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Gay and Bisexual Male Suicide Problems: Part 4 of 7: Abstracts / Summaries - A
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Abstracts / Summaries: Papers, Articles, & Books - Part A (Part B: Youth Risk Behavior Surveys)

See "Attempted Suicide" Results For Homosexually Oriented Males & Females: More Than 140 Studies!

See: More Than 250 Full Text Papers and Documents Related to GLBT Suicidality.

Two Studies Are Re-Analysed by Plöderl et al., (2013) In The Published Study: "Suicide Risk and Sexual Orientation: A Critical Review."
Conclusion: Sexual Minority Adolescents Are At Greater Risk for Dying by Suicide. The Expanded Analysis Related to This Study is Available!

Note:
Changes / Additions to this resource will initially be made on - This Web Page - and here about one month later.

First Study - from Denmark - To Show That
Adult Gay & Lesbian Peope Are Likely
At Higher For Suicide

Bagley, C., and Tremblay P. (1997) Suicidal behaviors in homosexual and bisexual males. Crisis, 18(1), 24-34.

Abstract by authors: A stratified random sample of 750 males in Calgary, Canada, aged 18-27 years, were given questions on sexual activity and orientation. Mental health questions included a measure of suicidality and of acts of deliberate self-harm. A computerized response format, which has ben established as a good method method for eliciting sensitive personal data, ensured anonymity. Almost 13% of the males were classified as homosexual or bisexual on the basis of being currently homosexually active or by self-identification. Significant higher rates of previous suicidal ideas and actions were reported by homosexually oriented males accounting for 62.5% of suicide attempters. These findings, which indicate that homosexual and bisexual males are 13.9 times more at risk for a serious suicide attempt, are consonant with previous findings. The predominant reason for the suicidality of these young males may be linked to the process of "coming out," especially for those who currently have high levels of depression. These results underscore the need for qualified services rarely available to homosexually oriented youth.

Research Highlights:

The study essentially replicates the Bell & Weinberg (1978) suicidality results. To the age of 21 in this earlier study, and to the average age of 22.7 years in the Bagley and Tremblay (1997) study, homosexual/bisexual males were about 14-times more likely to have been suicide attempters than heterosexual males.

Homosexual/bisexual males are 2.94 times more at risk for self-harm activities than heterosexual males. (Note: In many studies of adolescent suicide problems, "self-harm" activities are often enough tabulated as suicide attempts.)

Sexually active homosexual and bisexual males are 6- and 11-times more at risk to have made a life-threatening suicide attempt than their heterosexual counterparts.

Celibate homosexual and heterosexual males have the highest current depression scores; celibate homosexual males have the highest scores.

The highest current depression scores for celibate homosexual males and the fact that 4 out of 5 (80%) suicide attempters in the homosexually oriented category are in the bisexual category or are celibate homosexual males, reflects/replicates the Bell and Weinberg (1978) mental health results for asexuals who had greater problems such as "more regret over their homosexuality," and were more likely to be "less exclusively homosexual and more covert than other respondents." (p. 134) Dysfunctionals also had more regrets over their homosexuality, but were highly sexually active and not coupled. Both groups were more depressed, tense, paranoid, depressed, lonely; and less self-accepting (p. 200-201).

Using the 2 X 2 Table located at - http://home.clara.net/sisa/twoby2.htm and the following data from the Bagley and Tremblay (1997)  study - 5 GB attempters and 77 GB non-attempters - and - 3 heterosexual attempters and 665 heterosexual non-attempters  - produces an OR (for attempting suicide) = 14.4 (95% CI, 3.4-61.4). The OR for "Self-Harm" (37 heterosexual males reporting self-harm / 631 not reporting self harm,  and 13 GB reporting self-harm / 69 males not reporting self-harm,  - produces an OR (for self-harm) = 3.2 (95% CI, 1.6 - 6.3).  This information is not given in the study.
 

Bell A.P., and Weinberg, M.S. (1978) Homosexualities: a study of diversity among men & women. Simon and Schuster, N.Y.

Data Summary:

The Sampling: The largest sample pool was of white predominantly homosexual males obtained via the following venues: Public Advertising (914), Bars (994), Personal Contacts (617), Gay Baths (249), Public Areas such as parks rest rooms, and streets (137), Homophile Organizations (222), Mailing Lists - with mail back cards (200), and private Bars (220). The total sample of white homosexual males (N = 3533) was then subjected to random sampling within contact cells to produce the final study sample of 575 white predominantly homosexual males. Obtaining the good (likely highly representative) study sample was accomplished because the researchers applied their great knowledge of homosexually oriented males to the sampling process. Therefore, the final study sample represented, as best as possible, the entirety of homosexually oriented males living in the San Francisco Bay Area. The sampling method also likely produced the  most representative sample taken to date of white homosexually oriented males living in a North American city. The control sample fo predominantly heterosexual males (N = 284) was obtained via stratified random sampling.

Although this study does not have "peer review" status because the results were published in two book (Homosexualities: a study of diversity among men & women (1978), and Sexual Preference (1981) by Bell, Weinberg, and Hammersmith - a two-volume book (one volume being the "Statistical Appendix"), the data with respect to Suicidality of both white and Afro-American predominantly homosexual and heterosexual males did receive peer review status via the published study by Joseph Harry (1983).

For white males: Seriously contemplated suicide (37%); Suicide attempt rate 105/575 (18.3%), re-attempter rate (7% out of 18%, 39.9%), 47% first attempt before age of 21 years, 79% before age of 26 years; therefore, 47/79 (59.5%) of suicide attempts occurring before age 26 occurred before age of 22; 27% of all first attempts occurring before age 17, and 22% after age 25. Suicide attempt problem occurring throughout age group, declining slightly after age 25.

Proportion of first-time suicide attempters who are homosexually oriented based on two percentage estimates (5% and 10%) of the male population in the "wholly or predominantly homosexual" category.

Using a "5% homosexual/bisexual of the male population" estimate:

To age 17, 42.5%; to age 21, 41.6%; to age 25, 22%, to the average age of subjects (37 years), 23.4%.

Using a "10% homosexual/bisexual of the male population" estimate:

To age 17, 60.9%, to age 21, 60.1%; to age 25, 39.2%; to the average age of subjects (37 years), 39.3%

Compared to the control group of predominantly heterosexual males, predominantly homosexual males were:

To age 17, 14-times more likely to be a "first-time" suicide attempter: 4.9% vs .35%. Using the 2 X 2 Table located at - http://home.clara.net/sisa/twoby2.htm and the following attempter / non attempters data for the two group (38 / 547 and 1 / 283) , 95% CI - Odds Ratio:  2.0<14.5<107.0. Pearson's= 11.893 (p= 0.0005)

To age 20, 13.6-times more likely to be a "first-time" suicide attempter: 9.5% vs .70%. Using the 2 X 2 Table located at - http://home.clara.net/sisa/twoby2.htm and the following attempter / non attempters data for the two group (55 / 520 and 2/282), 95% CI - Odds Ratio: 3.6<14.9<61.6. Pearson's= 24.093 (p= 0.0000)

To age 25, 5.8-times more likely to be a first-time suicide attempter: 14.4% vs 2.47%. Using the 2 X 2 Table located at - http://home.clara.net/sisa/twoby2.htm and the following attempter / non attempters data for the two group (83/492 and 7/277) , 95% CI - Odds Ratio:  3.0<6.7<14.6. Pearson's= 29.04 (p= 0.0000).

To average age of sample (37 years), 5.8-times more likely to be a suicide attempter: 18.4% vs 3.17%. Using the 2 X 2 Table located at - http://home.clara.net/sisa/twoby2.htm and the following attempter / nonattempters data for the two group (105/470 and 9/275) , 95% CI - Odds Ratio:  3.4<6.8<13.7. Pearson's= 37.619 (p= 0.0000).

The above figures are calculated from data given in Tables 21.14 and 21.15, p. 453-4.

Asexuals had greater problems such as "more regret over their homosexuality," and were more likely to be "less exclusively homosexual and more covert than other respondents." (p. 134) Dysfunctionals also had more regrets over their homosexuality, but were highly sexually active and not coupled. Both groups more depressed, tense, paranoid, depressed, lonely; and less self-accepting (p. 199-201).

The lifetime suicide attempt rate for white homosexual males was 18%, compared to 21% for Black homosexual males; their respective suicide re-attempter rate being 38.8% and 33.3%. Black homosexual males were 10.5-times more likely to have been suicide attempter than their heterosexual male counterparts.

43% of White homosexual male suicide attempters reported that their first attempt was relationship-related, meaning that these occurred after fully/somewhat becoming part of the gay community.
 

Brady, S. and Busse, WJ. (1994) The gay identity questionnaire: a brief measure of homosexual identity formation. The Journal of Homosexuality, Vol. 26(4), 1-22.

Research Highlights

A sample of 196 males at different stages of homosexual identity formation were studied using a psychological well-being scale with a number of items. The most significant psychological well-being difference occurred between stages 3 (tolerance of one homosexuality) and stage four (acceptance of one's homosexuality), and the most significant discriminating item in the scale was "feeling suicidal." It had a F-ratio of 14.54, p < .0000, and the next most significant item was "mental hygiene" with an F-ratio of 6.05, p < .0006.
 

Cochand P, Bovet P (1998). HIV infection and suicide risk: an epidemiological inquiry among male homosexuals in Switzerland. Social Psychiatry and Psychiatric Epidemiology, 33(5), 230-4.  (A PubMed "abstract" link with a document delivery service.)

Research Highlights. A sample of 164 HIV- (n = 84),  HIV+ (n = 65), and HIV? self-defined gay and bisexual males from the French speaking part of Switzerland (mean age = 36.4 years, age range = 22- to 66-years-old) produced lifetime attempted suicide rates of 26% and 18% for HIV- and HIV+ males, respectively, the average being 22.7%. The scores on Pöldinger's scale for suicidality also produced a greater suicidality potential of HIV+ relative to HIV- males after correcting for possible biasing factors.

Note: Twenty subjects (20/164, 12.2%) refused to supply suicidality information, "some of them stating through handwritten annotations that they refused to link suicidality and homosexuality." Individuals with this "objection" who are not suicidal, nor have suicide attempts in their history, would have probably been more than willing to supply their "non-suicidality" history; it would help produce research results showing that homosexual males are not at risk. It is therefore possible that the withholding of suicidality information is linked to the existence of suicide problems (maybe not in the category they assumed researchers were seeking), but research has not yet been done to explore the suicidality history of gay and bisexual males who would refuse to complete the "suicidality" section of a research questionnaire.

Cochran, Susan, and Mays, Vickie (2000). Lifetime prevalence of suicide symptoms and affective disorders among men reporting same-sex sexual partners: results from NHANES III. American Journal of Public Health, 90(4), 573-78. (A PubMed "abstract" link with a document delivery service.)

Research Highlights:

A subsample of the NHANES III sample (n = 3648 males 17- to 39-years-old) were interviewed in their homes (Note 1). They were "assessed for both prevalence of affective disorders and related symptoms and genders of their lifetime sexual partners."  Only 2.2 percent of males (homosexually oriented) acknowledged having "any male sex partners in their lifetime," and they were reported to have a lifetime suicide attempt incidence of 19.3%, compared to a 3.6% incidence for males who only had female sexual partners, and a 0.5% incidence for males reporting having had no sexual partners. For homosexually oriented males, 98% of the ones reporting a suicide attempt were 17- to 29-years-old, but heterosexually active males who had attempted suicide did not have such an age range concentration. The incidence of suicide attempters were unrelated to age categories for heterosexually oriented males. Homosexually oriented males would therefore be 5.4 times (19.3 vs 3.6%) more likely to be suicide attempters than males reporting having had only female sex partners (CI 95%, OR: 2.21<5.36<12.98). The greater likelihood for recurrent Major Depression and for "any affective disorder" for homosexually oriented males compared to males reporting only females sex partners was 3.5 times (12.2 vs 3.5% - CI 95%, OR: 0.93<3.64<14.20) and 2.4 times (21.5 vs 8.8% - CI 95%, OR: 0.90<2.55<7.24), respectively. Homosexually oriented males also had significantly higher composite scores for suicide-related symptoms. (See second caveat and a re-calculation below.)

Note 1 - Caveat: Face-to-face interviews continue to be used as in the NHANES III study of 17- to 39-year-old males. Only 2.2 percent of males acknowledged having "any male sex partners in their lifetime" (p. 575), and similar methodologically flawed studies are then cited (given range of study results: "2% to 7%") to conclude that "this is consistent with the prevalence observed in NHANES III" (p. 577), thus creating the illusion of validity for their demographic results. Not mentioned, however, is that this range of demographic results suggests a possible 350 percent underestimating error for lowest results. Instead, it is asserted that "the willingness of men to report same-sex partners in a population-based survey such as NHANES is unknown; thus, the extent to which homosexually experienced men... declared no male sex partners cannot be determined" (p. 577). This assertion, however, is only made possible by not citing studies (e.g. Bagley and Tremblay, 1998; Turner et al., 1998) indicating the likelihood of producing significant underestimating errors when highly flawed methodology is used.

Note 2 - Caveat: It is reported fact that almost all same-sex active suicide attempters (98%) were below the age of 30 years, with little supplied with respect to explaining their relatively great absence for males 30 to 39 years of age. This anomaly may well be related to the AIDS factor given that its greatest effect (related illness and deaths) occurred in the 30- to 39-year-old category and during the sampling/study years: 1988-94. The authors did not address this issue in spite of the greatest difference in "suicide attempt" incidence not being between 'homo-sex' reporting males compared to 'hetero-sex'-only reporting males (19.3% vs. 3.6%: an "5.4 times" factor = Risk Ratio, Odds Ratio = 6.4). The greatest difference is  between 'homo-sex' reporting males in the 17-29 year-old vs. 30-39 year-old categories: 31.3% (14.7/47) vs.  .98% (.3/31) - a "31.9-times" factor. These figures are based on weighted data supplied by the authors which also make possible an "estimated" re-calculation of "suicide attempt" data for males in the 17- to 29-year-old category (given below), thus producing results to the average age of about 23 years which can then be compared with the Bagley and Tremblay 1998 "suicide atempt" results for a sample of 18- to 27-year-old males with an average age of 22.7 years.

Re-Calculation of Data Using the 2 X 2 Table located at - http://home.clara.net/sisa/twoby2.htm: the following weighted data was used to calculate an approximation for the Odds Ratio [17- to 29-year old males reporting any lifetime same-sex partners [60.7% of 78) =  47)] versus same-age males reporting only lifetime female sex partners - (51.5% of 3214) =  1655)].  Respectively, in each category, suicide attempters versus non attempters are: 15/32 and 60/1595. For this group, the males reporting same-sex lifetime partners (maybe about 3% of these males), accounted for 20% (15/75) of all attempters in the 17-29 age category.

Data estimation for males reported having lifetime male partner(s): 78 males (age = 17-39)  with a suicide attempt incidence of 19.3% produces 15 (15.1) suicide attempters (weighted). The authors note, however, that a weighted 98% of attempters are in the 17- to 29-year-old category, meaning that 2% of attempters are in the 30- to 39 age group. In whole numbers, this "2%" equals to 0.3 attempters, meaning that all weighted 15 attempters (14.7) are essentially in the 17- to 29-year-old category.

Data estimation for males reported only lifetime female sex partner(s): 3214 males (age = 17-39) with a suicide attempt incidence of 3.6% produces 116 (115.7) suicide attempters (weighted). The authors note that  there were no statistical difference in the distribution of suicide attempters in the two age categories, which could mean there are differences, but the assumption for this "estimate" calculation is "equal distribution". Therefore, 51.5% of 115.7 attempters is 60 (59.6) attempters in the 17-29 age group.

Odds Ratio Calculation for males reporting lifetime same-sex partners compared to males reporting lifetime only female sex partner(s): 15/32 and 60/1595 (attempters / nonattempters), Pearson's= 86.828 (p < 0.0000) - 95% CI, Odds Ratio: 6.41<12.46<24.24. This result therefore applies for a sample of males ranging in age from 17 to 29, with a mean age, if weighted, of about 23 years. This result replicates the Odds ratio results of the Bagley and Tremblay (1997) study - 95% CI, OR: 3.4<14.4<61.4 - in a male sample ranging in age from 18 to 27 years (mean age = 22.7 years) for significantly homosexually oriented males verses other males with respect to their "suicide attempt" history. NOTE: If calculation were done from the actual data, the results should be quite similar.

For the males with a 17-29 years age range in the Cochran and Mays (2000) study, there is a greater likelihood factor of  "8.7 times" [31.3% (14.7/47) versus 3.6% (60/1655)] for a suicide attempt by males who reported having male sex partner(s) compared to males reporting having only lifetime female sex partners.

Odds Ratio Calculation for males reporting lifetime same-sex partners versus males reporting only female sex partner(s) plus males reporting a celibate status:  15 / 32 (attempters / nonattempters) versus 61 [60 + 1]  / 1796 [1595 + 201] - 95% CI, OR: 7.10<13.8<26.82. This result is almost identical to the Odds Ratio noted above in the Bagley and Tremblay (1997) study of males (95% CI, OR: 3.4<14.4<61.4), for significantly homosexually oriented males compared to other males with respect to their history of having attempted suicide. NOTE: If calculation were done from the actual data, the results should be quite similar. Also: The sampling of young adult males in both studies occurred at about the same time (1988-92 for the NHANES III study, and 1991-2 for the Calgary study), which means that both group of males being compared were of about the same age at the same time, their adolescent years being spread over about 1.5 decades: 1975 (approx.) to the end of 1980s / very early 1990s (approx.) and living in similar environments with respect to social attitudes vis-a-vis homosexuality.

For the males with a 17-29 years age range in the Cochran and Mays (2000) study, there is a greater likelihood factor of  "9.2 times" [31.3% (14.7/47) versus 3.4% (61/1796)] for a suicide attempt by males who reported male sex partner(s) compared to males reporting only lifetime female sex partners and males reporting no sex partners.

Notes on the above data: 211 males (weighted) are reported to be in the "no sex partner" category, with 95.8% of these male (202 males) in the 17-29 age group, and  only one suicide attempter is in the group - in the younger group as noted by the study authors. Therefore: 201 nonattempters and 1 attempter in the 17-29 age category was added to the data related to same-age males reporting only female sex partner(s).

The anomalous suicide attempt difference between male aged 17-29 and males aged 30-39:

After the weighting/controlling statistical processes, the 31 (78 - 47 = 31) 'homo-sex' reporting males 30 to 39 years of age have only 2% of attempters (.3 of an attempter) in the 'homo-sex' male category, which is equal to a lifetime suicide attempt incidence of 1%, compared to an estimated 3.6% incidence for 'hetero-sex' reporting males. Therefore, for males in this age category, it is 'hetero-sex' males who are about 4-times more likely to be suicide attempters, compared to 'homo-sex' males.  This "1%" also means that the older (30-39 years) segment of the 'homo-sex' reporting males had a suicide attempt incidence about 31 times lower that their younger 'homo-sex' counterparts, and 19.3 times lower than the reported averaged "suicide attempt" incidence for all 'homo-sex' males, but this highly anomalous situation was not highlighted nor addressed by the authors. One important implication would be that 'homo-sex' reporting males in a certain decade not only almost stopped attempting suicide, but that they became much less at risk for attempting suicide than heterosexual males. This possibility, however, is unlikely given the consistent "higher risk" for attempting suicide study results for homosexually oriented males studied in samples dating back to 1969. Therefore, the "representation" likelihood of the older part of the 'homo-sex' male sample (30- to 39-year-old) is in question. The authors not only ignored this, but they also avoided discussing this serious problem occurring in data to be statistically analysed.

The NHANES III (National Health and Nutrition Examination Survey) "is a periodic population based health survey conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention" (p. 574). "S. D. Cochran conceived and designed the study, conducted the analysis, and co-wrote the manuscript. V. M. Mays cowrote the manuscript and contributed to the interpretation of study findings" (p. 577).
 

D'Augelli, A.R., and Hershberger, S.L. (1993). Lesbian, gay, and bisexual youth in community settings: personal challenges and mental health problems. American Journal of Community Psychology, 21(4), 421-48.

Research Highlights:

The sample: 142 males, 53 females (n = 194),  age range = 15 to 21 (Average = 18.9 years), 75% lesbian or gay self-identified, 25% bisexual- identified, 66% (128/194) white, 55% living with parents. Sample obtained from 14 GLB community centers in the United States.

Suicide attempt rate = 42% (81/194), no statistically significant difference in rates between males and females.

Predictors of suicide attempts: "Low self-esteem, alcohol abuse, depression, loss of friends due to sexual orientation."

Some of the  significant differences between attempters and nonattempters: age of first sex (12 vs 14 years, p < .01), problems with alcohol use (.97 vs .28, p < .001), problems with depression (1.68 vs .86, p < .001). On the Brief Symptom Inventory scores, attempters scored higher than nonattempters at the p < .001 significance  on the following items: somatization, interpersonal sensitivity, phobic anxiety, paranoid ideation, psychoticism, thoughts of death and dying, and on the global severity index.

Seeing a counselor or therapist: currently = 20% (39/194): 18/52 females (33%) and  21/142 (15%) males. 51% of males (72/142) and 65% of females (Average = 55%, 107/194) with a history of having sought such help.

Females scored significantly higher than males on somatization, anxiety, and hostility.

In the past year, 42% of subjects reported feeling overwhelmed "sometimes," 21% "often" which strongly correlated (p < .001) with depression and anxiety. "That lesbian, gay, and bisexual youth are at psychological risk can also be concluded from this study; many problems "are experienced as distressing."

Comment: Due to the predominance of white respondents, racial/ethnic comparisons are not reported. There are 66 individuals of color, compared to 52 females, yet comparisons are given between males and females. Ethnic/race results would be interesting given that the available data suggest high rates of suicidality in ethnic/race minority individuals who are homosexually oriented. (Tremblay, 1995).

Related Online Information: A, B (must scroll to locate summary, 2nd in list).
 

D'Augelli AR, Hershberger SL, Pilkington NW (1998). Lesbian, gay, and bisexual youth and their families: disclosure of sexual orientation and its consequences. American Journal of Orthopsychiatry, 68(3), 361-71. (A PubMed "abstract" link with a document delivery service.)

Research Highlights: Same sample as the D'augelli and Hershberger (1993) study. Suicidality results related to disclosure status - Having "come out" to their families versus Being "in the closet": attempted suicide (41% vs 12%), current "frequent to occasional" thoughts of suicide (30% vs. 12%). "Those who had disclosed reported verbal and physical abuse by family members".
 

Dorais, Michel (2000). MORT OU FIF: Contextes et mobiles de tentatives de suicide chez des adolescents et jeunes hommes homosexuels ou identifiés comme tels. Et  perspectives de prevention. Québec: Université Laval. 120 pages. Resumé (Abstract) et information pour commander l' étude (information related to obtaining the study). [Québec Study - Death or Fag: The contexts and motives for suicide attempts by adolescent and young adult homosexually oriented males. Recommendations for suicide prevention.]
 

DuRant RH, Krowchuk DP, Sinal SH (1998). Victimization, use of violence, and drug use at school among male adolescents who engage in same-sex sexual behavior. Journal of Pediatrics, 133(1), 113-118. Research result highlights in Vermont Youth Risk Behavior Survey (1995).
 

Faulkner AH, and Cranston K (1998). Correlates of same-sex sexual behavior in a random sample of Massachusetts high school students.  American Journal of public health, 88(2), 262-266. Research result highlights in Vermont Youth Risk Behavior Survey (1995).
 

Fergusson DM, Horwood LJ, Beautrais AL (1999). Is sexual orientation related to mental health problems and suicidality in young people? Archives of General Psychiatry, 56(10), 876-880. Full Text available online.

Highlights:

Study of a  a 21-year longitudinal birth cohort sample of 1265 children born in Christchurch, New Zealand. At age 21, 2.8% (n = 28) were classified as being of gay, lesbian, or bisexual sexual orientation. Conclusion: " Findings support recent evidence suggesting that gay, lesbian, and bisexual young people are at increased risk of mental health problems, with these associations being particularly evident for measures of suicidal behavior and multiple disorder." At 95% confidence interval, GLB youth at 6.2 times (2.7 - 14.3) more likely to have reported a suicide attempt, and 5.9 times (2.4 - 14.8) more likely to be classified has having experienced 2 or more psychiatric disorders.

Calculations: The following results are calculated from the suicide attempt incidence based on data given, including the suicide attempt incidence (attempted suicide at least once) of 7.8% for the sample. Lifetime suicide attempt incidence for heterosexual individuals = 7.0%; 32.1% for homosexual individuals, OR (Odd Ratio) = 6.2 times greater odds for an attempt. Calculated using 2 X 2 Table located at - http://home.clara.net/sisa/twoby2.htm . Data producing same OR of 6.2 (95%CI - 2.7 - 14.3 is: 9 GLB attempters and 19.9 non-attempters and 69 heterosexual attempters and 910 heterosexual non-attempters.

Odd Ratios for other attributes - Homosexual youth more at risk than heterosexual youth: suicidal ideation (5.4), major depression (4.0), generalized anxiety disorder (2.8), conduct disorder (3.8), nicotine dependence (5.0), substance abuse/dependence (1.9), two or more disorders (5.9).
 

Flavin DK, Franklin JE, and Frances RJ (1986). The acquired immune deficiency syndrome (AIDS) and suicidal behavior in alcohol-dependent homosexual men. American Journal of Psychiatry, 143(11), 1440-2. Highlights:

A report on three alcoholic gay males in their late 30s who deliberately sought to contract HIV as a way to commit suicide.
 

Frances RJ, Wikstrom T, Alcena V (1985). Contracting AIDS as a means of committing suicide. American Journal of Psychiatry, 142(5), 656 (letter).

Highlights:

A homosexual alcohol male with a history of many suicide attempts  and diagnosed with anxiety disorder is reported to have sought out many sexual partners so that he would contract HIV/AIDS and die - which was the outcome of his effort..
 

Garofalo R, Wolf RC, Kessel S, Palfrey J, and DuRant RH (1998). The association between health risk behaviors and sexual orientation among a school-based sample of adolescents. Pediatrics, 101(5), 895-902. Research result highlights in Massachusetts Youth Risk Behavior Survey (1995)
 

Gibson, P. (1989) Gay male and lesbian youth suicide. In: Feinlieb, M.R., Ed. Report of the Secretary's Task Force on Suicide, Volume 2: Prevention and Intervention in Youth Suicide. U.S. Department of Health & Human Services. Also published in Remafedi, G. Ed. (1994a).

Comment: Excellent summary of the many potentially suicide-related problems affecting sexual minority youth, including transgender youth. To 1989, the available studies indicated that sexual minority youth were at greater risk for suicide attempts and probably suicide. Summary. Adapted Excerpt.
 

Grossman AH, and Kerner MS (1998). Self-esteem and supportiveness as predictors of emotional distress in gay male and lesbian youth. Journal of Homosexuality, 35(2), 25-39.  (A PubMed "abstract" link with a document delivery service).

Research Highlights:  Study of 90 gay and lesbian youth (14- to 21-years of age) recruited via a New York gay and lesbian youth organization: 58 males (55% Black or Latino) and 32 females (85% Black or Latina) reporting having had suicidal thoughts (57% and 53%, respectively) and having attempted suicide (26% - 15/58, and 38% - 12/32, respectively). Nine of the attempters reported one suicide attempt, nine reported two suicide attempts, and nine reported 4 to 10 suicide attempts.
 

Hammelman T (1993). Gay and lesbian youth: contributing factors to serious attempts or consideration of suicide. Journal of Gay and Lesbian Psychotherapy. 2(1), 77-89.

Research Highlights:

Sample: 28 males, 20 females (12% bisexual) with 25% and 35% attempted suicide rates, respectively; 43% and 57% having been suicidal, respectively.  70% of attempted suicides occurred before the age of 18 years.

Lifetime attempted suicide rate for abused youth (38%), youth with substance abuse problems (41%), and youth rejected by family (36%).

64% of attempters state that sexual orientation was a part (35%) or most (29%) of the problem linked to their suicide attempt.
 

Harry J (1989).Sexual identity issues. In: Davidson, L. and Linnoila M., Eds. Report of the Secretary's Task Force on Suicide, Volume 3: Risk factors for suicide. U.S. Department of Health & Human Services. Also Published as  a book (same title and author) by Hemisphere Publishing Corporation, New York.

The available studies indicate that GLB individuals are at greater risk for having suicide problems. The paper concludes with: "However, all studies of homosexuals to date still involve non-probability samples, hence, estimates of rate of suicide can only be approximate. The time may be ripe for a survey of the general population that includes a question, possibly placed among demographic items, on sexual orientation. This would permit more accurate, if still imperfect, estimates of the true risk of suicidal behaviors among such populations."
 

Harry J (1983).Parasuicide, gender, and gender deviance. Journal of Health and Social Behavior, 24, 350-61. Also published in Remafedi, G. Ed. (1994a), p. 69-88.

Research Highlights

A further analysis of the Bell & Weinberg (1978) sample. Suicide attempt results given based both on sexual orientation and high/low levels of "childhood cross-gendering" or femininity for males. "Loner" status is also evaluated.

Gay white and black males: 126/683 (18.4%) attempted suicide to age of data intake - Mean age = 36 years.

Heterosexual white and black males: 10/337 (3.0%) attempted suicide to age of data intake - Mean age = 36 years.

Using the 2 X 2 Table located at - http://home.clara.net/sisa/twoby2.htm and the following attempter / nonattempters data for the two group (126 / 557 and 10 / 327) , 95% CI - Odds Ratio:  3.8<7.4<14.3. Pearson's= 46.799 (p= 0.0000).

488/683 (71.4%) of gay males were rated in the "high childhood cross-gendering" category, while 29/337 (8.6%) of heterosexual males were in this category.

Assuming that homosexual males account for about 10% of the male population, heterosexual and homosexual males with scores on the "feminine" side of the median on a masculinity-feminity scale were estimated to form about 15% of the male population, and these males account for 41% of males reporting at least one suicide attempt by the average age of 37 years for the sample studied. When the non-feminine homosexual males are added, all homosexual males and heterosexual feminine males account for 53% of males reporting at least one suicide attempt in their lives.

Another factor studied was "the loner" status of males as they grew up. "Loner" feminine homosexual males were at greater risk for a suicide attempt than their non-loner counterpart (21% vs. 13%), and the same applied for "loner" feminine heterosexual males compared to their non-loner counterpart (10% vs. 0%).

The data also permitted a "homosexual" probability estimate for males who are feminine. Given that 71.4% of homosexual males (7.14% of all males) were rated on the "feminine" side of the median on the masculinity-femininity scale, and that 8.6% of heterosexual males (7.75% of all males) were similarly rated, the probability that a "feminine" boy will be homosexual is about 50/50. Using the femininity (0) to masculinity (6) scale (7 divisions), however, as reported by Bell, Weinberg, and Hammersmith (1981) Sexual Preference: Statistical Appendix (Indiana University Press, p. 75), higher levels of self-reported childhood femininity increases the probability that one will be homosexual: 28% of homosexual males rated 0-2 on the scale, while only 1% of heterosexual males did. Again using the 10% estimate, a 0-2 rating reflects a 76% probability that a boy will be homosexual, and this estimate replicates the results of a longitudinal study carried out by Green, R. (1987) The "Sissy Boy Syndrome" and the development of homosexuality  (Yale University Press, N.Y.). It was reported that 75% of the highly feminine boys studied were homosexual or bisexual by adulthood (p. 99-101).
 

Heath KV, Botnick MR, Martindale SL, Schechter MT, O'Shaughnessy MV, Hogg RS (1999).Social Determinants of Suicide Attempts among Young MSM [Men Who Have Sex With Men]. Presented at the 8th annual Canadian Conference on HIV/AIDS Research, May, 1999, Victoria, BC. Related Information about this sample of MSM.

From Conference Abstract available online at the Vanguard Project Web Pages:

MSM between the ages of 18 and 30 completed questionnaires detailing demographic information, sexual behaviours, history of forced and paid sex, comfort with sexual orientation, use of illicit drugs, and previously validated measures of depression, social support, alcohol dependency and self-esteem. Participants were also asked whether they had ever attempted to commit suicide. Comparisons between those who had and had not attempted suicide were carried out using contingency table analysis. Step-wise logistic regression was used to identify predictors of suicide attempt after adjustment for multiple explanatory variables.

Of the 345 participants, 19.4% had attempted suicide. Those who had attempted suicide were significantly less likely to have completed high school (p=0.006) and more likely to have annual incomes below $10,000 CA (p=0.002). As regards social-sexual characteristics, forced sex in childhood and adolescence and having been paid for sex were more commonly reported by attempters than non-attempters (all p<0.01). Suicide attempters had higher depression scores and lower levels of social support and self esteem (all p<0.01). The use of nitrite inhalants (poppers) and alcohol addiction were also elevated among suicide attempters (p=0.002 and p=0.001 respectively). In multivariate analysis the use of poppers (AOR=2.37; 95%CI 1.30,4.33), low social support (AOR=2.19; 95%CI 1.18,4.09) and low/moderate self-esteem (AOR=3.73; 95%CI 2.03,6.86), were associated with elevated risk of attempted suicide.
 

Herdt G, and Boxer A (1993). Children of Horizons: How Gay and Lesbian Teens Are Leading a New Way Out of the Closet. Beacon Press, Boston, Mass..

Highlights:

Sample: 141 males and 61 females (less than 22-years-old) who had attended the Horizon youth group in Chicago. Attempted suicide rate 20% and attempts occurred before coming to the group.
 

Herrell R, Goldberg J, True WR, Ramakrishnan V, Lyons M, Eisen S. Tsuang MT,  (1999). Sexual orientation and suicidality: a co-twin control study in adult men, Archives of General Psychiatry, 56(10), 867-874. Full Text available online.

Research Highlights:

The study used twins from the population-based Vietnam Era Twin Registry, Hines, Ill. For study, a subsample of 103 middle-aged male-male twin pairs were identified in which one member of the pair reported male sex partners after age 18 years while the other did not and was therefore assumed to be heterosexual. Twin pairs born between 1939 and 1957, age range 40 to 60 (approx.).

At a 95% confidence interval, The unadjusted matched-pair odds ratios results were  2.4 (1.2-4.6) for thoughts about death, 4.4 (1.7-11.6) for wanted to die, 4.1 (2.1-8.2) for suicidal ideation, 6.5 (1.5-28.8) for attempted suicide, and 5.1 (95% CI, 2.4-10.9) for any of the suicidal symptoms. "After adjustment for substance abuse and depressive symptoms (other than suicidality), all of the suicidality measures remain significantly associated with same-gender sexual orientation except for wanting to die (odds ratio, 2.5 [95% CI, 0.7-8.8])."

Conclusion: "...reports of lifetime measures of suicidality are strongly associated with a same-gender sexual orientation. These effects cannot be explained by abuse of alcohol and other drugs, nonsuicidal depressive symptoms, or the numerous unmeasured genetic and nongenetic familial factors accounted for in the co-twin control design.

Members of Twin Pairs - Percent Reporting
Suicidality/
Category
Thoughts 
About Death
Wanted
to Die
Suicidal
Ideation
Suicide
Attempt
No Homo-sex
Twin Pairs - n = 6434
21.9%
6.7%
15.3%
2.2%
No Homo-sex
Twin Pairs - n = 103
30.1%
9.7%
25.2%
3.9%
One Twin Reports 
Homo-sex - 103 Pairs
n = 103
47.6%
26.2%
55.3%
14.7%
Both Report Homo-sex
8 Twin Pairs
n = 16
50.0%
25.0%
56.3%
18.8%

NOTE: The authors, in the "Comment" section summarize the OR (Odds Ratio) for previous studies, giving OR = "6.2 (95% CI, 1.4-26.3)". This is incorrect. Using the 2 X 2 Table located at - http://home.clara.net/sisa/twoby2.htm and the following data from the Bagley and Tremblay (1997)  study - 665 heterosexual non-attempters, 3 attempters; 77 GB non-attempters and 5 attempters.- produces an OR (for attempting suicide) = 14.4 (95% CI, 3.4-61.4)

Hershberger SL, Pilkington NW, and D'Augelli AR (1997). Predictors of suicide attempts among gay, lesbian, and bisexual youth. Journal of Adolescent Research, 12(4), 477-497.

Research Highlights: Sample of 194 15-21 yeas old gay, lesbian, and bisexual youth obtained from varied youth groups in the United States. Males (73%), 66%
caucasian. Attempted suicide incidence for males is 40% and 43% for females.
 

Jordan KM (1997). I will survive: lesbian, gay, and bisexual experience of high school. Journal of Gay and Lesbian Social Services, 7(4), 17-33.

Highlights:  A sample of 34 gay, lesbian, and bisexual students completed a questionnaire and 35.3% (12/34) reported a previous suicide attempt.
 

Kelly B, Raphael B, Judd F, Perdices M, Kernutt G, Burnett P, Dunne M, Burrows G (1998).Suicidal ideation, suicide attempts, and HIV infection. Psychosomatics, 39(5), 405-15.

Research Highlights:.

A cross-sectional sample of Australian human immunodeficiency virus (HIV)-positive (n = 164) and HIV-negative (n = 65) homosexual and bisexual men were studied (mean age = 33.0 years, age range = 20- to 60-years-old). The HIV-positive and HIV-negative males had lifetime suicide attempt rates of 21.4% and 29.1% respectively. The discriminating factors for a lifetime history of suicide attempts were (1) a lifetime diagnosis of dysthymic disorder (0.56), a positive lifetime diagnosis of major depression (0.46), DSQ-immature defence score (0.43), and DSQ-neurotic defence score (0.32) (Canonical correlation = 0.38, X2 = 26.25, df=4, p < 0.0001). Correlation are also given for males with current suicide ideation, EPI-neuroticism scores being the most significant (0.52). Of the HIV-negative males who had attempted suicide, 66.7% had attempted suicide more than once.
 

Kourany RFC (1987). Suicide among homosexual adolescents. Journal of Homosexuality, 13(4), 111-7. Also published in Remafedi G, Ed. (1994), p. 89-97.

Research Highlights:

Sixty-six psychiatrists (randomly sampled members of the American Society of Adolescent Psychiatry) responded to a questionnaire about suicide in homosexual adolescents, and 18 of them (18/66, 27%) "felt that the subject matter was not applicable to their practice." Twenty-seven (27/66, 41%) reported some experience with "suicidal gestures among homosexual adolescents," while 39 (59%) reported having no experience and therefore no opinion to offer. 18 psychiatrists with some experience with homosexual youth  (66%, or 27% of total sample) "considered gestures by homosexual adolescents more serious and more lethal than similar ones by the heterosexual group," and 4 psychiatrists disagreed.

Comment:  The available research indicates that many distressed homosexually oriented adolescents have been in contact with mental health professionals, including psychiatrists, often enough after a suicide attempt. Why then would so many psychiatrists dealing with adolescents report not having encountered GLB adolescents? A part of the answer supplied by Martin & Hetrick (1988). They report that some suicidal GLB adolescents withhold sexual orientation information from therapists. Unfortunately, research has not yet been carried out to determine how many GLB adolescent suicide attempters do this. One reason for the phenomenon may be the detected homophobia and/or homo-ignorance commonly reported to be the status quo of mental   health professions, including psychiatry. Another reason may be that many GLB adolescents attempt suicide because they do not want to be gay or lesbian, thus opting for death and therefore living up to the socially learned belief rendered in the title of the first book addressing GLB suicide issues: I Thought people like that killed themselves by Eric Rofes (1983). Adolescents who have detected a homosexual component within - and opt for death instead - may predictably not be forthcoming in revealing this aspect of Self to others, including mental health professionals. They may even deny their homosexual desires it if it is suspected and related information is being requested.
 

Kruks G (1991). Gay and lesbian homeless/street youth: special issues and concerns. Journal of Adolescent Health, 12, 515-8.

Highlights:

The available data on the suicide problems of gay and lesbian homeless/street youth is reviewed; the indications are that they are at higher risk for having suicide problems. It is noted that a sample of gay street youth which had originally been a part of the Schneider et al. (1989) study (but the results were not published) consisted of "53 gay-identified street youths.. served by the YSD" (Youth Services Department of Los Angeles) and 53% of them "has attempted suicide at least once, and 47% more than once" (p. 517).
 

Lock J, and Steiner, H (1999). Gay, lesbian, and bisexual youth risks for emotional, physical, and social problems: results from a community-based survey. Journal of the American Academy of Child and Adolescent Psychiatry, 38(3), 297-304. (Full Text from findarticles.com)

Research Highlights:    A sample of 1,769 upper middle class California high school students (grades 9 to 12, age range = 12 to 18 years, mean age = 15.9 years) was studied using the Juvenile Wellness Survey which is divided into 5 domains: (1) general risk taking, (2) mental health problems, (3) sexual victimization and risk, (4) eating and dietary problems, (5) general health problems. The survey is a self-reporting pencil-and-paper instrument administered in such a way that the subjects remain anonymous. The samples was 59% white, 3.5% Hispanic, 2.1% African-American, 17.9% Asian-American, and 17.7% describing themselves as "other." In the sample, "106 (6% of total, 52% male, 48% female) self-identified as GLB; and additional 224 (13% of total, 38% male, 62% female) reported they were unsure of their sexual orientation.

"Significantly increased health risks for self-identified GLB youth were found in mental health, sexual risk-taking, and general health risks compared with self-identified heterosexuals, but not in health domains associated with substance abuse, homelessness, or truancy" often reported to be a risk factor in community-based studies and in some Youth Risk Behavior Surveys. YRBS studies, however, are more representative of all students because middle class, lower middle class and working class students (the majority of American students) are also represented in the sampling of students.
 

Macdonald R, Cooper T (1998). Young gay men and suicide: A report of a study exploring the reasons which young men give for suicide ideation. Youth Studies Australia, 17(4), 1998, 23-27. (Must scroll to locate abstract.)

Highlights: From a qualitative study of seven gay males aged 18 to 25, two (28%) reported a suicide attempt and another reported having been seriously suicidal. A short description of the situation leading to their suicidal crisis is given along with recommendations to help such youth. It is noted that "when initiatives are planned and strategies implemented that target young people, young gay people usually remain invisible and unrepresented at the level of local, state and federal government, and within mainstream youth services." For the three individuals studied, the factors implicated in their suicide problems were: the high religiosity of their families and related homonegativity, feelings of isolation and no one to whom to confide, and problems related to accepting their sexual orientation.
 

Magnuson, C. (1992). Lesbian and gay youth in Ottawa: the importance of community. Pink Triangle Youth, Ottawa, Canada. Also as a Master's thesis at Carleton University, Ottawa.

Research Highlights:

Sample: 129 GLB youth aged 14 to 25 years; 77 gay/bisexual males; 52 lesbian/bisexual females; suicide attempt rates of 26% (males) and 44% (females).

Reporting having had suicidal feelings: males (61%), females (76%).

Reporting having attempted suicide: males (26%), females (44%).

Suicide attempt rates for youths in the following categories: sexually abused (76%), physically abused (72%), emotionally and psychologically abused (56%).

Negative response to offpring's homosexuality by family linked to 45.7% of suicide attempters; their suicide attempt rate: 61.5%.

Reasons given by subjects for suicide attempt: confusion with or difficulty  accepting one's homosexual orientation (29%), loneliness (20%), sadness or depression (18%), parental abuse (16%), fear of or actual experience of rejection (16%), lack of support system (8%), and others.
 

Martin AD, and Hetrick ES (1988). The stigmatization of the gay and lesbian adolescent. Journal of Homosexuality, 15(1/2), 163-183.

Highlights:

A report is given on the GLB youth who contacted the Hetrick & Martin Institute in New York (also called The Institute for the Protection of Gay and Lesbian Youth Inc.). 35% of clients were white, median age 17 years, and 60% were male. It is noted that "most problems of gay and lesbian adolescents are strongly interrelated." From a client sample of several hundred individuals interviewed, a 21% attempted suicide rate is reported.

One observation made would be of major interest to mental health professionals and adolescent/youth suicide researchers: "...we have had nine clients who were under treatment for suicide attempts but who had not yet told their therapists either that they were homosexual or that that was a factor in the suicide attempt (p. 173)." Uribe & Harbeck (1992) also report a similar observation.

Another factor which may be related to mental health problems, including suicidal problems for sexual minority adolescents, is rape. "Rape is a prevalent form of violence against gay and lesbian adolescents, especially in institutional settings. For the gay male in particular, identification as homosexual in a group home or shelter makes rape probable rather than possible. In many instances, the young person who is raped is blamed for bringing it on himself (p. 175)."
 

Martin RL, Cloninger CB, Guze SB, and Clayton PJ (1985). Mortality in a follow-up of 500 psychiatric patients. Archives of General Psychiatry, 42, 58-66.

Research Highlights:

In a 6- to 12-year follow-up study of 500 psychiatric patients, six died from suicide, two of whom (33%) were determined to be homosexual. According to the authors, "it should be noted that in this study homosexuality was associated with a history of suicide attempts at the index evaluation, as well as with completed suicide during follow-up (p. 65)." The reference given for the significant association of "suicide attempts" and "homosexuality" is: Woodruff RA, and Clayton PJ (1972). Suicide attempt and psychiatric diagnosis. Diseases of the Nervous System, 33, 617-29. The association of "homosexuality" and high risk for suicidality in South African psychiatric patients was reported by Pretorius, HW. (1992) in an MD Thesis Study. Motto et al. (1985) also reported a homosexual/bisexual factor to be significant in suicides of psychiatric patients. As a rule, in studies of risk factors for suicide and suicide attempts by current or former psychiatric patients, sexual orientation information is not solicited for correlation purposes as rendered below.

A March 1998 survey of Medline (via Medscape) produced 1980-1998 results indicating that "homosexuality" is generally completely ignored in studies of individuals with psychiatric diagnoses. A search for:

"psychiatric patients" and "suicide" produced 216 items. Adding "homosexuality" to the search list only produced two items, both the same, and they were not specifically related to suicide in the homosexual population.

"psychiatric patients" and "suicide attempt" produced 16 items. Adding "homosexuality" to the search list produced "0" items.

"schizophrenia" and "suicide" produced 562 items. Adding "homosexuality" to the list produced only two items, both dealing with isolated cases.

"bipolar or manic" and "suicide" produced 360 items. Adding "homosexuality" to the search list produced "0" items.

"homosexuality" and (suicide or "suicide attempt") and (schizophrenia or bipolar or "personality disorder" or depression)] produced 30 items, and the same search omitting "homosexuality" produced 3930 items. Most of the 30 items represent studies of gay/bisexual males, or papers related to homosexuality issues. No studies were added to the two noted in this bibliography: Motto et al. (1985) and Martin et al. (1985). The Bagley and Tremblay (1997) study was one of the 30 items.

A search of Medline (1980-1998) for all references of "homosexuality" and "suicide or suicide attempt" produced 107 items, and 16,816 items were returned using only "suicide or suicide attempt." Therefore, there are only about 0.64% of "suicide & suicide attempt" items referenced in Medline which mention "homosexuality" issues. Therefore, "homosexuality" is generally nonexistent in the professional "suicide" literature indexed on Medline. "Homosexuality" is noted in only about 6 out of 1,000 items.
 

Mathy, Robin M (2002). Suicidality and Sexual Orientation in Five Continents: Asia, Australia, Europe, North America, and South America. International Journal of Sexuality and Gender Studies, 7, 2/3, 215-225. Abstract.

Data Summary:

Sampling: Every “1,000th” Visitor to an Internet Website of an international news organization:MSNBC
Percentage who Participating in the Human Sexuality Study: 25%

Attempted S. = Attempted Suicide
Attempt: [%] = Incidence for Having Attempted Suicide

*p < :05: **p < :01: ***p < :001: Fisher Exact Test

Homo.Bi = Homosexual / Bisexual
Hetero = Heterosexual
Attempt or Attempted S. = Attempted Suicide

12.6%: Averaged Percentage of Population Sample that is Homo/Bi males: 7.1% to 17.2% (Range)
13.2%: Averaged Percentage of Population Sample that is Homo/Bi females: 5.1% to 20.5% (Range)




Millard J (1995).Suicide and suicide attempts in the lesbian and gay community. Australian and New Zealand Journal of Mental Health Nursing, 4(4), 181-189.

Summary: It is noted that mainstream suicidology reports certain risk factors for suicidal behavior but that the risk factors implicated in gay and lesbian suicide issues are generally unrecognized. The paper addressed factors such as "discrimination, gay adolescence, coming out, establishment of a gay identity, HIV/AIDS, intrapersonal stressors, drugs and alcohol, racial/ethnic factors and limited support structures." The ignorance of these issues in professional groups, in mainstream society, and in GLB communities is deemed to be a problem, with implications for mental health nursing.
 

Motto JA, Heilbron DC, and Juster RP (1985). Development of a clinical instrumentto estimate suicide risk. American Journal of Psychiatry, 142(6), 680-6.

Research Highlights:

A two-year follow-up study of  2,753 adults "hospitalized due to a depressive or suicidal state" produced a number of factors associated with the risk for suicide. One of the most significant was being bisexual and sexual active, or homosexual and inactive (celibate). The Bagley and Tremblay (1997) study results suggest elevated levels of mental health problems for males in these categories, and Bell and Weinberg (1978) also report similar results for celibate homosexual males. Rarely, however, is the sexual orientation of "at risk" psychiatric patients investigated in studies of suicidality. (See the related Medline search via Medscape.)
 

O'Brien CA,Travers R, and Bell L (1993). No Safe Bed: lesbian, gay and bisexual youth in residential services. Central Toronto Youth Services, Toronto, Canada.

Research Result Implications:

Based on interviews with GLB youth who experienced the available residential services, and interviews of professionals in the field, the residential system in Toronto, Canada's largest and most gay-positive city, is deemed to not only be highly ignorant of GLB youth and their needs, but also abusive to the point of likely being causal in the suicide attempts (and suicides) of some GLB youth. The residential system was described to be a "profoundly dangerous" environment for these youth.
 

Pattison EM, and Kahan J (1983). The deliberate self-harm syndrome. American Journal of Psychiatry, 140(7), 867-72.

Research Highlights:

A search of the professional literature from 1960 to 1980 produced a total of 63 reported cases of self-harm involving 27 males and 29 females ranging in ages from 6 to 75 years. 44.4% (12/27) of the male were homosexual, 7 of whom were young. Therefore, in the professional literature, homosexual young males were greatly over-represented in self-harm activities, but most cases were reported to be one-time events involving a suicide attempt.
 

Proctor C.D, and Groze VK, (1994). Risk factors for suicide among gay, lesbian, and bisexual youths. Social Work, 39(5), 504-13.

Research Highlights:

Sample: 152/221 white (69.1%), 21-years-old or younger, average age = 18.5 years, 159  males (71.9%) and 62 females (38.1%), 52/221 (23.5%) lesbians, 139/221 (62.9%) gay, and 30/221 (13.6%) bisexual (20 males, 10 females). Sample obtained from 24 GLB community center in the United States and Canada.

Suicide attempters = 89/221 (40.3%); history of being suicidal but not attempting = 57/221 (25.8%); non-suicidal = 75/221 (33.9%).

On the Adolescent Health Questionnaire, all three section (family, social environment, and self-perception), scores lowest for attempters, next lowest for suicide ideators and  nonattempters, and highest for non-suicidal individuals.
 

Qin P, Agerbo E, Mortensen PB (2003). Suicide risk in relation to socioeconomic, demographic, psychiatric, and familial factors: a national register-based study of all suicides in Denmark, 1981-1997. American Journal of Psychiatry, 160(4):765-72. (Abstract)

Excerpt:

"...registered [same-sex] partners included as a separate category in the analysis had an odds ratio of 4.31 (95% CI=2.23–8.36) in the crude analysis and 3.63 (95% CI=1.71–7.67) in analyses with adjustment for other factors in the full model [for having committed suicide compared to opposite-sex married couples]".

Note: The above was noted more as an aside. Personal communication with the lead researcher also revealed a non-interest in publishing a related paper even though such data and related analyses have been long awaiting in mainstream suicidology in the Western world.
 

Reinherz HZ, Giaconia RM, Silverman AB, Friedman A, Pakiz B, Frost A, and Cohen E (1995).Early psychosocial risk for adolescent suicidal ideation and attempts . Journal of the American Academy of Child and Adolescent Psychiatry, 34(5), 599-611.

and

Reinherz HZ, Giaconia RM, Pakiz B, Silverman AB, Frost AK, and Lefkowitz ES (1993). Psychosocial risks for major depression in late adolescence: a longitudinal study. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 1155-63

Research Highlights:

Two papers which are part of a series based on a longitudinal community study of  nearly 400 males and females beginning in 1977 when participants were 5- to 6-years old. In the Reinherz et al. (1993) paper, "dependence" as rated by the mother at the age of 5 years for boys (a gender nonconformable attribute) was one of the two factors most significantly related to major depression in late adolescence; the other factor was both self-rated and mother-rated anxiety.

In the Reinherz et al. (1995) paper, gender nonconformity in preschool ("behaviors that are counter to typical gender norms, such as aggressive behavior in females and dependence in males") was determined to be one of  the "early gender-specific risks for suicidal ideation."

Comment: In neither paper was it mentioned that early (even later) gender nonconformity attributes, especially for males, is related to having a homosexual orientation as revealed by the  Bell and Weinberg (1978) data and in other studies. The same may also apply for lesbians. This omission  was probably the result of the researchers (from the Simmons College School of Social Work) lacking knowledge about homosexuality, but the reviewers at Journal of the American Academy of Child and Adolescent Psychiatry may also be responsible.

A March, 1998 Medline search of the subject "homosexuality" in the journal revealed only 3 items; one is a 1995 letter to the editor. One 1990 paper discussed "custody" issues, including "the homosexual parent," and a 1997 paper, Gay and lesbian issues in child and adolescent psychiatry training as reported by training directors (Townsend MH, et al., vol. 36(6), 764-68), reported on the continued ignorance of child/adolescent psychiatrists with respect to "the vulnerability of LGB youths." The result was based on a survey of "residency training directors in U.S. child and adolescent psychiatry programs."

A March 1998 PubMed (Medline) search produced 31 papers (1996-98) containing child/adolescent "suicide" information and none of them identified "homosexuality" to be in any way significantly associated with child and adolescent suicide problems. Five of the papers were published in The Journal of the American Academy of Child and Adolescent Psychiatry's special issue on child and adolescent suicide: Vol 36(11), November, 1997. Many studies of GB males reporting average ages of  12 to 15 years for the first suicide attempts indicates that many of them are attempting suicide during early adolescence, and even during childhood. Most psychiatrists appear to be unaware of this fact, some being in denial of the facts. Far too many psychiatrists have been collaborating to maintain their ignorance concerning the suicidality of gay/bisexual male children and adolescents; the results of such activities has certainly been harmful to most (all?) children and adolescents in this high risk category.
 

Remafedi G, French S, Story M, Resnick MD, and Blum R (1998). The relationship between suicide risk and sexual orientation: results of a population-based study. American Journal of Public Health, 88(1), 57-60. Related news items:  Research result highlights in Massachusetts Adolescent Health Survey (1987) Full Text.
 

Remafedi G (1994a). Death by Denial: studies of suicide in gay and lesbian teenagers. Alyson Publication, Boston.

Highlights:

Contains a number of published studies and one report: Harry (1983)Kourany (1987), Remafedi et al. (1991), Report of the Massachusetts' Commission on Gay and Lesbian Youth (1993). - The report, as well as others from The Commission now available online. - Book Acquisition.
 

Remafedi G (1994). Predictors of unprotected intercourse among gay and bisexual youth: knowledge, beliefs, and behavior. Pediatrics, 94(2), 163-168.  Full Text.

Research Highlights:

239 gay/bisexual males 13- to 21-years-old (mean = 19.9 years), 63% at extreme risk for prior HIV exposure.

140/238 (59%) reported a history of sexual abuse/assault and 70/238 (29%) has been arrested for illegal activities.

70/237 (30%) reported at least one suicide attempt. Previous psychiatric hospitalization (15%) mostly  for suicide attempts or depression.
 

Remafedi G (1987). Adolescent homosexuality: psychosocial and medical implications. Pediatrics, 79(3), 331-7.  Full Text.

Research Highlights:

A sample (n = 29) of predominantly white homosexual (23/29, 79%) and bisexual (6/29) males age 16-19 (Av. 18.3 years) produced a suicide attempt rate of 34% (10/29), 20% (2/10) being multiple attempters.

5/10 report that the attempt was related to sexual orientation, 8/10 attempts occur soon after self-identification as homosexual.

28/29 (96.5%) have contemplated suicide,  9/29 (31%) report psychiatric hospitalization (5/9 for a suicide attempt), mental health problems requiring consultation (21/29, 72%, 12/21 for sexual orientation issues), substance abuse (17/29, 58%), chemical dependency treatment (5/29, 17%), chemical dependency (5/29, 17%), running away (14/29, 48%), conflict with the law (14/29, 58%), truancy (7/29, 24%), dropping out of school (8/29, 28%).
 

Remafedi G, Farrow JA, and Deisher RW (1991). Risk factors for attempted suicide in gay and bisexual youth. Pediatrics, 87(6), 869-75. Full Text.

Research Highlights:

Risk factor for suicide attempts in gay/bisexual male youth studied using a sample of 137 American gay and bisexual males ranging in age from 14 to 21 years of age.

Suicide attempt rate:  30% (41/137), with almost half attempting suicide more than once, and 21% of suicide attempts resulting in medical or psychiatric admissions.

Subjects were 3-times more likely to be attempters if they were in the feminine category and the same applied for "illicit drug use". They were especially at high risk if they identified as gay or bisexual at a young age.

Forty percent (40%) of these males had been runaways, 39 percent had been sexually abused, 35 percent had been arrested, 23 percent were classified gender nonconformable (feminine), and 17 percent had engaged in prostitution. The associated attempted suicide rates for males having these (often overlapping) attributes are 36, 46, 44, 47, and 52 percent, respectively.

"Fifty four percent of all suicide attempts (37/68) received risk scores in the 'moderate to high' lethality range." In the 45 attempted suicide cases where the rescuer was not the victim (76% of cases), 58% "received scores in the 'moderate to least' rescuable range. In other words, the predicted likelihood of rescue was moderate to low despite the actual occurrence of an intervention" (p. 871).
 

Rich CL, Fowler RC, Young D, and Blenkush M (1986). San Diego suicide study: comparison of gay and straight males. Suicide and Life-Threatening Behavior, 16(4), 448-57.

Research Highlights:

In a series of 283 suicides, 13 male victims were deemed to be homosexual, ranging in age from 21- to 42-years of age. There were 106 male suicide victims in the same age range out of 202 male victims. In this age range, 10.9% of the victims were homosexual; the implications are that gay males are not over-represented in suicide if openly gay males account for about 10% of the male population.. This assumption, however, may not be the case given the highly to partly closeted nature of many gay and bisexual males. Remafedi (1994a) comments on this study in the Introduction to his book, Death by Denial: "Moreover, since suicide attempts in homosexual persons have been found to be associated with nondisclosure of orientation, it is reasonable to expect that the 10 percent figure is the lowest possible estimate of the actual proportion of gay suicides in the San Diego cohort. Unfortunately, the authors minimized their own findings by overestimating the prevalence of homosexuality in the general population and underestimating the likelihood of missed cases of gay and lesbian suicide" (p. 11).
 

Roesler T, and Deisher RW (1972). Youthful male homosexuality. Homosexual experience and the process of developing homosexual identity in males aged 16 to 22 years. JAMA, 219(8):1018-23.

Research Highlights:

A study of 60 16- to 22-year-old gay/bisexual males. Coming out was often related to serious problems. 19/60 (31%) reported "a significant suicide attempt." 7/19 (37%) of attempters were re-attempters. 29/60 (48%) reported having visited a psychiatrist.
 

Rofes E (1983). I thought People Like That Killed Themselves. Grey Fox Press, San Francisco, CA.

Highlights:

Contains a chapter on the high risk for suicide of GLB adolescents/youth. Also notes that suicide is an ongoing problems, even after making more formal contact with GLB communities. Even some gay community leaders are reported to have committed suicide.
 

Saewyc EM, Bearinger LH, Heinz PA, Blum RW, Resnick MD (1998). Gender differences in health and risk behaviors among bisexual and homosexual adolescents. Journal of Adolescent Health, 23(3), 181-8.  Research result highlights in Massachusetts Adolescent Heath Survey (1987).

Safren SA, Heimberg RG (1999). Depression, hopelessness, suicidality, and related factors in sexual minority and heterosexual adolescents. Journal of Consulting and Clinical Psychology, 67(6), 859-66. (A PubMed "abstract" link with a document delivery service.)

Research Highlights:

A sample of 48 heterosexual youth matched with 56 gay, lesbian, and bisexual youth ranging in age from 16 to 21 years. For GLB youth versus heterosexual youth: attempted suicide (30%: 14/56  vs 13%: 6/48), definite desire to die from the attempt (58%: 8/14 versus 33%: 2/6, thinking of suicide often/ very often (20%: 11/56 versus 0%: 0/48), thinking of suicide often/very often or sometimes (40%: 22/56 versus 10%: 5/48). Youth sample taken from after school programs, meaning that both group were experiencing  some problems.

Savin-Williams RC (1994). Verbal and physical abuse as stressors in the lives of lesbian, gay male, and bisexual youths: associations with school problems, running away, substance abuse, prostitution, and suicide. Journal of Consulting and Clinical Psychology, 62(2), 261-9.

Research Highlights:

Author reviews "at risk" status of GLB youth on the basis of the available research.

Author comments on the response(s) of most professionals in adolescent/youth problem prevention/intervention fields to the relevant papers published in their journals: "Unfortunately and tragically, few have listened." (p. 266)

An unpublished study Suicidal Behavior and gay-related stress among gay and bisexual male adolescents by Rotheram-Borus MJ, Hunter J, and Rosario M (1992) is summarized:

Sample: 139 males, 89% of color, 60% reporting feeling suicidal during week before data intake, 39% having attempted suicide, 52% being repeat attempters.

Gay-related stressors, attempters/nonattempters: out to parents (53%/30%), discovered gay by parents (37%/23%), by other in the family (53%/30%), ridiculed for sex identity (57%/44%), all not statistically significant.

For sample, lifetime prevalence 50% higher for alcohol, 300% higher for marijuana, and 800% higher for cocaine/crack than national average for same-age male youth.

This study was eventually published. See Rotheram-Borus et al (1994).
 

Schneider SG, Farberow NL, and Kruks GN (1989). Suicidal behavior in adolescent and young adult gay men. Suicide Life Threatening Behavior, 19(4), 381-94.

Research Highlights:

Sample = 108 males age 16-24; 22/108 (20%) reported at least one suicide attempt; 59/108 (55%) reported having been suicidal (50% (38/76) for white males and 66% (21/32) for males of color. There were 28 males (26%) who were in the "recently suicidal" category.

For 22 suicide attempters:

Mean age of first suicide attempt: 16.3 years.

Youngest suicide attempter: 12-years-old.

Multiple attempters = 10/22 (45%), 2 to 14 attempts. Eleven (11) receive no treatment for their first attempt.

Mean results in "mostly true" range of response scale to following items existing at time of suicide attempt: "Feeling no hope for the future," "experienced painful feelings," "felt helpless," "felt worthless or inadequate," and "felt lonely or isolated."

Significant differences between suicide attempters and nonsuicidal group: (1) average age of same sex attraction (8.1 vs 10,7 years, p < .01), (2) involved in first homosexual relationship (16.2 vs 17.7, p < .01), (3) labeled feelings but not self as homosexual (12.1 vs 14.1 years, p < .04).

Only 4 out of 21 attempters (19%) "had disclosed their sexuality to any key support before their first attempt." This result has important implication with respect to interpreting suicide results from research soliciting "sexual orientation" information for adolescents/youths who have died as a result of their suicide attempt. It is possible that only one out of five GB males committing suicide are identified as being homosexually oriented.

Eight of the first suicide attempts (8/21, 38%) occurred in the period when the individual was coming out, the event occurring either "shortly before of after their first attempt."

Only two out of 22 attempters felt good about being gay (or possibly being gay) before their first attempt; 20/21 were aware of same-sex attractions before first attempt occurred.

"All of the gay men who reported alcoholic fathers and familial physical abuse (n = 7) were suicidal."
 

Shaffer D, et al. (1995). Sexual Orientation in Adolescents Who Commit Suicide. Suicide and Life-Threatening Behavior, Vol. 25(suppl.), 64-71.

Research Highlights and Commentary:
 
 

Simpson B (1994). Opening Doors: making substance abuse treatment and other services more accessible to lesbian, gay and bisexual youth. Central Toronto Youth Services, Toronto, Canada.

Research Results Implications.

An investigation of youth substance abuse treatment programs in Toronto, Canada's largest and most gay-positive city, resulted in a 75-page report revealing that, at its worse, GLB youth were being abused in these programs. At best, these youth were generally receiving inappropriate services, thus placing them at risk for having their substance abuse problem aggravated. The likelihood of exacerbating often associated problems, such as suicidality, would also be increased with such inappropriate and harmful services.
 

Uribe V, and Harbeck KM (1992). Addressing the needs of lesbian, gay, and bisexual youth: the origins of PROJECT 10 and school-based intervention.  In Harbeck, KM. (1992) Coming out of the Classroom closet: gay and lesbian students, teachers, and curricula.  Harrington Park Press, NY, 1992, 9-28.  Also published in The Journal of homosexuality. 22(3-4), 9-28.

Research Highlights:

Study sample: volunteer; gay, lesbian, and bisexual students from Fairfax High School and other high schools; total number 50, 37 males 13 females, age range 16 to 18, 20/50 white; 35/37 males sexually active, average age first sexual experience + 14, majority of which was anonymous sex (probably adult male), and 12/37 had sex with at least one female. (p. 19-20)

For 37 males: "only two had a positive relationship with their families over the issue of being gay," the common response being "extreme family disruption to forcible expulsion from home;" 20/37 not living at home, 36/37 reporting problems with alcohol and/or drugs, half reporting a suicide attempt and all seeking help outside the school (about half of the attempters) did not reveal their homosexual orientation to mental health professional. (p. 20). Martin & Hetrick (1988) report a similar observation.

Coming out: "As a group, the respondents singled out their junior high school years as the most painful for them.  Coming out to themselves, without psychological or social support, was described as 'a time when I wanted to die,' 'a period where I just wanted to blot out all my feelings,' or 'a time when I felt like I was suffocating."' Harassment has sometimes begun in elementary school and greatly increased by junior high (grade 7) and into high school. (p. 20)

Females: 5/13 reported having problems with alcohol, 5/13 had sex with another female, 8/13 were "out" to parents but told it as "a phase", 3/13 reported "serious suicide attempts." (p. 21-22)
 

Vincke J, and van Heeringen K (+1998).Suicidal ideation and behavior among homosexual adolescents and young adults: a comparative study. Paper presented at the 7th European Symposium on Suicide and Suicidal Behaviour. As of November, 1998, the paper related to the study was being written and it will soon be submitted for publication. Published as van Heeringen C, Vincke J (2000). Suicidal acts and ideation in homosexual and bisexual young people: a study of prevalence and risk factors. Social Psychiatry and Psychiatric Epidemiology, 35: 494-99.  (A PubMed "abstract" link with article delivery service.) Full text available online.

Research Highlights:  Information related to study is available on a web page located at the Unit for Suicide Research web site (University of Ghent, Belgium).

Study of 404 15- to 27-year-old males and females. 137 gay/bisexual males and 82 lesbian and bisexual females. Suicide attempt prevalence: gay bisexual males (12.4%). heterosexual males (5.9%). lesbian and bisexual females (25.0%), and heterosexual females (5.4%).
 

Waldo CR, Hesson-McInnis, MS, and D'Augelli, AR (1998) Antecedents and consequences of victimization of lesbian, gay, and bisexual young people: A structural model comparing rural university and urban samples  American Journal of Community Psychology, 26(2), 307-34.

Research Highlights:

A sample of 54 lesbian, gay, and bisexual youth from a rural university setting was studied and compared to the sample of 194 urban GLB youth studied by Hershberger & D'Augelli (1995). "Results indicated that a revised model of victimization exhibited sufficient fit to the urban sample data and provided preliminary support for the generalizability of the model beyond the initial sample." The suicide attempt rate for the GLB youth in a rural university setting was 32%, compared to 42% for the urban sample.
ACKNOWLEDGMENTS

  The development of these GLBT information web pages were made possible through the collaboration of Richard Ramsay (Professor, Faculty of Social Work, University of Calgary) and Pierre Tremblay (independent researcher, writer, and GLBT children and youth advocate) who both recognize that often needed social changes occur as the result of knowledge availability and dissemination. Additional Information at: Warning, Acknowledgments, Authors.

These GLBTQ Info-Pages were located at the University of Southampton from 2000 to 2003, this being the result of a collaboration with Dr. Chris Bagley, Department of Social Work Studies, University of Southampton.

Graphics are compliments of Websight West. The Synergy Centre donated computer/Internet time to facilitate the construction of this GLBT information site. Both are owned by a Chris Hooymans, a friend, and former publisher of a gay & lesbian magazine in Calgary, Alberta, Canada. Chris continues to offer his expertise whenever needed and he has supplied, free of charge, the hosting of the site - Youth Suicide Problems: A Gay / Bisexual Male Focus - where a smaller - GLBTQ Education Section - is located.

Computer time was also supplied by Rick Reist & Glenn Lynas, and Glenn also supplied other forms of assistance.

Many thanks to Wendy Stephens from The Department of Communications Media, University of Calgary.  She communicated with publishers of many academic journals (an ongoing time-consuming process) for permission to reproduce abstracts from papers and studies on these GLBT information web pages.

INFORMATION LIMITATIONS

The information made available on this web page does not represent all the relevant information available on the Internet, nor in professional journals and in other publications.

This web page was constructed to supply a spectrum of information for individuals seeking to understand one or more of the many gay, lesbian, bisexual, queer and transgender issues.


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