Suicidality at the intersection of sex, sexual orientation, and gender expression among secondary school students in Hong Kong: a population-based studyResearch in context
Summary: Background: Previous suicide research has seldom examined the collective impact of multiple social identities/positions, and suicidality among sexual and gender minority adolescents remains understudied in Chinese contexts. Using intersectionality as both a theoretical and analytical frame...
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Elsevier
2024-12-01
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| Series: | The Lancet Regional Health. Western Pacific |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666606524002463 |
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| author | Zixu Li Paul Siu Fai Yip |
| author_facet | Zixu Li Paul Siu Fai Yip |
| author_sort | Zixu Li |
| collection | DOAJ |
| description | Summary: Background: Previous suicide research has seldom examined the collective impact of multiple social identities/positions, and suicidality among sexual and gender minority adolescents remains understudied in Chinese contexts. Using intersectionality as both a theoretical and analytical framework, we investigate the combined effects of sex, gender expression, and sexual orientation on suicidal ideation and suicide attempts among secondary school students in Hong Kong. Methods: Data from 8023 adolescents (mean age = 14.76, SD = 1.66; 44.56% girls) who participated in the 2021 wave of the Youth Sexuality Study (YSS) were included in analysis. Multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) estimated the prevalence of suicidal ideation and suicide attempts for adolescents across various combinations of social identities/positions (i.e., sex x gender expression x sexual orientation), assessed the extent to which these identities/positions accounted for the total variance in suicide behaviors, and examined the interactive intersectional effects (i.e., two-way or higher–level interactions) between the identities/positions. Findings: Girls categorized as non-heterosexual with nonconforming gender expression, girls categorized as non-heterosexual with neutral gender expression, and boys categorized as non-heterosexual with nonconforming gender expression reported the highest prevalence of suicidal ideation and suicide attempts. The total variance in suicidal ideation and suicide attempts attributable to the identities/positions were 12.60% and 10.50%, respectively. However, there were no significant interactive intersectional effects. Interpretation: Adolescents with multiple marginalized identities/positions showed the highest prevalence of suicidal ideation and suicide attempts. Comprehensive suicide prevention strategies should go beyond individual-level risk factors and promote holistic systemic changes. Intervention solely targeting one identity/position may not be sufficient. Funding: The data used in this study is made available by Family Planning Association of Hong Kong and the Research Subcommittee for the Youth Sexuality Study 2021. The work was supported by the Department of Health of the Hong Kong SAR Government. |
| format | Article |
| id | doaj-art-2a9b26389cd348cca046d2f3084a7a6f |
| institution | Kabale University |
| issn | 2666-6065 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health. Western Pacific |
| spelling | doaj-art-2a9b26389cd348cca046d2f3084a7a6f2024-12-07T08:28:39ZengElsevierThe Lancet Regional Health. Western Pacific2666-60652024-12-0153101252Suicidality at the intersection of sex, sexual orientation, and gender expression among secondary school students in Hong Kong: a population-based studyResearch in contextZixu Li0Paul Siu Fai Yip1Department of Social Work and Social Administration, The University of Hong Kong, Hong KongDepartment of Social Work and Social Administration, The University of Hong Kong, Hong Kong; HKJC Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong; Corresponding author. The HKJC Centre for Suicide Research and Prevention, The University of Hong Kong, 2/F, The HKJC Building for Interdisciplinary Research, 5 Sassoon Road, Pokfulam, Hong Kong, China.Summary: Background: Previous suicide research has seldom examined the collective impact of multiple social identities/positions, and suicidality among sexual and gender minority adolescents remains understudied in Chinese contexts. Using intersectionality as both a theoretical and analytical framework, we investigate the combined effects of sex, gender expression, and sexual orientation on suicidal ideation and suicide attempts among secondary school students in Hong Kong. Methods: Data from 8023 adolescents (mean age = 14.76, SD = 1.66; 44.56% girls) who participated in the 2021 wave of the Youth Sexuality Study (YSS) were included in analysis. Multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) estimated the prevalence of suicidal ideation and suicide attempts for adolescents across various combinations of social identities/positions (i.e., sex x gender expression x sexual orientation), assessed the extent to which these identities/positions accounted for the total variance in suicide behaviors, and examined the interactive intersectional effects (i.e., two-way or higher–level interactions) between the identities/positions. Findings: Girls categorized as non-heterosexual with nonconforming gender expression, girls categorized as non-heterosexual with neutral gender expression, and boys categorized as non-heterosexual with nonconforming gender expression reported the highest prevalence of suicidal ideation and suicide attempts. The total variance in suicidal ideation and suicide attempts attributable to the identities/positions were 12.60% and 10.50%, respectively. However, there were no significant interactive intersectional effects. Interpretation: Adolescents with multiple marginalized identities/positions showed the highest prevalence of suicidal ideation and suicide attempts. Comprehensive suicide prevention strategies should go beyond individual-level risk factors and promote holistic systemic changes. Intervention solely targeting one identity/position may not be sufficient. Funding: The data used in this study is made available by Family Planning Association of Hong Kong and the Research Subcommittee for the Youth Sexuality Study 2021. The work was supported by the Department of Health of the Hong Kong SAR Government.http://www.sciencedirect.com/science/article/pii/S2666606524002463SuicideAdolescentsSexual orientationGender expressionIntersectionalityMultilevel analysis |
| spellingShingle | Zixu Li Paul Siu Fai Yip Suicidality at the intersection of sex, sexual orientation, and gender expression among secondary school students in Hong Kong: a population-based studyResearch in context The Lancet Regional Health. Western Pacific Suicide Adolescents Sexual orientation Gender expression Intersectionality Multilevel analysis |
| title | Suicidality at the intersection of sex, sexual orientation, and gender expression among secondary school students in Hong Kong: a population-based studyResearch in context |
| title_full | Suicidality at the intersection of sex, sexual orientation, and gender expression among secondary school students in Hong Kong: a population-based studyResearch in context |
| title_fullStr | Suicidality at the intersection of sex, sexual orientation, and gender expression among secondary school students in Hong Kong: a population-based studyResearch in context |
| title_full_unstemmed | Suicidality at the intersection of sex, sexual orientation, and gender expression among secondary school students in Hong Kong: a population-based studyResearch in context |
| title_short | Suicidality at the intersection of sex, sexual orientation, and gender expression among secondary school students in Hong Kong: a population-based studyResearch in context |
| title_sort | suicidality at the intersection of sex sexual orientation and gender expression among secondary school students in hong kong a population based studyresearch in context |
| topic | Suicide Adolescents Sexual orientation Gender expression Intersectionality Multilevel analysis |
| url | http://www.sciencedirect.com/science/article/pii/S2666606524002463 |
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