594ICE FALCON: a method more powerful than Mendelian Randomisation for causation assessment

Abstract

Abstract Background Evidence shows that sexual minority adolescents (SMA) have a higher risk of developing emotional and behavioral problems (i.e., internalizing and externalizing problems) than their heterosexual peers, which may subsequently cause an increased risk of suicidality. However, the associations remain unclear and whether biological sex may moderate such associations is still unknown. The current study was conducted among Chinese adolescents to test whether emotional and behavioral problems mediates association between sexual minority status and suicidal behavior and to explore whether such mediation is moderated by biological sex. Methods Data were drawn from 7th to 12th grade students of the 2019 School-based Chinese Adolescents Health Survey (n = 16,663). Self-reported questionnaires were adopted and moderated mediation models were performed. Results Emotional and behavioral problems (peer, emotional, conduct problems and hyperactivity) partially mediated the effects of sexual minority status on suicidal ideation (indirect effect = 0.017, 95% CI = 0.012–0.022) and suicide attempts (indirect effect = 0.010, 95% CI = 0.007–0.014). Greater effects were found among female students than males who self-identified as sexual minorities, suggesting these indirect effects were moderated by biological sex. Conclusions Biological sex moderates the indirect effects of emotional and behavioral problems on association between sexual minority status and suicidal behaviors. Early school-based suicide prevention strategies can be targeted at SMA (particularly female students who suffer from emotional or behavioral problems). Key messages Emotional and behavioral problems are associated with an elevated risk of suicidality among SMA. Biological sex moderates these associations.