Gay and Bisexual Males Are the Most At Risk For More Serious Suicidal Behaviors

On the basis of suicidality data from American Youth Risk Behavior Surveys carried out in the 1990s, homosexually oriented adolescents in public schools (males and females combined for analysis) are generally at increasing risk for more serious suicide behaviors, compared to their heterosexually oriented counterparts. The same also applies for homosexual/bisexual self-identified males and females (and more so for males) in a 1992 Canadian study of British Columbia adolescents in schools. Unfortunately, the incidences for adolescents reporting that they had attempted suicide multiple times are most often never reported in spite of the fact that Youth Risk Behavior Surveys do solicit such information (Note 1).

Furthermore, no one has yet considered the option of making a composite "higher risk" attempted suicide variable - especially when the suicidality counts are low for homosexually oriented adolescents - by combining those who attempted suicide multiple times (an "at risk" behavior for both future suicide attempts as youths [Goldston et al., 1999; Hultén et al., 2001; Lewinsohn et al., 1994; Miranda et al., 2008; Pfeffer et al., 1993; Wichstrøm, 2000] and likely in adulthood [Pagura et al., 2008], and also for future suicides [Brent et al., 1999 - noting that previous single and multiple attempters were not separated for analysis]) with those for whom one or more of their suicide attempts resulted in having received medical care. Bryan et al. (2008) summarizes the "at risk" situation for multiple attempters:

"It is now well established that multiple suicide attempters, compared with suicide ideators (i.e., zero attempters) and single attempters, are a clinically distinct group with greater levels of pathology and risk for future suicide attempts and death by suicide (e.g., Forman, Berk, Henriques, Brown, & Beck; 2004; Lewinsohn, Rohde, & Seeley, 1996; Rudd, Joiner, & Rajab, 1996; Walker, Joiner, & Rudd, 2001). Past suicidal behavior has a direct and robust relationship with future suicidal behavior, above and beyond the contribution of other well-established suicide-related variables such as depression, hopelessness, personality pathology, and certain demographic variables (Joiner et al., 2005)."

In a 2009 online survey carried out in Dane County Wisconsin schools (Robinson & Espelage, 2011: Tabled Results), LGBQT as a group, and lesbian, gay, bisexual and transgender students individually (not including questioning students), were more at risk for attempting suicide multiple times than once, when compared to straight (heterosexual) students.

In the Robinson & Espelage (2011) study, the results for suicidal ideation in the past 30 days (Tabled Results: Any Suicidal Ideation, Rarely, Sometimes, and Almost All The Time: "During the Past 30 Days, have you seriously thought about killing yourself?") ... also produced similar results. Compared to straight (heterosexual) students, LGBQT as a group, and lesbian, gay, bisexual, questioning and transgender students individually, were at increasing risk for more ongoing suicidal ideation. It is possible that experiencing increasing levels of suicide ideation, and especially 'seriously thinking about killing oneself' "almost all the time" for a month, may place an adolescent at increasing risk for attempting suicide, maybe multiple times, but this potential association is not reported on. It is also possible that experiencing higher levels of suicidality (high suicide ideation levels and suicide attempts) are, individually or combined, high risks for adolescent suicide.

In 2011, the CDC - via its MMWR publication - reported the suicidality results for all the 2001 to 2009 Youth Risk Behavior Surveys - each as a grouped data set from 2001 to 2009 (2001, 2003, 2005, 2007, 2009, but not all these years are represented in some cases) - from both states and cities - that had solicited sexual orientation information, such as identity and/or the sex of one's sexual partner(s). The "In the Past Year" suicidality results are re-tabulated here to show that sexual minority adolescents (males and females, combined) are, as a rule (or generally - See results using median variable incidences for the studies ***), at increasing risk - relative to their heterosexual counterparts - for the more serious suicidal behaviors or outcomes. This fact would suggest that sexual minority adolescents are also more at risk for suicide. The Suicidality Variables Data Tables are:

A. State Study Results Generated on the Basis of Sexual Identity: Delaware, Maine, Massachusetts, Rhode Island, Vermont.

Gay / Lesbian Identity vs. Heterosexual Identity.

Bisexual Identity vs. Heterosexual Identity.

"Not Sure" 'Identity' vs. Heterosexual Identity.

B. City Study Results Generated on the Basis of Sexual Identity: Boston, Chicago, New York, San Francisco.

Gay / Lesbian Identity vs. Heterosexual Identity.

Bisexual Identity vs. Heterosexual Identity.

"Not Sure: 'Identity' vs. Heterosexual Identity.

C. State Study Results Generated on the Basis of the Sex of One's Sexual Partner(s): Connecticut, Maine, Delaware, Massachusetts, Rhode Island, Vermont, Wisconsin.

Only Same-Sex Sex Partners vs. Only Opposite-Sex Sex Partners.

Both-Sex Sex Partners vs. Only Opposite-Sex Sex Partners.

D. City Study Results Generated on the Basis of the Sex of One's Sexual Partner(s): Boston, Chicago, Milwaukee, New York, San Diego.

Only Same-Sex Sex Partners vs. Only Opposite-Sex Sex Partners.

Both-Sex Sex Partners vs. Only Opposite-Sex Sex Partners.

*** The median incidences used in the referenced data table are from the 2011 CDC document that were calculated on the basis of both the statewide Youth Risk Behavior Surveys - that have majority White populations - and city Youth Risk Behavior Surveys - where the majority population is Black and Hispanic, except in the San Francisco survey where the majority population (60.7%) is given as "Other" that is mostly Asian (about 43%) and about 18% other races and multi-race. Because of this major difference in population make-up, median incidence values for suicidality variables were calculated and tabled separately for State Youth Risk Behavior Surveys and City Youth Risk Behavior Surveys. On the basis of data presented in the two tables, as well as in other tables, the following is concluded:

1. As a rule, adolescents who identify as Gay/Lesbian, Bisexual, or "Not Sure" are at increasing risk for the more serious suicidal behaviors, compared to their heterosexual identified counterparts.

2. As a rule, in (1), adolescents who identify as Gay/Lesbian, Bisexual, or "Not Sure" - who are in mostly White statewide populations - are at the greatest risk for the more serious suicidal behaviors such as "having attempted suicide" and "having attempted suicide that also resulted in having received medical attention" when compared to their heterosexual counterparts. Those at lesser risk for these suicidal behaviors are the predominantly Black and Hispanic adolescent populations who live in cities and also identify as Gay/Lesbian, Bisexual, or "Not Sure".

This proposition was also the conclusion in the following paper: Marshal MP, Dietz LJ, Friedman MS, Stall R, Smith HA, McGinley J, Thoma BC, Murray PJ, D'Augelli AR, Brent DA (2011). Suicidality and depression disparities between sexual minority and heterosexual youth: a meta-analytic review. Journal of Adolescent Health, 49(2): 115-123. Abstract. PDF Download. "Disparities increased with the increase in the severity of suicidality (ideation [OR = 1.96], intent/plans [OR = 2.20], suicide attempts [OR = 3.18], suicide attempts requiring medical attention [OR = 4.17]). Effects did not vary across gender, recruitment source, and sexual orientation definition." [Note: Effects do vary. See # 3.]

This phenomenon was first reported ten years ago, on the basis of data from Youth Risk Behavior Surveys in the following document: Tremblay P, Ramsay R (2000). The Social Construction of Male Homosexuality and Related Suicide Problems; Research Proposals for the Twenty First Century. Paper Presented at The 11th Annual Sociological Symposium: "Deconstructing Youth Suicide," San Diego State University, March, 2000. Full Text. See: "Table 2 - GLB Youth: Increasing "At Risk" Status For The More Serious Suicide Problems: Youth Risk Behavior Survey Results."

3. Sexual minority adolescents manifesting the least risk for suicidality - that also includes no trend to be at increasing risk for the more serious suicidal behaviors when compared to their heterosexual counterparts - belong to a City population category (Mostly Black and Hispanic) who report having had Only Same-Sex Sex Partners with the majority identifying as heterosexual (Possibly meaning "Normal"), as in generally NOT identifying as Gay/Lesbian, Bisexual, or "Not Sure" (Likely meaning "Not Normal"). The suggestion is: It is likely NOT enjoying same-sex sex that places some adolescent at risk for suicidality, but that it is the highly stigmatized 'believed-to-be' sexual minority status (Gay, Lesbian, Bisexual) identification (or pending identification likely applying for those in the "Not Sure" category) that is implicated in adolescents being at great risk for suicidal behaviors. This concept was proposed in a 2000, 2004 paper by Tremblay & Ramsay. The first author experienced this non-suicidality outcome for males while growing up in an environment where about 80% of adolescent males enjoyed homo-sex on a regular basis but obviously could NOT identify as minority 'anything' given that they formed the great majority of adolescent males. See related published account of such a North American - Canadian - adolescent male environment existing in the 1960s and 1970s.

Note: Although the Youth Risk Behavior Survey data makes possible the reporting of results for "Multiple Suicide Attempts," the CDC 'policy' for YRBS reporting has been to ignore this 'At Risk" suicidality attribute/factor in their publications of results. Researchers who have published "At Risk" related papers based on Youth Risk Behavior Survey data seem to have also done the same.

Similar results - being at greater risk for the more serious suicidal behaviors - have been produced for American homosexually oriented adult males in the NHANES Survey, in the Netherlands' NEMESIS Survey, for male twins discordant for sexual orientation in the Population-Based Vietnam Era Twin Registry, for all homosexually oriented males versus all heterosexually oriented males in the Population-Based Vietnam Era Twin Registry, and for the suicidality of homosexually versus heterosexually oriented adults in an Austrian study. However, the same pattern of risk was not reported for homosexually oriented females in the Netherlands' NEMESIS Survey, but the Odds Ratios are also statistically non-significant (ns). A similar outcome applies for homosexually oriented females in a New Zealand Birth Cohort study (to the age of 26 years), while homosexually oriented males generally show the expected pattern. In Austria, the Plöderl & Fartacek (2009) data reveals that homosexually oriented males and females are more at risk for the more serious suicide attempts than they are for less serious aborted suicide attempts, compared to their heterosexual counterparts.

Generally, major surveys of adults that have suicidality variables have had subsamples of less than 100 homosexually oriented males or females, meaning that there were few counts for those who had attempted suicide, and even fewer for variables that indicate more serious suicide behaviors such as for those who attempted suicide multiple times, for those reporting serious suicide attempts, or for those who received medical attention related to their suicide attempt(s).

For example, in reference to the Netherlands' NEMESIS Survey, de Graaf et al. (2006) note that the four question on suicidality were: "death ideation (thoughts of death) (“Have you ever had a period of 2 weeks or more during which you were preoccupied with your own death, others’ death or dying in general?”), death wishes (“Have you ever had a period of 2 weeks or more during which you wanted to be dead?”), suicide contemplation (suicide ideation) (“Have you ever been so down that you thought of committing suicide?”), and actual deliberate self-harm (suicide attempt) (“Have you ever attempted suicide?”). These questions were asked on a lifetime basis. These suicide items were the same questions that were used in the Epidemiologic Catchment Area Survey (Weissman, Klerman, Markowitz, & Ouellette, 1989) and the U.S. National Comorbidity Survey (Kessler et al., 1999)."

What is not mentioned, however, is that the U.S. National Comorbidity Survey (NCS) has additional suicidality variables indicating degrees of higher severity related to one or more suicide attempt(s) (Table 1). However, as noted above, the problem with using such variables for comparisons between a subset of homosexually oriented individuals and heterosexual individuals is count related. That is, given that there are less than 100 male or female study participants who are homosexually oriented, with a smaller percentage who attempted suicide, and even fewer with high levels of severity for their suicide attempt(s), generating statistically significant Odds Ratio comparisons become impossible or near impossible. To Illustrate this, results from the 1990-92 NCS are given in Table 2. Most results - the Odds Ratios - are statistically non-significant (ns).

Replication of the "More at Risk for the More Serious Suicidal Behavior" has also been reported in a 2005 Austrian study of GLB adults matched with heterosexual adults on the basis of sex, age and education.

To Note: Problems have been reported with respect to whether or not study participants who report that they have attempted suicide actually attempted suicide (Moscicki, 1989; Moscicki et al., 1989; Meehan et al (1992); de Wilde & Kienhort, 1994; and O'Carroll et al., 1996. Moscicki et al. (1989) highlighted the nature of the problem in a part of the discussion of their epidemiologic catchment area study results under the title "Limitations":

"Suicide attempt" could thus have been interpreted by the respondent as an act of deliberate self-harm without the intention of dying, a genuine (and failed) attempt to end one's life, or as something else (perhaps an "accident" had been explained to them by a physician that had seen it as an unconscious suicide attempt). Suicide ideation, similarly, may mean different things to different people. (p. 122)

Meehan et al (1992) explored the problem by studying a sample of university students. The results were:

Of the 694 respondents, 374 (54%) reported having ever considered suicide and 181 (26%) had considered suicide during the preceding 12 months. Thirteen (2%) students reported having attempted suicide during the preceding 12 months, and 72 (10%) reported ever having attempted suicide. The number of students answering affirmatively to questions about injuries sustained, medical care sought, and hospitalization as a result of attempted suicide decreased progressively: only 18 (3%) students reported having ever sought medical care due to a suicide attempt, and seven (1%) were ever hospitalized... The prevalence of self-reported attempted suicide is not representative of the prevalence of self-injury and provides little information concerning the seriousness of the attempt. The use of specific questions similar to those used in this study should be considered in future surveys. (p. 41)

de Wilde & Kienhort (1994) reviewed a number of Dutch studies (1988 - 1993) and some of the interpretation problems were discussed.

Was this behavior a suicide attempt? This decision is heavily dependent upon the idea the respondent has about a suicide attempt (p. 267). ...one does not have to want to die in order to attempt suicide (268). To answer these problems in both methods of sampling, more fundamental research is necessary. To establish a reliable frequency of attempted suicide, the investigation should not be made bigger and bigger, but perhaps more experimental, or qualitative. Studies should investigate the decision process of labelling a behavior as an attempted suicide, one should design a manual that every person can handle in the same way, and also, desperately, a common concept of attempted suicide. Only then, safe estimates and reliable statements about this thermometer of well-being of our youth can be made (p. 269).

O'Carroll et al. (1996) noted that a number of published classifications existed for suicides and suicidal behaviors, dating back to 1974, but also noted: "Unfortunately, at this writing, neither these or any other classification efforts have been widely adopted" (p. 26). They then proposed their own nomenclature (p. 34) that included a definition of "suicide attempt" and related issues:

A potentially self-injurious behavior with a non fatal outcome, for which there is evidence (either explicit or implicit) that the person intended at some (non-zero) level to kill himself-herself. A suicide attempt may or may not result in injuries. A "suicidal act" includes all suicide attempts plus all acts resulting in suicide. "Suicide-related behavior" is also defined: Potentially self-injurious behavior for which there is explicit or implicit evidence either that (a) the person intended at some (non-zero) level to kill himself/herself, or, the person wished to use the appearance of intending to kill himself/herself in order to attain some other end. Suicide-related behavior comprises suicidal acts and instrumental suicide-related behavior.

The earliest research work carried out in this respect, however, was by Ramsay & Bagley (1985) & by Bagley & Ramsay (1985) as noted by Moscicki (1989):

This is the only known community survey that has addressed the important distinction between deliberate self-harm without intent to die, which the authors called "parasuicide," and a lethal suicide attempt [defined by the intent to die]. (p. 136)

Moscicki (1989) noted that, in the Ramsay & Bagley (1985) study, "respondents were asked in a semi structured interview about sociodemographic characteristics, childhood history, social ties, religiosity, stress, health, "suicidal behaviors," and "suicidal actions"," and she listed the 6 questions related to suicidality that are located in the Appendix of the 1985 Ramsay & Bagley paper (p. 165), with the emphasis being placed on the last two items:

1. Have you ever felt that life was not worth living?

2. Have you wished that you were dead - for instance, that you could go to sleep and not wake up?

3. Have you ever thought of taking your life, even if you would not really do it?

4. Have you ever reached the point where you seriously considered taking your own life and perhaps made plans how you would go about doing it?

5. Have you ever deliberately harmed yourself, but in a way that stopped short of a real intent to take your life?

6. Have you ever made an intentional attempt to take your life?

These questions were asked of the 750 young adult male participants (age = 18 to 27 years, stratified random sample) in the Bagley & Tremblay (1997) study, with additional information solicited about the suicide attempt reported by those affirmatively replying to the question: "Have you ever made an intentional attempt to take your life?" Only one out of 8 males in this category had not made a very serious attempt at killing himself. The results also showed what was noted above: homosexually oriented males are more at risk for the more serious suicidal behaviors.

Stratified Random Sample: 750 Young Adult Calgary Males Lifetime Suicidality Risk: Homosexually vs. Heterosexually Oriented Males
Variable	Homosexually Oriented *	Heterosexually Oriented *	Odds Ratio
All Self-Harm	13 / 82	37 / 668	3.2 (1.6, 6.3)
Self-Harm, No Intent to Die	8 / 82	34 / 334	2.0 (0.90, 4.5)
Attempted Suicide, Intent to Take One's Life	5 / 82	3 / 668	14.4 (3.4, 61.4)
* Homosexually Oriented: Study participants described themselves as "homosexual" or "bisexual", or reported having at least one same-sex sex partner in the past 6 months. Data Source: Bagley & Tremblay (1997)

Table 1: U.S. National Comorbidity Survey Questions After: "Have you ever attempted suicide?"
Variable Number	Question Number	Question
V6310	U41a	How many times has Event 15 [attempting suicide] happened to you in your lifetime?
V6311	U41b	How old were you the first time?
V6312	U41c	There are three statements lettered A, B, and C under Event 15. Which of these statements best describes your situation when you were (AGE IN U41b) years old and Event 15 happened--A, B, or C?
		(A) I made a serious attempt to kill myself and it was only luck that I did not succeed.
		(B) I tried to kill myself, but I knew the method was not fool-proof.
		(C) My attempt was a cry for help, I did not want to die.
V6313	U41d	When (did/was the last time) Event 15 happen(ed)--in the past month, past six months, past year, or more than a year ago?
V6314	U41e	How old were you [the last time (Event 15 happened)]?
V6315	U41f	Did this result in an injury or poisoning (the last time it happened)? Yes/No
V6316	U41g	Did it require medical attention? Yes/No
V6317	U41h	Did it require overnight hospitalization? Yes/No
"Event 15" = Ever Attempted Suicide Information Source: Kessler RC (2000-2006, 2000)

Table 2: Lifetime Suicide Symptoms Risk Homosexual vs. Heterosexual Males & Females National Comorbidity Survey
Variables	Men		Women
Variables	Odds Ratio	95% CI	Odds Ratio	95% CI
Thought About Suicide	2.2*	1.2, 4.2	2.0*	1.0, 3.9
Made a Plan for Committing Suicide	1.6	0.6, 4.3	2.6	1.0, 6.9
Attempted Suicide	2.4	1.0, 5.8	1.5	0.7, 3.4
Data Source: Gilman et al. (2001), * p < .05 Homosexual Males = 74, Heterosexual Males = 2,310 Homosexual Females = 51, Heterosexual Females = 2,475

Increasing Risk for the More Serious Suicide Problems in the Past Year Youth Risk Behaviour Survey Results Based on Self-Identification American States That Solicited Related Data in 2001-2009 Surveys, Combined * Gay / Lesbian vs. Heterosexual Incidences: Males & Females, Combined
Survey -> / Suicide Behaviour Category	Delaware 2003, 05, 07, 09 Gay / Lesbian (n = 133, 1.3%) vs. Heterosexual (n = 9,801, 93.5%)	Maine 2007, 09 Gay / Lesbian (n = 186, 1.2%) vs. Heterosexual (n =9,513, 93.3%)	Massachusetts 2001to 2009 Gay / Lesbian (n = 196, 1.2%) vs. Heterosexual (n =15,780, 93.6%)	Rhode Island 2007, 09 Gay / Lesbian (n = 91, 1.7%) vs. Heterosexual (n =4,836, 90.7%)	Vermont 2005, 07, 09 Gay / Lesbian (n = 264, 1.0%) vs. Heterosexual (n =21,466, 93.0%)
Suicide Seriously Considered	35.3% vs. 10.9% RR: 3.2, OR: 4.5	29.5% vs. 10.1% RR: 2.9, OR: 3.7	43.4% vs. 13.2% RR: 3.3, OR: 5.0	20.5% vs. 9.9% RR: 2.1, OR: 2.3	N/A
Suicide Planned	36.8% vs. 8.5% RR: 4.3, OR: 6.3	31.1% vs. 15.7% RR: 2.6, OR: 3.3	37.1% vs. 10.7% RR: 3.5, OR: 4.9	15.8% vs. 9.6% RR: 1.6, OR: 1.8	31.7% vs. 8.0% RR: 4.0, OR: 5.3
Attempted Suicide	27.0% vs. 5.7% RR: 4.7, OR: 6.1	22.3% vs. 5.1% RR: 4.4, OR: 5.3	33.1% vs. 6.4% RR: 5.2, OR: 7.2	25.8% vs. 6.3% RR: 4.1, OR: 5.2	25.4% vs. 3.8% RR: 6.7, OR: 8.6
Suicide Attempt(s) & Medical Care	12.9% vs. 1.5% RR: 8.6, OR: 9.7	N/A	15.1% vs. 2.2% RR: 6.9, OR: 7.9	12.4% vs. 3.9% RR: 4.3, OR: 4.7	13.4% vs. 1.1% RR: 12.2, OR: 13.9
'Race' = % White % Black % Hispanic % Other	56.7% 28.4% 8.8% 6.1%	95.3% 0.7% 1.3& 2.8%	74.7% 8.7% 11.5% 5.2%	69.4% 9.2% 17.6% 3.8%	95.2% 0.7% 1.2% 2.9%
Data Source: Centers for Disease Control and Prevention (2011) * Combined Surveys: 2001, 2003, 2005, 2007, 2009, Years Specified. Basic RRs (Risk Ratios) & ORs (Odds Ratios): Calculated from Given Percentages at: http://statpages.org/ctab2x2.html RR & OR Statistical Significance Determination: If the Given 95% Confidence Intervals - Not Shown - for Two Compared Incidences do not Overlap. Not Statistically Significant RR & OR Indicated with "ns".

Increasing Risk for the More Serious Suicide Problems in the Past Year Youth Risk Behaviour Survey Results Based on Self-Identification American States That Solicited Related Data in 2001-2009 Surveys, Combined * Bisexual vs. Heterosexual Incidences: Males & Females, Combined
Survey -> / Suicide Behaviour Category	Delaware 2003, 05, 07, 09 Bisexual (n = 396, 3.8%) vs. Heterosexual (n = 9,801, 93.5%)	Maine 2007, 09 Bisexual (n = 432, 3.4%) vs. Heterosexual (n =9,513, 93.3%)	Massachusetts 2001to 2009 Bisexual (n = 536, 3.2%) vs. Heterosexual (n =15,780, 93.6%)	Rhode Island 2007, 09 Bisexual (n = 287, 5.2%) vs. Heterosexual (n =4,836, 90.7%)	Vermont 2005, 07, 09 Bisexual (n = 941, 3.7%) vs. Heterosexual (n =21,466, 93.0%)
Suicide Seriously Considered	46.1% vs. 10.9% RR: 4.2, OR: 7.0	36.4% vs. 10.1% RR: 3.6, OR: 5.1	46.2% vs. 13.2% RR: 3.5, OR: 5.6	40.2% vs. 9.9% RR: 4.1, OR: 6.1	N/A
Suicide Planned	34.0% vs. 8.5% RR: 4.0, OR: 5.5	37.0% vs. 15.7% RR: 2.4, OR: 3.1	36.4% vs. 10.7% RR: 3.4, OR: 4.8	35.7% vs. 9.6% RR: 3.7, OR: 5.2	37.7% vs. 8.0% RR: 4.7, OR: 7.0
Attempted Suicide	29.3% vs. 5.7% RR: 5.2, OR: 6.9	20.6% vs. 5.1% RR: 4.0, OR: 4.8	28.0% vs. 6.4% RR: 4.4, OR: 5.7	32.0% vs. 6.3% RR: 5.1, OR: 7.0	26.7% vs. 3.8% RR: 7.0, OR: 9.2
Suicide Attempt(s) & Medical Care	11.3% vs. 1.5% RR: 7.5, OR: 8.4	15.9% vs. 0.9% RR: 17.7, OR: 20.8	11.2% vs. 2.2% RR: 5.1, OR: 5.6	10.1% vs. 3.9% RR: 2.6, OR: 2.8	10.8% vs. 1.1% RR: 9.8, OR: 10.9
'Race' = % White % Black % Hispanic % Other	56.7% 28.4% 8.8% 6.1%	95.3% 0.7% 1.3& 2.8%	74.7% 8.7% 11.5% 5.2%	69.4% 9.2% 17.6% 3.8%	95.2% 0.7% 1.2% 2.9%
Data Source: Centers for Disease Control and Prevention (2011) * Combined Surveys: 2001, 2003, 2005, 2007, 2009, Years Specified. Basic RRs (Risk Ratios) & ORs (Odds Ratios): Calculated from Given Percentages at: http://statpages.org/ctab2x2.html RR & OR Statistical Significance Determination: If the Given 95% Confidence Intervals - Not Shown - for Two Compared Incidences do not Overlap. Not Statistically Significant RR & OR Indicated with "ns".

Increasing Risk for the More Serious Suicide Problems in the Past Year Youth Risk Behaviour Survey Results Based on Self-Identification American States That Solicited Related Data in 2001-2009 Surveys, Combined * "Not Sure" vs. Heterosexual Incidences: Males & Females, Combined
Survey -> / Suicide Behaviour Category	Delaware 2003, 05, 07, 09 "Not Sure" (n = 136, 1.3%) vs. Heterosexual (n = 9,801, 93.5%)	Maine 2007, 09 "Not Sure" (n = 324, 2.1%) vs. Heterosexual (n =9,513, 93.3%)	Massachusetts 2001to 2009 "Not Sure" (n = 377, 2.1%) vs. Heterosexual (n =15,780, 93.6%)	Rhode Island 2007, 09 "Not Sure" (n = 137, 2.5%) vs. Heterosexual (n =4,836, 90.7%)	Vermont 2005, 07, 09 "Not Sure" (n = 610, 2.3%) vs. Heterosexual (n =21,466, 93.0%)
Suicide Seriously Considered	40.4% vs. 10.9% RR: 3.7, OR: 5.5	27.6% vs. 10.1% RR: 2.7, OR: 3.4	29.1% vs. 13.2% RR: 2.2, OR: 2.7	18.6% vs. 9.9% RR: 1.9, OR: 2.1	N/A
Suicide Planned	30.1% vs. 8.5% RR: 3.5, OR: 4.6	31.7% vs. 15.7% RR: 2.0, OR: 2.5	24.6% vs. 10.7% RR: 2.3, OR: 2.7	20.0% vs. 9.6% RR: 2.1, OR: 2.3	22.4% vs. 8.0% RR: 2.8, OR: 3.3
Attempted Suicide	26.7% vs. 5.7% RR: 4.7, OR: 6.0	20.7% vs. 5.1% RR: 4.1, OR: 4.9	20.9% vs. 6.4% RR: 3.3, OR: 3.9	16.1% vs. 6.3% RR: 2.6, OR: 3.8	16.6% vs. 3.8% RR: 4.4, OR: 5.0
Suicide Attempt(s) & Medical Care	12.0% vs. 1.5% RR: 8.0, OR: 8.9	16.8% vs. 0.9% RR: 18.7, OR: 22.2	10.2% vs. 2.2% RR: 4.6, OR: 5.0	5.6% vs. 3.9% RR: 1.4, OR: 1.5 ns	10.8% vs. 1.1% RR: 7.6, OR: 8.2
'Race' = % White % Black % Hispanic % Other	56.7% 28.4% 8.8% 6.1%	95.3% 0.7% 1.3% 2.8%	74.7% 8.7% 11.5% 5.2%	69.4% 9.2% 17.6% 3.8%	95.2% 0.7% 1.2% 2.9%
Data Source: Centers for Disease Control and Prevention (2011) * Combined Surveys: 2001, 2003, 2005, 2007, 2009, Years Specified. Basic RRs (Risk Ratios) & ORs (Odds Ratios): Calculated from Given Percentages at: http://statpages.org/ctab2x2.html RR & OR Statistical Significance Determination: If the Given 95% Confidence Intervals - Not Shown - for Two Compared Incidences do not Overlap. Not Statistically Significant RR & OR Indicated with "ns".

Increasing Risk for the More Serious Suicide Problems in the Past Year Youth Risk Behaviour Survey Results Based on Self-Identification American Cities That Solicited Related Data in 2001-2009 Surveys, Combined * Gay / Lesbian vs. Heterosexual Incidences: Males & Females, Combined
Survey -> / Suicide Behaviour Category	Boston 2001 to 2009 Gay / Lesbian (n = 79, 1.1%) vs. Heterosexual (n = 6,792, 93.4%)	Chicago 2003, 05, 07, 09 Gay / Lesbian (n = 102, 2.6%) vs. Heterosexual (n = 3,534, 90.5%)	New York 2005, 07, 09 Gay / Lesbian (n = 468, 1.4%) vs. Heterosexual (n = 24,553, 91.2%)	San Francisco 2001, 05, 07, 09 Gay / Lesbian (n = 121, 1.4%) vs. Heterosexual (n = 7,546, 90.3%)
Suicide Seriously Considered	20.4% vs. 11.7% RR: 1.7, OR: 1.9 ns	30.0% vs. 11.9% RR: 2.5, OR: 3.2	29.7% vs. 11.8% RR: 2.5, OR: 3.1	18.8% vs. 12.1% RR: 1.5, OR: 1.7 ns
Suicide Planned	20.2% vs. 10.7% RR: 1.9, OR: 2.1	18.8% vs. 9.4% RR: 2.0, OR: 2.2	21.2% vs. 10.0% RR: 2.1, OR: 2.4	20.6% vs. 11.9% RR: 1.7, OR: 1.9
Attempted Suicide	34.3% vs. 8.9% RR: 3.8, OR: 5.3	32.6% vs. 9.6% RR: 3.4, OR: 4.5	21.5% vs. 7.2% RR: 3.0, OR: 3.5	15.1% vs. 7.3% RR: 2.1, OR: 2.3
Suicide Attempt(s) & Medical Care	15.7% vs. 3.0% RR: 5.2, OR: 6.0	9.9% vs. 3.4% RR: 2.9, OR: 3.1	7.8% vs. 2.1% RR: 3.7, OR: 3.9	7.0% vs. 2.2% RR: 3.2, OR: 3.3
'Race' = % White % Black % Hispanic % Other	15.4% 46.4% 29.1% 9.2%	9.9% 50.4% 35.5% 4.2%	11.9% 34.9% 36.1% 17.1%	8.1% 11.4% 19.8% 60.7%
Data Source: Centers for Disease Control and Prevention (2011) * Combined Surveys: 2001, 2003, 2005, 2007, 2009, Years Specified. Basic RRs (Risk Ratios) & ORs (Odds Ratios): Calculated from Given Percentages at: http://statpages.org/ctab2x2.html RR & OR Statistical Significance Determination: If the Given 95% Confidence Intervals - Not Shown - for Two Compared Incidences do not Overlap. Not Statistically Significant RR & OR Indicated with "ns".

Increasing Risk for the More Serious Suicide Problems in the Past Year Youth Risk Behaviour Survey Results Based on Self-Identification American Cities That Solicited Related Data in 2001-2009 Surveys, Combined * Bisexual vs. Heterosexual Incidences: Males & Females, Combined
Survey -> / Suicide Behaviour Category	Boston 2001 to 2009 Bisexual (n = 215, 2.9%) vs. Heterosexual (n = 6,792, 93.4%)	Chicago 2003, 05, 07, 09 Bisexual (n = 148, 3.7%) vs. Heterosexual (n = 3,534, 90.5%)	New York 2005, 07, 09 Bisexual (n = 1,353, 4.3%) vs. Heterosexual (n = 24,553, 91.2%)	San Francisco 2001, 05, 07, 09 Bisexual (n = 296, 3.7%) vs. Heterosexual (n = 7,546, 90.3%)
Suicide Seriously Considered	40.5% vs. 11.7% RR: 3.5, OR: 5.2	35.4% vs. 11.9% RR: 3.0, OR: 4.1	40.5% vs. 11.8% RR: 3.4, OR: 5.1	38.8% vs. 12.1% RR: 3.2, OR: 4.6
Suicide Planned	34.5% vs. 10.7% RR: 3.2, OR: 4.4	30.0% vs. 9.4% RR: 3.2, OR: 4.1	34.8% vs. 10.0% RR: 3.5, OR: 4.8	35.8% vs. 11.9% RR: 3.0, OR: 4.1
Attempted Suicide	28.9% vs. 8.9% RR: 3.2, OR: 4.2	26.3% vs. 9.6% RR: 2.7, OR: 3.4	30.5% vs. 7.2% RR: 4.2, OR: 5.7	24.7% vs. 7.3% RR: 3.4, OR: 4.2
Suicide Attempt(s) & Medical Care	13.0% vs. 3.0% RR: 4.3, OR: 4.8	11.3% vs. 3.4% RR: 3.3, OR: 3.6	8.3% vs. 2.1% RR: 3.9, OR: 4.2	12.1% vs. 2.2% RR: 5.5, OR: 6.1
'Race' = % White % Black % Hispanic % Other	15.4% 46.4% 29.1% 9.2%	9.9% 50.4% 35.5% 4.2%	11.9% 34.9% 36.1% 17.1%	8.1% 11.4% 19.8% 60.7%
Data Source: Centers for Disease Control and Prevention (2011) * Combined Surveys: 2001, 2003, 2005, 2007, 2009, Years Specified. Basic RRs (Risk Ratios) & ORs (Odds Ratios): Calculated from Given Percentages at: http://statpages.org/ctab2x2.html RR & OR Statistical Significance Determination: If the Given 95% Confidence Intervals - Not Shown - for Two Compared Incidences do not Overlap. Not Statistically Significant RR & OR Indicated with "ns".

Increasing Risk for the More Serious Suicide Problems in the Past Year Youth Risk Behaviour Survey Results Based on Self-Identification American Cities That Solicited Related Data in 2001-2009 Surveys, Combined * "Not Sure" vs. Heterosexual Incidences: Males & Females, Combined
Survey -> / Suicide Behaviour Category	Boston 2001 to 2009 "Not Sure" (n = 184, 2.5%) vs. Heterosexual (n = 6,792, 93.4%)	Chicago 2003, 05, 07, 09 "Not Sure" (n = 115, 3.2%) vs. Heterosexual (n = 3,534, 90.5%)	New York 2005, 07, 09 "Not Sure" (n = 786, 3.2%) vs. Heterosexual (n = 24,553, 91.2%)	San Francisco 2001, 05, 07, 09 "Not Sure" (n = 368, 4.7%) vs. Heterosexual (n = 7,546, 90.3%)
Suicide Seriously Considered	19.8% vs. 11.7% RR: 1.7, OR: 1.9	20.9% vs. 11.9% RR: 1.8, OR: 2.0	26.5% vs. 11.8% RR: 2.2, OR: 2.7	17.5% vs. 12.1% RR: 1.4, OR: 1.5
Suicide Planned	19.9% vs. 10.7% RR: 1.9, OR: 2.1	20.9% vs. 9.4% RR: 2.2, OR: 2.5	20.7% vs. 10.0% RR: 2.1, OR: 2.3	17.8% vs. 11.9% RR: 1.5, OR: 1.6
Attempted Suicide	21.8% vs. 8.9% RR: 2.4, OR: 2.8	18.5% vs. 9.6% RR: 1.9, OR: 2.1	18.3% vs. 7.2% RR: 2.5, OR: 2.9	13.0% vs. 7.3% RR: 1.8, OR: 1.9
Suicide Attempt(s) & Medical Care	10.3% vs. 3.0% RR: 3.4, OR: 3.7	6.8% vs. 3.4% RR: 2.0, OR: 2.1 ns	6.7% vs. 2.1% RR: 3.2, OR: 3.3	4.4% vs. 2.2% RR: 2.0, OR: 2.0 ns
'Race' = % White % Black % Hispanic % Other	15.4% 46.4% 29.1% 9.2%	9.9% 50.4% 35.5% 4.2%	11.9% 34.9% 36.1% 17.1%	8.1% 11.4% 19.8% 60.7%
Data Source: Centers for Disease Control and Prevention (2011) * Combined Surveys: 2001, 2003, 2005, 2007, 2009, Years Specified. Basic RRs (Risk Ratios) & ORs (Odds Ratios): Calculated from Given Percentages at: http://statpages.org/ctab2x2.html RR & OR Statistical Significance Determination: If the Given 95% Confidence Intervals - Not Shown - for Two Compared Incidences do not Overlap. Not Statistically Significant RR & OR Indicated with "ns".

Increasing Risk for the More Serious Suicide Problems in the Past Year Youth Risk Behaviour Survey Results Based on Sex of Sex Partner(s) American States That Solicited Related Data in 2001-2009 Surveys, Combined * "Only Same-Sex Sex Partner(s)" (OSSSP) vs. "Only Opposite-Sex Sex Partner(s)" (OOSSP) Incidences: Males & Females, Combined
Survey -> / Suicide Behaviour Category	Conn. 2007, 09 OSSSP (n = 104, 2.5%) vs. OOSSP (n = 2,229, 52.9%)	Del. 2003 to 09 OSSSP (n = 100, 1.0%) vs. OOSSP (n = 5,497, 53.6%)	Maine 2001 to 07 OSSSP (n = 137, 2.4%) vs. OOSSP (n = 2,668, 51.7%)	Mass. 2001 to 09 OSSSP (n = 340, 2.1%) vs. OOSSP (n = 8,634, 53.3%)	R.I. 2007, 09 OSSSP (n = 159, 2.7%) vs. OOSSP (n = 2,915, 56.0%)	Vt. 2001 to 09 OSSSP (n = 246, 0.7%) vs. OOSSP (n = 13,638, 39.0%)	Wis. 2007, 09 OSSSP (n = 82, 1.9%) vs. OOSSP (n = 2,436, 54.7%)
Suicide Seriously Considered	22.1% vs. 14.4% RR: 1.5, OR: 1.7 ns	27.8% vs. 13.7% RR: 2.0, OR: 2.4	19.7% vs. 15.9% RR: 1.2, OR: 1.3 ns	25.3% vs. 16.4% RR: 1.5, OR: 1.7	19.4% vs. 12.4% RR: 1.6, OR: 1.7	---% vs. ---% RR: ---, OR: ---	30.8% vs. 15.6% RR: 2.0, OR: 2.4
Suicide Planned	20.9% vs. 9.8% RR: 2.1, OR: 2.4	28.2% vs. 10.6% RR: 2.7, OR: 3.3	16.9% vs. 14.3% RR: 1.2, OR: 1.2 ns	19.2% vs. 13.2% RR: 1.4, OR: 1.6	20.0% vs. 10.9% RR: 1.8, OR: 2.0	32.5% vs. 14.1% RR: 2.3, OR: 2.9	24.9% vs. 10.7% RR: 2.3, OR: 2.8
Attempted Suicide	19.5% vs. 8.2% RR: 2.4, OR: 2.7	19.0% vs. 8.0% RR: 2.4, OR: 2.7	13.1% vs. 7.7% RR: 1.7, OR: 1.8 ns	21.1% vs. 8.5% RR: 2.5, OR: 2.9	16.5% vs. 8.2% RR: 2.0, OR: 2.2	20.4% vs. 8.3% RR: 2.5, OR: 2.8	19.8% vs. 6.7% RR: 2.9, OR: 3.4
Suicide Attempt(s) & Medical Care	3.3% vs. 3.0% RR: 1.1, OR: 1.1 ns	8.4% vs. 2.6% RR: 3.2, OR: 3.4	4.2% vs. 2.7% RR: 1.6, OR: 1.6 ns	8.5% vs. 3.1% RR: 2.7, OR: 2.9	11.6% vs. 3.6% RR: 3.2, OR: 3.5	9.2% vs. 2.9% RR: 3.2, OR: 3.4	8.1% vs. 2.1% RR: 3.9, OR: 4.1
OSSSP, Identity = %Heterosexual % Gay/Lesbian % Bisexual % Unsure	NA	17.0% 60.0% 19.3% 3.7%	74.3% 10.8% 14.2% 0.7%	66.5% 19.0% 11.4% 3.2%	59.5% 24.1% 11.3% 5.1%	24.5% 46.7% 22.3% 6.5%	NA
'Race' = % White % Black % Hispanic % Other	68.2% 13.7% 14.4% 3.7%	56.7% 28.4% 8.8% 6.1%	95.3% 0.7% 1.3% 2.8%	74.7% 8.7% 11.5% 5.2%	69.4% 9.2% 17.6% 3.8%	95.2% 0.7% 1.2% 2.9%	79.8% 9.4% 5.8% 5.1%
Data Source: Centers for Disease Control and Prevention (2011) * Combined Surveys: 2001, 2003, 2005, 2007, 2009, Years Specified. Basic RRs (Risk Ratios) & ORs (Odds Ratios): Calculated from Given Percentages at: http://statpages.org/ctab2x2.html RR & OR Statistical Significance Determination: If the Given 95% Confidence Intervals - Not Shown - for Two Compared Incidences do not Overlap. Not Statistically Significant RR & OR Indicated with "ns".

Increasing Risk for the More Serious Suicide Problems in the Past Year Youth Risk Behaviour Survey Results Based on Sex of Sex Partner(s) American States That Solicited Related Data in 2001-2009 Surveys, Combined * "Both-Sex Sex Partners" (BSSP) vs. "Only Opposite-Sex Sex Partner(s)" (OOSSP) Incidences: Males & Females, Combined
Survey -> / Suicide Behaviour Category	Conn. 2007, 09 BSSP (n = 215, 4.8%) vs. OOSSP (n = 2,229, 52.9%)	Del. 2003 to 09 BSSP (n = 293, 2.8%) vs. OOSSP (n = 5,497, 53.6%)	Maine 2001 to 07 BSSP (n = 178, 3.0%) vs. OOSSP (n = 2,668, 51.7%)	Mass. 2001 to 09 BSSP (n = 563, 3.4%) vs. OOSSP (n = 8,634, 53.3%)	R.I. 2007, 09 BSSP (n = 258, 4.9%) vs. OOSSP (n = 2,915, 56.0%)	Vt. 2001 to 09 BSSP (n = 827, 2.0%) vs. OOSSP (n = 13,638, 39.0%)	Wis. 2007, 09 BSSP (n = 167, 3.6%) vs. OOSSP (n = 2,436, 54.7%)
Suicide Seriously Considered	43.3% vs. 14.4% RR: 3.0, OR: 4.5	44.7% vs. 13.7% RR: 3.3, OR: 5.1	44.3% vs. 15.9% RR: 2.8, OR: 4.2	46.4% vs. 16.4% RR: 2.8, OR: 4.4	38.0% vs. 12.4% RR: 3.1, OR: 4.3	---% vs. ---% RR: ---, OR: ---	45.6% vs. 15.6% RR: 2.9, OR: 4.5
Suicide Planned	37.2% vs. 9.8% RR: 3.8, OR: 5.4	35.3% vs. 10.6% RR: 3.3, OR: 4.6	35.4% vs. 14.3% RR: 2.5, OR: 3.3	37.9% vs. 13.2% RR: 2.9, OR: 4.0	35.8% vs. 10.9% RR: 3.3, OR: 4.6	45.8% vs. 14.1% RR: 3.2, OR: 5.1	35.2% vs. 10.7% RR: 3.3, OR: 4.5
Attempted Suicide	29.7% vs. 8.2% RR: 3.6, OR: 4.7	35.7% vs. 8.0% RR: 3.5, OR: 6.4	28.9% vs. 7.7% RR: 3.7, OR: 4.9	30.7% vs. 8.5% RR: 3.6, OR: 4.8	29.9% vs. 8.2% RR: 3.6, OR: 4.8	40.7% vs. 8.3% RR: 4.9, OR: 7.6	27.7% vs. 6.7% RR: 4.1, OR: 5.3
Suicide Attempt(s) & Medical Care	12.8% vs. 3.0% RR: 4.3, OR: 4.7	15.6% vs. 2.6% RR: 6.0, OR: 6.0	15.9% vs. 2.7% RR: 5.9, OR: 6.8	13.5% vs. 3.1% RR: 4.3, OR: 4.9	8.2% vs. 3.6% RR: 2.3, OR: 2.4 ns	21.9% vs. 2.9% RR: 7.5, OR: 9.4	14.7% vs. 2.1% RR: 7.0, OR: 8.0
BSSP, Identity = %Heterosexual % Gay/Lesbian % Bisexual % Unsure	NA	17.3% 14.7% 61.9% 6.1%	63.4% 2.3% 24.9% 9.4%	36.5% 9.9% 44.0% 9.6%	32.1% 5.5% 51.8% 10.6%	27.3% 10.2% 51.9% 10.7%	NA
'Race' = % White % Black % Hispanic % Other	68.2% 13.7% 14.4% 3.7%	56.7% 28.4% 8.8% 6.1%	95.3% 0.7% 1.3% 2.8%	74.7% 8.7% 11.5% 5.2%	69.4% 9.2% 17.6% 3.8%	95.2% 0.7% 1.2% 2.9%	79.8% 9.4% 5.8% 5.1%
Data Source: Centers for Disease Control and Prevention (2011) * Combined Surveys: 2001, 2003, 2005, 2007, 2009, Years Specified. Basic RRs (Risk Ratios) & ORs (Odds Ratios): Calculated from Given Percentages at: http://statpages.org/ctab2x2.html RR & OR Statistical Significance Determination: If the Given 95% Confidence Intervals - Not Shown - for Two Compared Incidences do not Overlap. Not Statistically Significant RR & OR Indicated with "ns".

Increasing Risk for the More Serious Suicide Problems in the Past Year Youth Risk Behaviour Survey Results Based on Sex of Sex Partner(s) American Cities That Solicited Related Data in 2001-2009 Surveys, Combined * "Only Same-Sex Sex Partner(s)" (OSSSP) vs. "Only Opposite-Sex Sex Partner(s)" (OOSSP) Incidences: Males & Females, Combined
Survey -> / Suicide Behaviour Category	Boston 2001 to 09 OSSSP (n = 183, 2.7%) vs. OOSSP (n = 3,834, 57.3%)	Chicago 2003 to 09 OSSSP (n = 119, 3.2%) vs. OOSSP (n = 2,195, 56.5%)	Milwaukee 2007, 09 OSSSP (n = 133, 3.9%) vs. OOSSP (n = 2,145, 60.9%)	New York 2005, 07, 09 OSSSP (n = 743, 2.5%) vs. OOSSP (n = 13,815, 49.3%)	San Diego 2001, 03, 05 OSSSP (n = 83, 1.7%) vs. OOSSP (n = 1,904, 37.2%)
Suicide Seriously Considered	17.8% vs. 11.7% RR: 1.5, OR: 1.6	27.5% vs. 12.8% RR: 2.1, OR: 2.6	17.3% vs. 11.8% RR: 1.5, OR: 1.6	27.5% vs. 14.3% RR: 1.9, OR: 2.3	45.5% vs. 23.6% RR: 1.9, OR: 2.7
Suicide Planned	19.5% vs. 11.1% RR: 1.8, OR: 1.9	11.4% vs. 10.5% RR: 1.1, OR: 1.1 ns	19.4% vs. 10.5% RR: 1.8, OR: 2.0	19.2% vs. 12.1% RR: 1.6, OR: 1.7	31.5% vs. 18.7% RR: 1.7, OR: 2.0
Attempted Suicide	22.8% vs. 9.6% RR: 2.4, OR: 2.8	23.3% vs. 11.2% RR: 2.1, OR: 2.4	15.8% vs. 10.6% RR: 1.5, OR: 1.6	18.7% vs. 9.6% RR: 1.9, OR: 2.2	26.0% vs. 14.4% RR: 1.8, OR: 2.1
Suicide Attempt(s) & Medical Care	7.8% vs. 3.3% RR: 2.4, OR: 2.5 ns	6.5% vs. 4.3% RR: 1.5, OR:1.5 ns	5.3% vs. 4.2% RR: 1.3, OR: 1.3 ns	6.6% vs. 2.7% RR: 2.4, OR: 2.5	6.3% vs. 4.6% RR: 1.4, OR: 1.6 ns
OSSSP, Identity = % Heterosexual % Gay/Lesbian % Bisexual % Unsure	77.8% 13.4% 6.6% 2.3%	49.4% 33.4% 10.6% 6.6%	NA	63.9% 19.3% 10.3% 6.5%	NA
'Race' = % White % Black % Hispanic % Other	15.4% 46.4% 29.1% 9.2%	9.9% 50.4% 35.5% 4.2%	13.4% 63.5% 17.7% 5.4%	11.9% 34.9% 36.1% 17.1%	27.5% 14.1% 40.4% 18.0%
Data Source: Centers for Disease Control and Prevention (2011) * Combined Surveys: 2001, 2003, 2005, 2007, 2009, Years Specified. Basic RRs (Risk Ratios) & ORs (Odds Ratios): Calculated from Given Percentages at: http://statpages.org/ctab2x2.html RR & OR Statistical Significance Determination: If the Given 95% Confidence Intervals - Not Shown - for Two Compared Incidences do not Overlap. Not Statistically Significant RR & OR Indicated with "ns".

Increasing Risk for the More Serious Suicide Problems in the Past Year Youth Risk Behaviour Survey Results Based on Sex of Sex Partner(s) American Cities That Solicited Related Data in 2001-2009 Surveys, Combined * "Both-Sex Sex Partner(s)" (BSSP) vs. "Only Opposite-Sex Sex Partner(s)" (OOSSP) Incidences: Males & Females, Combined
Survey -> / Suicide Behaviour Category	Boston 2001 to 09 BSSP (n = 193, 2.8%) vs. OOSSP (n = 3,834, 57.3%)	Chicago 2003 to 09 BSSP (n = 129, 3.1%) vs. OOSSP (n = 2,195, 56.5%)	Milwaukee 2007, 09 BSSP (n = 189, 4.9%) vs. OOSSP (n = 2,145, 60.9%)	New York 2005, 07, 09 BSSP (n = 1,169,4.0%) vs. OOSSP (n = 13,815, 49.3%)	San Diego 2001, 03, 05 BSSP (n = 100, 1.9%) vs. OOSSP (n = 1,904, 37.2%)
Suicide Seriously Considered	38.3% vs. 11.7% RR: 3.3, OR: 4.7	36.0% vs. 12.8% RR: 2.8, OR: 3.8	47.9% vs. 11.8% RR: 4.1, OR: 6.9	36.5% vs. 14.3% RR: 2.5, OR: 3.4	56.4% vs. 23.6% RR: 2.4, OR: 4.2
Suicide Planned	28.0% vs. 11.1% RR: 2.5, OR: 3.1	26.3% vs. 10.5% RR: 2.5, OR: 3.0	36.9% vs. 10.5% RR: 3.5, OR: 5.0	33.5% vs. 12.1% RR: 2.8, OR: 3.7	48.8% vs. 18.7% RR: 2.6, OR: 4.1
Attempted Suicide	27.7% vs. 9.6% RR: 2.9, OR: 3.6	20.2% vs. 11.2% RR: 1.8, OR: 2.0 ns	43.7% vs. 10.6% RR: 4.1, OR: 6.5	27.7% vs. 9.6% RR: 2.9, OR: 3.6	42.9% vs. 14.4% RR: 3.0, OR: 4.5
Suicide Attempt(s) & Medical Care	17.6% vs. 3.3% RR: 5.3, OR: 6.3	7.4% vs. 4.3% RR: 1.7, OR:1.8 ns	14.2% vs. 4.2% RR: 3.4, OR: 3.8	9.8% vs. 2.7% RR: 3.6, OR: 3.9	20.3% vs. 4.6% RR: 4.4, OR: 5.3
BSSP, Identity = % Heterosexual % Gay/Lesbian % Bisexual % Unsure	35.5% 8.3% 49.0% 7.2%	22.0% 11.6% 50.5% 15.9%	NA	27.5% 6.6% 51.4% 14.6%	NA
'Race' = % White % Black % Hispanic % Other	15.4% 46.4% 29.1% 9.2%	9.9% 50.4% 35.5% 4.2%	13.4% 63.5% 17.7% 5.4%	11.9% 34.9% 36.1% 17.1%	27.5% 14.1% 40.4% 18.0%
Data Source: Centers for Disease Control and Prevention (2011) * Combined Surveys: 2001, 2003, 2005, 2007, 2009, Years Specified. Basic RRs (Risk Ratios) & ORs (Odds Ratios): Calculated from Given Percentages at: http://statpages.org/ctab2x2.html RR & OR Statistical Significance Determination: If the Given 95% Confidence Intervals - Not Shown - for Two Compared Incidences do not Overlap. Not Statistically Significant RR & OR Indicated with "ns".

Increasing Risk for the More Serious Suicide Problems in the Past Year Youth Risk Behaviour Survey Results: Using Median Incidence Estimates For American States & Cities That Solicited Sexual Orientation Related Data in 2001-2009 Surveys, Combined * - Males & Females, Combined**
Survey -> / Suicide Behaviour Category	Gay/Lesbian vs. Hetero- sexual: Median Incidences For 5 State and 4 City Surveys	Bisexual vs. Hetero- sexual: Median Incidences For 5 State and 4 City Surveys	"Not Sure" vs. Hetero- sexual: Median Incidences For 5 State and 4 City Surveys	* OSSSP vs. OOSSP: Median Incidences** For 7 State and 5 City Surveys	* BSSP vs. OOSSP: Median Incidences** For 7 State and 5 City Surveys
Suicide Seriously Considered	29.6% vs. 11.7% RR: 2.5, OR: 3.2	40.3% vs. 11.7% RR: 3.4, OR: 5.1	23.7% vs. 11.7% RR: 2.0, OR: 2.3	25.3% vs. 14.3% RR: 1.8, OR: 2.0	44.3% vs. 14.3% RR: 3.1, OR: 4.8
Suicide Planned	21.2% vs. 10.0% RR: 2.1, OR: 2.4	35.7% vs. 10.0% RR: 3.6, OR: 5.0	20.9% vs. 10.0% RR: 2.1, OR: 2.4	19.7% vs. 11.0% RR: 1.8, OR: 2.0	35.6% vs. 11.0% RR: 3.2, OR: 4.5
Attempted Suicide	25.8% vs. 6.4% RR: 4.0, OR: 5.1	28.0% vs. 6.4% RR: 4.4, OR: 5.7	18.5% vs. 6.4% RR: 2.9, OR: 3.3	19.7% vs. 8.4% RR: 2.3, OR: 2.7	29.8% vs. 8.4% RR: 3.5, OR: 4.6
Suicide Attempt(s) & Medical Care	12.6% vs. 2.2% RR: 5.7, OR: 6.4	11.3% vs. 2.2% RR: 5.1, OR: 5.7	8.4% vs. 2.2% RR: 3.8, OR: 4.1	7.2% vs. 3.0% RR: 2.4, OR: 2.5	14.5% vs. 3.0% RR: 4.8, OR: 5.5
Data Source: Centers for Disease Control and Prevention (2011) * Combined Surveys: 2001, 2003, 2005, 2007, 2009 - Not All Years May be Represented. Basic RRs (Risk Ratios) & ORs (Odds Ratios): Calculated from Given Percentages at: http://statpages.org/ctab2x2.html Note: These results - obtained via using the median incidence values reported by the CDC - represent a 'ballpark' estimate. The most appropriate method available to average incidences in many studies - and also produce 95% Confidence Intervals - is by using meta-analyses. * OSSSP: Only Same-Sex Sex Partner(s). - OOSSP: Only Opposite-Sex Sex Partner(s). - BSSP: Both-Sex Sex Partners.

Increasing Risk for the More Serious Suicide Problems in the Past Year Youth Risk Behaviour Survey Results: Using Median Incidence Estimates For American States That Solicited Sexual Orientation Related Data in 2001-2009 Surveys, Combined * - Males & Females, Combined**
Survey -> / Suicide Behaviour Category	Gay/Lesbian vs. Hetero- sexual: Median Incidences For 5 State Surveys	Bisexual vs. Hetero- sexual: Median Incidences For 5 State Surveys	"Not Sure" vs. Hetero- sexual: Median Incidences For 5 State Surveys	* OSSSP vs. OOSSP: Median Incidences For 7 State Surveys**	* BSSP vs. OOSSP: Median Incidences For 7 State Surveys**
Suicide Seriously Considered	32.4% vs. 10.5% RR: 3.1, OR: 4.1	43.1% vs. 10.5% RR: 4.1, OR: 6.5	28.3% vs. 10.5% RR: 2.7, OR: 3.4	22.1% vs. 15.0% RR: 1.5, OR: 1.6	44.3% vs. 15.0% RR: 2.9, OR: 4.5
Suicide Planned	31.7% vs. 9.6% RR: 3.3, OR: 4.4	36.4% vs. 9.6% RR: 3.8, OR: 5.4	24.6% vs. 9.6% RR: 2.6, OR: 3.1	20.9% vs. 10.9% RR: 1.9, OR: 2.2	35.4% vs. 10.9% RR: 3.2, OR: 4.5
Attempted Suicide	25.8% vs. 5.7% RR: 4.5, OR: 5.7	28.0% vs. 5.7% RR: 4.9, OR: 6.4	20.7% vs. 5.7% RR: 3.6, OR: 4.3	19.5% vs. 8.2% RR: 2.3, OR: 2.7	29.9% vs. 8.2% RR: 3.6, OR: 4.8
Suicide Attempt(s) & Medical Care	12.1% vs. 1.5% RR: 8.1, OR: 9.0	11.7% vs. 1.5% RR: 7.8, OR: 8.7	6.7% vs. 1.5% RR: 4.5, OR: 4.7	8.4% vs. 2.9% RR: 2.9, OR: 3.1	14.7% vs. 2.9% RR: 5.1, OR: 5.8
Identity = % Heterosexual % Gay/Lesbian % Bisexual % Unsure	Does Not Apply			5 of 7 States 17.0% - 74.3% - 66.5% - 59.5% - 24.5% 60.0% - 10.8% - 19.0% - 24.1% - 46.7% 19.3% - 14.2% - 11.4% - 11.3% - 22.3% 3.7% - 0.7% - 3.2% - 5.1% - 6.5%	5 of 7 States 17.3% - 63.4% - 36.5% - 32.1% - 27.3% 14.7% - 2.3% - 9.9% - 5.5% - 10.2% 61.9% - 24.9% - 44.0% - 51.8% - 51.9% 6.1% - 9.4% - 9.6% - 10.6% - 10.7%
'Race' = % White % Black % Hispanic % Other	'Race' - 5 States 56.7% - 95.3% - 74.7% - 69.4% - 95.2% 28.4% - 0.70% - 8.70% - 9.20% - 0.70% 8.80% - 1.30% - 11.5% - 17.6% - 1.20% 6.10% - 2.80% - 5.20% - 3.80% - 2.90% Delaware, Massachusetts, Rhode Island, Vermont Mostly White			'Race' - 7 States 68.2% - 56.7% - 95.3% - 74.7% - 69.4% - 95.2% - 79.8% 13.7% - 28.4% - 0.70% - 8.70% - 9.20% - 0.70% - 9.40% 14.4% - 8.80% - 1.30% - 1.5% - 17.6% - 1.20% - 5.8% 3.70% - 6.10% - 2.80% - 5.20% - 3.80% - 2.90% - 5.10% Conn., Del., Maine, Mass., R.I., Vt., Wis. Mostly White
Data Source: Centers for Disease Control and Prevention (2011) * Combined Surveys: 2001, 2003, 2005, 2007, 2009 - Not All Years May be Represented. Basic RRs (Risk Ratios) & ORs (Odds Ratios): Calculated from Given Percentages at: http://statpages.org/ctab2x2.html Note: These results - obtained via using the median incidence values for American states - represent a 'ballpark' estimate. The most appropriate method available to average incidences in many studies - and also produce 95% Confidence Intervals - is by using meta-analyses. * OSSSP: Only Same-Sex Sex Partner(s). - OOSSP: Only Opposite-Sex Sex Partner(s). - BSSP: Both-Sex Sex Partners.

Increasing Risk for the More Serious Suicide Problems in the Past Year Youth Risk Behaviour Survey Results: Using Median Incidence Estimates For American Cities That Solicited Sexual Orientation Related Data in 2001-2009 Surveys, Combined * - Males & Females, Combined**
Survey -> / Suicide Behaviour Category	Gay/Lesbian vs. Hetero- sexual: Median Incidences for 4 City Surveys	Bisexual vs. Hetero- sexual: Median Incidences for 4 City Surveys	"Not Sure" vs. Hetero- sexual: Median Incidences For 4 City Surveys	* OSSSP vs. OOSSP: Median Incidences** For 5 City Surveys	* BSSP vs. OOSSP: Median Incidences** For 5 City Surveys
Suicide Seriously Considered	25.0% vs. 11.8% RR: 2.1, OR: 2.5	37.9% vs. 11.8% RR: 3.2, OR: 4.6	20.3% vs. 11.8% RR: 1.7, OR: 1.9	27.5% vs. 12.8% RR: 2.1, OR: 2.6	38.3% vs. 12.8% RR: 3.0, OR: 4.2
Suicide Planned	20.4% vs. 10.3% RR: 2.0, OR: 2.2	34.6% vs. 10.3% RR: 3.4, OR: 4.6	20.3% vs. 10.3% RR: 2.0, OR: 2.2	19.4% vs. 11.1% RR: 1.7, OR: 1.9	33.5% vs. 11.1% RR: 3.0, OR: 4.0
Attempted Suicide	27.0% vs. 8.1% RR: 3.3, OR: 4.2	27.6% vs. 8.1% RR: 3.4, OR: 4.3	18.4% vs. 8.1% RR: 2.3, OR: 2.6	22.8% vs. 10.6% RR: 2.1, OR: 2.5	27.7% vs. 10.6% RR: 2.6, OR: 3.2
Suicide Attempt(s) & Medical Care	8.8% vs. 2.6% RR: 3.4, OR: 3.6	11.7% vs. 2.6% RR: 4.5, OR: 5.0	6.7% vs. 2.6% RR: 2.6, OR: 2.7	6.5% vs. 4.2% RR: 1.5, OR: 1.6	14.2% vs. 4.2% RR: 3.4, OR: 3.8
Identity = % Heterosexual % Gay/Lesbian % Bisexual % Unsure	Does Not Apply	Does Not Apply	Does Not Apply	OSSSP Identity 77.8%- 49.4%- 63.9% 13.4% - 33.4% - 19.3% 6.60% - 10.6% - 10.3% 2.30% - 6.60% - 6.50%	BSSP Identity 35.5% - 22.0% - 27.5% 8.30% - 11.6% - 6.60% 49.0%- 50.5%- 51.4% 7.20% - 15.9% - 14.6%
'Race' = % White % Black % Hispanic % Other	'Race' - 4 Cities 15.4% - 9.90% - 11.9% - 8.10% 46.4% - 50.4% - 34.9% - 11.4% 29.1% - 35.5% - 36.1% - 19.8% 9.20% - 4.20% - 17.1% - 60.7% Boston - Chicago - New York - San Francisco Mostly Black / Hispanic, SF Anomaly: High Asian Population			'Race' - 5 Cities 15.4% - 9.9% - 13.4% - 11.9% - 27.5% 46.4% - 50.4% - 63.5% - 34.9% - 14.1% 29.1% - 35.5% - 17.7% - 36.1% - 40.4% 9.20% - 4.20% - 5.40% - 17.1% - 18.0% Boston - Chicago - Milwaukee - New York - San Diego Mostly Black / Hispanic
Data Source: Centers for Disease Control and Prevention (2011) * Combined Surveys: 2001, 2003, 2005, 2007, 2009 - Not All Years May be Represented. Basic RRs (Risk Ratios) & ORs (Odds Ratios): Calculated from Given Percentages at: http://statpages.org/ctab2x2.html Note: These results - obtained via using the median incidence values for American Cities - represent a 'ballpark' estimate. The most appropriate method available to average incidences in many studies - and also produce 95% Confidence Intervals - is by using meta-analyses. * OSSSP: Only Same-Sex Sex Partner(s). - OOSSP: Only Opposite-Sex Sex Partner(s). - BSSP: Both-Sex Sex Partners.

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Reasons For Living

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Increasing Risk for the More Serious Suicide Problems in the Past Year Youth Risk Behaviour Survey Results Based on Self-Identification as Gay / Lesbian / Bisexual, and/or Same-Sex Sexual Behaviour
Survey -> / Suicide Behaviour Category	Mass. 95 ¹ *GLBN (Gay, Lesbian, Bi- sexual, Not Sure) vs.** Non-GBLN*	Mass. 97 ¹ GLB and/ or Homo-sex Active vs. Heterosexual -Identified	Seattle 95 GLB- Identified vs. Hetero- sexual identified	Vermont 95¹ Males & Females: Homo-sex vs. Hetero-sex active.	Mass. 93¹ Males & Females: Homo-sex vs. Hetero-sex active.	Mass. 01 GLB and/ or Homo-sex Active vs. Heterosexual -Identified
Suicide Seriously Considered	46.4% vs. 24.6% **RR: 1.9	54% vs. 22% RR: 2.5	34.2% vs. 16.7% RR: 2.1	59.2% vs. 37.1% RR: 1.6	41.7% vs. 28.6% RR: 1.5	47% vs. 19% RR: 2.5
Suicide Planned	40.5% vs. 17.5% RR: 2.3	41% vs. 18% RR: 2.3	31.1% vs. 15.7% RR: 2.0	52.8% vs. 28.7% RR: 1.8	29.7% vs. 24.5% RR: 1.2	37% vs. 14% RR: 2.6
Attempted Suicide	36.0% vs. 8.9% RR: 4.0	37% vs. 8% RR: 4.6	20.6% vs. 6.7% RR: 3.1	40.7% vs. 15.2% RR: 2.7	27.5% vs. 13.4% RR: 2.1	31% vs. 8% RR: 3.9
Multiple Attempts	N/A	N/A	N/A	N/A	16.1% vs. 2.0% RR: 8.0 >= 4 Times	N/A
Suicide Attempt(s) & Medical Care	N/A	19% vs. 3% RR: 6.3	9.4% vs. 2.2% RR: 4.3	26.5% vs. 6.2% RR: 4.3	20% vs. 4.7% RR: 4.2	16% vs. 3% RR: 5.4

Dane County, Wisconsin: Grades 7 to 12 In-School 2009 Online Survey - Attempted Suicide, Past Year: Once, More Than Once
Categories	Attempted Suicide (%) Chi Squared p ¹	RR & OR ²	Attempted Suicide Once (%) Chi Squared p ¹	RR & OR ²	Attempted Suicide More Than Once (%) Chi Squared p ¹	RR & OR ²
Straight 94.3% n = 13,267	3.0%	Ref.	2.1%	Ref.	0.9%	Ref.
LGBTQ ² 5.7% n = 803	15.3% p < 0.0001	5.1 5.8	8.8% p < 0.0001	4.2 4.5	6.5% p < 0.0001	7.2 7.6
Gay 0.6% n = 79	16.1% p < 0.0001	5.4 6.3	5.8% p = 0.0552 ns	2.8 2.9	10.3% p < 0.0001	11.4 12.6
Lesbian 0.6% n = 82	16.2% p < 0.0001	5.4 6.2	10.1% p < 0.0001	4.8 5.2	6.1% p = 0.0002	6.8 7.1
Bisexual 2.8% n = 397	21.2% p < 0.0001	7.1 8.7	12.3% p < 0.0001	5.9 6.5	8.9% p < 0.0001	9.9 10.8
Questioning 1.8% n = 249	14.6% p < 0.0001	4.9 5.5	10.4% p < 0.0001	4.9 5.4	4.2% p < 0.0001	4.7 4.8
Transgender 0.8% n = 108	16.6% p < 0.0001	5.5 6.4	3.1% p = 0.4337 ns	1.5 1.5	13.7% p < 0.0001	15.2 17.5
Data Source: Robinson & Espelage (2011) LGBTQ Students account for 23.6% of the suicide attempters & 20.4% of the Multiple Suicide Attempters. 1. Chi Squared "p" as given by study authors: GLBTQ Categories vs. Straight. 2. Approximate Risk Ratios (RR) & Odds Ratios (OR) Calculated on the basis of given percentages at http://statpages.org/ctab2x2.html 3. LGBTQ = 803, but L + G + B + T + Q = 915. Reason: For some (n = 112), More than One Identification.

Dane County, Wisconsin: Grades 7 to 12 In-School 2009 Online Survey - Suicidal Ideation, Past 30 Days: Rarely, Sometimes, All The Time
Categories	Suicide Ideation, Yes (%) Chi Squared p ¹	RR & OR ²	Suicide Ideation, Rarely (%) Chi Squared p ¹	RR & OR ²	Suicide Ideation, Sometimes (%) Chi Squared p ¹	RR & OR ²	Suicide Ideation, Almost All The Time (%) Chi Squared p ¹	RR & OR ²
Straight 94.3% n = 13,267	8.8%	Ref.	6.3%	Ref	1.9%	Ref.	0.6%	Ref.
LGBTQ ² 5.7% n = 803	33.5% p < 0.0001	3.8 5.2	19.1% p < 0.0001	3.0 3.5	8.6% p < 0.0001	4.5 4.9	5.8% p < 0.0001	9.7 10.2
Gay 0.6% n = 79	30.7% p < 0.0001	3.5 4.6	13.4% p = 0.0017	2.1 2.3	9.2% p = 0.0003	4.8 5.2	8.0% p < 0.0001	13.3 14.4
Lesbian 0.6% n = 82	24.7% p < 0.0001	2.8 3.4	11.7% p = 0.0301	1.9 2.0	8.7% p = 0.0009	4.6 4.9	4.3% p < 0.0001	7.2 7.4
Bisexual 2.8% n = 397	44.0% p < 0.0001	5.0 8.1	24.8% p < 0.0001	3.9 4.9	12.2% p < 0.0001	6.4 7.2	7.0% p < 0.0001	11.7 12.5
Questioning 1.8% n = 249	32.1% p < 0.0001	3.6 4.9	18.7% p < 0.0001	3.0 3.4	9.0% p < 0.0001	4.7 5.1	4.5% p < 0.0001	7.5 7.8
Transgender 0.8% n = 108	22.7% p < 0.0001	2.6 3.0	7.9% p = 0.2387 ns	1.2 1.3	2.9% p = 0.3113 ns	1.5 1.5	11.9% p < 0.0001	19.8 22.4
Data Source: Robinson & Espelage (2011)\ LGBTQ Students account for 37.0% of students seriously thinking about killing themselves almost all of the time in the past 30 days. 1. Chi Squared "p" as given by study authors: GLBTQ Categories vs. Straight. 2. Approximate Risk Ratios (RR) & Odds Ratios (OR) Calculated on the basis of given percentages at http://statpages.org/ctab2x2.html 3. LGBTQ = 803, but L + G + B + T + Q = 915. Reason: For some (n = 112), More than One Identification.

New York City 2007 Youth Risk Behavior Survey: Grades 9 to 12 Suicidality, Past Year: Non-Heterosexual vs. Heterosexual ¹
Categories / Variables	Heterosexual % Incidence	GLBU % Incidence	Risk Ratio ²
Seriously Considered Suicide	14%	37%	2.6
Planned Suicide	10%	29%	2.9
Attempted Suicide	8%	31%	3.9
Injured, Poisoned, or Overdosed in an Attempt	2%	9%	4.5
Data Source: Farley et al (2008) Results are reported to be similar in three New York City neighborhoods with high rates of illness and premature death: East and Central Harlem, Bedford-Stuyvesant and Bushwick, and the South Bronx. See Noyes et al. (2008). 1. Males & Females analysed together, but differences possible/expected. All 'Race' groups analyzed together, but differences possible/expected. All Non-Heterosexual Students (GLBU = Gay, Lesbian, Bisexual, Unsure) analyzed together, but differences are possible/expected. 2. The counts are not given for populations or incidences. It is therefore not possible to calculate confidence intervals and statistical significance values. However, it can be assumed that differences are statistically significant.

British Columbia 1992 Adolescent Health Survey 12-Month Suicidality Risks: Males, Grade 7 to 12
Categories	Homosexual	Bisexual	Homosexual & Bisexual
Categories	Incidences * Risk Ratio 95% CI	Incidences * Risk Ratio 95% CI	Incidences * / Related Counts	Odds Ratio 95% CI	Risk Ratio 95% CI
Consider / Planned Suicide	48.5 vs. 11.2% 4.3 (3.0, 6.2)	30.3 vs. 11.2% 2.7 (2.0, 3.6)	34.5% (49 / 142). vs. 11.2% (752 / 6,714)	4.2 (2.9, 6.0)	3.1 (2.4, 3.9)
Attempted Suicide	40.6 vs. 3.7% 11.0 (7.1, 17.0)	16.4 vs. 3.7% 4.4 (2.8, 6.9)	21.8% (31 / 142) vs. 3.7% (252 / 6,559)	7.3 (4.8, 11.0)	5.9 (4.2, 8.2)
Attempted Suicide & Related Injury	19.4 vs. 1.3% 14.9 (7.0, 31.4)	5.6 vs. 1.3% 4.3 (1.9, 9.6)	13.1% (19 / 145) vs. 1.3% (91 / 7,000)	11.4 (6.8, 19.4)	10.1 (6.3, 16.1)
* Incidences: Homosexual / Bisexual / Homosexual & Bisexual versus Heterosexual Counts for Combined "Homosexual & Bisexual Males" Calculated From Given Information. Minor Errors Are Expected in Counts and Generated Risk/Odds Ratios. Data Source: Rein (1998) - Note 1: Suicidality Questions

USA NHANES Survey: 17 - 39 Years Old Males Risk, Lifetime: Suicide Related Behaviors Homosexual vs. Heterosexual Males
Category	Odd Ratios, 95% CI No Control Variables	Odd Ratios. 95% CI Control Variables**
Thoughts of Death ** 38.6% vs. 24.3% RR: 1.6	1.95 (1.05, 3.63)*	1.86 (0.97, 3.57)
Desire to Die 18.5% vs. 7.6% RR: 2.4	2.18 (1.23, 6.32)*	2.47 (1.01, 6.05)*
Suicide Ideation 41.2% vs. 17.2% RR: 2.4	3.38 (1.80, 6.32)*	3.11 (1.56, 6.19)*
Attempted Suicide 19.3% vs. 3.6% RR: 5.4	6.45 (2.74, 15.23)*	5.36 (2.21, 12.98)*
** Control Variables: Age, Race/Ethnicity, Family Income, * p < 0.05 Incidence For Variable, Homosexual vs. Heterosexual, RR = Risk Ratio, No Controls Data Source: Cochran SD, Mays VM (2000)**

Netherlands' NEMESIS Survey: 18 - 64 Years Old Males Risk, Lifetime: Suicide Related Behaviors Homosexual vs. Heterosexual Males
Category	Odd Ratios, 95% CI Control Variable: Age	Odd Ratios, 95% CI Control Variables: Age + *
Death Thoughts ** 48.8% vs. 26.7% RR: 1.8	2.58 (1.66, 4.01)	1.82 (1.13, 2.92)
Death Wishes 26.8% vs. 5.8% RR: 4.6	5.93 (3.55, 9.92)	3.38 (1.82, 6.67)
Consider Suicide 40.2% vs. 7.8% RR: 5.2	7.74 (4.86, 12.32)	5.72 (3.30, 9.91)
Attempted Suicide 14.6 vs. 1.6 RR: 9.1	10.23 (5.18, 20.20)	5.57 (2.58, 12.04)
Netherlands Mental Health Survey and Incidence Study (NEMESIS) * Control Variables: age, mood, anxiety, substance use, psychotic, and eating disorders Incidence For Variable, Homosexual vs. Heterosexual, RR = Risk Ratio, No Controls Data Source: De Graff et al. (2006)**

Netherland's NEMESIS Survey: 18 - 64 Years Old Females Risk, Lifetime: Suicide Related Behaviors Homosexual vs. Heterosexual Females
Category	Odd Ratios, 95% CI Control Variable: Age	Odd Ratios, 95% CI Control Variables: Age + *
Death Thoughts	1.28 (0.70, 2.34). ns	0.88 (0.46, 1.66), ns
Death Wishes	1.11 (0.47, 2.65), ns	0.61 (0.24, 1.57), ns
Consider Suicide	2.12 (1.03, 4.36)	1.32 (0.59, 2.93), ns
Attempted Suicide	1.52 (0.36, 6.39), ns	0.96 (0.22, 4.26), ns
Netherlands Mental Health Survey and Incidence Study (NEMESIS) * Control Variables: age, mood, anxiety, substance use, psychotic, and eating disorders Data Source: De Graff et al. (2006)

New Zealand Birth Cohort: To 26 Years Old Homosexual vs. Heterosexual*: Males & Females
Category	Males Odd Ratios (95% CI) Unadjusted	Females Odd Ratios (95% CI) Unadjusted
Suicide Ideation (Past Year)	3.1 (1.5, 6.6)	2.9 (1.6, 5.3)
Self-Harm (Ever) **	5.5 (2.8, 11.0)	1.9 (1.1, 3.2)
Attempted Suicide (Ever)	3.2 (1.4, 7.2)	1.4 (0.7, 2.7) n.s.
Injury (Self-Harm, Past Year)	6.4 (3.2, 13.0)	2.1 (0.8, 5.6) n.s.
* Heterosexual = 100% Heterosexual. Homosexual = All Others All Self-Harm, Includes Suicide Attempts. Data Source: Skegg et al. (2003)**

Lifetime Suicidality Risks for Sexual Orientation Discordant American Middle-Aged Male Twins Pairs (N = 206) In The Population-Based Vietnam Era Twin Registry
	Odd Ratio * 95% CI	Odd Ratio 95% CI	Odd Ratio 95% CI	Odd Ratio 95% CI	Odd Ratio 95% CI
Control Variables ->	None	Alcohol Abuse / Dependence	Drug Abuse / Dependence	Depressive Symptoms	All Three
Death Thoughts 47.6% vs. 30.1% ** RR: 1.6	2.4 (1.2, 4.6)	2.4 (1.2, 4.8)	2.2 (1.2, 4.3)	1.9 (1.0, 4.0)	2.1 (1.0, 4.5)
Want To Die 26.2% vs. 9.7% RR: 2.7	4.4 (1.7, 11.6)	4.4 (1.6, 12.1)	3.0 (1.0, 9.3)	3.5 (1.2, 10.1)	2.5 ns (0.7, 8.8)
Suicide Ideation 55.3% vs. 25.2% RR: 2.2	4.1 (2.1, 8.2)	4.1 (2.0, 8.2)	3.8 (1.9, 7.9)	3.7 (1.8, 7.5)	3.6 (1.7, 7.5)
Attempted Suicide 14.7% vs. 3.9% RR: 3.8	6.5 (1.5, 28.8)	5.6 (1.2, 25.7)	6.2 (1.4, 27.7)	25.0 (1.1, 564.8)	--
* Odds Ratios: Homosexual vs. Heterosexual Twins - All Statistically Significant, Except For "ns" Homosexual: Males reporting having had one or more same-sex partner since the age of 18 years. ** Incidence For Variable, 103 Homosexual vs. 103 Heterosexual Males, RR = Risk Ratio Data Source: Herrell et al. (1999)

Suicidality Related Risks for All Middle-Aged Homosexual vs. Heterosexual American Males The Population-Based Vietnam Era Twin Registry
	All Heterosexual Males n = 6,537 Incidence	All Homosexual Males n = 119 Incidence, Risk Ratio	Odd Ratio * 95% CI
Death Thoughts	22.0% 1440 / 6537	47.9% 57 / 119 RR: 2.2	3.3 (2.3, 4.7)
Want To Die	6.7% 441 / 6537	26.1% 31 / 119 RR: 3.9	4.9 (3.2, 7.4)
Suicide Ideation	15.4% 1010 / 6537	55.5% 66 / 119 RR: 3.6	6.8 (4.7, 9.8)
Attempted Suicide	2.2% 146 / 6537	15.2% 18 / 118 RR: 6.9	7.9 (4.6, 13.4)
* Odds Ratios: All Homosexual vs. All Heterosexual Males in Twin Sample, No Control Variables Homosexual: Males reporting having had one or more same-sex partner since the age of 18 years. Data Source: Herrell et al. (1999) - Counts / Incidences / Odds Ratios Calculated From Given Data.

Current Suicidality Risks: Austria Homosexually vs. Heterosexually Oriented Adults
Variable	358 Homosexually Oriented MF* n (%)	267 Heterosexually Oriented MF* n (%)	Odds Ratio
Suicide Ideation	98 (28%)	35 (13%)	2.5 (1.6, 3.9)
Serious Suicide Ideation	65 (18%)	18 (7%)	3.7 (1.8, 5.3)
Aborted Attempts	18 (5%)	2 (1%)	7.1 (1.6, 30.7)
Attempted Suicide	6 (2%)	0 (0.0%)	??
* M = Males - F = Females -- Mean Age = 36.2 Years Austrian Volunteers from GLB Organizations & General Population Groups, Matched for Analysis. Data Source: Ploderl & Fartacek (2005)

Suicidality In Homosexually and Heterosexually Oriented Men and Women ¹ Austria: Ploderl & Fartacek (2005)
Variable	358 GLB ² Men & Women n / %	267 Heterosexual ³ Men & Women n / %	Odds Ratio
Suicide Ideation Lifetime (Minus Last year)	250 / 70%	121 / 45%	2.9 (2.1 - 4.0)
Serious Suicide Ideation Lifetime (Minus Last Year)	179 / 50%	58 / 22%	3.6 (2.5 - 5.2)
Suicide Attempts (Aborted Attempts Removed) "Criterion 2" = Real Attempts Lifetime	34 / 10%	5 / 2%	6.9 (2.4 - 19.6)
Suicide Attempts Requiring Medical care, Lifetime	11 / 3%	1 / 0%	8.4 (1.1 - 65.7)
1. Heterosexual control group was matched on the basis of sex, age, and education. 2. GLB sample obtained via gay and lesbian community organizations. 3. The heterosexual sample was recruited from organizations such as fire departments, the Red Cross of Salzburg, and the University of Salzburg.

"Attempted Suicide" Risks: Austria Homosexually vs. Heterosexually Oriented Adult Plöderl & Fartacek (2009)
Categories	Males			Females
Categories	Homo- / Bi- Sexual N = 70	Hetero- Sexual N = 75	* OR 95% CI p	Homo- / Bi- Sexual N = 72	Hetero- Sexual N = 73	* OR 95% CI p
Lifetime Attempted Suicide ²	5 (7%)	0 (0%)	- 0.024 (F) 0.057 (Y) 0.029 (Y¹)	10 (14%)	3 (4%)	3.8 (1.06, 13.2) 0.046 (F) 0.077 (Y) 0.038 (Y¹)
Males & Females Combined ¹	Homosexual/Bisexual: 15 / 142 = 10.6% vs. Heterosexual: 3/148 = 2.0% *OR: 1.7<5.7<18.8 – p = .003 (F), 0.006 (Y), 0.003 (Y¹)
Lifetime Aborted Attempted Suicide ²	7 (10%)	1 (1%)	8.2 (1.3, 52.3) 0.029 (F) 0.055 (Y) 0.027 (Y¹)	14 (19%)	7 (10%)	2.3 (0.88, 5.86) 0.104 (F)
Males & Females Combined ¹	Homosexual/Bisexual: 21 / 142 = 14.8% vs. Heterosexual: 8 / 148 = 5.4 % * OR: 1.3<3.0<6.7 – p = .010 (F)
p : Fisher Exact (F) - Yates, Corrected, Two-tailed (Y) - Yates, Corrected, One-tailed (Y¹): Calculation by Webpage Author at: http://statpages.org/ctab2x2.html - http://www.graphpad.com/quickcalcs/contingency1.cfm All ORs (Odd Ratios) Calculated by Webpage Author at: http://statpages.org/ctab2x2.html 1. Additions & Calculation by Webpage Author 2. Counts not given in paper. Supplied by Dr. Martin Plöderl

Bibliography