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Limited studies have examined the co-occurrence of poor mental health and HRBs, if co-occurrence differs by sexual identity, and associated risks for self-harm and attempted suicide in adolescents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study included 10,233 adolescents aged 17\u00a0years (51% female\/11% sexual minority) from the UK-wide Millennium Cohort Study. Sexual identity, MHP, seven HRBs (like regular smoking, drug use and sexual risk behaviour), self-harm and attempted suicide were self-reported. MHP were assessed using the strengths and difficulties questionnaire [SDQ] emotional symptoms subscale for depression\/anxiety. We assessed associations between sexual identity and co-occurrence of MHP and HRBs using multinomial logistic regression. We estimated predicted probabilities for self-harm or attempted suicide based on sexual identity and MHP-HRB co-occurrence status using logistic regression models with appropriate interaction terms (between sexual identity and MHP-HRB co-occurrence status variables).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>MHP prevalence was higher in gay\/lesbian (48%) and bisexual (49%) adolescents compared to heterosexual peers (19%). Self-harm (bisexual, 64%; gay\/lesbian, 53%; heterosexual, 19%) and attempted suicide (bisexual, 24%; gay\/lesbian, 17%; heterosexual, 6%) prevalence were higher in SMA compared to heterosexual peers. Gay\/lesbian and bisexual adolescents consistently had higher probability for MHP-HRB co-occurrence compared to heterosexual peers (example, for gay\/lesbian individuals: RRR 3.16 [95% CI 2.1\u20134.68] for MHP-1HRB, RRR 3.54 [95% CI 2.06\u20136.08] for MHP-\u2009\u2265\u20093HRB, for bisexual adolescents: RRR 2.44 [95% CI 1.85\u20133.20] for MHP-1HRB, RRR 4.11 [95% CI 2.99\u20135.66] for MHP-\u2009\u2265\u20093HRB). MHP-HRB co-occurrence and sexual minority identity were independently associated with greater odds for self-harm or attempted suicide. SMA had higher probabilities of reporting self-harm than heterosexual peers with the same level of MHP-HRB co-occurrence. For example, 37.2% of heterosexual adolescents with MHP-1HRB reported self-harm. Corresponding numbers were twice as high in bisexual (75.7%) and gay\/lesbian (77.9%) individuals. Similarly, 58.3% of heterosexual adolescents with MHP-\u2009\u2265\u20093HRBs reported self-harm, increasing to 84.6% in bisexual and 83.8% in gay\/lesbian peers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>SMA are more likely to experience MHP-HRB co-occurrence, which is associated with substantially higher risks for self-harm and attempted suicide compared to heterosexual peers. Findings highlight the need for better public health policies to address MHP and associated comorbidities to reduce sexual identity-related health inequities in adolescence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12916-025-04236-2","type":"journal-article","created":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T08:40:33Z","timestamp":1752136833000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Sexual identity inequalities in the co-occurrence of poor mental health and health risk behaviours\u2014a national cross-sectional study"],"prefix":"10.1186","volume":"23","author":[{"given":"Amal R.","family":"Khanolkar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexis","family":"Karamanos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laia","family":"Becares","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,9]]},"reference":[{"key":"4236_CR1","unstructured":"Mental health of children and young people in England, 2023 - wave 4 follow up to the 2017 survey. 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Ethical approval for the age 17 main stage was obtained on 18th October 2017 from the National Research Ethics Service (NRES) Research Ethics Committee (REC) North East \u2013 York (REC ref: 17\/NE\/0341). All data are anonymized and available to researchers via the UK Data Service. Cohort members \u226516 years provided verbal consent to take part in the study. The cohort members (16 or older at the time of the interview and considered adults) provided verbal informed consent to take part in the survey overall, and for each individual survey element. Parents did not have to provide consent for the interviewer to approach the cohort members. Interviewers were required to ensure that consent from the cohort member was as fully informed as possible. To do this, cohort members needed to understand the full details of processes, the reasons they were being asked to take part in each element, and the details around storage and use of data. Complete details on all ethics including informed consent can be found in the Millennium Cohort Study Seventh Sweep (MCS7) Technical Report which can be accessed here: https:\/\/cls.ucl.ac.uk\/wp-content\/uploads\/2020\/01\/MCS7_Technical_Report.pdf.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"417"}}