Elva Etienne via Getty Images A new study found that nearly 50% of LGB high school students have considered suicide, compared to 13% of straight students.

Despite decades of progress on cultural visibility and political rights, queer youth are still killing themselves at alarming rates.

According to a study by The Trevor Project, an LGBTQ suicide prevention organization, lesbian, gay and bisexual young adults are over four times more likely to report planning or attempting suicide in the past year. Nearly 50% of LGB high school students have considered suicide, compared to 13% of straight students.

The study is based on data from nationwide surveys of high school students and young adults taken in 2017 and 2018. Because federal surveys don’t collect data on gender identity for people over 18, the Trevor Project study does not include information on transgender or non-binary students. Research has consistently found that transgender youth have higher rates of suicide than their straight or LGB peers.

The study also reveals that the suicide disparity between straight and LGB high school students persists into young adulthood.

“We’re not seeing LGB youth catching up once they move out of the home and start independent lives,” said Amy Green, the Trevor Project’s research director. This indicates that the suicide disparity isn’t just the result of overt abuse from fellow students or parents during adolescence. Queer young adults may be experiencing lingering trauma from the time they spent in the closet or ongoing discrimination.

This theory, known as “minority stress,” may also explain another surprising finding from the study: For high school students, bisexuals were more likely to have attempted suicide than their straight or gay peers.

Trevor Project Bisexual high schoolers have higher rates of suicidal ideation than their straight or gay peers.

Travis Salway, a professor of epidemiology at Simon Fraser University who researches LGBT mental health, said higher suicide risk among bisexuals is a consistent research finding across all age groups. The explanation, he said, is that bisexual individuals often feel rejected from both straight and queer cultures.

“If you’re a bisexual in a heterosexual relationship, other people will just assume you’re straight, which makes you feel invisible,” Salway said. “And then if you try to join the queer community, you find that there’s very little recognition or representation of your experiences. One of the greatest risks for suicide is feeling like you don’t matter or you don’t belong. That erasure is a huge challenge for bisexual people.”

The suicide disparity between the queer and straight communities — and between bisexuals and their gay and lesbian peers — persists into adulthood. Salway said rates of suicide attempts are highest among adolescents, fall in young adulthood, then spike again as LGB people reach their 30s and 40s.

“A lot of people start to consider suicide in high school, but as they age they develop coping mechanisms through their job or their social network and those suicidal thoughts go away,” Salway said. But then, as they lose friends and family members as part of aging, those feelings of loneliness and depression return. “We’ve been attentive to the risk of suicide among queer adolescents but we also need to look at what’s happening in adulthood,” Salway said.

All of these findings challenge the presumption that greater societal acceptance of queer people will automatically result in better health outcomes. Despite the massive gains in cultural awareness and advances in political rights, there are still profound disparities in openness to LGB students throughout the United States. According to the LGBTQ anti-bullying organization GLSEN, over 70% of LGBTQ students experienced verbal harassment at school in 2017.

We know that there are effective ways to prevent suicide, but we need a much stronger national effort to begin actually reducing LGBTQ youth suicide. Amy Green, Trevor Project research director

Broader societal factors could also play a role. Suicides among American adolescents have been rising steadily since 2007, a phenomenon researchers still cannot fully explain. Plus, research has found that depression and drug use spiked among the LGB community during the nationwide debate over banning gay marriage in 2004 and 2005. Recent political developments, such as the highly publicized ban on trans soldiers in the military, may be having a similar effect.

Regardless of the cause, though, Green said that the United States needs to make deliberate investments in suicide reduction among queer youth and young adults.

“This isn’t going to get better on its own,” Green said. In recent years, the VA has significantly reduced suicide among veterans by providing comprehensive screening and follow-up services for patients receiving services from a VA medical center. The U.S. could make a similar effort with the queer community.

“We know that there are effective ways to prevent suicide,” Green said, “but we need a much stronger national effort to begin actually reducing LGBTQ youth suicide.”