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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.

Research Proposals For The Twenty First Century

Homosexually oriented adolescent and young adult homosexually oriented males are at risk for suicide problems. This fact is reflected in HIV-related cohort studies reporting high rates of major depressive disorder (MDD) in adult gay male psychiatric histories (Atkinson et al., 1988; Williams et al., 1991; Rosenberger et al., 1993; Perkins et al., 1994; Dew et al., 1997). These studies and the Bagley and Tremblay (1998) study have nonetheless reported normal rates of current depressive mental health problems for adult gay males, and the same applies for one sample of HIV-positive and HIV-negative African-American men (Peterson, 1996). For a larger similar sample of African-American males, however, elevated current rates of depression were reported (Richardson, 1997), and Schneider et al. (1991) reported that 30 percent of gay men studied experienced suicidal ideation within a 6-month period.

Adult gay males also have psychiatric histories characterized by elevated rates of drug and/or alcohol abuse (Atkinson et al., 1988; Williams et al., 1991; Rosenberger et al., 1993; Johnson et al., 1996; Dew et al., 1997). These problems seem to be eventually overcome (Bux, 1996), but McKirnan and Peterson (1989) do report higher levels of current alcohol problems for gay males, and the same applies for a large sample of African-American gay and bisexual males (Richardson et al., 1997). Given that adult gay males apparently have elevated rates of personality disorders (Perkins, 1993; Johnson, 1996) and neuroticism (Kelly et al., 1998) that is an indicator of certain personality disorders, and that a link exists between personality disorders and alcoholism (Morgenstern et al., 1997), a subgroup of adult gay males with significant substance abuse problems may exists. Bailey (1999) comments: "Homosexual people are at a substantially higher risk for some forms of emotional problems, including suicidality, major depression, and anxiety disorder. Preliminary results from a large, equally well-conducted Dutch study [Sandfort et al, 1999] generally corroborate these findings" (p. 883).

One reason for this result, however, may be also related to other subgroups of homosexual males, one example being "celibate homosexual males. " They form about 15 percent of the homosexual male population and they have been reported to have ongoing problems (Bell and Weinberg, 1978), including elevated rates of current depression (Bagley and Tremblay, 1998), and a part of their problems may be related to the gay identification process. Not having passed the "tolerance" stage in the coming out process (the next stage is self-acceptance) is associated with mental health problems in adulthood as reported in one study of 196 adult gay and bisexual males (mean age = 28.8 years). 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 greater suicidality scores of males still at the "tolerance" stage (Brady and Busse, 1994).

Adult gay males are also at risk for experiencing minority stress which, in part, may be related to their high likelihood for having experienced psychological and physical abuse in society (Herek et al., 1997). Stigmatization-related negative life events predict psychological dysfunction in gay men (Ross, 1990), and "minority stress" negatively affects their mental health, increasing their risk for suicidal problems (Meyer, 1996). Much is therefore unknown about adult homosexually oriented males with respect to mental health issues and suicidality, and the same applies for the resolutions of problems from the high risk period of adolescence and young adulthood to middle and old age.

A variety of studies are therefore needed to answer many of the questions related to homosexually oriented males, their mental health, and suicide problems over their lifespan. However, recommendations in this paper are generally restricted to adolescent and young adult males. Some research projects could also include older males given that related information is needed to compare with results from studies of contemporary youth. I am in agreement with Remafedi's (1999) emphasis on the need for  "[p]rospective, longitudinal studies... [required] to examine the evolving risk of suicide across the lifespan of homosexual persons." He also noted that "although the understanding of gay, lesbian, and bisexual youth suicide is increasing, many questions remain regarding sex and ethnic differences, predisposing social and psychiatric conditions, protective factors, and constructive interventions" (p. 1291). Remafedi concluded that "[f]uture population-based surveys should routinely inquire about sexual orientation to retest prior findings in diverse settings" (p. 1291). Unfortunately, the history of ignoring homosexuality issues in mainstream research of almost all human problems continues to be the rule.
 

Youth Risk Behavior Survey Data Sets

There are, however, low cost research projects which could be immediately undertaken, especially with respect to existing YRBS (Youth Risk Behavior Survey) data sets which have solicited homosexuality information from adolescents in public schools (Table 5). In the listed studies, students were asked questions in one or two of the following three categories:
1. Sexual Orientation - Identification as gay, lesbian, bisexual, or heterosexual, or are they unsure about their sexual orientation.

2. Same-Gender Sexual Activity - Usually defined as having "sexual intercourse" with an individual of one's own sex.

3. Harassment Based on Homosexual Orientation -  The question may be: "Have you ever been threatened or hurt because someone thought you were gay, lesbian, or bisexual?" (Wisconsin, 1997), or  something like "In the past 30 days, what were you harassed about? (If more than one reason, what was the most upsetting or offensive to you?) Possible Answers: a. I was not harassed; b. Race or national origin; c. Unwanted sexual attention or comments; d. Perceived sexual orientation (gay/lesbian/bisexual); e. Physical disability; f. Other not listed; g. Don't know why I was harassed. (Oregon, 1997)

 
Table 5 - Youth Risk Behavior Surveys /
Other Surveys: Data Sets
Information Solicited /
Data Sets 1
Self-
Identification
GLBN 2
Same-Gender
Sexual
Activity
Subjected 
to Anti-
Gay Abuse
Related
Published Papers
Minn '87(1)
Yes
   
Remafedi et al., '98
Saewyc et al., '98
Mass '93
 
Yes
 
Faulker et al., '98
Mass '95
Yes
Yes
 
Garofalo et al., '98/'99
Mass '97
Yes
Yes
   
Mass '99
 N/A
 
 
 
Seattle '95
Yes
 
Yes
 
Vermont '95
 
Yes
 
Durant et al., '98
Vermont '97
 
Yes
   
Vermont '99
 
Yes
   
Wisc '97
   
Yes
 
Oregon '97
   
Yes
 
Oregon '99
 N/A
 
Yes
 
Conn '971
   
Yes
 
SF '97
 
Yes 3
   
1. All Youth Risk Behavior Survey Studies, except for Minnesota (1987): "Minnesota Adolescent Health Survey Questionnaire") and Connecticut (1997): "Voice of Connecticut Youth Survey" Results available from SSCW, 1999).
2. Self-Identification as gay (G), bisexual (B), lesbian (B), or "Not Sure" about one's sexual orientation (N).
3. Question asked about sexual activity was apparently not appropriate thus making results of little value ((SSCW, 1999) .

The data generated by these questions, given the information also solicited about other problems (e.g. suicide attempts, varied forms of drug and alcohol use), permits the exploration of significant associations between individuals deemed to be homosexually oriented (gay, lesbian, or bisexual identified, possibly including the ones unsure of their sexual orientation) and other negative outcomes that can be compared to the results for heterosexually oriented individuals. Although published and unpublished studies have reported homosexually oriented adolescents to be at significantly greater risk for many negative life events (e.g. various drug and alcohol usage: Note 10), not one YRBS study has explored the data sets via Multivariate Cluster Analysis to produce a more holistic perception of the at risk situation for homosexually oriented adolescents, and the same applies for community based studies of these youth.

All YRBS which have solicited self-identifying "homosexuality" information from adolescents (self-identification as homosexual, gay, lesbian, or bisexual and/or engaging in same gender sexual activity) have reported a greater likelihood for "suicide attempts" by homosexually oriented adolescents (Table 2), and especially by homosexually oriented males when the data was analysed on the basis of gender. Although adolescent males attempt suicide at rates about one-third that of females, they are about 4-times more likely to commit suicide (Garland and Ziegler, 1993), thus indicating major suicidality differences based on gender. Given these differences, plus the fact that the relative likelihood for a suicide attempt between homosexually and heterosexually oriented individuals is much higher for males than it is for females (Garofalo et al., 1999: 6.4-times versus 2-times; Remafedi et al., 1998: 7-times versus 1.4-times), all statistical analyses must therefore be done separately for males and females, and results reported accordingly. It has long ago been established that individuals with serious problems, such as alcoholism, should be separated on the basis of both sexual orientation and gender for analysis. A factor may be significantly associated with lesbian problems but not with gay male problems, and combining gay males and lesbians for analysis may reduce the factor to statistical insignificance (Tuite and Luitan, 1986).

For homosexually oriented male youth, variation in their relative likelihood for having suicide problems, compared to heterosexual males, may also be related to other factors such as illegal drug use and abuse, having been sexually abused, or other variables, but such statistical analyses have not been done with YRBS data sets. Their greater likelihood for a suicide attempt may also be specifically generated for more than one variable, for comparisons with heterosexual adolescents, or for comparisons with other homosexually oriented male nonattempters, as done by Remafedi et al. (1991). This study, however, only reported greater likelihood of a "suicide attempt" on the basis of individual variables, leaving inquisitive students wondering if suicide attempts are even more likely for individuals having more than one risk factor in their histories. Real life situations involving suicide problems are generally holistic in nature, with many problems factoring into events such as suicide attempts, suicide attempts associated with having received medical attention, and suicide.

The available YRBS data sets could therefore produce an exceptional study summarizing the risk status of homosexually oriented students based on self-identification and/or being homosexually active, inclusive or not of the ones unsure about their sexual orientation. Those who are unsure about their sexual orientation may be treated as a separate population. The study would also report on the effects of harassment based either on one's known or assumed homosexual orientation, thus producing results not only for homosexually oriented adolescents who are harassed, but for adolescents not sure of their sexual orientation, and for the ones claiming to be heterosexual but are targeted for similar harassment. An unrecognized and unresearched major factor in such harassment is gender nonconformity existing in  individuals who may be heterosexual identified, gender nonconformity being the underlying reason motivating the abuse of sissies in elementary schools. Sissy boys, however, often become the ones targeted for anti-gay harassment in junior and senior high schools and a longitudinal study reported that gender nonconformity in preschool ("behaviors that are counter to typical gender norms, such as aggressive behavior in females and dependence in males") was one of  the "early gender-specific risks for suicidal ideation" in adolescence (Reinherz et al., 1995).

With respect to adolescent suicide problems, the importance of harassment on the basis of sexual orientation is made apparent from the Seattle (1995) YRBS data (Table 6). Gay, lesbian, bisexual adolescents (known or assumed to be homosexually oriented), and heterosexual adolescents who were subjected to harassment based on their assumed "homosexual orientation" are at about equal risk for attempting suicide (20.5% and 20.3%). These incidences represent a 4-times greater likelihood for a suicide attempt in the past 12 months compared to heterosexual identified adolescents not targeted for such abuse and having a suicide attempt incidence of 5.5 percent..

 
Table 6 - Suicide Attempt Results Based on Sexual Identity
and Being / Not Being Targeted for Anti-Gay Abuse.
Seattle (1995) Youth Risk Behavior Survey
CATEGORIES
Heterosexual
Not Targeted*
N = 6664
89.6% N
Heterosexual
Targeted
N = 449
6.0% N
GLB** Not Targeted
N = 214
2.9% N
GLB
Targeted
N = 110
1.5% N
Suicide Attempters***
Percent  Incidence in each Category and [Percent of All Suicide Attempters]
5.5%
380/6664
[71%]
380/535
20.5%
92/449
[17.2%]
92/535
19.1%
41/214
[7.7%]
41/535
20.3
22/110
[4.1%]
22/535
Suicide Attempters: Associated Medical Attention - Percent Incidence in each Category and [Percent of These Suicide Attempters]
 1.7%
113/6664
[62.8%]
113/180
8.6%
39/449
[21.7%]
39/180
7.8%
17/214
[9.4]
17/180
9.6%
11/110
[6.1%]
11/180
Percent of Attempters
in the Category of Seeking  or 
Requiring Medical Attention
29.7%
(113/380)
42.4%
(39/92)
41.6%
(17/41)
50.0%
(11/22)
  *Was Target of Offensive Comments or Attacks Re: 
   Sexual Orientation at School or on the Way to School.
 **GLB: Gay, lesbian, or bisexual
***Attempted suicide in the past 12 months

In YRBS studies, it would also be important to report the proportions of suicide attempters who are homosexually oriented, as Bagley and Tremblay (1997) did. They reported that 10.9 percent of homosexual and bisexual males accounted for about 25 percent of young adult males reporting lifetime "self-harm" activities, and these males also accounted for 62.5 percent of males reporting a serious suicide attempt. The same should be done in YRBS studies, with a bonus possible when harassment data is solicited for individuals harassed because of their known or perceived homosexual orientation.

From the 1995 Seattle YRBS data (Table 6), GLB adolescents, forming 3.4 percent of the student population, account for 11.8 percent of suicide attempters, and 15.6 percent of suicide attempters reporting that receiving medical attention was associated with their attempts. However, "the homosexuality factor" in the form of "harassment based on perceived homosexual orientation" is also associated with suicide attempts by heterosexual identified adolescents, the group having suicide attempt incidences equal to that of GLB adolescent. It could therefore be said that "the homosexuality factor" is associated with about 30 percent (29%) of adolescent suicide attempters, and 40 percent (37.3%) of suicide attempters reporting that receiving medical attention was associated with their suicide attempts.

For such results, however, given that some homosexually oriented adolescents were not identified in this study (the ones who were homosexually active but did not identify as gay, lesbian, or bisexual), that the ones "not sure" about their sexual orientation were eliminated from the data analysis, and the high likelihood that many homosexually oriented male adolescents (maybe up to 75 percent) are likely to not report identification information on a pencil-and-paper questionnaire (Turner et al., 1998), the previously noted estimates would be minimums. These estimates, stated as minimums, are also extremely significant for educators needing quantitative results permitting the recognition of a very significant factor in youth suicide problems, and especially in the more serious forms of this problem.
 

Youth Risk Behavior Survey: Standardizing Question

Students of youth suicidality based on sexual orientation would greatly appreciate some standardization of question related to sexual orientation in Youth Risk Behavior Surveys which solicit relevant information. Given the current social construction of sexuality in the western world, suggestion in this respect are:

Sexual Orientation

1. How would you describe your sexual orientation or desires?
 
A. heterosexual
I am attracted only 
to opposite sex individuals.
B. homosexual
(gay or lesbian) -
I am attracted only to same-sex individuals.
C. bisexual
I am attracted to individuals of
both sexes.
D. unsure
I am not sure about my sexual orientation
E. None of the above.

Sexual Behavior

1. In the past 5 years, I have related "sexually" with... ("had sex with"), and you may chose more than one answer.
 
A. Opposite sex Individual(s) less than five (5) years younger or older than me. B. Opposite sex individual(s) more than five (5) years older than me. C. Opposite sex individual(s) more than five (5) year younger than me.
D. Same sex Individual(s) less than five (5) years younger or older than me. E. Same sex individual(s) more than five (5) years older than me. F. Same sex individual(s) more than five (5) year younger than me.

2. In the past year (last 12 months), I have related "sexually" with... ("had sex with"), and you may chose more than one answer:
 
A. Opposite sex Individual(s) less than five (5) years younger or older than me. B. Opposite sex individual(s) more than five (5) years older than me. C. Opposite sex individual(s) more than five (5) year younger than me.
D. Same sex Individual(s) less than five (5) years younger or older than me. E. Same sex individual(s) more than five (5) years older than me. F. Same sex individual(s) more than five (5) year younger than me.

3. During the past 3 months, with how many "same-sex" individuals did you relate sexually (have sex with)?
 
A. I have never had sex with same-sex individuals. B. I have had same-sex sexual experiences, but not during the past 3 months. C.  One (1) person. D. Two (2) people.
D. Three (3) people.  E. Four (4) people. F. Five (5) people. F. Six or more people.

4. Questions similar to #3 could be asked of all students to determine the number of lifetime sexual partners of either gender.

Gender Conformity

One's gender nonconformity is very much related to harassment by peers in schools and in society. It is also related to homosexuality, in the popular imagination, and to some degree with the reality of homosexuality as it exist in the modern world. Gender nonconformity, at least for males, is also related to suicide problems. The following question solicit relevant information will produce data which may be important in the understanding of students reporting to have a number of problems.

1. Some boys may be very feminine (like girls) and some girls can be very masculine (like boys). Choose one description in the following list - from "very feminine to "very masculine"  that "you" think best describes you.

A. Very feminine.
B. Feminine.
C. A little more feminine than masculine.
D. As much feminine as masculine.
E. A little more masculine than feminine.
F. Masculine.
G. Very Masculine

2. For Boys to Answer: When you were in grades 1 to 6 (Elementary School), you may have been told that you were too feminine and you were even called a "sissy" or other names meaning the same thing. If this happened to you, which one of the statements below best describes what happened to you?

A. I was never called such names.
B. I was called such names only a few times.
C. I was called such names often enough.
D. I was often called such names but by only a few students.
E. I was often called such names by many students.

3. For Boys to Answer: When you were in grades 7 to 9 (Junior High), you may have been told that you were too feminine and you were even called "gay," "fag," or other names meaning the same thing. If this happened to you, which one of the following statements below best describes what happened to you?

A. I was never called such names.
B. I was called such names only a few times.
C. I was called such names often enough.
D. I was often called such names but by only a few students.
E. I was often called such names by many students.

Questions similar to  #2 and #3 would be developed for girls considered to be "too masculine" and called related names.

A Boyhood Gender Nonconformity Scale developed by Hockenberry and Billingham (1987) and later modified by Phillips and Over (1992) could be used to measure the past "femininity" status of boys, but corresponding items for females need to be developed given that a similar gender nonconformity scale for girls does not appear to exist.

Suicidal Behaviors

In addition to the suicide related questions in the CDC (1999) Questionnaire (No. 22 - 26), the following question would permit a more comprehensive data set related to suicide issues specified to be unknowns in Table 2.

Last 12 Months:

1. If you attempted suicide during the past 12 months, and an attempt resulted in a visit to a hospital, how long were you in the hospital?
 
A. I did NOT attempt suicide in past 12 months. B. A few hours, but not one full day.  C. One (1) to two (2) days.
D. Three (3) days to seven (6) days. E. One (1)  to two (2) weeks. F.  More than Two weeks.

2. If you attempted suicide during the past 12 months, did you receive counseling or therapy  related to your suicide attempt from a psychiatrist, psychologists, or other qualified person such as a school counselor, social worker, etc.? If so, how long did the counseling last?
 
A. I did NOT attempt suicide in past 12 months. B. Less than one week.  C. More than one (1) week but less than one (1) month. 
D. One (1) to three (3) months.  E. One (3) to three (6) months.  F. More than six (6) months.

3. If you attempted suicide during the past 12 months, which of the following would best describe how you really felt at the time?

A. I hurt myself, but I knew I was not going to die.

B. I hurt myself, but knew I was not going to die. I did it because I wanted to tell someone I needed help, or because I wanted to get needed attention.

C. I hurt myself and did not want to die, but what I did almost caused my death.

D. I really wanted to die, but I knew it would not happen. I knew what I was doing would not kill me.

E. I really wanted to die, and I was sure that what I did would kill me.

Suicide Behavior Before a Year Ago:

1. Your were asked if you attempted suicide in the last 12 months, and you may or may not have done this. Did you attempt suicide before a year ago?

A. Yes, I did attempt suicide before a year ago.

B. No, I did not attempt suicide before a year ago.

Following these question would be a set of three questions nearly identical to the three questions asked for a suicide attempt in the past 12 month. The questions would begin with: "If you attempted suicide before a year ago,..." and would be preceded by the CDC questions 23-25 rewritten to apply to this time period. The data resulting from these questions would likely be priceless in terms of obtaining lifetime suicide attempt incidences, determining the severity of suicide attempts, and the individual's intent to die.
 

Youth Risk Behavior Surveys: Error Determination

A serious problem in demographic research that includes sexual orientation questions is the general absence of a subset of behavior related questions for those who self-identify as bisexual or homosexual  that are based on the acknowledgment of related sexual desires and/or manifestations of related desires based on varying degrees of participation in - and enjoyment of - same-gender sexual activities. When questions of this kind are asked, using face-to-face interviews telephone interviews, the underestimation in reported behaviors is estimated to range from 200 to 800 percent, based on study by Bagley and Tremblay (1998) who used computer technology methods to solicit taboo sexual information from young adult males.

In the same year, Turner et al. (1998) reported on the effectiveness of using computer technology (including the use of headphones) for soliciting taboo information from a large randomly selected sample of males aged 16 to 19 years. Using pencil-and-paper methodology produced a 400 percent underestimate (on average) for male reporting same-gender sexual activity compared to results obtained from using computer technology, and high underestimates were also reported for other taboo behaviors such as the varied use of illicit drugs.

Such underestimates will likely negatively affect statistical correlations between homosexually oriented adolescents and taboo at risk behaviors such as illicit drug use, and it would therefore be in the interest of all relying on YRBS data and related statistical correlations, including the CDC, to know about the likely underestimates existing in previous YRBS studies, and especially the underestimates for the proportion of students who are homosexually oriented and would have revealed this fact about themselves if  flawed data-intake methodology had not been used. It is therefore proposed that YRBS studies using computer technology methods be done in Massachusetts to establish an error estimate for the homosexuality data and related statistical correlations reported in the previous YRBS studies done in Massachusetts.

The supplementary questions listed above should also be incorporated in the study because the information should produce improved descriptions of adolescent suicide problems, and a better understanding of suicide problems based on sexual orientation and associated behaviors. In addition, the data will permit an improved understanding of suicide issues related to adolescents reporting harassment and abuse based on one's assumed homosexual orientation and/or one's perceived gender nonconformity, the two often being related issues. Exploring associations of the number of sexual partners of either gender (for a 3-month period, and in one's lifetime) with a number of other problems is also important given the greater "at risk" associations reported by Durant et al. (1998) for homosexually active adolescents compared to their heterosexual counterparts who had four or more sexual partners in a 3-month period.
 

Mainstream Population Sampling

Mainstream population sampling is done by researchers wishing to explore certain human realities, often in subpopulation, and they wish to avoid possible bias problems associated samples of self-selected individuals; such criticism were made by Moscicki (1995) and Muehrer (1995) with respect to suicidality results from volunteer samples of gay and lesbian individuals who were closely associated with the more visible parts of gay communities. Mainstream study population may be truly random, or near-random as Bagley and Tremblay (1997, 1998) obtained via stratified random sampling methods. On the basis of such sampling, they were able to demonstrate and confirm that homosexually oriented young adult males have been at significantly greater risk for suicide behaviors in their life histories, and even more at risk for engaging in serious suicide attempts (Note 8).

Random telephone dialing techniques also produce apparently representative study population, and demographic results may be significantly different from the composition of gay community samples commonly used in studies. This outcome was reported by Harry (1990) and summarized in the abstract:
[N]ational probability sample of [American] males interviewed by telephone and asked their sexual orientation. Of these males 3.7 percent reported that they were homosexual or bisexual. Homosexual / bisexual men were compared with heterosexual ones on the demographic variables. This sample produced larger numbers in those groups which appear to be underrepresented in the usual samples drawn from the gay world. These groups include those with little education, married men, older men, minorities, and those living in small towns. It is suggested that probability samples which do not draw directly or heavily from the gay world for homosexual respondents obtain a broader sampling of those having homosexual feelings or behaviors (p. 89).
Harry (1989) reported that 38% of the sampled male population self-identified as homosexual or bisexual was not Caucasian, compared to 18% for heterosexual males, and the same overrepresentation of gay and bisexual males from racial minorities (non-Caucasian) also the result of an 1998 Exit Poll. People of color  formed 32 percent of the sample versus an 18 percent representation in the general population, with 4 percent of the sample identifying as gay, lesbian, or bisexual (HRC, 1999). Such results are important for researchers to know, especially with respect to recognizing that gay community samples represent a subset of the total population of homosexually oriented males in society. Telephone sampling, however, only produce study samples of individuals willing to reveal their homosexual orientation to someone requesting the information, and a significant percentage of homosexually identified individuals may withhold relevant information: about 60 to 70 percent of them if the Bagley and Tremblay (1998) homosexual and bisexual identification result for young adult males (11.1%) is accepted as a reasonable approximation of reality. Furthermore, more sensitive "identification" information, such as having engaged in same-sex sexual activity, is often not solicited, thus not permitting the identification of individuals who have been homosexually active but are not identifying as homosexual, gay, lesbian, or bisexual.

Reasonably representative study samples are birth cohorts commonly used in longitudinal studies, as it was done in New Zealand where sexual orientation information was solicited from the subjects at the age of 21 years (Fergusson et al., 1999). As a result of soliciting such information, researchers confirmed that GLB (gay, lesbian, and bisexual) individuals were more at risk for having certain mental health problems. At a 95% confidence interval, homosexually oriented youth were reported to be 6.2 times (CI, 2.7 - 14.3) more likely to have reported a suicide attempt. They were also 5.9 times (CI, 2.4 - 14.8) more likely to be classified as having experienced two or more psychiatric disorders, thus confirming the overrepresentation of homosexually oriented youth in "suicide attempt" problems and in diagnosed psychiatric conditions. Another similar study from New Zealand is being prepared for peer review publication and it will report suicidality results based on gender related sexual attraction (sexual orientation). Distinctions may be made between self-harm and suicide attempts as it was done in the Bagley and Tremblay (1997) study (Note 15).

Study cohorts used for longitudinal studies are obtained via varied sampling methods, and study results are produced by controlling for certain demographic variables such as age, sex, gender, education level, etc.. These samples are generally taken to study specific problems, and the purpose of the CARDIA Cohort is embodied in the name: The Coronary Artery Risk Development in Young Adults.  At baseline (1985-86), the sample consisted of an enrollment of 5,115 young adults, 18 to 30 years of age and, about ten years later, a decision was made to solicit "homosexuality" information to investigate of health effects possibly associated with experiencing anti-gay discrimination (Krieger and Sidney, 1997). The male demographic results based on "ever having a same-sex sexual partner" (Table 7: 15.3% for male) was similar to the Bagley and Tremblay (1998) 14.0% percent result for young adult males in the same category. The  CARDIA Cohort study reported only slightly fewer females (13.3%) who reported having at least one sexual partner.

 
Table 7 - Cardia Cohort: Lifetime Same-Sex Partners
(Totals - Weighted* Results)
Race/Gender:
White/Black Men
White/Black Women
Total: 
Men/Women
Sex of Sexual Partner
N = 693
N = 1031
1,724
Only Same-Sex
Weighted %
5.7% & 0.5%
(5.2%)
1.8% & 0.7%
(1.7%)
3.5%
Both Sexes
Weighted %
10.6% & 5.4%
(9.7%)
12.3% & 5.8%
(11.6%)
10.6%
Total
Weighted %
n = 90
(15.3%)
14.1% & 6.6% 
(13.3%)
14.2%
*Calculations by author, assuming a U.S. population of only white and black individuals, with about 90% Caucasian and 10% African-American individuals. The results are therefore a reasonable "approximation" of the percentage of white and Black American individuals who report having had lifetime same-gender sexual experiences.

From the CARDIA Cohort, about 5.2 percent of young adult males could be classified "homosexual" given their history of exclusive same-sex partners, a result consonant with the Bagley and Tremblay (1998) report that 5.6 percent of males self-identified as homosexual. The remaining 8.8 percent of males (14% minus 5.6%) reporting lifetime same-sex partners since the age of 12 years in the Bagley and Tremblay (1998) study also replicates the CARDIA Cohort 9.7 percent of males reporting to have been behaviorally bisexual.

Study samples used in longitudinal studies are one of the inexpensive ways that important information may be obtained to better understand the part of human problems associated with homosexuality. Unfortunately, most researchers documenting the evolving lives of individuals in cohort samples have been oblivious to the predictable overrepresentation of homosexually oriented individuals in the many problems studied, including mental health issues such as depression and suicide. This was the case, for example, with a large sample of individuals, now about 27 years of age, that researchers first studied at the age of 5 to 6 years, the last data intake occurring at the age of 21 years. It was then reported that gender nonconformity in preschool ("behaviors that are counter to typical gender norms, such as aggressive behavior in females and dependence in males") was determined to be one of  the "early gender-specific risks for suicidal ideation" (Reinherz et al., 1995). For boys, this would be an indication that having a homosexual or bisexual  orientation in adulthood may be significantly correlated to serious problems at some point in one's life, but students of homosexuality and related problems have been deprived of this low-cost knowledge because mainstream researchers have remained ignorant of "the homosexuality factor" in many youth problems. It is therefore recommended that all researchers carrying out longitudinal studies should be contacted and advised in this respect because it is doubtful that anyone has been doing such "informed" advocacy work in mainstream youth problem research.

Special Samples in Studies of Homosexuality

Special population samples have many roles to play in shedding light on various  aspects of homosexuality. A population-based cohort of fraternal and identical twins, for example, may be used to explore the possibility of genes being a factor in the genesis of homosexuality given that "same family" environments are being controlled for with fraternal twins and identical twins, and that identical twins have the same genes. Recently, the twin cohort known as the Vietnam Era Twin Registry (age range = 40 to 60 years) was used by Herrell et al. (1999) to investigate the greater risk for lifetime suicidality of homosexually oriented males compared to heterosexual males. At a 95% confidence interval, the unadjusted matched-pair odds ratios results were  2.4 (1.2-4.6) for thoughts about death, 4.4 (1.7-11.6) for wanted to die, 4.1 (2.1-8.2) for suicidal ideation, 6.5 (1.5-28.8) for attempted suicide, and 5.1 (95% CI, 2.4-10.9) for any of the suicidal symptoms. "After adjustment for substance abuse and depressive symptoms (other than suicidality), all of the suicidality measures remain significantly associated with same-gender sexual orientation except for wanting to die (odds ratio, 2.5 [95% CI, 0.7-8.8])" (p. 867).

Study samples may also be of a human group with attributes making it very expensive to use random sampling to obtain the required numbers of individuals needed to produce statistical significance. For example, Bagley and Tremblay (1997) reported that 1% of young adult males were serious suicide attempters, with 5 out of 8 attempters being homosexual or bisexual. It would be almost impossible, however, to say much with reasonable certainty about the results other than concluding that homosexually oriented males are overrepresented in the male youth group engaging in serious suicide attempts. To better understand the situation, a larger sample of homosexually oriented males who attempted suicide would be needed, but it would take a random sample of about 6,000 male youth in Calgary to generate a sample of 40 homosexual and bisexual suicide attempters for analysis. Studying such large samples is expensive and other types of samples, such as the community based sample of 137 gay and bisexual male youth studied by Remafedi et al. (1991), may be used for the statistical analysis of factors significantly associated with suicide attempts. Most study samples of gay, lesbian, and bisexual individuals have been in this category.

Often enough, researcher may also wish to study homosexuality in other population such as schizophrenic males who form about one percent of the male population and are at extremely high risk for committing suicide: about 10 to 20 percent of them will eventually commit suicide, depending on diagnosis. Assuming that homosexually oriented schizophrenic males form a maximum of 10 percent of this population, it would therefore take a population sample of about 5,000 individuals to generate a sample of 5 homosexually oriented schizophrenic males (or maybe 10 if they are overrepresented), and this sampling result would only reveal their representation in the schizophrenic male population.

A common solution to the high cost of using large random samples is, for example, to study various samples of about 100 mostly schizophrenic males in psychiatric male populations to determine their representation, and five such studies reported representation percentages ranging from 14.1 and 22 percent for males who were homosexually active (Susser et al., 1995: 16%; McDermott et al., 1994: 22%; Cournos et al., 1994: 22%; Kalichman et al., 1994: 22%; Lyketsos et al., 1983: 14.1%). The average of these percentages (19%) indicates that the representation of homosexually active individuals in male schizophrenic populations is about twice their representation in the average population given the 9.2 percent estimate reported by Bagley and Tremblay (1998) for currently homosexually active young adult males. One study also reported that none of the homosexually active schizophrenic males perceived themselves to be homosexual (Cournos et al., 1994). The implications are that schizophrenic males acting on their homosexual desires is independent of the "identity" concept so often mentioned in association with modern restricting concept of male homosexuality.

Three of the above cited studies also reported that 10 to 50 percent of homosexually active mostly schizophrenic males had traded sex with males for goods or money (Susser et al., 1995; Cournos et al., 1994; Kalichman et al., 1994), meaning that most of these males may be much like "trade males" of a former age of male homosexuality described at the beginning of this paper. Some of these males, however, may be at risk for sexual assault given that, in one Toronto study of sexually assaulted mostly young adult males visiting a sexual assault center, 35 percent were reported to have cognitive deficits, but a possible link to mental disorders such as schizophrenia or other psychiatric problems was not mentioned (Stermac et al., 1996).

Very little has been written about homosexuality and its effects in the sector of the population deemed to have mental disorders, but the above data indicates overrepresentation, and the similar results were produced from HIV/AIDS related cohort studies of gay and bisexual adult males. Compared to general male population studies, as noted above, gay and bisexual males have high incidences of major depressive disorder (MDD) in the psychiatric history, and they are overrepresented in personality disorders often associated with elevated rates of suicidality.

As a rule, the homosexuality factor in suicide problem of males with psychiatric diagnoses has been ignored, even though there are indications that homosexuality is overrepresented in the suicides of psychiatric patients. 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 (Motto et al., 1985), and a seven-year follow-up of 500 psychiatric patients reported that homosexuals accounted for one-third of the suicide deaths. Interestingly, the authors noted that the study represented the first attempt to ascertain the sexual orientation of such study subjects (Martin et al., 1985), and the endeavor has not been repeated possibly die to indifference.
 

The role of Grounded Theory and Ethnomethodology Studies in the Research of Male Homosexual Realities.

Studies of the many facets of male homosexuality requires the application of an important rule noted by The Working Group (1995) in the first special issue on "sexual orientation" of Suicide and Life-Threatening Behavior.

Researchers must know the community they are studying (p. 83).

A major problem with the concept of "gay community," however, is its constituents. Who are they? During the period that bisexual people were not supposed to exist, were bisexual individuals a part of "the gay community"? What about schizophrenic males who are homosexually active and may be sexually relating with gay identified males? Homosexual and bisexual males of color have a near double representation in telephone surveys, forming about one-third of homosexual and bisexual identified males, but are they a part of "gay communities" which historically have been white dominated and racist in nature? Is it possible then that the concept of "the gay community" is but a minority subset of the modern world of male homosexuality, as gay identified males also happen to be from a historical perspective?

The problems I have observed gay and bisexual youth manifesting when they venture into "gay communities" are significant and they often continue, sometimes getting worse as often observed with gay male youth with respect to drug use and abuse. As previously noted, the more "feminine" gay males will have significant problems after the venture into "gay communities," but studies are almost nonexistent on the process of integration into "gay communities," and the problems to be encountered by often "at risk" gay and bisexual male youth. Gay communities have also been known for white racism resulting in varied abuses of people of color (Tremble et al., 1989), and there is significant stigma related to "public sex" engaged in by many gay identified males (Tewsbury, 1996). Lying is also common when gay and bisexual males are meeting each other with sexual objectives in mind (de Luze, 1990), and one's class status may also significantly affect one's attachment to gay communities (Chapple et al., 1998).

As demonstrated by de Luze (1990), ethnomethodology studies carried out by researchers participating in the group being studied would greatly improve our knowledge and understanding of what actually exist in the more visible and invisible sectors of gay communities. Some GB male youth, for example, have been reported to be contracting HIV as a way of committing suicide (Johnston, 1995; Tompkins-Rosenblatt, 1997) and, although some gay community individuals have blamed this on society's homophobia (Johnston, 1995, p. 225-6), a recent grounded theory study of gay male youth implicated gay community attributes in the problem (Seal et al., 2000). The study also reported on the likely harmful phenomenon articulated by Kenji Yoshino (2000) in "The epistemic contract of bisexual erasure:" the tacit agreement by the very recent socially constructed gay and heterosexual polarities to invalidate / ignore the existence of bisexual individuals.

It's [the gay community] a very pressuring community. A lot of peer pressure when it comes to being gay or straight. For some strange reason bisexuality isn't really considered sexuality. Bisexuals are seen as gay men who are having trouble with their sexuality. Like it is the first stage of coming out. If someone is really bisexual, people will harass them until they say if they are gay or straight. It's more or less, you know you're gay, get over it (Seal et al., 2000, p. 13).
Recommendations have been made for "participant observation" ethnomethodology studies to be done in gay communities (Weston, 1993; Boulton, 1995), much like the study done by de Luze (1990), but a significant number of gay leaders may not want certain community truths to be known, apparently because it will make gay communities look bad in the eyes of mainstream society. Problems, however, cannot effectively tackled unless implicated realities are acknowledged and addressed.

It is therefore very important to study the lives of homosexually oriented male adolescents and young adults who are at risk for suicide problems - likely to also be present in association with individuals testing HIV-positive (Forstein, 1994; Siegal and Meyer, 1999) - and especially the factors "actually" implicated or "causal" for individuals contemplating the end of their lives, and for the ones who will commit suicide. Our feelings are within our minds, meaning that the "why" questions must be asked, and the answers will likely be subjective in nature, often informing the researcher that there is much more to a decision to kill oneself than significantly correlated items (such as a male being "feminine," abusing drugs and/or alcohol, etc.) often encountered in quantitative studies. For some individuals, manifestation of suicidality may also be a way of working though other life threatening problems as reported in the Siegel and Meyer (1999) qualitative study. A friend wrote the following about "grounded theory" in his 1997 doctoral thesis proposal:

Grounded theory was developed as a method of inductively generating theory from data in order to counter what its creators saw as "the embarrassing gap between theory and empirical research" (Glasser and Strauss, 1967, VII). In their Original work, Glasser and Strauss discovered how categories of meaning related to dying emerged from the study of interviews with medical staff treating terminally ill patients. The concepts that manifested themselves were seen as thus being "grounded" in the data rather than being imposed by theory. Grounded theory has been chosen for the [doctoral thesis] study because the method respects subjective meaning of people's experiences.
The suicide problems of homosexually oriented male adolescents and young adults have generally not been explored by researchers using a "grounded theory" approach, and the method is needed to identify significant factors associated with the suicide problems of homosexually oriented male adolescents before and after they make contact with gay communities. At best, some quantitative studies of at risk individuals contain indication that suicide problems have not ended for studied individuals. The Remafedi et al. (1991) data indicates that about 20 percent (28/137) of studied gay and bisexual male youth were not in the category of "no current suicide intent," and 46 percent (13/28) of these males had attempted suicide. Another 3.6 percent of gay and bisexual male youth (5/137) had a suicide plan, and 60% of them (3/5) had already attempted suicide. Given that suicide is rare for male youth (approximately 1/5,000/year in average population, but the rate would be much higher in gay and bisexual male population), these "at risk" gay and bisexual male youth may be the ones eventually committing suicide. Therefore,  improving our understanding of the most "at risk" individuals would require venturing into their minds to discover related perceptions, and a grounded theory approach is recommended to better understand suicide issues from the perspective of the ones having these problems.
 
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