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The U.S  Surgeon General :
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The National Strategy for Suicide Prevention
Released in 2001

2010-2011 News / Update

Feds support new national LGBT youth suicide prevention task force (USA, 2010)
Task Forces Focus on LGBT Youth, American Indians/Alaska Natives, Military/Veterans (2010)
Related: 1, 2, 3. Notes of Caution / Warnings: 1, 2 (Paragraphs 7-9), 3, 4.
Will it be white racist GLBT suicide prevention? - To be Ignored: Two Spirit Youth? GLBT Street Youth?
Will these GB adolescent males also be ignored as it was done by HIV/AIDS Prevention Researchers?

To Effectively Address a Serious Problem, Good to Know How It Developed. Related Paper.
A Department of Silence: Bullying of LGBT youth not a priority (2010).

U.S. Department of Health and Human Services (HHS) Office of the Surgeon General and National Action Alliance for Suicide Prevention (2012).
2012 National Strategy for Suicide Prevention: Goals and Objectives for Action
. Washington, DC: HHS, September. PDF Download. Download Page.

See section "Lesbian, Gay, Bisexual, and Transgender Populations."

The October 15-18, 1998 Consensus Development Conference, Advancing the National Strategy for Suicide Prevention: Linking Research and Practice.

The Conference was organized by SPAN (Suicide Prevention and Advocacy Network) and cosponsored by CDC (Center for Disease Control), as the first major collaborative effort by government and the private sector. Related Information that may or may not be still available. Relevant information, however, is given in a web page that was constructed soon after the Surgeon General released his "Call to Action."

One Paper on GLBT Suicide Problems was Presented at the Conference.

Suicide among Gay, Lesbian, Bisexual and Transgender Persons  was written by J. Stephen McDaniel, M.D., Emory University School of Medicine and David W. Purcell, JD., Ph.D., Centers for Disease Control (CDC).

This paper was worked on considerably since 1998 and an author was added to accomplish this task. It was eventually published as:

McDaniel, J.S., Purcell, D.W., & D'Augelli, A.R. (2001).The relationship between sexual orientation and risk for suicide: Research findings and future directions for research and prevention. Suicide and Life-Threatening Behavior, 31(1) (Suppl.), 84-105.

After the initial silence about gay and lesbian youth suicidality issues in The Surgeon General's Call To Action To Prevent Suicide - 1999, a number of individuals went to work. When the National Strategy for Suicide Prevention was eventually published in 2001 and the following references to gay and lesbian issues were made:

The National Strategy for Suicide Prevention
(Available on the Internet: Web Page or PDF Download from mentalhealth.org)

FOREWORD
GOALS AND OBJECTIVES FOR ACTION

Development of specific activities provides the opportunity to address the particular needs of subgroups at high risk for suicide and particular cultural/ethnic/social contexts for implementation. For instance, the objective to "increase the proportion of family, youth, and community service organizations and providers with evidence based suicide prevention programs" can be achieved by different prevention activities appropriate for younger African-American males, the elderly, gay and lesbian youth, persons with major mental illnesses, or American Indians and Alaskan Natives. (p. 24)

Seek to eliminate disparities that erode suicide prevention activities. This is an important commitment in the National Strategy. Health care disparities are attributable to differences such as race or ethnicity, gender, education or income, disability, age, stigma, sexual orientation, or geographic location. (p.25)
 

GOALS AND OBJECTIVES FOR ACTION: GOAL 1 - Promote Awareness that Suicide is a Public Health Problem that is Preventable.

Because no one is immune to suicide the challenge is to develop a variety of messages targeting the young and the old, various racial and ethnic populations, individuals of various faiths, those of different sexual orientations, and people from diverse socioeconomic groups and geographical regions. (p. 46)
 

GOALS AND OBJECTIVES FOR ACTION: GOAL 4 - Develop and Implement Suicide Prevention Programs.

An alternative approach to school-based efforts that focus on suicide prevention is to target risk and protective factors that occur earlier in the pathways to suicide, and to also consider specific needs and subcultures of the school population (e.g., gay and lesbian youth) (McDaniel et al., 2001). For example, there are many proven prevention programs that reduce substance use and aggressive behavior by teaching techniques in problem solving and building positive peer relations (see Appendix C). When implemented effectively, these programs have the potential for reducing risk for suicide simultaneous with other negative outcomes, in this case substance use and aggressive behavior. (p. 65)
 

GOALS AND OBJECTIVES FOR ACTION: GOAL 8 - Improve Access to and Community Linkages with Mental Health and Substance Abuse Services.

The elimination of health disparities and the improvement of the quality of life for all Americans are central goals for Healthy People 2010 (DHHS, 2000). Some of these health disparities are associated with differences of gender, race or ethnicity, education, income, disability, geographic location, or sexual orientation. Many of these factors place individuals at increased risk for suicidal behaviors, because they limit access to mental health and substance abuse services. (p. 98)
 

APPENDIX C: SPECIAL POPULATIONS AT RISK

GAY, LESBIAN, AND BISEXUAL YOUTH

Several State and national studies have reported that high school students who report same-sex sexual behavior or self-identify as gay, lesbian, or bisexual (GLB) have higher rates of suicidal thoughts and attempts in the past year compared to youth who report exclusively heterosexual sexual behavior or self-identify as heterosexual in orientation (McDaniel & Purcell, 2001). Experts do not agree completely about the best way to measure reports of adolescent suicide attempts, or sexual orientation, so the data are subject to question. But they do agree that efforts should focus on how to help GLB youth grow up to be healthy and successful despite the obstacles that they face. Because school-based programs limited to suicide awareness have not proven effective for youth in general, and in some cases have led youth to consider suicide as a normal response to stress or have caused increased distress in vulnerable youth (Vieland et al., 1991), there is reason to believe that they may not be helpful for GLB youth either. Issues of stigma, labeling, privacy, and appropriateness of referrals for youth needing services must be considered to ensure that prevention programs for sexual minority populations are safe and effective. (p. 180)

Some excerpt highlights (with commentary, as needed) from the McDaniel, J.S., Purcell, D.W., & D'Augelli, A.R. (2001) review of suicidality studies wholly or partly related to homosexuality issues. [The relationship between sexual orientation and risk for suicide: Research findings and future directions for research and prevention. Suicide and Life-Threatening Behavior, 31(1) (Suppl.), 84-105.]

On the Studies that sought to Estimate the Number of Homosexually Oriented Individuals who attempted Suicide:

Morbidity: Suicide Attempts

Research on attempted suicide also is a complicated endeavor. A primary barrier is the lack of a clear definition for the term suicide attempt. O’Carroll and his colleagues (1996) proposed a complex nomenclature for suicide-related behaviors to clarify communications, advance research on suicide, and improve the effectiveness of interventions.  Although the proposal could bring clarity to the topic, it has not yet been widely integrated into research.  Another significant limitation is the lack of reliable and valid measures for attempted suicide (Muehrer, 1995).  This limitation was highlighted by Meehan, Lamb, Saltzman, & O’Carroll, (1992), who conducted an epidemiologic survey of 649 young adults and found that the self-reported suicide attempts did not always reflect actual self-injury, which suggests that researchers need to ask multiple question about suicide-related behavior.  Without clear definitions that lead to accurate measurement, the interpretation and the generalizability of data are limited.

Research on suicide among GLB people is further complicated because the definition and measurement of sexual behavior and of sexual orientation are not standardized (Gonsiorek, Sell, & Weinrich, 1995). For example, some researchers ask directly about self-identification, whereas others classify participants based on report of same-sex sexual behavior. In many cases, participants are grouped together based on same-sex orientation or behavior, even though there might be important differences between people who adopt a gay or lesbian identity and those who engage in same-sex sexual behavior without such self-labeling.  The relationship between sexual behavior and identity is complex and not completely understood, but it is another factor making this research sometimes difficult to interpret.   Another limitation of research on suicide among GLB people is that most researchers have examined risk factors but have ignored factors that promote resilience.

Given the difficulties of studying a hidden population, it is not surprising that no national data on the frequency of suicide attempts by GLB people exist. Nonetheless, many studies on suicide attempts have been published over the past three decades. The next two sections review studies of GLB people and suicide attempts. Earlier studies of self-reported suicide attempts were limited by the use of convenience samples of self-selected participants or by the lack of a comparison group, or both.  Since 1997, however, eight better-designed studies with GLB samples, mostly of youths and young adults, have been published.  While even these studies have methodological limitations (e.g., the use of a variety of definitions for suicide attempts and sexual orientation, the use of measures with limited evidence of reliability and validity), they represent major advances over prior research. ( p. 87)

Concerning the Bell & Weinberg 1978 Study (1969 Sample), the following is reported:
One early study attempted to obtain a more representative sample of GLB people.  Bell and Weinberg (1978) recruited a large sample of African American and Caucasian gay men and lesbians from a variety of sources and then randomly selected a smaller stratified sample (race by sex) for in-depth interviews.  In the sample, 35% of gay men and 38% of lesbians had made suicide attempts or had seriously considered suicide. One-quarter (25%) of lesbians and 20% of gay men had actually attempted suicide.  Gay men were six times more likely than heterosexual men to have attempted suicide, and lesbians were twice as likely as heterosexual women to have attempted suicide.  Most attempts took place at age 20 or younger, and nearly one-third took place before age 17.   These researchers also found that rates of loneliness and depression were higher for gay men and lesbians than for heterosexuals.  One study limitation is that the interviews were conducted almost 30 years ago and therefore could reflect a cohort effect (e.g., more GLB people attempting suicide in a more hostile era). Recent studies, however, have corroborated these results, suggesting that cohort effects are not powerful factors and that suicide attempt rates among GLB people are relatively stable over time (Herrell, 1999).

Prior to 1997, Bell and Weinberg’s (1978) study provided the strongest evidence of an elevated rate of suicide attempts among GLB people. Despite methodological limitations, high rates of suicide attempts were found across studies among GLB people recruited in a variety of settings and using varying recruitment techniques. This finding, combined with the higher rates found among GLB people in studies with comparison groups, led to the conclusion that GLB people were more likely to attempt suicide than heterosexuals. (p. 90)

Commentary:

The authors  note that "One study limitation is that the interviews were conducted almost 30 years ago and therefore could reflect a cohort effect (e.g., more GLB people attempting suicide in a more hostile era). Recent studies, however, have corroborated these results, suggesting that cohort effects are not powerful factors and that suicide attempt rates among GLB people are relatively stable over time (Herrell, 1999). " The assumption here is that suicide attempts by gay and bisexual males would have been more common in the past than they are in the present, but this does not appear to be the case. That is, the available evidence indicates that attempted suicide incidences by gay and bisexual males have been increasing since Bell & Weinberg (1978) sampled predominantly homosexual males in 1969.

The Bell % Weinberg (1978) Sample: The large sample (taken in 1969) was of 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 largest part of the sample consisted of  white homosexual males (N = 3533)  and these candidates for study were then subjected to random sampling within contact cells to produce the final study sample of 575 white predominantly homosexual males.

"First Time Suicide Attempt' Results for White Males:

For white males: Seriously contemplated suicide (37%); Suicide attempt incidence 105/575 (18.3%), re-attempter incidence (7% out of 18.3%, 39.9%), 47% of the first attempts occurred  up to the age of 20 years, 79% to the age of 25 years; therefore, 47/79 (59.5%) of suicide attempts that occurring before the age of 26 years occurred before age of 21 years. Twenty-seven percent (27%) of all first attempts had occurred before age 18 years, and 22% after age 25. The suicide attempt problem occurring throughout age group, declines slightly after age 25.
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  0.35%. Using the 2 X 2 Table located at - http://home.clara.net/sisa/twoby2.htm and the following nonattempter / attempters data for the two group (38 / 547 and 1 / 283) , 95% CI - Odds Ratio:  2.0<14.5<107.0. Pearson's X2= 11.893, p = 0.0005

To age 20, 13.6-times more likely to be a "first-time" suicide attempter: 9.5% vs  0.70%. Using the 2 X 2 Table located at - http://home.clara.net/sisa/twoby2.htm and the following nonattempter / attempters data for the two group (55 / 520 and 2/282), 95% CI - Odds Ratio: 3.6<14.9<61.6. Pearson's X2 = 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 nonattempter / attempters data for the two group (83/492 and 7/277) , 95% CI - Odds Ratio:  3.0<6.7<14.6. Pearson's X2 = 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 nonattempter / attempters data for the two group (105/470 and 9/275) , 95% CI - Odds Ratio:  3.4<6.8<13.7. Pearson's X2 = 37.619, p < 0.0000

The above figures are calculated from data given in Tables 21.14 and 21.15, p. 453-4: Bell A.P., and Weinberg, M.S. (1978) Homosexualities: a study of diversity among men & women. Simon and Schuster, N.Y.

The "suicide attempt" incidence to the ages of 17 years (4.9%) and 20 years (9.5%) for white predominantly homosexual males, when compared to more recent "suicide attempt" incidences for homosexually oriented male youth based on community samples (Average of many studies = 30%, approximately), and especially when compared to results from more representative sampling of self-identified gay and bisexual males in Massachusetts' schools. For example, in the Garofalo R, Wolf RC, R, Lawrence MS, and Wissow S  (1999) study [Sexual orientation and risk of suicide attempts among a representative sample of youth. Archives of Pediatric and Adolescent Medicine, 153(5), 487-93.]:
The study is an analysis of 3.8% of public school students reporting being GLBN (gay, lesbian, bisexual, or "not sure" of their sexual orientation), and 96.2% reporting being heterosexual, their average age being 16.1 years. Latter group includes individuals reporting same-sex activity, but not identifying as GLBN, or 0.81% of the sample. The 1.9% percent of the sample reporting same-sex activity had a suicide attempt rate (for the past 12 months) of 30.6% versus 9.2% for their heterosexual counterpart. The suicide attempt rate for adolescents identified as GLBN was 31.0% versus 9.1% for heterosexual identified adolescents, .22.7% versus 9.1% for adolescents "not sure" of sexual orientation, and 35.3% versus 9.1% for GLB identified adolescents (not including "not sure" adolescents).
Although the authors stated that GBN males were 6.5 times more likely than heterosexual males to report a suicide attempt, it was apparently not deemed important to report the percentage of suicide attempters in each category, but the 12-month suicide attempt rate for all males in the sample was given:  6.4%. Using a sample estimate of about 4.7% for GBN males (3.8% GB males + .0.9% "not sure") in calculations, the relative rate of suicide attempters would be approximately 33% versus 5.1% for GBN males compared to heterosexual males.
Another study from the Bell & Weinberg study period compared adult homosexual males from a gay organization (n = 85) to a control group of adult heterosexual males (n = 35) [Saghir, M.T.,  Robins, E.,  Walbran, B. & Gentry, K.A.  (1970). Homosexuality III: Psychiatric disorders and disability in the male homosexual. American Journal of Psychiatry, 126, 1079-1086.]. The results: 7% of the homosexual males (6 / 85) reported having attempted suicide and, as noted by McDaniel, J.S., Purcell, D.W., & D'Augelli, A.R. (2001), "most participants reported that their suicide attempts were made before age 20" (p. 90). Not noted by the authors, however, is the fact that the results of this study should NOT have been reported without noting the following important fact: The incidence difference between the homosexual and heterosexual male suicide attempters  (6 / 85 versus 0 / 35) is not statistically significant. Using the 2/2 table at - http://home.clara.net/sisa/twoby2.htm - and the following numbers: 6 attempters, 79 non-attempters (homosexual) and 0 attempters, 35 non-attempters (heterosexual), the Pearson Chi Square is: X2 = 2.601,  p= 0.1068. At best, the results should have been reported as only representing a trend in the direction of homosexual males being more at risk for having attempted, compared to heterosexual males.

Therefore: The two estimates for the lifetime suicide attempt incidence of homosexual white males who were growing up before 1969 is 18.3% (Bell & Weinberg, 1978) and 7% (Saghir et al, 1970), but the adolescent attempted suicide incidence would be lower, the best estimate being from Bell & Weinberg (1978). To to the age of 17 years: 4.9% vs  0.35%, and to the age of 20 years: 9.5% vs  0.70% for predominantly homosexual white males compared to predominantly heterosexual white males.

Given that the Youth Risk Behavior Surveys used by Garofalo et al. (1999) surveyed Grade 9 to 12 students with an average age of 16.1 years, it could be suspected that the "suicide attempt" problem for homosexually oriented adolescents has greatly increased in the past 40 years by a factor of about "6-times": 4.9% to about 30%. Yet, in direct conflict with the information they present,  McDaniel, J.S., Purcell, D.W., & D'Augelli, A.R. (2001) state:

"Recent studies, however, have corroborated these results, suggesting that cohort effects are not powerful factors and that suicide attempt rates among GLB people are relatively stable over time (Herrell, 1999)" (p. 90).
That is, they are "assuming" - in violation of the results of the studies noted - that the adolescence suicide attempt incidence for homosexually oriented males has not changed in the last 50 years. I use a "50 years" estimate instead of the stated "30 years" because, with respect to suicide attempts occurring up to the age of 20 years, the most homosexual males studied were in the 11-to-20 years range (adolescence) between 1931 and 1961 given that the average age of the homosexual and heterosexual males sampled for study in 1969 was about 36 years. That is, on average, they were 16 years of age in 1949.

The citation of the "Herell et al., 1999" study results as the 'proof' or an indicator that the suicide attempt rate for homosexual males has not changed, however, was the result of torturing results more than a bit to support one's beliefs. That is, the Bell and Weinberg (1978) data used the Kinsey Scale to determine sexual orientation while, in the "Herell et al., 1999" study, the following is noted: the questionnaire used only "asked subjects only about the behavioral dimension;" that is, their history of sexual partners in adulthood by gender. (The full text of the "Herell et al., 1999" study is available at http://archpsyc.ama-assn.org/issues/v56n10/rfull/yoa8085.html) Using this criteria for determining  "sexual orientation, Herell et al., 1999 reported that "about 2%" of the male twins studied were homosexually oriented. The authors then noted: "While this proportion is smaller than the estimate of 4.9% measured by the National Health and Social Life Survey for American adult men, it is within the range of all recent estimates from probability samples, and formal policies prohibiting military service by homosexuals may have reduced this percentage.(50, 51)

Cited Studies:
50. Laumann EO, Gagnon JH, Michael RT, Michaels S. The Social Organization of Sexuality: Sexual Practices in the United States. Chicago, Ill: University of Chicago Press; 1994.
51. Michaels S. The prevalence of homosexuality in the United States. In: Cabaj RP, Stein RS, eds. Textbook of Homosexuality and Mental Health. Washington, DC: American Psychiatric Press; 1996:43-63.

These "2%" study results, however, were severely criticized by Bagley & Tremblay (1998), the indications being that such studies had used highly flawed methodology given that the "homosexuality" information sought was still highly taboo in our society. (See Bagley & Tremblay, 1998 available online, or another version of the same paper published in The Journal of Homosexuality, Vol. 36, No. 2, 1998: Pubmed Abstract). This is a situation where studies with similarly highly flawed methodology will likely produce similarly highly flawed results. The Bagley & Tremblay (1998) study highlighted this fact by reporting an incidence of 9.2% for young adult male reporting recent same-gender sexual contacts: "in the past 6 month," meaning that these males were homosexually active as adults. Also meaning that the Herell et al (1999) study estimate of 2 % would represent an underestimation of about +400%. For more information about population estimates for homosexually oriented people see the Addendum to the Bagley & Tremblay (1998) study.

The above noted problem is serious but, even if it is not considered, the best that can be said about the Herell et al. (1991) study is that the "male-male twin pairs born between 1939 and 1957" had "1949" as their average year of birth, compared to 1933 for the Bell & Weinberg (1968) sample, meaning that only about 15 years separates these two sample. Furthermore, Herell et al. (1999) did not report what McDaniel, J.S., Purcell, D.W., & D'Augelli, A.R. (2001) noted: "that suicide attempt rates among GLB people are relatively stable over time (Herrell, 1999)" (p. 90). Herell et al. (1999) stated:

The effect is also relatively constant across different birth cohorts spanning more than 30 years. The mean birth year for the Saghir and Robins34 and the Bell and Weinberg28 studies is about 1935, and the interviews were conducted in the 1960s. The VET sample has a mean birth year of 1949 and the interviews were conducted in the early 1990s. The men in the Bagley and Tremblay37 sample were in their 20s in the early 1990s when the interviews were conducted. The mean birth year of the male subsample used by Remafedi et al41 is 1972. There does not appear to be a reduction in the association over these birth cohorts that one might expect given social change in recent years. An explanation for the consistency of these ORs might be that the social changes have had less impact during adolescence than later in the life course.
They reported that the "ORs" - that is the "Odd Ratios" - has apparently remained the same over the years. This conclusion, however, is a misrepresentation of the facts. That is, the OR in the Remafedi et al. 1998 study was about "7" (given by Herell et al. as: 7.1 (95% CI, 3.1-16.5)  for students with an average age of 15 years, the caveat for this study being that they used flawed methodology to soliciting highly taboo information from adolescents. Furthermore, by the average age of 15 years (rage 13 to 18 years) many males are not yet ready to report on anything related to homosexuality existing within themselves. In the Herell et al. (1999) study itself, the reported OR for attempting suicide was 5.1 (95% CI, 2.4-10.9) for males reporting any adult homo-sex activity compared to males reporting only hetero-sex experiences . Concerning the Saghir & Robins (1973) study, Herell et al. (1999) reported:
The point estimate of the OR from their data indicates that homosexual men were more than 5 times as likely to report having attempted suicide than nonhomosexuals, although the small sample size and small number of attempts in the data result in an unstable result (95% CI, 0.3-100.8).
By "unstable," what is meant - or implied - is not stated. That is, the difference between the two groups is not statistically significant. The stated results, however, begin to create an illusion to be unraveled below.

Concerning the Bagley & Tremblay study, the following is stated:

Among the 5 recent probability samples, 2 studies report ORs or data from which ORs can be estimated. Bagley and Tremblay37 selected a probability sample in 1991 and 1992 of 18- to 27-year-old men in Calgary (n=750) in which 69 (9.2%) reported sexual contact with men. The OR for homosexuality (measured by behavior or self-identification) and lifetime prevalence of suicide attempts in their study is 6.2 (95% CI, 1.4-26.3).
This report is false! Bagley and Tremblay "actually" reported something quite different, and it was most difficult to miss given that the following is quoted from the Abstract situated at the beginning of the paper and that this abstract is available at Pubmed (Abstract):
Homosexually oriented males accounted 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 OR was not given in the paper but it is close to the above RR (Risk Factor) and it can  can easily be calculated from the given data - the counts - supplied in the published paper:
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 Homo/Bi attempters and 77 Homo/Bi 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 Pearson Chi Square is 22.1, p < .0000.
Furthermore, Bagley & Tremblay (1997) stated that their results (to the average age of 22.7 years for the young adult male sample (age 18 to 27 years) was "consonant with previous finding.," and, as stated in the paper,  this was the Risk Ratio for the Bell & Weinberg (1978) study for male attempting suicide to the age of 20 as noted above. The Odds Ratio is similar as noted above, and it is restated:
Bell & Weinberg (1978): To age 20, 13.6-times more likely to be a "first-time" suicide attempter: 9.5% vs  0.70%. Using the 2 X 2 Table located at - http://home.clara.net/sisa/twoby2.htm and the following nonattempter / attempters data for the two group (55 / 520 and 2/282), 95% CI - Odds Ratio: 3.6<14.9<61.6. Pearson's X2 = 24.09, p < 0.0000
Herell et al. (1999) therefore attempted to create the illusion of "Odd Ratio" consistency to any average age for samples: 15 years for the Remadedi et al. (1998) study, 22.7 years for the Bagley & Tremblay (1997) study, 37 years for the Bell & Weinberg (1978) study, and for middle aged twin males in their own study. To accomplish this, howewer, they avoided to note, as stated in the Bagley & Tremblay (1997) study, that the risk for a suicide attempt (relative to heterosexual males) was much higher when homosexual males were young, and that this higher risk factor had been "replicated." Avoiding this issue then required another piece of work: a misrepresentation of the results, meaning that a the Odds Ratio for the Bagley & Tremblay (1997) study was somehow magically calculated / changed to "6.2 (95% CI, 1.4-26.3)" when it should have been 14.9 (95% CI, 3.6-61.6).

Following the creation of the above illusion, McDaniel, J.S., Purcell, D.W., & D'Augelli, A.R. (2001) then used this created illusion in yet another way: they would completely misrepresent what Herell et al. (1999) had reported. They cited the Herell et al. (1999) study to give some credibility to another illusion of what seems to be a gross misrepresentation of the available data: "that suicide attempt rates among GLB people are relatively stable over time (Herrell, 1999)" (p. 90). The facts, however, as based on the available data, tell another story for homosexually oriented males in the United States. It could be said that their attempted adolescent attempted suicide incidence (let's say to average ages ranging from 16 to 19), has increased from approximately 5% fifty years ago to about 30% in the past 20 years. Furthermore, such an increase in the incidence of attempting suicide is not what could be deemed "relatively stable over time." Stated otherwise, when it is reported that the American youth suicide rate has tripled in the last 50 years and there is alarm in this respect, it is not because the youth suicide rate has remained "relatively stable over time." Given that this applies for a "3-times" factor, surely the same would apply for what appears to be a "6-times" factor for the increase in homosexually oriented male youth attempting suicide over the same period.

Why McDaniel, J.S., Purcell, D.W., & D'Augelli, A.R. (2001) would have wanted to create this illusion - this misrepresentation of the facts - and also misrepresent what was [incorrectly] reported by Herell et al (1999) as a result of significant distortion of the facts -  is not known at the moment, but all reading the McDaniel, J.S., Purcell, D.W., & D'Augelli, A.R. (2001) paper - the only paper on homosexuality-related issues referenced in the American National Strategy for Suicide Prevention (2001) - are warned to be careful, and not only the above noted issue.


On Resiliency and The National Strategy for Suicide Prevention:

A definition for "resilience" is given in The National Strategy for Suicide Prevention's Appendix E - Glossary:

"Resilience – capacities within a person that promote positive outcomes, such as mental health and well-being, and provide protection from factors that might otherwise place that person at risk for adverse health outcomes" (p. 201)
The restricted definition of resilience - limiting it to the "capacities with a person" - is, however, a reflection of what  James Gabarino (2001) noted:
"The third concept we need to bring to our toolbox [if "at risk" boys are to be helped] is humility about resilience. I've used the term before: resilience: the ability to deal with adversity, the idea that we can cope but we also have limits. In American society, however, the term resilience has a kind of dark side to it. In this judgmental society, it's a short step between celebrating coping and judging those who are not coping. The worse example I encountered was when I was testifying in the murder trial of a 16-year-old boy. My job was to explain to the jury how the accumulation of risk in the absence of assets should be understood in making sense of what the boy did - not just to excuse what he did, but to make sense of it. In the cross-examination the prosecutor asked, 'What's wrong with this boy that he isn't resilient?' And I realized that instead of being a celebration of coping, we are now making a deficiency judgment." (Barbarino, 2001: 176-177. Bold emphasis mine.)
Does this mean that, for some reason, the ones involved with the production of The National Strategy for Suicide Prevention sought to embody the "dark side" of American society  with respect to a potential definition of "resilience?" Why, however, would the 'architects' of The National Strategy for Suicide Prevention have done this? It would therefore seem that almost everything that needs to be done to help homosexually oriented adolescents if their suicidality levels is to be reduced is thereby precluded by The National Strategy for Suicide Prevention's definition of resilience, or more precisely, by what was omitted from the definition of resilience. It is widely reported, for example, that homophobia-related social (including school-based) factors - abuses - need to be eliminated if the associated risks for suicidality in homosexually oriented adolescents are to be reduced. However, the above definition of "resilience" does not include environment factors and related changes in these factors as being part of the "resiliency" concept. Should the concept of "resilience" include environment factors? Could it be that the 'architects' of The National Strategy for Suicide Prevention were maybe highly ingnorant of what has been articulated about "resilience" by the experts in the field?

If such a high ignorance about "resilience" exists for the 'architects' of The National Strategy for Suicide Prevention, and if "resilience" is deemed to be of great importance in terms of reducing youth suicidality problems and suicides (as well as other problems often assoicated with risks for suicidality), could it therefore not be said that such ignorance reflects unacceptable - maybe even lethal - ignorance on the part of the 'architects' of The National Strategy for Suicide Prevention?

Information about "resilience" is readily available, as the following example from the Internet illustrates. After  Rouse, Longo, and Trickett (1999) listed the definitions of resilience by the experts in the field, the following was emphasized in the section titled:

"Definition of Resilience"

"These definitions have practical applications. What they mean to the practitioner is that some children who are exposed to chronic or severe stress will turn out competent. These children will successfully adapt over time. These children will need tremendous biological, psychological, and environmental resources in order to do this. These children cannot do it themselves. They need love, care, and support not only from their parents, but from educational personnel and other community adults as well...
The definition is also not simple because resilience is contextual. The individual characteristics and environmental factors that lead to resilience in one context may not lead to resilience in another. For instance, academic resilience may be related to a certain set of individual characteristics and environmental factors. However, these same factors and characteristics may not equal emotional resilience. Different kinds of resilience are related to different kinds of support.
The definition is not simple because resilience is complex. It takes personal characteristics such as social skills and environmental factors such as mentoring to create the resilience phenomenon. Resilience does not just come from the person. Additionally, it draws on biological (temperament) and psychological (internal locus of control) characteristics of the person. The environment's role cannot be forgotten. Environmental factors also come into play. People, opportunities, and atmospheres all add to the resilience equation. A resilient personality is not sufficient. It takes the person and his or her environment. "
What is an "environmental" situation in schools that could be associated, not with resilience, but with its opposite such as being associated with suicide problems for some youth? Are there some youth who are targeted for intense abuse only because they are suspected of being "gay" or "lesbian"? Could it be, for example, that North American schools are highly "toxic environments" for most individuals suspected of being gay or lesbian?

The "Hatred in the Hallways:Violence and Discrimination Against Lesbian, Gay, Bisexual and Transgender Students in U.S. Schools" study by Human Rights Watch (2001) answers this question, but similar information has been available for decades in books, papers, and articles reporting on the homophobia in schools and the related abuses. The report begins with:

Lesbian, gay, bisexual, and transgender youth of school age in the United States often suffer daily harassment, abuse, and violence at the hands of their peers. These students spend an inordinate amount of energy figuring out how to get to and from school safely, avoiding the hallways when other students are present in order to escape slurs and shoves, cutting gym classes to escape being beaten up—in short, attempting to become invisible.
For some, the burden of coping each day with relentless harassment is too much. They drop out of school. Some commit suicide. Others barely survive. A few fight back, demanding that school  administrations ensure their safety, that recognition of gays and lesbians be integrated into the curriculum, that they be allowed to organize gay-straight student groups, and that they be encouraged to celebrate their identities.
The situation in schools is highlighted the nationally representative American study of Grade-8 to Grade-11 students, "Hostile Hallways: Bullying, Teasing, and Sexual Harassment in School," by the American Association of University Women (2001). It was reported that:
About equal numbers of students—three-quarters of those surveyed—say they would be very upset if someone spread sexual rumors about them, if someone pulled off or down their clothing, or if someone called them gay or lesbian (p. 3). The latter was reported by 74% of boys and 73% of girls (p. 11). Apparently, this result was an improvement when compared to the "86%" result in a similar study carried out in 1993 (p. 12).
Schools as social institutions are places where the word "gay" and synonymous words such as "fag," "faggot," and "poof" / "poofter" commonly used in Britain and Australia, are not concepts / words invented by children or adolescents. These words are given / taught to them by their society and young males in western countries have also used these words in highly predictable ways (Plummer, 1999, 2001), almost like all these boys had gone to the same school of homophobic abuse. Goldstein (1999) defines the current American definition of the word "gay" in reference to the Columbine High School murder / suicide event:
"The word 'faggot' has never merely meant homosexual. It has always carried the extrasexual connotation of being unmanly [being like a female]. But these days, the implications of that insult have expanded. To say that a certain behavior is 'so gay' can apply to anything stupid, clumsy, or outré. It's probably the most effective way to call a guy a loser, and in this age of sexual candor, when high school students know that some of their peers may actually be gay, the accusation has an even more fearsome ring."
A similar meaning for the word "gay" was noted in the study "Hatred in the Hallways":
"One young gay youth who had dropped out of an honors program angrily protested, 'Just because I am gay doesn't mean I am stupid,' as he told of hearing 'that's so gay' meaning 'that's so stupid,' not just from other students but from teachers in his school."
Will the Surgeon General do anything about the above highly abusive situation existing in American schools? Not if he thinks that all related negative results are the result of a lack of "resilience" as defined in The National Strategy for Suicide Prevention.

When the Surgeon General made available his "Call to Action to Prevent Suicide" in 1999, there was silence about gay and lesbian youth suicidality issues, but these individuals are now included in The National Strategy for Suicide Prevention. What, however, does this "actually" mean? What actually will be done about the highly homophobic situation existing in most American schools? Nothing?

What would a psychological autopsy end up saying about a boy suspected of being gay who was being abused accordingly in school and in his neighborhood? Could it be:

"Obvious, his suicide was related to anxiety problems, depression too, and conduct disorder was likely given that he was in so many fights and often did not come to school. It's unfortunate that he did not receive help. There are good drugs available to help these boys. Without doubt, he was also lacking in resilience."


References

AAUW (2001). Hostile Hallways: Bullying, Teasing, and Sexual Harassment. American Association of University Women Educational Foundation (http://www.aauw.org/). Internet: http://www.aauw.org/2000/hhpressbd.html . PDF Download:  http://www.aauw.org/2000/hostile.pdf .

Garbarino J (2001). Lost Boys: why our sons turn violent and how we can save them. Smith College Studies in Social Work (7)2: 196-81.

Garbarino, James: "James Garbarino, Ph.D. is Co-Director of the Family Life Development Center, and a Professor of Human Development at Cornell University. He has authored or coauthored over 15 books on children, worked with children from Palestine and Kuwait regarding the impact of war on their lives, and practiced in Chicago for 10 years. He has worked extensively over the last two years with boys from the Austin McCormick Correctional Facility, and used this experience to write this [1999] book." The book is: 'Lost Boys: why our sons turn violent and how we can save them." From: http://www.psychpage.com/family/library/garbarino.html. He also authored "Raising Children in a Socially Toxic Environment" (1995, San Francisco: Jossey-Bass)

Goldstein, Richard (1999). The ‘Faggot’ Factor: The chickens came home to roost at Columbine High. OC Weekly, May 21-27. Internet: http://www.ocweekly.com:80/ink/99/37/news-goldstein.shtml

Human Rights Watch (2001). Hatred in the Hallways: Violence and Discrimination Against Lesbian, Gay, Bisexual and Transgender Students in U.S. Schools. New York / Washington: Human Rights Watch. Internet: http://www.hrw.org/reports/2001/uslgbt/ .

McDaniel, Purcell, D'Augelli A (2001). Suicide and suicidal behaviors among gay, lesbian, and bisexual persons. Suicide and Life-Threatening Behavior, 31(Suppl.): 84-105.

Plummer, David (2001). The quest for modern manhood: masculine stereotypes, peer culture and the social significance of homophobia. Journal of Adolescence, 24(1): 15-33.

Plummer, David (1999). One of the boys: masculinity, homophobia, and modern manhood. New York: Haworth Press.

Rouse KAG, Longo M, Trickett M (1999). Fostering Resilience in Children. Bulletin 875-99. The Ohio State University. Internet: http://ohioline.osu.edu/b875/ - Citation from "Definition of resilience": http://ohioline.osu.edu/b875/b875_1.html


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