Colorado Paper - 1997
Gay and Bisexual
Male Youth: Overrepresented in
Suicide Problems and Associated Risk Factors.
By Pierre J. Tremblay
in Collaboration with Richard Ramsay,
prepared for distribution at the Third Bi-Regional Adolescent Suicide Prevention
Conference Breckenridge, Colorado, September, 1997: An Invitational Conference.
Defining the Problem and meeting the challenge: Creating a Safety Net in
Our Communities to Prevent Youth Suicide.
Faculty of Social Work, University of Calgary.
of the Conference: U.S. Department of Health and Human Services,
Health Resources and Services Administration (HRSA), Maternal and Child
Health Bureau and Centers for Disease Control and Prevention, National
Center for Injury Prevention and Control; Comprehensive Health Education
Foundation; HRSA Region VIII and X Field Offices; University of Washington,
Division of Adolescent Medicine, and Harborview Injury Prevention and Research
Homosexual / Bisexual Risk Factor in Suicide.
Homosexual / Bisexual Factor in Male Youth Suicidal Behaviors.
"Child Sexual Abuse" Risk Factor in Male Youth Suicidal Behaviors.
/ Bisexual Males At Risk for Attributes and Experiences Associated With
High Rate of Suicidality:
Gay / Bisexual Male Overrepresentation in Mental Disorders.
Gay / Bisexual Male Overrepresentation in Alcohol and Drug Use Problems.
Gay / Bisexual Male Overrepresentation in Child Sexual Abuse.
Gay / Bisexual Male Risks for Mental Health Problems and Suicidality.
Out, Effeminacy, and Family Problems.
GB Male High Risk for Social Abuse and Violence.
GB Male High Risk for Becoming Runaway / Homeless/Street Youth and Engaging
For Youth Suicidology.
The demographic results of a 1997 study
indicates that about 10% of male children and adolescents are on a journey
to becoming identifiable homosexual or bisexual young adults (1),
and the results have been replicated in the Cardia study cohort (2).
Their journey is the "coming out" process, usually occurring in
adolescence, and it has been extensively studied as an identity formation
process (3). Coming out is a social construct, and the
same applies to associated problems.Young individuals are recognizing their
same-sex attractions/desires (sexual orientation) in a traditionally homophobic
society, reflected in the fact that a majority of youth manifest homo-negative
attitudes (4, 5), with predictable
consequences for GLB (gay, lesbian, and bisexual) youth.
In 1993, the American Academy of
Pediatrics reviewed the GLB adolescent research data and concluded that
these youth were at risk for having many problem, including suicidal problems,
thus warranting concern by pediatricians (6). A similar
concern, however, has not been manifested by mainstream researchers of
youth suicide. Sexual orientation issues have generally been ignored in
their studies of adolescents and young adults (7). The
same applies for other helping professions, even after related papers were
published in their journals (8), but the situation is
Meanwhile, the empirical data has
continued to indicate that homosexual/bisexual adolescents are at risk
for suicide problems, but most studies have either focused only on males,
or the larger part of studied samples was male. At least for GB males,
the evidence indicating their overrepresentation in male youth problems
has become compelling, especially with respect to suicide problems and
associated risk factors. Major changes are therefore warranted in mainstream
youth suicide research and in adolescent/youth suicide prevention and intervention
HOMOSEXUAL / BISEXUAL RISK FACTOR IN SUICIDE
Homosexually oriented individuals have
been reported to be at risk for suicide since the end of the nineteenth
century (9-13; 7:
summary). The first research-based confirmation of the proposition occurred
in two 1985 studies. One two-year follow-up of 2,753 adults hospitalized
for depression and/or suicidality reported that being bisexual or a celibate
homosexual was one of the 15 variables implicated in suicides (14),
and a seven-year follow-up of 500 psychiatric patients reported that homosexuals
accounted for one-third of the suicide deaths. The authors noted that the
study represented the first attempt to ascertain the sexual orientation
of such study subjects (15), and the endeavor has not
been repeated. Determining the sexual orientation of individuals after
they have died, however, is fraught with many more problems than the ones
some researchers have noted (16, 17).
In general population surveys, unaddressed methodological problems related
to the often closeted status of homosexual/bisexual males may have produced
underestimates ranging from 200% to 800% (1).
Three North American studies (18-20)
have nonetheless attempted to establish the sexual orientation of suicide
victims after their death but the studies have been plagued by methodological
problems (16, 17). To date, a study
has not been conducted of gay/bisexual individuals who have made serious
suicide attempts to learn how, if at all, their sexual orientation could
have been determined had their deaths occurred, but some related information
exists. In one study of GB youth, only four out of the 21 suicide attempters
(19%) reported that they "had disclosed their sexuality to any key support
before the first attempt" (21). Without such knowledge
and other relevant information poor research methodology will continue
to be used and significant underestimates are likely.
HOMOSEXUAL / BISEXUAL FACTOR IN MALE YOUTH SUICIDAL BEHAVIORS
Determining the sexual orientation of
subjects after a suicide attempt is decidedly easier than attempting the
determination after an individual's death, and it is a lesser problem if
all subjects in a sample are self-identified GLB (gay, lesbian, or bisexual)
individuals.In the latter category, 12 North American studies of accessible
gay/bisexual-identified male youth have produced suicide attempt estimates
ranging from 20 to 50 percent, the average being about 30% (16,
17). Although these gay community-based samples (mostly
taken between 1985 to 1994) have been deemed "biased" and of little significance
by some mainstream suicidologists (22, 23),
they do indicate that the youth studied have been at high risk. The results
have also continued to replicate the ones produced by the Kinsey Institute's
classic study of homosexualities (24).
Bell and Weinberg's 1978 study of
a 1969 sample of 575 predominantly homosexual males and 284 predominantly
heterosexual males (24) - matched on the basis of age,
education, and occupational level - produced data indicating that homosexual
males were 13.6 times more likely to have attempted suicide by the age
of 21 years (9.5% vs 0.70%). Homosexual males have therefore continued
to be at risk for having suicide problems during adolescence as the recent
studies indicate. Furthermore, 6 of the 12 recent studies reported the
percentage of suicide attempters who were repeat attempter, and the 39.6%
average (16, 17) replicates the Bell
and Weinberg homosexual male suicide reattempter rate of 38.9%.
It was only recently, however, that
three large study samples produced suicide attempt and sexual orientation
data indicating that homosexually oriented adolescents have been at greater
risk for suicidal behaviors than their heterosexual counterparts. In 1997,
the result of a 1996 Seattle school study of 8,406 adolescents in grades
7 to 12 (5% GLB) became internationally available via the Internet (25).
The study produced important one-year problem prevalence results for self-identified
GLB adolescents versus heterosexual adolescents (followed by the risk ratio):
(1) made a suicide plan (31.1% vs 15.7% / 2:1), (2) attempted suicide (20.6%
vs 6.7% / 3:1), and (3) attempted suicide resulting in medical attention
(9.4% vs 2.2% / 4:1). Remafedi et al. (26) studied a
1987 Minnesota sample of 36,254 grades 7 to 12 adolescents from which a
subsample of 175 GB males and 165 heterosexual male adolescents was taken,
controlling for a number of social attributes. GB males were about 7 times
more at risk for a suicide attempt than heterosexual males given their
respective 28.1% and 4.2% attempted suicide rates. (Note
1: Results of the Massachusetts and Vermont school-based Youth Risk
behavior Survey studies.)
Bagley and Tremblay (1997) studied
a 1991-92 stratified random sample of 750 Calgary males aged from 18 to
27 years and reported that the 10.9% of the sample - classified to be homosexual
or bisexual on the basis of self- identification (11.1%) and/or being currently
homosexually active (9.2%) - had been 13.9 times more likely to attempt
suicide (an attempt at self-killing) than heterosexual males (16,
17). This result (to the average age of 22.7 years) replicated
the Bell and Weinberg "13.6 times" homosexual higher risk factor to the
age of 21 years for a first-time suicide attempt. It was also reported
that homosexual and bisexual males were 3 times more likely to have engaged
in self-harm activities and they accounted for 26% of the self-harm cases,
thus replicating the results of a 1983 study. A survey of the literature
over a 20-year period revealed that homosexual individuals accounted for
15 of the 56 (27%) self-harm cases reported (27).
The Bagley and Tremblay data on self-harm
behaviors and suicide attempts revealed, for the first time on the basis
of random sampling, that gay/bisexual male youth were at risk for the most
serious form of self-harm (an attempt at self-killing), thus placing them
at greater risk for the most serious consequences of suicide attempts:
being hospitalized, maybe being injured for life, and even dying as indicated
by the data in another study (28). By 1996, the Seattle
school study noted above had also produced data replicating the trend for
homosexually oriented adolescents to be overrepresented in the most serious
forms (and probably the most serious results) of suicidal attempts. Compared
to heterosexual adolescents, GLB (gay, lesbian, and bisexual) adolescents
were three times more at risk for a suicide attempt than heterosexual adolescents,
but they were four times more at risk for a suicide attempt requiring medical
"CHILD SEXUAL ABUSE" RISK FACTOR IN MALE YOUTH SUICIDAL BEHAVIORS
Bagley and Tremblay (1997) reported
that 5 out of 8 suicide attempters were homosexual/bisexual males (16,
17), and a previous study of the same sample had reported
that 6 out of 8 suicide attempters (75%) had been sexually abused (experienced
unwanted sexual acts) before the age of 17 (29). A significant
suicidal behavior risk factor intersection has therefore existed in homosexually
oriented youth who experienced CSA (child sexual abuse), but mainstream
adolescent/youth suicidality studies have generally not solicited both
sexual orientation and CSA information from subjects. The Bagley et al.
(1995) study of 1087, grades 7 to 12, males (30) reported
that 9.8% of the boys had been sexually abused from "once" to "often,"
these males accounting for 60.9% of boys answering affirmatively to the
statement "I deliberately try to hurt or kill myself." The highest risk
for reported suicidal behaviors was also directly related to the reported
rates of abuse. Boys reporting sexual abuse were 14.5 times more likely
to have engaged in suicidal behaviors compared to non-abused boys, and
the risk factor (37 times) was highest for boys sexual abused "often" (n
= 18). In the same study, a sample of 1035 girls produced a 24.6% CSA rate
but sexually abused girls had a 4.3 times greater likelihood of having
engaged in suicidal behaviors compared to non-abused girls; the ones abused
"often" (n = 53) were 10.8 times more at risk for reporting suicidal behaviors.
A 1996 Minnesota school-based study did not present data to make similar
comparisons possible, but sexually abused boys had high suicide attempts
rates (26.6%) and rates of up to 46% for specific conduct disorders (31).
To date, as noted by Garnefski and
Diekstra (32), almost all the research reporting a relationship
between suicidal problems and child sexual abuse has been done on female
samples. Research on the effects of child sexual abuse on males has been
lacking, and one assumption having been that "male victims are less adversely
affected than female victims." Therefore, they explored the effect of sexual
abuse on boys by studying a large representative sample of 12- to 19-year-old
adolescents. Sexually abused girls were 4.8 times more likely to report
suicidal thoughts/behaviors than non-abused girls, but boys were 10.8 times
more likely to have been suicidal than non-abused boys, thus essentially
replicating the results of the Bagley et al. study (30).
Boys were also more likely than girls to manifest other problems (eg. emotional
and conduct disorders), although this was not the case in the Bagley et
al. (1995) study. In conclusion, Garnefski and Diekstra noted that child
sexual abuse is strongly associated with "the existence of a multiple problem
pattern in both sexes," and that "the aftermath for boys might be even
worse or more complex than for girls" (32).
/ BISEXUAL MALES AT HIGH RISK FOR ATTRIBUTES AND EXPERIENCES ASSOCIATED
WITH HIGH RATES OF SUICIDALITY.
In a 1993 review of the adolescent suicide
research it was noted that "almost all adolescent suicide victims have
suffered from psychiatric illness (33)."The same emphasis
was made in a 1995 research review of adolescent suicide and suicidal behaviors
(34) and in a general review of the epidemiology of suicidal
behaviors (22). Alcohol and substance use/abuse problems
were in second place, with minor mention of other problems, including the
effects of early negative life experiences (35, 36)
and environmental or ecological factors (37) given more
emphasis by other suicidologists (child sexual abuse and life stresses
are two of these factors). As a rule, having a homosexual orientation in
a highly homo-negative society had been either ignored (34,
35) even when addressing the effects of child sexual
abuse (36), challenged (22), or only
briefly mentioned in an "aside" nonintegrated manner (33,
37, 38). For people concerned about
the general welfare of GLB adolescents, and especially their suicide problems,
the 1995 "sexual orientation" supplement of Suicide and Life-Threatening
Behavior (39) did not offer much hope that the problem
would be soon recognized and addressed in mainstream suicidology.
To date, the two studies requesting
sexual orientation information from adolescents have reported that GLB
adolescents (25: 5% of adolescents), or self-identified GB male adolescents
(26: 2% to 3% of males) to be at higher risk for suicide
attempts. These adolescents, however, only represent the ones acknowledging
their homosexual orientation who were also willing to come out, at least
anonymously, to someone else: the self-disclosure to researchers via answers
on a questionnaire. Many soon-to-be self-identified or "coming-out" GLB
adolescents may have reported suicide attempts possibly related to their
unwanted homosexual orientation, but they had not yet reached the stage
of accepting their sexual desires nor being able to acknowledge this. These
studies may therefore greatly underestimate the magnitude of GLB adolescent
suicide problems and the proportion of adolescent suicide attempters who
are homosexually oriented, but these errors may be corrected with studies
of older individuals. The first such study reported that more than half
(62.5%) of young adult males with a suicide attempt history are homosexually
oriented (16, 17), and that they account
for about 25% of males reporting self-harm behaviors. The results also
suggest that these males have been also overrepresented in factors associated
with male suicide and suicidal behaviors, as recent research results have
Gay / Bisexual Male Overrepresentation in Mental Disorders
All studies requesting sexual orientation
and suicide information from youths have been reporting that "homosexuality"
is major factor implicated in adolescent and youth suicidal problems, especially
with respect to the overrepresentation of GB males in adolescent male suicide
attempt problems, and maybe suicide (16, 17).
The same conclusion also applies on the basis of AIDS-related research
which has produced studies reporting GB adult males have been at great
risk for mental disorders associated with suicidal problems, especially
having a major depressive disorder (MDD). Their psychiatric histories (40-43)
have revealed lifetime MDD prevalence rates ranging from 29% to 35% (mean
32.8%) for generally asymptotic HIV+ males, and 33% to 61% (mean 43.8%)
for HIV- males, compared with lifetime prevalence rates of 2.5% to 12.7%
in the general adult male population (44). Gay males
are also being reported to have high rates of personality disorders (PDs)
well known to be comorbid with alcoholism problems (45);
one study produced a 20% prevalence rate for HIV+ (none with AIDS) and
HIV- males (46), and the other reporting a 33% and 15%
prevalence in asymptotic HIV+ males and HIV- males (47),
respectively, compared to a prevalence rate of 5% to 15% (10%) in the general
population (46, 47).
These studies, and others without
psychiatric histories (48, 49), have
generally reported rates of current depressive mental health problems (often
measured over a six-month period) to not be elevated compared to rates
in the average male population, and the same applies for one sample of
HIV+/HIV- African American men (50). A larger sample
of homosexual, bisexual and heterosexual HIV+/HIV- African American men,
however, reported elevated rates of lifetime mental disorders as well as
elevated current rates (51), and the same applies for
a study of men with or at risk for HIV which was not differentiated on
the basis of sexual orientation (44). The latter results,
when combined with the current GB male higher risk for personality disorders
and other related problems (46, 47),
indicate that a significant sector of the GB adult male population has
ongoing mental health problems. The Bell and Weinberg study reported "first-time"
attempted suicides to occur in all age groups at about the same rate for
GB males, and at elevated rates compared to heterosexual males also studied:
4.9%/.35% to age 17 years; 4.6%/.35% from age 18 to 21 years; 4.9%/1.77%
from age 22 to 25 years; and 4.0%/.70% from age 26 to the age subjects
were interviewed, the average age of the samples being 37 years (24).
Therefore, as a group, GB males have
had ongoing serious problems which may be resolved at a young age for some,
but they are being experienced at a later age by others. Celibate homosexuals
males (forming about 15% of the GB male population) have been identified
to have ongoing problems (17, 24),
and one study reported an association with child sexual abuse (17).
Stigmatization-related negative life events predict psychological dysfunction
in gay men (52) and "minority stress" negatively affects
their mental health, even increasing their risk for suicidal problems (53).
About 30% of gay men report suicidal ideation occurring within a 6-month
period (54). Internalized homophobia, sometimes associated
with sexual dysfunction (55), is also linked to many
problems (49, 56, 57),
and its negative effects are especially pronounced in adolescents. Internalized
homophobia or socially induced self-hatred (existing in degrees) and its
resolution/elimination is represented by the "self-acceptance" stage of
the coming-out process. For some individuals, however, socially indoctrinated
homo-negativity is never overcome and related mental health problems last
Gay / Bisexual Male Overrepresentation in Alcohol and Drug Use Problems.
It was long believed that about 30%
of GB (gay and bisexual) males had substance use/abuse/addiction problems
but Bux (1996) reviewed the studies and concluded that flawed methodology
had produced these results. He also asserted that, on the basis of the
recent empirical evidence, "gay men are not at significantly higher risk
for developing drinking problems than heterosexual men" (58).
This may not be the case because the more recent studies (59,
60) only investigated current alcohol and drug use, and
a history of such use (including problem use, addiction and treatment for
dependency) was not solicited; one study did report higher rates of current
alcohol problems for gay men (59). In GB male youth samples
studied, substance use/abuse rates have been high, as it is expected in
populations manifesting high suicidality rates; 11% of 137 GB males less
than 22-years-old had already been in a chemical dependency treatment program
(19), and 36 out of the 37 GB male adolescents in a high
school study reported subtance abuse problems (61). A
1996 study reported that about 19.1% of GB males (n = 501, age = 13 to
21 years) had scores in the elevated range indicating a drug abuse problem
(62). The 1996 Seattle school study (25)
also reported that GLB adolescents were more likely to have engaged in
heavy or high risk drug use (35.8% vs 22.5% / 1.5:1).
GB males have been at high risk for
contracting HIV and related studies have reported high rates of substance
use or abuse disorder when their psychiatric histories were taken. For
samples of predominantly white well educated GB males (n = 68 to 208, mean
ages = 30 to 40 years), lifetime rates of alcohol use or abuse disorder
are 38.0%, 58.7%, and 36.5% (40-42)
compared to lifetime rates of 19.1% to 32.5% in the adult male population
(44). Lifetime rates of drug use or abuse disorder are
27.9%, 54.3%, and 48.6%, compared to lifetime rates of 6.5% to 14.6% in
the adult male population (44). Rates of substance use
or abuse disorder are 70.6% and 55.1% (41, 46),
compared to lifetime rates of 35.4% in the adult male population (44).
Therefore, the GB male risk for having had substance abuse problems as
adolescents and/or as young adults is about 1.5 times that of heterosexual
males, but their risk for developing drug problems is about two- to three-times
the risk for heterosexual males. The situation may also be more serious
for young African American GB males (n = 252) given that the lifetime rates
of substance use disorder is apparently not significantly different than
the rate for heterosexual African American males (n = 250) at risk for
contracting HIV mostly because of their drug use. In this sample, "61.1%
[of males] reported a history of regular use of one or more illicit drugs
at some time in their lives (51)."
Gay / Bisexual Male Overrepresentation in Child Sexual Abuse
A debate has existed as to whether or
not GB (gay and bisexual) males have been at higher risk for CSA (child
sexual abuse) compared to heterosexual males. One 1979 study reported that
boys sexually abused before the age of 13 were 4 times more likely to be
homosexual than boys not sexually abused (63). A 1992
study reported a 37% for CSA occurring to the age of 19 in a sample of
1001 self-identified GB males obtained from STD and health clinics, but
a differentiation was not made between wanted and unwanted sexual activities
and age differences were used as a criteria for determining CSA (64).
Using similar criteria, a 1997 study reported a 35.5% incidence of CSA
occurring before the age of 17 years in a sample of 327 GB men participating
in a cohort study related to HIV risk (65). In a 1995
study of 182 GB Puerto Rican men in New York, however, CSA occurring before
the age of 13 years was reported only in the "unwilling" category (18%),
and the men reported to have been "willing" participants (18%) were placed
in a separate category (66). Another study of 95 HIV+/HIV-
males (92% GB males, 67% Caucasian) reported a 20% rate of CSA (a defined
by the men, themselves) to have occurred before the age of 12 years, nonwhite
males having the highest risk (29.0%) compared to white (15.6%) males (67).
A 1991 study of forty 18- to 19-year-old homosexual males in Singapore
reported a CSA rate of 45% for these males, compared to a 4% rate in a
control group of 47 heterosexual males, all being in training at a large
From these data and assuming that
20 to 30 percent of North American GB males have been subjected to "unwanted"
sexual acts before the age of 17, it is probable that GB males have been
more at risk for CSA than heterosexual males and the risk may be even higher
for nonwhite GB males. International lifetime prevalence estimates for
CSA in boys ranges from 2 to 11 percent, and these rates are similar to
North American statistics, with Canada having prevalence rates of up to
16% (69). A recent major Canadian study produced a male
CSA rate of 4.3% for "unwanted" sexual acts having occurred while males
were growing up (69), the rate being 9.8% in an Alberta
school-based study of adolescents (30), 15.6% in an Alberta
stratified random sample of young adult males (29), and
1% in a large Minnesota school-based sample of adolescents (31).
An underreporting problem may have occurred in the latter study given that
the problem has been common in studies requesting sensitive sexual information
related either to CSA or sexual orientation, especially from adolescents
but also for older individuals (1, 16,
GAY / BISEXUAL MALE RISKS FOR MENTAL HEALTH PROBLEMS AND SUICIDALITY.
prevalence of psychiatric disorders, including substance abuse disorders,
and higher risk for having been sexually abused as children, indicates
that GB (gay and bisexual) male youth are likely to be at greater risk
for suicidal behaviors, suicide attempts, and maybe suicide. These risk
factors are also interrelated, but they are not the only problems placing
GB male adolescents at higher risk for suicidal problems. A number of problem
experienced by GB male youth are not (or generally not) experienced by
their heterosexual male counterparts, and some of them are associated with
poorer mental health problems and risk for suicidal behaviors.
Out, Effeminacy, and Family Problems
Some problems intimately linked to a
high risk for suicide attempts by GB male adolescents, such as the coming
out period often associated with a socially induced self-hatred (21,
70-72), and the age at which coming
out occurs (28: greater risk at a younger age), has no
equivalent in the heterosexual male population. Not having passed the "tolerance"
stage in the coming out process (the next stage is self-acceptance) is
also associated with mental health problems, even in adulthood. One 1994
study of 196 adult GB males (mean age = 28.8 years) reported that the most
significant discriminator on a psychological well-being scale (with twice
the F-ratio of the next most significant measure, p less than .0000) was
the suicidality of males still at the "tolerance" stage (73).
In a 1995 study of 165 GLB youth (15- to 21-years old) with a suicide attempt
rate of 42%, "the single largest predictor of mental health was self-acceptance
Highly "feminine" boys (most of whom
are or will be GB males: 75-77) have
also been at higher risk for suicide attempts (28) because
they are the ones believed to be homosexual as children and adolescents,
and they are therefore more likely to receive the brunt of society's traditional
disapproval (hatred-related abuses via peers, adults, and even professionals)
for homosexual males. GB adolescent males have been more likely to be assaulted
by parents than heterosexual males, and effeminate homosexually active
adolescent GB males have been the most at risk for such assaults (78).
GB adolescents have also been at risk for only being tolerated or even
rejected in their families (79-80).
One study of 221 GLB youth (suicide attempt rate = 40.3%) reported family
problems to be in second place, after the youth's self-perception, with
respect to risk for a suicide attempt (81).
Gay / Bisexual Male High Risk for Social Abuse and Violence
The 1996 Seattle school study (25)
reported that GLB adolescents were, compared to heterosexual adolescents,
more likely (1) to have been threatened or injured with a weapon (18.6%
vs 10.6% / 2:1), (2) to have had a fight-related injury requiring medical
attention (14.9% vs 5.1% / 3:1), (3) to feel unsafe in school with related
absences in the past month (20.9%/13.9% vs 11.9%/6.1% / 2:1), and (6) to
have been the target of anti-gay harassment or violence (34.4% vs 6.3%
/ 5:1). In a study of high school GLB adolescents, the situation was described:
"The sample response indicated that there was widespread verbal and physical
harassment in school. While some harassment began in elementary school,
it increased significantly in frequency and intensity beginning in seventh
grade and continuing throughout secondary school (61)."
This abuse and violence, however, also continues to be experienced at high
rates later in life as revealed by 24 studies reporting victimization ranging
from verbal abuse to physical assaults experienced by about 81% and 16%,
respectively, of GLB adults and youth. Furthermore, victims of such assaults
are more likely to manifest higher rates of depression, anxiety, anger,
and symptoms of posttraumatic stress (82) which may exacerbate
existing mental health and suicidal problems.
Gay / Bisexual Male High Risk for Becoming Runaway / Homeless / Street
Youth and Engaging in Prostitution
The high risk for GB male adolescents
to have family problems has placed them at high risk for becoming runaways
(28, 83), and 25% to 40% of male street
youth may be homosexually oriented (8, 16,
84, 85). Mainstream research, however,
has produced much lower estimates (2% to 6%) deemed to be "gross underestimates"
(8) for reasons also describing Toronto's GB male street
youth: "It is often very difficult for these kids to disclose their sexual
orientation, even when asked in an intake interview. Not many kids are
that up-front (86)." The secrecy exists for many reasons,
including the fact that GBL adolescents have been at high risk for abuse
in residential services (87).
Runaway youth have elevated suicide
attempt rates ranging from 15% to 29% (88, 89),
and homeless gay youth were estimated to be three times more at risk for
suicide attempts than their heterosexual counterparts (90);
one sample of 53 GB male street youth had a 53% attempted suicide rate
(84). Runaway GB male youth in a GB male youth sample
had a suicide attempt rate of 36%, and GB males who had engaged in prostitution
had a rate of 43% (28). A 1995 Los Angeles study of street
youth (85) reported that GB males were the most likely
to engage in survival sex (p less than .001), and a 1989 study of male
youth prostitutes (70% GB males) reported them to more depressed compared
to a control group of males; 26% of male prostitutes scored in the clinically
depressed range on the Beck Depression Inventory compared to 6% of males
in the control group (91).
Both depression and drug use has
been implicated in youth suicidality, and greater drug use has been reported
for male prostitutes (91). Sweeny et al. 1995 reported
that, in the part of their sample obtained from homeless youth centers,
18.2% of the teenage males reporting "male-to-male sex" also reported intravenous
drug use, and that these males formed 35% of the teenage male reporting
intravenous drug use from homeless centers (92). Another
risk factor for male youth prostitutes is their greater likelihood for
having been sexually abused. In a 1989 study of 46 male youth prostitutes
(average age of 16.2 years, 70% GB males), 72% of the GB males had been
sexual abused compared to 43% of heterosexual males, 43% of GB males had
been raped compared to 21% of heterosexual males, and 85% of the rapes
had not been related to their street life (93). These
experiences increase the risk for suicidal problems, and GB male prostitutes
would likely be at the greatest risk.
Little research work has been done
to understand the suicidal problems of male street youth in general and
GB male street youth in particular, especially for GB males engaging in
prostitution for a number of reasons, including as a part of coming out
(64, 93). Tremble (1993) reports that
the hopes of these males are high with respect to getting off the streets
and that for some, these hopes may involve finding a "sugar daddy" to take
care of them. Kruks (1991) described the situation for "many youth" coming
to the Los Angeles Youth Service Center. They "have long histories of being
involved in a succession of 'sugar daddy' relationships." These youths
were always dumped, the "whole cycle lasting an average of 1-2 months,
and the youth often becomes extremely suicidal at the end of each cycle
FOR YOUTH SUICIDOLOGY
The recent research has been repeatedly
confirming that GB (gay and bisexual) males have been (are) overrepresented
in adolescent male suicidal problems and associated risk factors, and that
their higher-than-heterosexual-male risk status likely extends into adulthood.
Although much more could have have been written about these males, such
as their higher risk for having eating disorders, the additional problems
of GB males of colour and their likely higher-than-white-GB-male risk for
having suicidal problems, gay community attributes which may contribute
to suicide problems (eg. relationship problems, rape, ageism, racism, and
community politics of "appearances"), the information presented should
suffice to hopefully initiate needed major changes in mainstream youth
In the special issue of Suicide
and Life-Threatening Behavior titled "Suicide Prevention Toward the
Year 2000" (94) the two papers addressing suicide prevention
in adolescents and young adult (95, 96)
were silent about homosexuality issues, and another paper (22)
did not confer much validity to the hypothesis that GB males are overrepresented
in suicide problems. The same applies for the Suicide and Life-threatening
Behavior issue on "sexual orientation" and suicide problems (39).
If, however, the hypothesis supported by recent research results is correct,
a major counterproductive oversight has occurred in the quest of mainstream
suicidologists to understand and thereby effectively address youth suicide
issues, especially male youth suicide problem given that males account
for about 80% of adolescent deaths from suicide.
Some of the recent suicidality research
has solicited sexual orientation information from adolescent and young
adult subjects (16, 17, 25,
26), and the results have revealed the importance of
soliciting such information in mainstream suicidality research. In fact,
the data has been needed to begin disentangling the suicidal behavior risk
factor problem so often mentioned by suicidologists. As a recent longitudinal
study of children and adolescent has demonstrated, even an attribute most
likely to apply to GB males (but not all of them), such as gender nonconformity
detected at the age of 5 or 6 years, is related to not only depression
problems in adolescence (97), but also to a likelihood
for suicide attempts (98). The result therefore confirms
the link between "feminine" GB males and a high risk for suicide attempts
reported in a major comprehensive study of the GB male youth suicide attempt
Generally, youth suicide prevention
and intervention programs have either ignored or marginalized sexual orientation
issues, and society's traditional homo-negativity may be implicated, thus
exacerbating the serious often life-threatening problems this social attribute
inflicts on homosexually oriented adolescents and youth. Studies have indicated
that the highest risk GB adolescents, such as runaways needing shelter
and the ones seeking substance abuse treatment, are not only poorly served
by professionals supplying related services, but they are often harmed
by the ones apparently working to help all youth (52,
99, 100). Causally implicated in these
problems is the widely reported homo-negativity of many professionals and
their general lack of a formal education about homosexuality, the coming
out process, and related problems.
Given the GB male high risk for suicide
problems, especially at a young age, and the general lack of related knowledge
and understanding which has dominated mainstream suicidology, nothing less
than a major educational remediation effort is needed to begin effectively
addressing the problem. Furthermore, major changes will be required not
only in prevention strategies focused on reducing adolescent suicidal behaviors,
but in communication strategies used to inform highly distressed suicidal
adolescents that help is available.
At best, the silence about homosexuality
issues in many adolescent suicide prevention programs has been 'telling'
suicidal GB adolescents what they likely feel about their problems: no
one will understand and be able to help them, and they may greatly fear
revealing their homosexual orientation to anyone. The results of this situation
may be catastrophic, and harmful consequences may also result from programs
which either marginalized homosexuality issues or do not address these
issues in a comprehensive manner.
The most important question each
director of suicide youth suicide prevention programs must ask is: "How
different would our program be if it was known that the majority of the
adolescent males attempting suicide in the most serius ways (and possibly
committing suicide) are homosexually oriented?" They must then begin amending
their programs in the direction indicated by the answer to the question,
given the facts of the case.
Note 1: Results
for the two 1995 school-based studies cited below were obtained from the
paper, Sexual Orientation and Youth Suicide, presented by Lynn Levine
and Linda Beeler at the Third Bi-Regional Adolescent Suicide Prevention
Conference, September 21-23, 1997, at Breckenridge, Colorado.
Massachusetts "1995 Youth Risk Behavior
Survey:" Grades 9-12 gay, lesbian, and bisexual students, and the ones
not sure about their sexual orientation, were over four times more likely
to have attempted suicide in the past year than heterosexual-identified
students. (Internet Link to study Below, as well as the reproduction of
the section related to GLB adolescents.)
Vermont "1995 Youth Risk Behavior
Survey:" Grades 8-12 GLB (gay, lesbian, and bisexual) students were
over 2.5 times more likely to have attempted suicide in the past year than
heterosexual-identified students. GLB adolescents were over 4 times more
likely to have made a suicide attempt requiring medical treatment.
on the Internet at http://www.doe.mass.edu/lss/yrb95/yrb95111.html
4.4% of all high school students,
and 6.4% of sexually experienced students have had sexual contact with
a member of the same sex and/or describe themselves as gay, lesbian,
Students who describe themselves
as gay, lesbian, or bisexual and/or who have had same-sex sexual contact
are more likely than their peers to report being involved in violence-related
incidences and being threatened, including:
being in a physical fight in the past
year (62.3% vs. 37.3%),
not going to school in the past month
because of feeling unsafe at school or on the way to or from school (20.1%
being threatened/injured with a weapon
at school in the past year (66.7% vs. 28.8%),
carrying a weapon in the past month
(43.5% vs. 19.0%), and
attempting suicide in the past year
(36.5% vs. 8.9%).
Students who describe themselves as
gay, lesbian, or bisexual and/or who have had same sex sexual contact are
more likely than their peers to engage in alcohol and illegal drug use
heavy alcohol use (5+ drinks in a row)
in the past 30 days (47.6% vs. 33.2%),
recent marijuana use (58.0% vs. 31.3%),
lifetime cocaine use (31.0% vs.
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