(Reuters Health) - Teens who hide their true sexual orientation are at higher risk for suicidal behaviors, a new study suggests.

The study focused on teens who either identified as gay or lesbian but had sexual contact with only the opposite sex or with both sexes, or who identified as heterosexual but had sexual contact with only the same sex or with both sexes.

These teens – who are experiencing what researchers call sexual orientation discordance - have a significantly elevated risk for suicide, investigators warn in the American Journal of Preventive Medicine.

Researchers surveyed nearly 7,000 high school students from across the U.S., asking 99 questions about health and risk behaviors. Two of the questions focused on sexual orientation.

About 4 percent of the teens had experienced sexual orientation discordance, responses showed. This was true for 32 percent of gay and lesbian students, compared to 3 percent of heterosexual students.

The survey also asked if respondents had seriously considered attempting suicide, made a plan about how they would attempt suicide or previously attempted suicide in the past year.

Nearly half of the kids who had experienced sexual orientation discordance – 46 percent – reported suicidal thoughts or behaviors, compared to 22 percent of students who didn’t feel a mismatch between their sexual identities and actions.

Nonfatal suicidal behaviors were also more common in females, those who were bullied on school property, those who drank alcohol or used marijuana, and those who had been physically forced to have sexual intercourse.

These findings among U.S. teens are similar to previous studies in adults, which also found links between sexual identity discordance, depression, drug and alcohol use, and suicidal ideation, the study authors wrote.

“Discrimination, stigma, prejudice, rejection, and societal norms may put pressure on sexual minorities to present a sexual identity inconsistent with their true sexual identity or to act in a manner inconsistent with their sexual identity,” they said.

“Understanding . . . the challenges that adolescents experiencing discordance may encounter will help strengthen overall suicide prevention approaches in youth,” coauthor Dr. Francis Annor of the Centers for Disease Control and Prevention in Atlanta, Georgia told Reuters Health.

“It’s important to know that suicide is preventable,” Annor told Reuters Health by email. A CDC guide to help communities decide on best policies, programs and practices to help youth is available at bit.ly/2IBUNtZ.

The new findings are important “because suicide has been the tenth leading cause of death in the general U.S. population for at least a decade and the third leading cause of death among teenagers - and suicide deaths have been increasing in the U.S.,” said Dr. John Blosnich of the West Virginia University in Morgantown. Blosnich, who wasn’t involved with this study, studies interpersonal and self-directed violence among LGBT groups and U.S. military veterans.

“You can imagine that a huge concern for teenagers who experience conflict with their sexual identity is whether they will be rejected by their family and friends,” Blosnich said in an email. He noted that a recently released major motion picture focuses on this very issue. The movie, from 20th Century Fox, is called Love, Simon.

SOURCE: bit.ly/2IEgZU3 American Journal of Preventive Medicine, online February 12, 2018.