To: pierre@virtualcity.com
pjtremblay@hotmail.com
ramsay@ucalgary.ca
Bisexual / Gay / Queer Male Suicality Index
The San Diego / Boulder Paper
Index Page and Links to More Information
A GLBT Education
Site Index

Previous Section
Colorado Paper ('97) - - Banff Paper ('95)

To: Table of Content - The Social Construction of Male Homosexuality and Related Suicide Problems...

By Pierre J. Tremblay in Collaboration with Richard Ramsay
Faculty of Social Work, University of Calgary.

The Paper  was Presented by Pierre Tremblay at The 11th Annual Sociological Symposium: "Deconstructing Youth Suicide," San Diego State University - March, 2000 (Cover Page). A part of the present updated paper was presented at the Gay Men's Health Summit in Boulder, Colorado - July, 2000. Now Available: A 2004 Updated Interim Version Of This Paper.

Male Youth Suicide Problems: Worsening Since 1950, Higher Rates for Homosexually Oriented Males, and Greater Risk for Suicide.

The male youth suicide problem for 15- to 24-year-old males increased 3-fold from 1950 to 1990 (Table 1), the increase being the greatest (5-fold) for males aged 15- to 19 years. Since 1950, males have also accounted for 88.5 percent of the additional deaths by suicide in the male and female 15- to 19-year-old category, and 95.5 percent of additional deaths in the 20- to 24-year-old group, meaning that the increase in youth suicides since 1950 has been almost exclusively a male problem. A number of general ideas have been given to explain the increasing adolescent male suicide problem, and Gibson (1989) was one of the first to suggest that homosexually oriented youth may account for about one-third of these deaths, but "some experts rejected the conclusions as being drawn from biased samples" (Remafedi, 1999, p. 1291; Remafedi 1999a).
 
Table 1 - American Youth Suicide Rates: 1950 to 1990
Increasing Youth Suicides: A 90% Male Problem
Age Range
(Years)
Suicide Rate
1950
[% Male]
Suicide Rate
1990
[% Male]
Suicide Rate
Increase
[% Male]
15 to 19
M - 3.5
F - 1.8
[66%]
M - 18.1
F - 3.70
[83%]
M: 14.6 ( 5.2X) 
F: 1.90 (2.1X)
[88.5%]
20 to 24
M - 9.3
F - 3.3
[73.8%]
M - 25.7
F - 4.10
[86.2%]
M: 16.4 (2.8X)
F: 0.8 (1.2X)
[95.3%]
15 to 24
M - 6.5
F - 2.6
[71.4%]
M - 22.0
F - 3.9
[84.9%]
M: 15.5 (3.4X)
F: 1.3 (1.5X)
[92.3%]
M = Males, F = Females, X = Suicide Rate Increase Multiple.
Suicide Rates: Deaths per 100,000 individuals per year.
Data Source: CDC, 1994, Table 1, p. 3.

Tremblay (1995) proposed that up to 50 percent of male youth suicide deaths may involve homosexually oriented males. This proposal contrasted with the results from two methodologically flawed postmortem studies (Rich et al., 1986; Shaffer et al., 1995) commonly used to suggest that homosexually oriented adolescents are not at greater risk for suicide than their heterosexual counterparts (Muehrer, 1995; Moscicki, 1995). On the basis of suicide risk indicators, however, including their research results, Bagley and Tremblay (1997a) speculated that more than half of male suicide deaths may involve homosexually oriented males. Given that the greatest increase in suicides has been in the 15- to 19-year-old category, that males form the vast majority of additional youth deaths from suicide since 1950, and that the greatest amount of male suicidality information based on sexual orientation criteria for this age group is available, a survey of the available information and related implications is warranted.

The trend in mainstream youth suicidology to assume that sexual orientation factors are not significantly different in suicide rates or suicide problems has created a general lack of awareness that homosexually oriented males may be greatly overrepresented in the worsening suicide problems (Gibson, 1989; Remafedi, 1994; Savin-Williams, 1994; Tremblay, 1995). This assumption persists in spite of the Bell and Weinberg (1978) study data indicating that white predominantly homosexual males, by the age of 20 years, were 14 times more at risk for a "first time" suicide attempt than their heterosexual counterparts. Bagley and Tremblay (1997) replicated this factor (to the average age of 22.7 years) for a large random sample of 18- to 27-year-old Calgary males, and a further analysis of the "suicide attempt" data for males 17 to 29 years of age in the Cochran and Mays (2000) NHANES III (National Health and Nutrition Examination Survey) study produced Odds Ratios similar to the two previously noted studies (OR range for the three studies: 12-15, Note 8). Given the average age of the Bell and Weinberg (1978) sample (37 years), the suicidality results for homosexual males best represent the situation existing in the early 1950s. At that time, "first time" suicide attempt incidence to the age of 17 years for white predominantly homosexual males was 4.9% percent: 28/575 (Bell and Weinberg, 1978).

The studies reporting on the suicidality of homosexually oriented male youth have used varied methodologies, thus creating interpretation problems and making it difficult to be absolute about the numbers, but a general trend is apparent from the available data and reported results. The lifetime suicide attempt incidence for homosexually oriented male adolescents has greatly increased over the years (about 6 times) given the Bell and Weinberg (1978) data (a 4.9% "first time" suicide attempt incidence by the age of 17), and the more recent study results. Studies based on varied North American volunteer community samples of gay and bisexual males report lifetime suicide attempt incidences averaging 30 percent (Bagley and Tremblay 1997), with a range of 20 to 42 percent for ten published American studies (Remafedi et al., 1999). These results have also been replicated in school based random sampling YRBS (Youth Risk Behavior Surveys, or similar surveys), and two of these studies specifically report suicidality results for male adolescents based on sexual orientation.

Based on a 1987 Minnesota study of grade 7 to 12 students, Remafedi et al. (1998) report a lifetime suicide attempt incidence of 28.1 percent for males identified as gay or bisexual by the average age of about 15 years, compared to 4.2 percent for heterosexual identified males. Using the same sample data, Saewyc et al. (1998) report that older gay and bisexual male adolescents (15- to 19-years-old) have a lifetime suicide attempt incidence of about 33% by the average age of about 17 years. Garofalo et al (1999) does not specifically give the suicide attempt rate (based on a 12-month period) for males identified as gay, bisexual, and "not sure" about their sexual orientation (GBN), but an estimate of 33 percent was determined on the basis of the information given (Note 6). Other studies (some not yet published, but the data is available) report similar results on average for homosexually oriented adolescents not differentiated on the basis of gender (Table 2).

 
Table 2 - GLB Youth: Increasing "At Risk" Status
For The More Serious Suicide Problems:
Youth Risk Behavior Survey Results
Survey

Suicidality Category

Mass 952
GLBN (Gay, Lesbian, 
Bisexual, Not Sure)  vs
Non-GBLN
Mass 971
GLB* and/or Homo-sex 
Active vs 
Heterosexual
-Identified
Seattle 951
*GLB-
Identified vs 
Hetero-
sexual
Identified
Vermont 952
Males &
Females: Homo-
sex active vs
Hetero-sex 
active.
Mass '93
Males & Females: Homo-sex active vs Hetero-sex
active. 
Considered Suicide
46.4% vs
24.6%
1.9-Times3
54% vs 
22%
2.5-Times
34.2% vs 16.7%
2.1-Times
59.2% vs 
37.1%
1.6-Times
41.7% vs
28.6%
1.5-Times
Planned Suicide
40.5% vs
17.5%
2.3-times
41% vs 
18%
2.3-Times
31.1% vs 15.7%
2.0-Times
52.8 vs 
28.7%
1.8-Times
 29.7% vs
24.5%
1.2-Times
Attempted 
Suicide
36.0% vs
8.9%
4.0-times
37% vs 
8%
4.6-Times
20.6% vs 6.7%
3.1-Times
40.7% vs 
15.2%
2.7-Times
27.5% vs 13.4%
2.1-Times
Medical Care
Associated with
Suicide Attempt 
N/A
19% vs 
3%
6.3-Times
9.4% vs 
2.2%
4.3-Times
26.5% vs 
6.2%
4.3-Times
20.0% vs 
4.7%
4.2-Times
"Self-Harm"
(Defined4)
Incidence:
"A" VS "B" 
?-Times
?-Times
?-Times
?-Times
?-Times
Suicide
Attempt
(Defined4)
Incidence:
"A" VS "B" 
?-Times
?-Times
?-Times
?-Times
?-Times
Medical or Psychiatric Hospitalization Associated with Suicide Attempt
Incidence:
"A" VS "B" 
?-Times
?-Times
?-Times
?-Times
?-Times
SUICIDES
Incidence:
"A" VS "B" 
?-Times
?-Times
?-Times
?-Times
?-Times
1. Unpublished Studies - 2. Published Studies but relevant data not given. Information obtained from other sources. 3. **More at Risk Factor for GLB Adolescents Compared to Heterosexual Adolescents.4. Defined by Ramsay and Bagley (1985) and Bagley and Ramsay (1985), and used by Bagley and Tremblay (1997): Note 7 - *GLBN = Gay, Lesbian, or Bisexual Identification; N = "Not Sure." 

Result from Youth Risk Behavior Surveys have also repeatedly indicated that homosexually oriented male and female adolescents are generally more at risk for the more serious suicide behavior: (1) considered suicide, (2) planning a suicide, (3) attempting suicide, and (4) attempting suicide with resulting medical attention (Table 2). In the category of "suicide attempt associated with having received medical attention," it is assumed that, as a rule, the most life threatening suicide attempts, or suicide attempts with a definite intent to die, would have a greater likelihood of resulting in the individual having receiving medical attention, but this may not always be the case, at least for gay and bisexual males (Remafedi et al. 1991).

The YRBS study results listed in Table 2 include homosexually oriented females, and female data tends to reduce major differences existing between males as indicated from the Garofalo et al. (1999) and Remafedi et al. (1998) study results. In the two studies, statistical significance was eliminated between homosexual and heterosexual female suicide attempters in the multivariate analysis, but great differences for suicide attempts incidence were reported for homosexually oriented males compared to their heterosexual counterparts. In the Garofalo et al. (1999) study, LBN females are 2.0-times more likely to report a suicide attempt than heterosexual females, while the factor is 6.5-times for GBN males compared to heterosexual males. In the Remafedi et al. (1998) study, the higher risk factor is 1.4 times for LB females and 7-times for GB males compared to their heterosexual counterparts. Therefore, it is suspected and predicted that an analysis of only the male data in other YRBS studies would likely show more serious suicidal behaviors than their heterosexual counterparts, compared to results generated from the combined male and female data (Table 2).

An indication of the magnitude of differences in suicidality of males based on sexual orientation was reported by Bagley and Tremblay (1997) on the basis of a large random sample of males ranging in age from 18- to 27-years-old. Their suicidality results are presented in two categories of self-harm behaviors based on previous epidemiological studies: "self-harm" (often called suicide attempts by adolescents, but without the intent to die, and the behavior is usually not life threatening), and "suicide attempts" representing a definite attempt at self-killing (Note 7). Compared to heterosexual males, homosexually oriented young adult males were 3 times more likely to report "self-harm" in their lifetime; this is remarkably similar to the reported differences, based on sexual orientation, for "suicide attempts" reported in YRBS studies (Table 2). For strictly defined "suicide attempts," however, Bagley and Tremblay (1997) reported that young adult homosexually oriented males were 14 times more likely to have attempted suicide than their heterosexual counterpart; and the magnitude of risk increases four to five times from their relative risk for for having engaged in "self-harm" activities, to their relative risk for a "suicide attempt" (Note 8).

Homosexually oriented male adolescents are also at risk for serious suicide attempts as reported by Remafedi et al. (1991) from their sample of 137 gay and bisexual male youth ranging in age from 14- to 21-years-old : "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). Unfortunately, since 1991, studies reporting on the suicidality of homosexually oriented youth have only reported "suicide attempts" (with a related analysis) without investigating their degree of  lethality, nor were "suicide attempts" rigorously evaluated to separate the ones best classified as "self-harm" from the ones best classified as deliberate attempts to take one's life (Note 7). The Remafedi et al. (1991) and YRBS data (Table 2), however, suggests that maybe more than 25 percent of suicide attempts by gay or bisexual identified adolescent males result in medical interventions, thus indicating a higher likelihood for suicide for these males.

The high proportion of homosexually oriented male adolescents who attempt suicide places them at higher risk for an eventual suicide either as adolescents or later in life  (Lewinsohn et al., 1993; Kotila and Lonnqvist, 1989; Sellar et al., 1990; Shafii et al., 1985; Otto, 1972). In this respect, Garland and Ziegler (1993) reported that the "best single predictor of death by suicide is probably a previous suicide attempt" (p. 172).  Community samples of homosexually oriented youth have also produced high rates for repeat suicide attempters, six study samples producing a 44.2 percent average for the proportion of gay and bisexual male suicide attempters who became repeat suicide attempters (Table 3), the suggestion being that suicide is an ongoing problem for many of these youth.  A similar percentage (39.9%) resulted from the Bell and Weinberg (1978) data, thus indicating consistency in this respect over time. Unfortunately, published studies have not been located on the risk for an eventual suicide by adolescents with a history of repeated suicide attempts. It is possible that such individuals, especially males, are at much higher risk for committing suicide than males with a history of only one suicide attempt.

 
Table 3: - G(L)B Youth Lifetime "Suicide Attempt" DATA
Published Studies (American)
STUDY (N)1 MALES MEAN AGE % SUICIDE ATTEMPTERS
REATTEMPT RATE
Roesler & Deisher, 1972
60
GB Males
20
31.0%
37%
Remafedi, 1987
29
GB Males
18.3
31.0%
20%
Schneider et al. 1989
108
GB Males
20.6
20.0%
45%
Remafedi et al. 1991
137
GB Males
19.6
30.0%
44%
Rotheram Borus, 1994
Visiting Hetrick & Martin 
Institute (N.Y.)
138
GB Males
(14-19)
+/- 17
39.0%
52%
Grossman & Kerner, 1998
902
GLB Youth
(14-21)
+/- 18
30.0%
67%
Means
(6 Studies)
   
30.2%
44.2%
1. A variety of community-based volunteer samples.

2. Sample of gay/bisexual/lesbian individuals with suicide attempt prevalence given for entire group.

The lifetime incidence of "suicide attempts" for homosexually oriented male adolescents has increased about 6-fold since 1950, from about 5 to 30 percent. Of significant  interest are the YRBS study result producing a "suicide attempt" average about about 30 percent for a 12-month period: 32.3% for the 5 studies (Table 2). Given that these rates coincide with lifetime estimates from community samples (Table 3), this similarity likely reflects, at least in part, the possibility that adolescents in school define a "suicide attempt" in a more liberal way; a minor injury may be interpreted to be a suicide attempt. Another possible contributing factor is the high likelihood of homosexually oriented adolescents to be repeat suicide attempters (Table 3). It is important to recognize, however, that the random sampling YRBS studies likely solicits data from a wider spectrum of homosexually oriented adolescents than the representation obtained from volunteer community based samples. If this applies, the suicide problems of homosexually oriented adolescents may actually be more serious than proposed in the worst case hypotheses.

At issue, however, has been their representation in youth suicide problems, and especially their representation in suicide statistics. Mainstream suicidologists have often criticized suicidality results from gay community based samples because of their assumed biased nature (Moscicki, 1995Muehrer, 1995), and always to counter efforts to have homosexuality issues addressed in youth suicide education and prevention programs where indifference to homosexuality was the rule, as it had been in mainstream youth suicidality research (Remafedi, 1994; Savin-Wiliams,1994; Tremblay, 1995). Tremblay (1995) also suggested that a mean spirited objective had motivated the production of the 1995 Suicide and Life Threatening Behavior special issues on "Sexual Orientation" edited by Muehrer, Moscicki, and Potter (1995) who are from the National Institute of Mental Health (NIMH) and the Centers for Disease Control (CDC).

Tremblay (1995) felt that the document was not created by individuals who really wanted to see homosexuality issues addressed in mainstream youth suicidality education and prevention programs, and that maybe mainstream youth suicidality researchers were not to be encouraged to begin soliciting sexual orientation information in their research. By 1999-2000, this outcome was the ongoing research behavior that the CDC was modeling as a part of its boldly emphasized "Leadership Role." Apparently, the CDC's role is "to ensure the availability of accurate and current information on health risk behaviors among young people, [to provide] funding and technical support to states and major cities to conduct a Youth Risk Behavior Survey" (CDC, 1999), but it is not to model any research behavior such as soliciting "sexual orientation" information from adolescents.

The CDC's official YRBS questionnaire does not solicit "sexual orientation" information (CDC, 1999a), meaning that the CDC does not recognize this factor in adolescent problems in spite of the wealth of information indicating otherwise, nor does the CDC apparently believe that such information should be solicited. Although the questionnaire does solicit information about "sexual intercourse," generally assumed to mean "penis-vagina" sex, anyone thinking the requested information may apply to same-sex sexual intercourse would be in error given the confirmation of its heterosexist definition in Question #63. "The last time you had sexual intercourse, what one method did you or your partner use to prevent pregnancy?" Therefore, to the year 2000, the CDC has continued to ignore "sexual orientation" issues in youth suicide problems, which can have only one result. When any "at risk" group of adolescents are ignored, their concerns are also ignored, and the ones responsible for this are essentially working to maintain a maximum casualty status in the ignored sector of the adolescent population.

In spite of the ongoing modeling of indifference to homosexuality issues in youth problems by the CDC, results from relatively rare school-based studies which had solicited "sexual orientation" were being peer reviewed and published: Remafedi et al. (1998) and Saewyc et al., (1998) for a 1987 Grade 7 to 12 Minnesota student sample, Garofalo et al. (1998, 1999) for a 1995 Grade 9 to 12 Massachusetts student sample; Faulker et al. (1998) for a 1993 Grade 9 to 12 Massachusetts student sample; and Durant et al. (1998) for a 1995 Grade 8 to 12 Vermont student sample. It was only for the Garofalo et al. (1999) study, however, that information was made available to permit an estimate of the proportion of male suicide attempters who are homosexually oriented.

Given the 12-month period 33 versus 5.1 percent attempted suicide rate for GBN (gay, bisexual, and "Not Sure" about their sexual orientation) males forming 4.7% of the male population, it was then possible to calculate that about one quarter (24.3%) of male suicide attempters are in the GBN category (Note 6). Therefore, 4.7% of the students of GBN males account for about 25% of the male suicide attempt problem. Given, however, that the study is based on an amended form of the pencil-and-paper Youth Risk Behavior Survey questionnaire from the Centers for Disease control (CDC, 1999a), and that these surveys likely underestimate the numbers of homosexually oriented individuals by a factor of 3 to 4 (Bagley and Tremblay, 1998; Turner et al., 1998), it is therefore postulated that all homosexually oriented male adolescents, had they been identified by Garofalo et al. (1999), would account for maybe 60 to 80 percent of male suicide attempters. This estimated correction would be consonant with the Bagley and Tremblay (1997) results: 62.5% of young adult male suicide attempters (lifetime incidence) were in the homosexual or bisexual category, defined on the basis of self-identification and/or being currently homosexually active.

The probability that homosexually oriented male youth account for at least 50 percent of suicide attempters, and the fact that these males are more at risk than heterosexual males for the more serious suicide behaviors, such as more serious forms of suicide attempts (Bagley and Tremblay, 1997, 1997a; Remafedi et al., 1991; Table 2), leads to the informed proposition that more than 50 percent of male youth suicides (maybe up to 75 percent) involve males for whom homosexuality issues are, or have been, a significant factor in their lives. It is also known that some males do commit suicide for reasons expressed by Nicolas and Howard (1998) in their study, "Better Dead Than Gay!" and as outlined by Tremblay (1998-1999) in a web page titled "Better to be Dead Than Gay."
 

Previous Section
Top of Page
Comments to:
pjtremblay@hotmail.com
ramsay@ucalgary.ca