2015, 5, e7569. [Google Scholar] [CrossRef] [PubMed]
  22. Guo, L.; Xu, Y.; Deng, J.; Gao, X.; Huang, G.; Huang, J.; Deng, X.; Zhang, W.H.; Lu, C. Associations between childhood maltreatment and non-medical use of prescription drugs among Chinese adolescents. Addiction 2017, 112, 1600–1609. [Google Scholar] [CrossRef] [PubMed]
  23. Lesbian, Gay, and Bisexual (LGB) Youth Sexual Orientation Measurement Work Group. Measuring Sexual Orientation of Young People in Health Research; Gay and Lesbian Medical Association: San Francisco, CA, USA, 2003. [Google Scholar]
  24. Li, P.; Huang, Y.; Guo, L.; Wang, W.; Xi, C.; Lei, Y.; Luo, M.; Pan, S.; Deng, X.; Zhang, W.H.; et al. Sexual attraction and the nonmedical use of opioids and sedative drugs among Chinese adolescents. Drug Alcohol. Depend. 2018, 183, 169–175. [Google Scholar] [CrossRef] [PubMed]
  25. Li, P.; Huang, Y.; Guo, L.; Wang, W.; Xi, C.; Lei, Y.; Luo, M.; Pan, S.; Deng, X.; Zhang, W.H.; et al. Is sexual minority status associated with poor sleep quality among adolescents? Analysis of a national cross-sectional survey in Chinese adolescents. BMJ Open 2017, 7, e17067. [Google Scholar] [CrossRef] [PubMed]
  26. Guo, L.; Xu, Y.; Deng, J.; Huang, J.; Huang, G.; Gao, X.; Wu, H.; Pan, S.; Zhang, W.H.; Lu, C. Association between nonmedical use of prescription drugs and suicidal behavior among adolescents. JAMA Pediatr. 2016, 170, 971–978. [Google Scholar] [CrossRef] [PubMed]
  27. Woods, E.R.; Lin, Y.G.; Middleman, A.; Beckford, P.; Chase, L.; DuRant, R.H. The associations of suicide attempts in adolescents. Pediatrics 1997, 99, 791–796. [Google Scholar] [CrossRef] [PubMed]
  28. Dietz, W.H.; Robinson, T.N. Use of the body mass index (BMI) as a measure of overweight in children and adolescents. J. Pediatr. 1998, 2, 191–193. [Google Scholar]
  29. Pietilainen, K.H.; Kaprio, J.; Rissanen, A.; Winter, T.; Rimpela, A.; Viken, R.J.; Rose, R.J. Distribution and heritability of BMI in Finnish adolescents aged 16y and 17y: A study of 4884 twins and 2509 singletons. Int. J. Obes. Relat. Metab. Disord. 1999, 23, 107–115. [Google Scholar] [CrossRef] [PubMed]
  30. Brener, N.D.; Mcmanus, T.; Galuska, D.A.; Lowry, R.; Wechsler, H. Reliability and validity of self-reported height and weight among high school students. J. Adolesc. Health 2003, 32, 281–287. [Google Scholar] [CrossRef]
  31. Goodman, E.; Hinden, B.R.; Khandelwal, S. Accuracy of teen and parental reports of obesity and body mass index. Pediatrics 2000, 106, 52–58. [Google Scholar] [CrossRef] [PubMed]
  32. Strauss, R.S. Comparison of measured and self-reported weight and height in a cross-sectional sample of young adolescents. Int. J. Obes. Relat. Metab. Disord. 1999, 23, 904–908. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  33. National Health and Family Planning Commission of China. Screening Standard for Malnutrition of School-Age Children and Adolescents. Available online: http://www.moh.gov.cn/ zwgkzt/pqt/201407/38b15c0a1ed444e8908e12752decaffa.shtml (accessed on 1 July 2018).
  34. WGOC (Working Group on Obesity in China). Body mass index reference norm for screening overweight and obesity in Chinese children and adolescents. Chin. J. Epidemiol. 2004, 25, 97–102. [Google Scholar]
  35. Zhou, B. Prospective study for cut-off points of body mass index in Chinese adults. Chin. J. Epidemiol. 2002, 23, 431–434. [Google Scholar]
  36. Zhou, B.F. Effect of body mass index on all-cause mortality and incidence of cardiovascular diseases—Report for meta-analysis of prospective studies open optimal cut-off points of body mass index in Chinese adults. Biomed. Environ. Sci. 2002, 15, 245–252. [Google Scholar] [PubMed]
  37. Shields, J.P.; Whitaker, K.; Glassman, J.; Franks, H.M.; Howard, K. Impact of victimization on risk of suicide among lesbian, gay, and bisexual high school students in San Francisco. J. Adolesc. Health 2012, 50, 418–420. [Google Scholar] [CrossRef] [PubMed]
  38. Denny, S.; Lucassen, M.F.; Stuart, J.; Fleming, T.; Bullen, P.; Peiris-John, R.; Rossen, F.V.; Utter, J. The association between supportive high school environments and depressive symptoms and suicidality among sexual minority students. J. Clin. Child Adolesc. Psychol. 2016, 45, 248–261. [Google Scholar] [CrossRef] [PubMed]
  39. Acierno, R.; Kilpatrick, D.G.; Resnick, H.; Saunders, B.; De Arellano, M.; Best, C. Assault, PTSD, family substance use, and depression as risk factors for cigarette use in youth: Findings from the National Survey of Adolescents. J. Trauma. Stress 2000, 13, 381–396. [Google Scholar] [CrossRef] [PubMed]
  40. Huang, R.; Ho, S.Y.; Wang, M.P.; Lo, W.S.; Lam, T.H. Sociodemographic risk factors of alcohol drinking in Hong Kong adolescents. J. Epidemiol. Community Health 2016, 70, 374–379. [Google Scholar] [CrossRef] [PubMed]
  41. Olweus, D. The Revised Olweus Bully/Victim Questionnaire; University of Bergen: Bergen, Norway, 1996. [Google Scholar]
  42. Wu, J.; He, Y.; Lu, C.; Deng, X.; Gao, X.; Guo, L.; Wu, H.; Chan, F.; Zhou, Y. Bullying behaviors among Chinese school-aged youth: A prevalence and correlates study in Guangdong Province. Psychiatry Res. 2015, 225, 716–722. [Google Scholar] [CrossRef] [PubMed]
  43. Birleson, P. The validity of depressive disorder in childhood and the development of a self-rating scale: A research report. J. Child Psychol. Psychiatry 1981, 22, 73–88. [Google Scholar] [CrossRef] [PubMed]
  44. Su, L.Y.; Wang, K.; Zhu, Y.; Luo, X.R.; Yang, Z.W. Norm of the depression self-rating scale for children in Chinese urban children. Chin. Ment. Health J. 2003, 8, 547–549. [Google Scholar]
  45. Mukamal, K.J.; Kawachi, I.; Miller, M.; Rimm, E.B. Body mass index and risk of suicide among men. Arch. Intern. Med. 2007, 167, 468–475. [Google Scholar] [CrossRef] [PubMed]
  46. Johns, M.M.; Lowry, R.; Demissie, Z.; Robin, L. Harassment and mental distress among adolescent female students by sexual identity and BMI or perceived weight status. Obesity (Silver Spring) 2017, 25, 1421–1427. [Google Scholar] [CrossRef] [PubMed]
  47. Burton, C.M.; Marshal, M.P.; Chisolm, D.J.; Sucato, G.S.; Friedman, M.S. Sexual minority-related victimization as a mediator of mental health disparities in sexual minority youth: A longitudinal analysis. J. Youth Adolesc. 2013, 42, 394–402. [Google Scholar] [CrossRef] [PubMed]
  48. Davis, B.; Royne Stafford, M.B.; Pullig, C. How gay-straight alliance groups mitigate the relationship between gay-bias victimization and adolescent suicide attempts. J. Am. Acad. Child Adolesc. Psychiatry 2014, 53, 1271–1278. [Google Scholar] [CrossRef] [PubMed]
  49. Miller, C.T.; Myers, A.M. Compensating for prejudice: How heavyweight people (and others) control outcomes despite prejudice. Prejudice 1998, 191–218. [Google Scholar] [CrossRef]
  50. Ash-Houchen, W.; Lo, C.C. Intersections of gender and sexual minority status: Co-occurring bullying victimization among adolescents. Comput. Hum. Behav. 2018, 80, 262–270. [Google Scholar] [CrossRef]
  51. Yelland, C.; Tiggemann, M. Muscularity and the gay ideal: Body dissatisfaction and disordered eating in homosexual men. Eat. Behav. 2003, 4, 107–116. [Google Scholar] [CrossRef]
  52. Russell, C.J.; Keel, P.K. Homosexuality as a specific risk factor for eating disorders in men. Int. J. Eat. Disord. 2002, 31, 300–306. [Google Scholar] [CrossRef] [PubMed]
  53. Yean, C.; Benau, E.M.; Dakanalis, A.; Hormes, J.M.; Perone, J.; Timko, C.A. The relationship of sex and sexual orientation to self-esteem, body shape satisfaction, and eating disorder symptomatology. Front. Psychol. 2013, 4, 887. [Google Scholar] [CrossRef] [PubMed]
  54. Blashill, A.J.; Tomassilli, J.; Biello, K.; O’Cleirigh, C.; Safren, S.A.; Mayer, K.H. Body dissatisfaction among sexual minority men: Psychological and sexual health outcomes. Arch. Sex. Behav. 2016, 45, 1241–1247. [Google Scholar] [CrossRef] [PubMed]
  55. Eubanks-Carter, C.; Burckell, L.A.; Goldfried, M.R. Enhancing therapeutic effectiveness with lesbian, gay, and bisexual clients. Clin. Psychol. Sci. Pract. 2005, 1, 1–18. [Google Scholar] [CrossRef]
  56. Johns, M.M.; Zimmerman, M.; Harper, G.W.; Bauermeister, J.A. Resilient minds and bodies: Size discrimination, body image, and mental health among sexual minority women. Psychol. Sex. Orientat. Gend. Divers. 2017, 4, 34–42. [Google Scholar] [CrossRef]
Table
Table 1. Sample characteristics and prevalence of BMI categories and suicide attempts, stratified by sexual minority status (N = 72,409).
Table 1. Sample characteristics and prevalence of BMI categories and suicide attempts, stratified by sexual minority status (N = 72,409).
VariablesTotal No. (%)Heterosexual Males No. (%)Sexual Minority Males a No. (%)χ2p-Value
Total72,409 (100.0)57,343 (80.1)15,066 (19.9)
Sexual minority status NANA
 Heterosexuals57,343 (80.1)NANA
 Sexual minorities males a15,066 (19.9)NANA
  Same-sex attractionNANA1038 (1.4)
  Both-sex attractionNANA1445 (1.9)
  UnsureNANA12,583 (16.6)
Age (years) 3891.72<0.001
 12–1316,614 (23.1)10,675 (19.0)5939 (39.5)
 14–1525,487 (35.5)19,846 (34.9)5641 (37.7)
 16–1722,886 (30.1)20,113 (33.3)2773 (17.6)
 18–207422 (11.3)6709 (12.8)713 (5.2)
Academic pressure 276.77<0.001
 None12,795 (17.8)9657 (16.9)3138 (21.2)
 Less31,765 (44.7)24,811 (44.3)6954 (46.3)
 Medium or great27,849 (37.5)22,875 (38.8)4974 (32.5)
Cigarette smoking 266.38<0.001
 No65,407 (90.4)51,271 (89.5)14,136 (93.9)
 Yes7002 (9.6)6072 (10.5)930 (6.1)
Alcohol consumption 448.79<0.001
 No56,957 (78.9)44,158 (77.4)12,799 (85.1)
 Yes15,452 (21.1)13,185 (22.6)2267 (14.9)
School victimization 74.24<0.001
 No64,117 (88.5)51,076 (89.0)13,041 (86.2)
 Yes8292 (11.5)6267 (11.0)2025 (13.8)
Depressive symptoms 349.88<0.001
 No58,682 (81.8)47,273 (83.3)11,409 (76.1)
 Yes13,727 (18.2)10,070 (16.7)3657 (23.9)
Suicide attempts 173.13<0.001
 No70,404 (97.4)55,991 (97.8)14,413 (95.8)
 Yes2005 (2.6)1352 (2.2)653 (4.2)
BMI category 34.22<0.001
 Normal weight49,995 (69.2)39,879 (69.7)10,116 (67.1)
 Underweight11,130 (16.0)8672 (15.8)2458 (16.9)
 Overweight7661 (10.2)5998 (10.0)1663 (10.8)
 Obesity3623 (4.6)2794 (4.5)829 (5.2)
Abbreviations: BMI, body mass index; No., number; NA, not applicable or no data available. a Sexual minority males included male adolescents who reported same-sex, both-sexes or unsure attraction. All numbers are unweighted, whereas all percentages are adjusted for sampling weights.
Table
Table 2. Association of sexual minority status, BMI category, and their interaction with suicide attempts among male adolescents (N = 72,409).
Table 2. Association of sexual minority status, BMI category, and their interaction with suicide attempts among male adolescents (N = 72,409).
VariableModel 1Model 2
Suicide AttemptsSuicide Attempts
OR (95% CI)p-ValueAOR (95% CI)p-Value
Sexual minority status
 Heterosexual males1.00 1.00
 Sexual minority males a1.88 (1.71–2.06)<0.0011.74 (1.57–1.93)<0.001
BMI category
 Normal weight1.00 1.00
 Underweight1.17 (1.03–1.32)0.0131.09 (0.96–1.23)0.194
 Overweight1.06 (0.91–1.22)0.4571.07 (0.92–1.25)0.383
 Obesity1.33 (1.10–1.60)0.0031.35 (1.11–1.64)0.003
Sexual minority status × BMI category-<0.001-0.025
Abbreviations: BMI, body mass index; OR, odds ratios; AOR, adjusted odds ratios; CI, confidence intervals. a Sexual minority males included male adolescents who reported same-sex, both-sexes or unsure attraction. Model 1 for suicide attempts was unadjusted. Model 2 for suicide attempts was adjusted for age, academic pressure, cigarette smoking, alcohol consumption, school victimization, and depressive symptoms. Sexual minority status × BMI category: Interaction between sexual minority status and BMI category.
Table
Table 3. Association between sexual minority status and suicide attempts among male adolescents, stratified by BMI category (N = 72,409).
Table 3. Association between sexual minority status and suicide attempts among male adolescents, stratified by BMI category (N = 72,409).
VariableNormal WeightUnderweightOverweightObesity
Suicide AttemptsSuicide AttemptsSuicide AttemptsSuicide Attempts
AOR (95% CI)AOR (95% CI)AOR (95% CI)AOR (95% CI)
Sexual minority status
 Heterosexual males1.001.001.001.00
 Sexual minority males a1.78 (1.56–2.02) ***1.82 (1.43–2.33) ***1.40 (1.01–1.92) ***2.15 (1.09–4.24) ***
Abbreviations: BMI, body mass index; AOR, adjusted odds ratios; CI, confidence intervals. a Sexual minority males included male adolescents who reported same-sex, both-sexes or unsure attraction. All the models were adjusted for age, academic pressure, cigarette smoking, alcohol consumption, school victimization, and depressive symptoms. *** p < 0.001.

Share and Cite

MDPI and ACS Style

Huang, Y.; Li, P.; Lai, Z.; Jia, X.; Xiao, D.; Wang, T.; Guo, L.; Lu, C. Chinese Sexual Minority Male Adolescents’ Suicidality and Body Mass Index. Int. J. Environ. Res. Public Health 2018, 15, 2558. https://doi.org/10.3390/ijerph15112558

AMA Style

Huang Y, Li P, Lai Z, Jia X, Xiao D, Wang T, Guo L, Lu C. Chinese Sexual Minority Male Adolescents’ Suicidality and Body Mass Index. International Journal of Environmental Research and Public Health. 2018; 15(11):2558. https://doi.org/10.3390/ijerph15112558

Chicago/Turabian Style

Huang, Yeen, Pengsheng Li, Zhisheng Lai, Xiaofei Jia, Di Xiao, Tian Wang, Lan Guo, and Ciyong Lu. 2018. "Chinese Sexual Minority Male Adolescents’ Suicidality and Body Mass Index" International Journal of Environmental Research and Public Health 15, no. 11: 2558. https://doi.org/10.3390/ijerph15112558

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop