Exploring suicidal ideation among sexual minority adolescents in Hong Kong : the origin, the disparity, and the mechanism

Abstract

Sexual minority adolescents consistently face a heightened risk of suicide, primarily due to the stress resulting from their marginalized and stigmatized status. However, research into the social prejudice faced by sexual minority populations and the suicide risks confronting sexual minority adolescents remains notably scarce within the Chinese context. To address these gaps, this thesis investigated the evolution of social prejudice toward sexual minority populations within a Chinese context by analyzing attitudinal shifts toward homosexuality among Hong Kong adolescents between 2011 and 2021. It also examined whether sexual minority adolescents experienced a higher prevalence of suicidal ideation, while considering the intersectionality of their social identities/positions. Additionally, the roles of various intra- and interpersonal factors in contributing to sexual orientation-based disparities in suicidal ideation are explored. Through these analyses, the thesis aims to provide a comprehensive understanding of the social and mental health challenges faced by sexual minority adolescents. Drawing on data from a territory-wide, population-representative survey of Hong Kong secondary school students, this thesis is structured into three interrelated studies: Study 1 examined temporal trends in three dimensions of attitudes toward homosexuality among Hong Kong adolescents. Using latent class analysis and multiple group latent class analysis, this study explored the heterogeneity in the attitudes and investigated whether and how these attitude patterns shifted between 2011 and 2021. The findings revealed a notable increase in the acceptance of homosexuality among Hong Kong adolescents during this period. However, their attitudes toward different aspects of homosexuality were not entirely consistent, underscoring the complexity of social prejudice. Study 2 employed multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) to investigate the combined effects of sex, gender expression, and sexual orientation on suicidal ideation among Hong Kong adolescents. The results indicated that non-heterosexual adolescents in Hong Kong faced nearly double the odds of experiencing suicidal ideation compared to their heterosexual peers. 12.60% of the total variance in suicidal ideation can be attributed to these social identities/positions. Adolescents with multiple marginalized identities/positions exhibited the highest prevalence of suicidal ideation, suggesting significant heterogeneities within sexual minority adolescents. Study 3 delved deeper into the potential mechanisms underlying sexual orientation-based disparities in suicidal ideation, employing the Blinder-Oaxaca decomposition analysis. The findings highlighted the significant role of family-related factors in shaping suicide risks among Chinese sexual minority populations. Additionally, sex differences were identified in the comparison of suicidal ideation between heterosexual and non-heterosexual adolescents, further emphasizing the nuanced nature of these disparities. Collectively, this thesis highlights the necessity of addressing not only the rights of sexual minority groups but also the more subtle yet significant forms of discrimination they encounter. The disadvantages associated with social identities/positions emphasize the need for comprehensive suicide prevention strategies that extend beyond individual-level risk factors to foster systemic change. Interventions that focus narrowly on a single social identity/position are likely to be insufficient. Particularly within Chinese contexts, fostering family understanding and acceptance emerges as a critical factor in improving the mental health and well-being of sexual minority adolescents.