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To Home of: Increasing Awareness of Gay, Lesbian, Bisexual, Transgender, Two Spirit, Queer... Suicide Issues
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Constructing "The Gay Youth Suicide Myth"
Thirty Years of Resisting a Likely Truth
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Suicidality Studies Index: All Studies: The Index. - All Random & Special Sample Studies. - All American & Canadian Studies. - All European Studies. - Transgender Studies. - The Results of Additional School-Based North American Youth Risk Behavior Surveys or Similar Surveys - Random Sampling - are Located at Another Location.

Other Pages: Homosexually Oriented People Are Generally at Greater Risk for the More Serious Suicidal Behaviors. - "Attempting Suicide" as Related To Gender Nonconformity & Transgender Issues. - Bell & Weinberg (1978) Homosexualities Study: "Attempted Suicide" Study Results.

Special Section: The 2013 Paper, "Suicide Risk and Sexual Orientation: A Critical Review," Reverses the Conclusions of Two Previously Published Papers. The Re-Analysis - Including Many Meta-Analyses & Using Unconditional Tests for Statistical Significance - Indicates that "Gay/Lesbian/Bisexual Adolescents Are at Risk for Suicide." - In Addition, Expanding the "At Risk" Category to Include Adolescents Known to Only Have Been Harassed/Abused - Because They Were Assumed to be Gay/Lesbian - Produces More Conclusive Results, Especially Applying for Males. This Category Represents "An Expanded Homosexuality Factor in Adolescent Suicide." - Associated Pages: Constructing "The Gay Youth Suicide Myth": Thirty Years of Resisting a Likely Truth (This Page) & Generating Cohen's Effect Size "h" Via Arcsin / Arcsine Transformations.


This Webpage was developed by Pierre Tremblay, Martin Plöderl and Richard Ramsay.


To 2008
: Almost Nothing Had Been Done To Include Sexual Orientation Issues In Suicide Education / Prevention Efforts.
To 2013: The CDC's Youth Risk Behavior Survey (YRBS) Continues To Omit Sexual Orientation Variables.
To 2012: Only a Small Minority of USA Cities or States Had Added Sexual Orientation Variables to Their YRBS.

Related Study Results (CDC, Summary) Implications: Sexual Orientation Variables Should Never be Omitted From Youth Surveys.
Likely:
Sexual Orientation Variables Should Never be Omitted From Adult Mental Health / Suicidality Surveys / Studies.

[D]epression, suicide and HIV/AIDS were seen as the most important health issues affecting the LGBTI community...
 The health of LGBTI people is rarely considered by mainstream agencies, despite poorer health outcomes. Sensitive and targeted public health
interventions that resonate with the community and that acknowledge the impact of being part of this marginalised group are required.
Comfort J, McCausland K (2013). Health priorities and perceived health determinants among Western Australians attending the 2011 LGBTI Perth Pride Fairday Festival. Health Promotion Journal of Australia, 24(1): 20-5. Abstract.

There was a time, not long ago, when those in the 'helping' professions, including 'mental help' professionals, would have been best described as 'professionals' who were only seeking to help heterosexual people, with a major focus being on harming, as much as possible, non-heterosexual people such as gay, lesbian, bisexual individuals. This was done, for example, when 'mental health' professionals had decreed that homosexual individuals were all mentally disordered and were to be treated (harmed) accordingly. However, even if this 'mental disorder decree for homosexual people' was removed from the American DSM (Diagnostic and Statistical Manual of Mental Disorders) in 1973, the ICD (The International Statistical Classification of Diseases and Related Health Problems) in 1992, with China having done the same only in 2003 (Mental Disorder Redefined, Homosexuality Excluded), these outcomes did not mean that 'mental health' 'professionals' would suddenly / 'magically' become knowledgeable of homosexually oriented people and begin helping. As with racist groups, heterosexist and homophobic groups may take generations to end their abuses of the hated ones, with ongoing more insidious ways developed to continue harming the hated ones. For example, by 1994, ignoring sexual minority issues in American psychology and psychiatry research was the rule as illustrated in a paper titled “"I only read about myself on bathroom walls": the need for research on the mental health of lesbians and gay men” (Rothblum, 1994). By the late 1990s and the early 2000s, the same neglect had been reported in family therapy, psychology, community psychology and social work, as reported here (must scroll). The ongoing inherently harming ways of many / most(?) 'mental health' professionals - as related to sexual minority clients - was documented in New Zealand (Semp, 2006, 2007), and the same is likely happening throughout the western world.

Rothblum ED (1994). "I only read about myself on bathroom walls": the need for research on the mental health of lesbians and gay men. Journal of Consulting and Clinical Psychology, 62(2), 213-20. (PubMed Abstract) Full Text.

Semp, David (2007). A Public Silence: Sexual Orientation and Mental Health Services. Presentation, Mental Health Awareness Week, 2007: Mental Health Foundation of New Zealand. Word Download.

Semp, David (2006). A public silence : discursive practices surrounding homosexuality. PhD Dissertation, The University of Auckland. Download Page. PDF Download: Front Pages. PDF Download: Whole Document.

Contents

  • Part 1: The Corrected Statistical Results for the Savin-Williams 2001 Study: All Male Suicide Attempters.
  • Part 2: The Unreported Statistical Results for Male Suicide Attempters Who Had Received Medical Care.

Dedication

This webpage is 'dedicated' to many mainstream suicidologists who have had a history of ignoring GLBT (Gay, Lesbian, Bisexual & Transgender) issues in their research, education, prevention and intervention activities, even after American studies from the 1970s (studies with control samples) had produced results indicating their higher risk for having attempted suicide.

In this recent document:

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

The section "Lesbian, Gay, Bisexual, and Transgender Populations" (Section in Appendix A) begins with:

"Studies over the last four decades suggest that LGBT individuals may have an elevated risk for suicide ideation and attempts. Attention to this disparity has been limited, in part because neither the U.S. death certificate nor the NVDRS [National Violent Death Reporting System] identify decedents’ sexual orientation or gender identity. Thus, it is not known whether LGBT people die by suicide at higher rates than comparable heterosexual people."

Given that the following paragraph reports on two meta-analyses of numerous major studies - mostly random - that have reported higher incidences for GLB people having attempted suicide, that would establish the "higher risk" to be more of "a fact" than a "may be" situation, it is possible that the first sentence should have been:

'Studies over the last four decades suggest that LGBT individuals may have an elevated risk for suicide.' [i.e. "for suicide" as opposed to "for suicide ideation and attempts."]

Nonetheless, even if the next paragraph begins with "Across many different countries, a strong and consistent relationship between sexual orientation and nonfatal suicidal behavior has been observed," the first sentence in the section will challenge all readers who may want to accept that this multiple "at risk" reporting - and the meta-analyses results - do represent "a fact."

In spite of the problem noted, the inclusion of GLBT issues in the 2012 National Strategy for Suicide Prevention: Goals and Objectives for Action may yield positive results. The LGBT section is reproduced below.

Lacking in the 2012 Strategy is the result of an important meta-analysis:

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): 115-23. Full Text. Abstract: "SMY [Sexual Minority Youth] reported significantly higher rates of suicidality (odds ratio [OR] = 2.92) and depression symptoms (standardized mean difference, d = .33) as compared with the heterosexual youth. 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.'

From this study, it could have been postulated that, if compared to heterosexual youth, GLBT youth are at increasing greater risk for the more serious suicidal behaviors, they may therefore be at even greater risk for the most serious negative outcome: death as the result of a suicide attempt. Supporting evidence, even if originating in another country, could then have been noted:

Qin P, Agerbo E, Mortensen PB (2003).  Suicide risk in relation to socioeconomic, demographic, psychiatric, and familial factors: a national register-based study of all suicides in Denmark, 1981-1997. American Journal of Psychiatry, 160(4):765-72. (Abstract) (Full Text) - "...registered [same-sex] partners included as a separate category in the analysis had an odds ratio of 4.31 (95% CI= 2.23–8.36) in the crude analysis and 3.63 (95% CI=1.71– 7.67) in analyses with adjustment for other factors in the full model [for having committed suicide compared to opposite-sex married couples]".

Mathy RM, Cochran SD, Olsen J, Mays VM (2009). The association between relationship markers of sexual orientation and suicide: Denmark, 1990-2001. Social Psychiatry and Psychiatric Epidemiology, 46(2): 111-7. PDF Download. PDF Download. From Abstract: "Using data from death certificates issued between 1990 and 2001 and population estimates from the Danish census, we estimated suicide mortality risk among individuals classified into one of three marital/cohabitation statuses: current/formerly in same-sex RDPs; current/formerly heterosexually married; or never married/registered. RESULTS: Risk for suicide mortality was associated with this proxy indicator of sexual orientation, but only significantly among men. The estimated age-adjusted suicide mortality risk for RDP men was nearly eight times greater than for men with positive histories of heterosexual marriage and nearly twice as high for men who had never married."

With respect to adolescent suicides, two psychological autopsy studies (one American and one Canadian) were not mentioned in the 2012 Strategy:

Shaffer D, Fisher P, Parides M, Gould M (1995). Sexual orientation in adolescents who commit suicide. Suicide and Life-Threatening Behavior, Supplement 25: 64-71. PubMed Abstract.

Renaud J, Berlim MT, Begolli M, McGirr A, Turecki G (2010). Sexual orientation and gender identity in youth suicide victims: an exploratory study. Canadian Journal of Psychiatry, 55(1): 29-34. PubMed Abstract. Full Text.

For the two studies, it could have been mentioned that both groups of authors violated a major rule in statistics: a statistically non-significant results when comparing two groups does not necessarily equate with the concept: There is no difference between the two groups. That is, both studies reported that sexual minority adolescents, compared to heterosexual adolescents, were not at greater risk for suicide. See: Related Webpage.

For analysis, both studies had also used inappropriate statistical procedures: the conditional Fisher Test. Had appropriate statistical procedures been used (unconditional tests for statistical significance), statistically significant results would have been produced, suggesting that sexual minority adolescents were at greater risk for suicide compared to heterosexual adolescents. Odds Ratio estimates also could have been calculated that suggest, at least for sexual minority adolescent males, their greater odds for dying by suicide was about 8 of 9. See: Related Webpage.

It was maybe the wish of the 2012 Strategy authors to permit all who want to believe that sexual minority youth are not at greater risk for suicide - commonly called The Gay Youth Suicide Myth - will continue having a “carte blanche” with respect to the propagation of this idea. Because the "suicide" issue was not addressed in the 2012 Strategy, The Gay Youth Suicide Myth believers will also be able to use results from the above peer reviewed studies (Shaffer et al., 1995 & Renaud et al., 2010) that both state that sexual minority adolescents are not at greater risk for suicide. It should be noted that the Shaffer et al., (1995) study occupies a special place on the propagation of The Gay Youth Suicide Myth, along with the special issue of Suicide & Life-Threatening Behavior in which it was published:

Supplemental 1995 Issue of Suicide & Life-Threatening Behavior: "Research Issues in Suicide and Sexual Orientation" edited by Eve K Mościcki (NIMH), Peter Muehrer (NIMH), Lloyd B Potter (CDC) & Ronald W Maris (Editor-in-Chief, Suicide & Life-Threatening Behavior, the journal of the American Association of Suicidology).  All Abstracts.


Examples of How the Homosexuality Related Suicide Data has been Described in the Suicidology Literature


Note: Many examples demonstrate how the statistically nonsignificant sexual orientation differences in the autopsy studies appear as “no-difference,” “lack of data” or as "no reliable data exist" in the literature. Several reviews do not discuss potential problems with a “no-difference” interpretation. Not one review discusses the statistical problems addressed in our manuscript. Additional information is given in a related webpage.


"Are gay and lesbian youth at high risk for suicide? With regard to completed suicide, there are no national statistics for suicide rates among gay, lesbian or bisexual (GLB) persons.  Sexual orientation is not a question on the death certificate, and to determine whether rates are higher for GLB persons, we would need to know the proportion of the U.S. population that considers themselves gay, lesbian or bisexual.  Sexual orientation is a personal characteristic that people can, and often do choose to hide, so that in psychological autopsy studies of suicide victims where risk factors are examined, it is difficult to know for certain the victim’s sexual orientation.  This is particularly a problem when considering GLB youth who may be less certain of their sexual orientation and less open.  In the few studies examining risk factors for suicide where sexual orientation was assessed, the risk for gay or lesbian persons did not appear any greater than among heterosexuals, once mental and substance abuse disorders were taken into account.
“However, studies examining linkages between sexual orientation and death by suicide have not found this association [127,129,130]. The failure to find linkages with suicide may be due to the fact that ascertainment of sexual orientation following suicide is more difficult than such assessment among those who survive suicide attempts.” (p. 424)

“Completed suicides does not appear to be more common in gay men and lesbians than in heterosexual persons,...” (p. 303).

"Risk Factors ... While there is no evidence that minority sexual orientation is more common in completed teen suicides than in controls, there is strong evidence that gay, lesbian, and bisexual youth of both sexes are significantly more likely to experience suicidal ideation and attempt suicide. Research in five sizable community samples has demonstrated increased risk (Faulkner and Cranston, 1998; Fergusson et al., 1999; Garofalo et al., 1998; Lock and Steiner, 1999; Remafedi et al., 1998)." (p. 35S)

“Both teams of researchers reporting population-based results concluded that the rates of suicide are no higher for gay men and lesbians than for heterosexuals.” (p. 85). “Limited data from two community-based studies suggest that GLB people are not at increased risk for suicides compared with the general population” (p. 102)

Note: See Spirito &
Esposito-Smythers (2006) below for the acceptance and propagation of this conclusion.


"Table 4. Factors Associated With an Increased Risk for Suicide ... Gay, lesbian, or bisexual orientation b ... bAssociated with increased rate of suicide attempts, but no evidence is available on suicide rates per se." (p. 12)

"e) Sexual orientation. Although no studies have examined rates of suicide among gay, lesbian, and bisexual individuals, available evidence suggests that they may have an increased risk for suicidal behaviors." (p. 15)

"e) Sexual orientation. It remains unclear whether suicide rates in gay, lesbian, and bisexual individuals differ from the suicide rate among heterosexual individuals." (p. 49)

“The difference was not statistically significant” (p. 24)

Mathy counters King et al.'s proposition that gay and lesbian people may be at higher risk for suicide:
King et al ( 2003) have published a valuable contribution to the literature regarding the mental health of lesbians and gay men. However, they erred in asserting that, ‘ No study has examined whether gay and lesbian people have elevated rates of completed suicide....’ (p. 557). This is important because studies of sexual orientation and attempted v. completed suicide have yielded different results. Nearly all studies of sexual orientation and attempted suicide have found that gay men and lesbians have higher rates of self-harm than heterosexuals. Conversely, all studies of sexual orientation and completed suicide have concluded that gay men and lesbians do not die by suicide at a higher rate than heterosexuals.

King, M., McKeown, E., Warner, J., et al (2003). Mental health and quality of life of gay men and lesbians in England and Wales. Controlled, cross-sectional study. British Journal of Psychiatry, 183, 552– 558.  Abstract/FREE Full Text

"One psychological autopsy study has examined the association between non-heterosexual sexual orientation and suicide, and failed to find a difference between cases and controls (Shaffer, Fisher, Hicks, Parides, & Gould,1995), although a psychological autopsy procedure may not be sensitive enough to detect issues of sexual orientation." (pp. 378-379)

"Gay, Lesbian, and Bisexual Youths: The process of exploring sexual orientation and “coming out” is a central developmental task for gay, lesbian, and bisexual (GLB) youths that often creates unique internal and interpersonal stresses—including parental rejection, peer isolation, and victimization - that may lead to suicidality (McDaniel et al. 2001). Rates of adolescent suicide attempts appear to be higher among GLB youths than heterosexual youths, but completed suicide is comparable across GLB and heterosexual youths (McDaniel et al. 2001). Remafedi et al. (1998) cite eight peer-reviewed studies that found attempted suicide rates ranging from 20% to 42%. A recent review of the literature concluded that GLB youths have a rate of suicidal behavior two to six times greater than that of heterosexual youths (McDaniel et al. 2001). Even larger differences have been found for suicide attempts requiring medical treatment..." (Underline emphasis added)

McDaniel JS, Purcell D, D’Augelli A (2001). The relationship between sexual orientation and risk for suicide: research findings and future direction for research and prevention. Suicide & Life-Threatening Behavior, 31(Supplement): 84-105.  PubMed Reference. PDF Download. (Download Page PDF Download.

Remafedi G, French S, Story M, Resnick MD, and Blum R (1998). The relationship between suicide risk and sexual orientation: results of a population-based study. American Journal of Public Health, 88(1), 57-60. Full Text. PDF Download.

"However, based upon results of (scarce) studies conducted to date, completed suicide rates do not appear to be increased among the gay and lesbian populations." (p. 67)

:"Sexual orientation" and related words such as "homosexuality" or "gay" are not a part of this book. That is, such issues were completely ignored. The same applies for the second edition published in 2013. See "index" in Amazon Reader.

“In addition, although it has been suggested that gay and lesbian youth may be at higher risk for suicidal behavior than heterosexual youth, research on this issue is complicated by a number of factors, including a lack of accurate youth suicide rates specific to the gay and lesbian population.” (p. 157)

“Rates of attempted suicide in homosexual and bisexual men and women are high, but evidence is lacking for suicide” (p. 1374). Reference used: King et al. (2008).
King et al. (2008). A Systematic Review of Mental Disorder, Suicide, and Deliberate Self Harm in Lesbian, Gay and Bisexual People. BMC Psychiatry. Full Text. Full Text. Abstract.
"Although we cannot report on whether or not LGB people are at greater risk than heterosexuals for completed suicide, the elevated risks for all forms of mental disorder, DSH and substance misuse would suggest very strongly that this is the case. Thus, national suicide strategies need to include LGB people as a high risk group now rather than await more evidence on suicide. The hidden nature of sexual orientation makes it very unlikely that we shall be able to show definitely in post-mortem psychological studies that LGB are over-represented among suicide victims." (p. 14 of 17)


Kostenuik M, Ratnapalan M (2010). Approach to adolescent suicide prevention. Canadian Family Physician, 56(8): 755-60. PDF Download. PDF Download.
Under the subheading of "Other Risk Factors," the following is written: "Gay and lesbian teens or those with sexual identity issues are a special risk group.31 Aboriginal youth are 1.5 times more likely to commit suicide than nonaboriginal youth.32
31. About.com [website]. Are gay and lesbian youth at high risk for suicide? Chicago, IL: About.com; 2010. Available from: http://parentingteens.about.com/cs/gayteens/a/gayyouthsuicide.htm. Accessed 2010 Jun 16.

32. Centers for Disease Control and Prevention. Suicide prevention evaluation in a Western Athabaskan American Indian Tribe—New Mexico, 1988–1997. MMWR Morb Mortal Wkly Rep 1998;47(13):257-61. Medline
For #31, the referenced web page is no longer available, but it is available via the Internet Archive WayBack Machine. The reference given for the information is MIMH (National Institute of Mental Health), but the document being cited or summarized is not given. In the article, Some research problems are mentioned and the following is stated: "In the few studies examining risk factors for suicide where sexual orientation was assessed, the risk for gay or lesbian persons did not appear any greater than among heterosexuals, once mental and substance abuse disorders were taken into account," that essentially states that "gay and lesbian person" are not at greater risk for suicide, these "persons," however, being adults and not "adolescents" (not mentioned) that is the subject of the paper. Although higher levels of adolescent gay, lesbian and bisexual suicidal behaviors is mentioned, the caveats place these results in question. Furthermore, under the guise that sexual minority youth possibly being harmed by school based suicide prevention programs, such possibly helpful prevention programs are not recommended, as apparently they are not recommended for all adolescents. Yet, a Google Search reveals that such adolescent suicide prevention programs do exist, with papers written about them, but it is likely that sexual minority adolescents have generally been ignored in these prevention efforts. The incorrect section that physicians would have accessed for their adolescent suicide related 'education' would have been:
"Because school based suicide awareness programs have not proven effective for youth in general, and in some cases have caused increased distress in vulnerable youth, they are not likely to be helpful for GLB youth either. Because young people should not be exposed to programs that do not work, and certainly not to programs that increase risk, more research is needed to develop safe and effective programs." 
The NIMH document that was being cited at the "About.com" website was not only in part out of date, but it was withdrawn from the NIMH website by 2004: NIMH (1999). Full Text. "Frequently Asked Questions about Suicide"  Available to 2004. Full Text.The document states:
"Are gay and lesbian youth at high risk for suicide?

With regard to completed suicide, there are no national statistics for suicide rates among gay, lesbian or bisexual (GLB) persons. Sexual orientation is not a question on the death certificate, and to determine whether rates are higher for GLB persons, we would need to know the proportion of the U.S. population that considers themselves gay, lesbian or bisexual. Sexual orientation is a personal characteristic that people can, and often do choose to hide, so that in psychological autopsy studies of suicide victims where risk factors are examined, it is difficult to know for certain the victim’s sexual orientation. This is particularly a problem when considering GLB youth who may be less certain of their sexual orientation and less open. In the few studies examining risk factors for suicide where sexual orientation was assessed, the risk for gay or lesbian persons did not appear any greater than among heterosexuals, once mental and substance abuse disorders were taken into account.

With regard to suicide attempts, several state and national studies have reported that high school students who report to be homosexually and bisexually active have higher rates of suicide thoughts and attempts in the past year compared to youth with heterosexual experience. Experts have not been in complete agreement about the best way to measure reports of adolescent suicide attempts, or sexual orientation, so the data are subject to question. But they do agree that efforts should focus on how to help GLB youth grow up to be healthy and successful despite the obstacles that they face. Because school based suicide awareness programs have not proven effective for youth in general, and in some cases have caused increased distress in vulnerable youth, they are not likely to be helpful for GLB youth either. Because young people should not be exposed to programs that do not work, and certainly not to programs that increase risk, more research is needed to develop safe and effective programs."

Given that, by 2010, numerous studies, review papers, and meta-analyses on the suicidality of sexual minority people were available (Related Webpage), what was offered by Kostenuik & Ratnapalan (2010) is somewhat shameful and likely reflects a complete indifference to a minority group that had been historically hated, vilified and discriminated against in Canada. A similar indifference - meaning 'we could not be bothered to seek relevant information' - applied for aboriginal youth in Canada who have also been severely discriminated against. At best for them, they report information only on American aboriginal youth, and even misreport the information given in the referenced paper's abstract. That is, the "Aboriginal youth are 1.5 times more likely to commit suicide than nonaboriginal youth" is for "American" aboriginal people for all ages from 1979 to 1992, as noted in the abstract. American aboriginal youth (ages 15-24 years) would have this risk factor given the suicide rate information located in the abstract: 31.7 (aboriginal) / 13.0 (others) = 2.4 higher suicide risk factor from 1991 to 1993. Most vexing about this reporting, however, is the authors' apparent complete ignorance about the Canadian aboriginal youth greater suicide risk that is much higher than for the American counterparts (6 to 7 times higher than it is for other youth, from 1990 to 1994), given that their paper is published in the peer reviewed "Canadian Family Physician" journal. References: PDF Download. PDF Download. Webpage: Reporting both American and Canadian aboriginal suicide data. That is , Canadian  physicians have been made to believe that Canadian aboriginal youth are only about 1.5 times at greater risk for suicide when the greater risk is more likely 6- to 7-times on average, with variations to be noted.

"Each of these studies has concluded that same-sex sexual orientation is not disproportionately represented among suicide victims.” (p. 16)

"Because no reliable data exists, we do not know whether LGBT youth die by suicide more frequently than their straight peers. Sexual orientation and gender identity data are not included on death certificates so aggregated national death data do not include this information. In addition, many LGBT youth do not disclose this information to family members and friends; as a result, sexual orientation and gender identity often do not show up in psychological autopsy interviews."

Note: The same is repeated in the AAS 2012 document "Suicidal Behavior among Lesbian, Gay, Bisexual, and Transgender Youth" that was announced as follows on the AAS Suicidology message board in May, 2012: "At the AAS conference [April, 2012], a number of people requested the links on the AAS web site for the new AAS resource sheets about youth suicide. Here they are": Resource Sheet about Suicidal Behavior among Lesbian, Gay, Bisexual, and Transgender youth...

Homosexuality issues are ignored.

Abstract: Due to several high profile suicides and increased social acceptance of lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) persons in the United States (U.S.), significant media attention has focused on the occurrence of and factors that contribute to sexual and gender minority youth (SGMY) suicide. Although previous research has established an increased likelihood of suicidal ideation among SGMY, no data exists on completed SGMY suicides in the U.S. or subsequent media coverage. This study examines variables related to completed SGMY suicides in the U.S. from written electronic media (N = 78) reports from 2004–2012 using a mixed-method content analysis. Qualitative results indicate the presence of three major content domains: warning signs, denial of the problem, and conflicting reports. Quantitative results suggest a lack of contextual information, but increased media citation of prevention resources between 2010 and 2012. Clinical and public health implications of SGMY media coverage are discussed. (Emphasis mine.)

Note: All who would not welcome data related to the sexual minority youth higher risk for suicide would be happy with the assertion made in the abstract: that no related data is available.


The Online, Book & Public Media "Gay Youth Suicide Myth" Propagation


The Historical Setting

Waidzunas (2012) describes the 1980 years as related to youth suicide issues in the United States:
"In the mid-1980s, concern over teen suicide in the United States reached a fever pitch when the federal government reported the teen suicide rate had increased threefold since the 1950s. In the predominant ‘‘family values’’ political framing of the day, many attributed this problem to drugs and family instability. Responding to public alarm, Margaret Heckler, Health and Human Services Secretary under Reagan, commissioned the Secretary’s Task Force on Youth Suicide to gather information on ‘‘risk factors’’ and strategies for intervention and prevention (Davidson and Linnoila 1989, 5). Gay activists attended events organized by the USDHHS Task Force and lobbied for inclusion of gay youth. According to Gibson, there were also people within the Reagan administration who fought for inclusion of gay and lesbian teen suicide in the Task Force report (Gibson 2006, personal interview). Because of Gibson’s experience working with gay and lesbian youth, a representative of the National Institutes of Health (NIH) approached him, asking him to write a paper providing an estimate of the problem’s scope, risk factors of suicide for gay and lesbian youth, and proposed solutions. (p.7)
Waidzunas T (2011-2012). Young, Gay, and Suicidal: Dynamic Nominalism and the Process of Defining a Social Problem with Statistics. Science, Technology & Human Values. Published online before print. Abstract.
Davidson, Lucy, and Markku Linnoila, eds. 1989. Secretary’s Task Force Report on Youth Suicide. Vol. 2: Risk Factors for Youth Suicide. Rockville, MD: U.S. Department of Health & Human Services. Download Page. PDF Download.

The Historical Breakthrough: Gay & Lesbian Suicide Risk in a Government Document

As  the result of the work by the Secretary’s Task Force on Youth Suicide, the US Department of Health and Human Services produced four volumes of papers that addressed related issues. Two of the commissioned papers wholly or partly related to suicide and homosexuality issues were:
Gibson P (1989). Gay and Lesbian Youth Suicide. In: Marcia R. Feinlieb, ed. Volume 3: Prevention and Intervention in Youth Suicide, Report of the Secretary's Task Force on Youth Suicide, U.S. Department of Health & Human Services, 1989. Gibson Paper: Full Text. Full Text. PDF Download. Volume 3: Download Page. PDF Download.

Harry, Joseph (1989). Sexual identity issues. In: Lucy Davidson and Markku Linnoila, eds. Volume 2: Risk Factors for Youth Suicide, Report of the Secretary's Task Force on Youth Suicide, U.S. Department of Health & Human Services, 1989.
Volume 3: Download Page. PDF Download

Attacking the Inclusion of Gay & Lesbian Suicide Risk in a Government Document

It did not take long, however, for certain powers-that-be in the US government to especially notice the Gibson (1989) paper. Chris Bull (1994) reports some related highlights in a cover story for The Advocate (A national gay and lesbian news magazine):

Conservatives are determined to keep the federal government from researching the topic After the findings of the 1989 HHS report were published. William Dannemeyer, who was at the time a Republican member of the House of Representatives from California, called for then-president Bush to "dismiss from public service all persons still employed who concocted this homosexual pledge of allegiance and scaled the lid on these misjudgments for good." HHS secretary Louis Sullivan chimed in as well writing in a letter to Dannemeyer that Cibson's work "undermined the institution of die family." In 1991, complaints from Sen. Jesse Helms (R-N.C.) led HHS to cancel what was to be the nation's largest-ever study of the sexual behavior of teenagers. Helms had complained that the study would invade the privacy of young people by asking them about private sexual matters.
Bull, Chris (1994). Suicidal Tendencies: Is anguish over sexual orientation causing gay and lesbian teens to kill themselves (Cover Story). The Advocate, April 5, No. 652: 35-42. Google Books.
Knowledge of what had been happening, however, was well known and it had been part of a 1991 cover story in The Advocate by Shira Maguen. Some related information is supplied by Stewart (1991). The situation at the time for at risk gay and lesbian adolescents is described:
Teen Suicide, The Government's Cover-up And America's Lost Children, by Shira Maguen, reviews the politics that have been used to bury research into adolescent homosexual suicides... Dr. Virginia Uribe, founder of Project 10 - Los Angeles Unified School District's drop-out prevention program aimed at the adolescent homosexual, says, "Many school systems across the country have suicide-prevention units, but 99.9% of them make no mention of the heightened risk of being gay or lesbian." Similarly, Remafedi says, "Virtually no professionals in the country receive any kind of special training on homosexuality, let alone the issues surrounding adolescent homosexuality ... Many of the professionals that we work with are reluctant to refer gay and lesbian kids to social support groups. On one level they believe that by doing so, they might entrench the persons homosexual identity. They are worried about parents' reactions or what their supervisors might think."

Stewart, Chuck (1991). Homosexuality and Education. A Project Presented to the Faculty of the School of Education, University of Southern California. In Partial Fulfillment of the Requirements for the Degree Master of Science in Education. Full Text.
Maguen, Shira (1991, September 24). Teen suicide: The government's cover-up and America's lost children. The Advocate, 586, 40-47.
Shira Maguen's 1991 Advocate cover story had elaborated on many gay and lesbian youth problems, some noted by T. DeCrecenzo who worked with these youth: "These kids have been ignored not only by the straight community but also by the gay community... The adult gay and lesbian community has an obligation to also step in and say, 'Yes, we'll do our share too.' The time is right for us to start networking across the nation. These kids are dying, they're being killed on the streets, they're drinking themselves to death, they're drugging themselves to death, they've been thrown out of their homes. The time has come for us as a gay and lesbian community to stand up for those young folks. It’s obvious no one else is going to do it" (Maguen, 1991: 47).
A Terri DeCrecenzo 2009 update by Mike Signorile: "The pioneering organization Gay and Lesbian Adolescent Services (GLASS) in LA was forced to file for bankruptcy. Terri DeCrecenzo, who I have known for many years and who founded that place and fought for LGBT youth, may now lose her home to the IRS and American Express. This is a horrible injustice, and may be just the beginning of what will happen to LGBT service organizations as things get worse: ..."
Signorile M (2009). Losing Gay Youth Centers. Blog, February 20. Full Text.
Teresa DeCrecenzo, MSW, was also the editor of the book "Helping gay and lesbian youth: New policies, new programs, new practice." Harrington Park Press/Haworth Press, Inc.: New York, NY, USA. Amazon. Google Books. For more information about Teresa DeCrecenzo, see "About the Editor" in Google Books. Teresa A. DeCrescenzo CV (2003).
Maguen's cover story likely represents the first significant public activism for the welfare of gay and lesbian youth as related to many "at risk" issues, including their suicide risk... that was related to information in the Gibson (1999) paper. This also resulted in the first major breakthrough in helping gay and lesbian youth that took the form of the 1993 "Governor's Commission on Gay and Lesbian Youth" in Massachusetts, now known as "The Massachusetts Commission on Gay, Lesbian, Bisexual & Transgender Youth" (Related Website). Concerning this, Rios (1997a) reported that "the conventional wisdom that gay teens are killing themselves has become so ingrained that it can influence public policy. Gov. William F. Weld of Massachusetts, for instance, cited the suicide "statistic" as a driving force behind his state's creation of a Governor's Commission on Gay and Lesbian Youth." The apparently supporting "bogus statistics" were also outlined and explained:
"If reporters had asked that question about the gay teen suicide rate, they would have learned that the "two to three times more likely to attempt suicide" and the "30 percent completed suicide" figures emerged from a 1989 U.S. Department of Health and Human Services task force report on youth suicide. The numbers were drawn from a single essay written, at the department's invitation, by a San Francisco social worker named Paul Gibson. Gibson did not base his numbers on original research, but rather on his own interpretation of available literature--literature that has since been criticized for methodological weaknesses. He concluded that gay and lesbian teens were two to three times more likely to attempt suicide, and then went on to extrapolate that such a figure also would indicate that gay and lesbian teens may account for 30 percent of all teen suicides. Mental health researchers, however, consider suicide attempts and actual suicides to be distinct phenomena. Although packaged in a government report, Gibson's paper was not government research, nor were his figures government statistics. But they were quickly picked up and presented as such by gay advocates and many reporters. Gibson says he never intended for the 30 percent figure to be used as a statistic, but he stands by both numbers. "I think that there is sample evidence available to indicate that these youth are at risk and that we need to help them now," he says. "We can't wait to help these youth until complete information is available.""
Rios DM (1997a). A bogus statistic that won't go away. American Journalism Review, July-August, 1997. Full Text. Full Text.
By 1993, however, some experts on youth suicide (in government agencies and universities) had been taking notice of the "bogus statistics" and that these statistics were being used, sometimes successfully, to begin programs that might help gay and lesbian youth, and especially the most distressed. The first to publicly wage an all out war was Dr. David Shaffer who had credentials that Peter LaBarbera (1994) was most happy to state in an article titled "The Gay Youth Suicide Myth" that was widely available online in the past and is still available at one website. LaBarbera (1994) reported that David Shaffer - who granted him an interview and additional ammunition to attack gay suicidality statistics - was "one of the country's leading authorities on suicide among youth," "a Columbia University psychiatrist and specialist on adolescent suicide," and also the "Irving Philips Professor of Child Psychiatry at Columbia University." In the interview, Shaffer had stated: "I struggled for a long time over [Gibson's] mathematics, but, in the end, it seemed more hocus-pocus than math." Peter LaBarbera is said to be: "a former reporter for The Washington Times, [and] is executive director of Accuracy in Academia, a Washington, D.C.-based group that monitors bias in higher education."
LaBarbera, Peter (1994, 1996). The Gay Youth Suicide Myth. The Journal of Human Sexuality, 196: 65-72.  Full Text. Reference. The Journal of Human Sexuality: Leadership University, sponsored by Faculty Commons, a non-profit organization in Plano, Texas. The article was first made available in February 1994 as an article in Insight produced by The Family Research Council. At that time, the article title was: "Gay Youth Suicide: Myth Used to Promote Homosexual Agenda." Full Text.
Shaffer had also made the following reference available to LaBarbera: "[18]David Shaffer, "Teen Suicide and Gays in the Military," unpublished paper from which the article in The New Yorker above (see footnote no. 1) was derived, March 22, 1993, p. 6. Shaffer is Irving Philips Professor of Child Psychiatry at Columbia University" that would prove to be a great help for the attack article he was writing. Also available to him was Shaffer's New Yorker 'attack' article:
Shaffer, David (1993). Political Science. The New Yorker, May 3, p. 116. Reference.
Dr. Gay Remafedi (Pediatrics, University of Minnesota, and researcher of suicidality and gay/bisexual youth) commented on Shaffer's New Yorker article in the introduction to his 1994 book, Death by Denial:
"Fueling the intrusion of politics into the science, well-funded scholars sometimes oppose new perspectives in their own field of research. Writing in the New Yorker magazine, a prominent suicidologist dismissed existing data on the risk for suicide for homosexual youth based on his perception that the participants had been 'unusual groups of gays' and criticized activists for using the data to justify social tolerance. He concluded; 'Suicide is usually a story of misperceptions and misunderstandings, of feelings of despair and lack of control; it cannot be attributed simply to having a difficult life. And it has no place in anyone's political agenda, no matter how worthy.' It is ironic that such critiques of peer-reviewed, published research are aired in popular magazines, rather than submitted to comparable scientific scrutiny. Even more disturbing is the fact that scholars themselves try to foreclose discussion of promising new ideas in defense of their own viewpoints and interests (p. 8-9)." 

Remafedi G, ed. (1994). Death by Denial: studies of suicide in gay and lesbian teenagers. Boston: Alyson Publication. Amazon. Google Books.


The 1994 NIHM / CDC / AAS  - With Invited Gay/Lesbian Professionals - Meeting to Address the "Gay & Lesbian Suicide Risk" Issue

By 1994, the stage had been set for what Cris Bull reported in his Advocate cover story: a "task force" or "panel" would be looking into the gay and lesbian suicide issues in July and reporting on the results. Rios (1997a) describes the panel's make-op:

"A panel convened in 1994 - with representatives of the U.S. Department of Health and Human Services, the Centers for Disease Control and Prevention, the National Institute of Mental Health, the American Psychological Association, the American Association of Suicidology, and gay and lesbian advocacy and service groups," the latter being, as listed by Peter Mueher (NIHM) in a March 21, 1997 letter to Pierre Tremblay: "the Sexual Minority Youth Assistance League of Washington, D.C., the National Gay and Lesbian Health Association, the Gay and Adolescent Social Services of Los Angeles, the Hetrick-Martin Institute of New York City, the Gay and Lesbian Medical Association, the National Gay and Lesbian Task Force, the Association of Gay and Lesbian Psychiatrists, the Office of Gay and lesbian Concerns of the American Psychological Association, and the Homosexual Affairs Committee of the American Academy of Child and Adolescent Psychiatry."

A meeting would occur that would likely result in an encounter between researcher familiar with gay and lesbian youth problems and those who lacked related knowledge. The latter would be the mainstream youth suicidologists, such as Dr. David Shaffer (Columbia University, with full credentials supplied by Peter LaBarbera as cited above) and Dr. Peter Muehrer (NIMH) who, according to Peter LaBarbera (1994) who interviewed him in 1994 to confirm the gay youth suicide myth, was "chief of the youth mental health program in the Prevention Research Branch of the National Institutes of Mental Health." Bull (1994) notes that "[T]he debate over youth suicide and sexual orientation is [also] taking place in the context of an even larger debate among scientists about the causes of suicide. Mainstream suicidologists argue that research indicates that in the overwhelming majority of suicides, the victim has a history of severe mental illness. Social factors like homosexuality, race, or poverty may play a role, they say, but are unlikely to prompt a suicide attempt by themselves. In fact, Shaffer says that... mental illness is the cause of most suicides..."

Bull (1994) elaborates on the opposing viewpoints by juxtaposing Shaffer views with those of Dr. Gary Remafedi (Pediatrics, University of Minnesota) that represented the view of sexual minority researchers:

"Shaffer says the psychological autopsy studies showing a relatively low number of gay youth suicides demonstrate the strength of gay youths in the face of great adversity and should be welcomed by gay advocates. "I actually take it as a very positive finding," he says. "In some ways it speaks to the positive mental health of gay youths. They can withstand the stress and grow up to be happy adults without resorting to suicide at a significantly higher rate than heterosexual youths." But Remafedi says ignoring the role of sexual orientation in youth suicide is a mistake. There clearly are social factors at work, and we have to do everything we can to alleviate them," he says. "Underlying mental illness simply can't account for the high suicide rate of gay and lesbian youth. We are raising the possibility that social factors rather than psychological factors may account for many suicides. It's a mistake to underestimate how powerful factors like homophobia can be in a young person's life." Remafedi says that because the study of suicide has long been dominated by researchers with training in mental health, the profession has largely ignored the social and political aspects of suicide. "The findings of the studies indicating a high incidence of suicide among gay youth are a break from traditional thought because the researchers are looking for a psychological diagnosis where there is none." he says. "It's homophobia that's killing these kids." Still, Shaffer's approach to youth suicide is the one that prevails..." (p. 40)

Bull (1994) had nonetheless also sounded a foreboding note via quoting Lloyd Potter who was "Team Leader, Suicide Prevention, Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia" since 1993 and would continue to be 'Team Leader" until 2000 (Lloyd Potter, CV, 2011: Full Text).

"But despite the changing political climate at HHS, the combination of right-wing pressure and the methodological questions raised by suicidologists - researchers who explore the psychological forces that lead to suicide  - causes some observers to wonder whether the link between gay and lesbian youth suicide and antigay discrimination can ever be adequately addressed by the federal government. "I'm well aware that we're stepping into a political minefield," says Lloyd Potter, a behavioral scientist at the National Center for Injury Prevention and Control at the CDC who is coordinating the new HHS gay teen suicide task force. "I'm cautiously optimistic about our ability to conduct research on sexual orientation, but just because I have some optimism doesn't mean it's going to happen." (p. 36)



The Special Issue of Suicide & Life-Threatening Behavior: "Research Issues in Suicide and Sexual Orientation."

Soon after, the meeting was held and the only major result seems to have been a September 1995 special supplemental issue (See Below) of the peer reviewed journal, Suicide and Life-Threatening Behavior, that is the publication of the America Association of Suicidology (AAS):

[Note: In 2000, one of the authors of this webpage had a chat with a gay professional attendee of the meeting who essentially reported that anyone truly concerned about the welfare of "at risk" gay, lesbian and bisexual youth had been 'royally screwed' by the powers-that-be at NIMH and the CDC who were helped to accomplish their objectives via the AAS publication. To date, none of the Gay / Lesbian professionals who had attended the meeting publicly reported on what had happened at the meeting, nor how they felt about the resulting publication. The story is yet to be written. Suffice to stay that the only empirical study published in the Special Issue was by Shaffer et al. with none of the suicidologists responsible for the Special Issue noticing that highly flawed statistical procedures had been used. It is worth noting that a "risk factor" paper by a well known suicidologist, David Brent, was published in the Special Issue, and that the paper did not mention anything related to homosexually oriented people. It is likely that, up to 1995, both David Brent (Curriculum Vitae) and David Shaffer (Profile), as youth suicidologists, had ignored homosexuality issues, including gender nonconformity issues, in their research, with the exception for Shaffer being the flawed analysis paper discussed herein. It would also appear like they have continued to ignore homosexuality issues in their child / adolescent / youth suicidality studies. Therefore, they appear to have acted in accordance with the 'spirit' of the 1995 Special Issue of Suicide & Life-Threatening Behavior: "Research Issues in Suicide and Sexual Orientation."]

Supplemental 1995 Issue of Suicide & Life-Threatening Behavior: "Research Issues in Suicide and Sexual Orientation" edited by Eve K Mościcki (NIMH), Peter Muehrer (NIMH), Lloyd B Potter (CDC) & Ronald W Maris (Editor-in-Chief, Suicide & Life-Threatening Behavior).  All Abstracts.

Mościcki EK, Muehrer P, Potter LB (1995)
. Introduction to supplemental issue: research issues in suicide and sexual orientation. Suicide & Life-Threatening Behavior, 25 Supplement: 1-3. National Institute of Mental Health, National Institutes of Health, Rockville, MD 20857, USA. Abstract.

Petersen AC, Leffert N, Graham BL (1995)
. Adolescent development and the emergence of sexuality. Suicide & Life-Threatening Behavior, 25 Supplement: 4-17. University of Minnesota, Minneapolis 55455, USA. Abstract.

Graber JA, Brooks-Gunn J (1995). Models of development: understanding risk in adolescence.  Suicide & Life-Threatening Behavior, 25 Supplement: 18-25. Adolescent Study Program, Teachers College, Columbia University, New York, NY 10027, USA. Abstract. Adolescent Study Program, Teachers College, Columbia University, New York, NY 10027, USA.

Rotheram-Borus MJ, Fernandez MI (1995)
. Sexual orientation and developmental challenges experienced by gay and lesbian youths. Suicide & Life-Threatening Behavior, 25 Supplement: 26-34; discussion 35-9. Department of Psychiatry, University of California, Los Angeles, USA. Abstract.

Olson ED, King CA (1995). Gay and Lesbian Self-Identification: A Response to Rotheram-Borus and Fernandez. Suicide & Life-Threatening Behavior, 25 Supplement: 35-39. First Page Excerpt.

Gonsiorek JC, Sell RL, Weinrich JD (1995). Definition and measurement of sexual orientation. Suicide & Life-Threatening Behavior, 25 Supplement: 40-51. Abstract.

Brent DA (1995)
. Risk factors for adolescent suicide and suicidal behavior: mental and substance abuse disorders, family environmental factors, and life stress. Suicide & Life-Threatening Behavior, 25 Supplement: 52-63. Western Psychiatric Institute & Clinic, Pittsburg, PA 15213, USA. Abstract.

Shaffer, D., Fisher, P., Parides, M., Gould, M (1995). Sexual orientation in adolescents who commit suicide. Suicide and Life-Threatening Behavior, Supplement 25: 64-71. Division of Child Psychiatry, New York State Psychiatric Institute, NY 10032, USA. Abstract.

Muehrer P (1995). Suicide and sexual orientation: a critical summary of recent research and directions for future research. Suicide & Life-Threatening Behavior, 25 Supplement: 72-81.
Prevention Research Branch, NIMH, Rockville, MD 20857, USA. Abstract.

Working Groups (1995). Recommendations for a research agenda in suicide and sexual orientation. Working Groups, Workshop on Suicide and Sexual Orientation. Suicide & Life-Threatening Behavior, 25 Supplement: 82-94. Reference.


The results  of the 1994 meeting were likely most troubling to many of the gay and lesbian researchers who had been studying gay, lesbian and bisexual youth and one of the researchers present at the 1994 meeting requested to NOT have his/her name place on the list for the "working groups." Pierre Tremblay in Calgary, Canada, was also troubled by the negative outcome that one of the researchers present at the meeting had been so optimistic about, with his optimism soon to be destroyed. As a result, Tremblay (1995: Full Text. Full Text), who had been preparing a paper to present at a suicide prevention conference in October 1995, expanded his  paper to include a critique of parts of the Suicide and Life-Threatening Behavior special issue on sexual orientation. The paper was first made available online in January 1996 at the QRD (
Full Text.). Basically, the outcome, at least as reported in the mainstream media, meaning that this result would be read my many, would be reported by Rios (1997a,b) as follows:

"At the end of an interview with actress Ellen DeGeneres, aired the night her lesbian TV character "came out," anchor Diane Sawyer addressed viewers of "PrimeTime Live": "And as we close, we're going to repeat a government statistic that a gay teenager is some three times as likely to attempt suicide as another teenager. Ellen DeGeneres has said whatever happens to her, tonight's broadcast was in part to hold on to them." It's a statistic that has been repeated innumerable times. The trouble is, there is no scientifically valid evidence that it's true. That was the conclusion - back in 1994 - of representatives of the Centers for Disease Control, the National Institute of Mental Health, the American Psychological Association, the American Association of Suicidology, and gay and lesbian advocacy and service groups, among others. They had met to see if there was a link between gay teens and suicide, which had been propelled into public consciousness by a single essay included in a 1989 U.S. Department of Health and Human Services report on youth suicide. Their finding was this: "There is no population-based evidence that sexual orientation and suicidality are linked in some direct or indirect manner. ... Yet the stunningly high number of suicide attempts represented by the "two to three times more likely" figure - along with an unsubstantiated companion statistic that gays and lesbians may account for 30 percent of completed teen suicides - has shaped public perceptions of gay teens for nearly a decade."

Rios, Delia M (1997b). Statistics on gay suicides are baseless, researchers say. The Seattle Times Company, May 22, 1997. Newhouse News Service. Full Text.

Peter Muehrer was quoted with respect to the statistics apparently being "baseless," the implications being that nothing would be done by the powers-that-be in Washington to help gay and lesbian youth because, apparently, no one knows for sure if they are at risk, even if many 'convenience' study samples taken in many parts of North America reported that these youth were at great risk for suicidality. In other words, what concerned individuals such as Paul Gibson was saying should and would be ignored: "I think that there is ample evidence available to indicate that these youth are at risk and that we need to help them now," Gibson said. "We can't wait to help these youth until complete information is available." (Rios, 1997b)

Rios' writings about 'the gay youth suicide myth' was noticed by many in the media and one New Hampshire newspaper editor, for example, dedicated an editorial to the issue:

"Some might recall that during the debate in the Legislature over the homosexual rights bill -- which was passed and signed into law by Gov. Jeanne Shaheen -- one argument marshaled in support was that according to "government statistics" homosexual teenagers are three times more likely to commit suicide because, it is alleged, they feel alienated and persecuted by the larger hostile heterosexual society...Well, it turns out that this "government statistic," like so many others cited by special-interest pleaders and mindlessly repeated by lazy and gullible journalists, is completely bogus. The American Journalism Review did some belated checking and found what any enterprising reporter could have discovered: the statistic is an invention. AJR reports that a panel convened in 1994 including representatives of the U.S. Department of Health and Human Services, the Centers for Disease Control, the National Institute of Mental Health, the American Psychological Association, the American Association of Suicidology and various homosexual advocacy groups found no evidence of higher suicide rates among homosexuals or any correlation, direct or indirect, between suicide and sexual orientation..."

Lessner, Richard (1997). Lies and Statistics: Homosexual Suicide Rate Grossly Exaggerated. Manchester Union Leader, Manchester, NH. Editorial, July 10, 1997. Full Text.
For newspapers to reproduce, Rios' news article distributed by Newhouse News Service had been based on her American Journalism Review (1997a), with this information then becoming part of a 2001 article by Carl Cannon also published in the American Journalism Review that was headlined with: "The Internet is an invaluable information-gathering tool for journalists. It also has an unmatched capacity for distributing misinformation, which all too often winds up in the mainstream media": 

Cannon, Carl M (2001). The Real Computer Virus. American Journalism Review, April, 2001. Full Text.

Cannon (2001) writes:

"Sometimes the proliferation of such errors carries more serious implications. A couple of years ago, Diane Sawyer concluded a "PrimeTime Live" interview with Ellen DeGeneres the night her lesbian television character "came out" by reciting what Sawyer called "a government statistic": gay teenagers are "three times as likely to attempt suicide" as straight teenagers. This factoid, which Sawyer said was provided to her by DeGeneres, is a crock." He later adds one of the possible arguments that Peter Muehrer had likely used to place concerned gay and lesbian researchers on the defensive: "Other clinicians fear that this misinformation could turn into a self-fulfilling prophecy. Peter Muehrer of the National Institutes of Health says he worries that a public hysteria over gay-teen suicide could contribute to "suicide contagion," in which troubled gay teens come to see suicide as a practical, almost normal, way out of their identity struggles." In other words, those concerned about the welfare of gay and lesbian youth could be told: 'If you continue with this "at risk" proposition, we will argue that you may well be the cause of their suicide problems!' In this respect, Rios (1997a) had reported: "Muehrer and his colleagues worry that the public focus on gay teen suicides might contribute to a phenomenon called "suicide contagion," in which troubled gay teens might begin to see suicide as an acceptable way out of their identity struggles."

In 2001, the book "You Are Being Lied To: The Disinformation Guide to Media Distortion, Historical Whitewashes and Cultural Myths" was published and it contained the following contribution:

Jenkins, Philip (2001). "A world That Hates Gays": Is There Really a Gay Teen Suicide Epidemic. In: Russ Kirk (ed). You Are Being Lied To: The Disinformation Guide to Media Distortion, Historical Whitewashes and Cultural Myths, pp. 176-186. New York, N.Y.: The Disinformation Company. PDF Download. Amazon.

Jenkins (2001) supplies factual information with interpretations that could be challenged if time was available, but the essence of his contribution was:

I have suggested that the “gay teen suicide” myth was closely linked to the politics of a specific historical moment, namely the intense cultural politics of the early 1990s, but the underlying idea did not simply fade away when that environment changed. Throughout the 1990s, the notion that “one third of teen suicides are gay” continued to be recycled and cited every time young people or teenagers featured in gay rights debates. In 1997 the figure was cited by Diane Sawyer in a television news feature on lesbian actress Ellen DeGeneres, and the following year, the number appeared in a 60 Minutes report.65 The prolonged life of the mythology suggests how very valuable it was to its proponents." (p. 185)

Nonetheless, with increasing published and peer reviewed population based suicidality survey results for adolescents and young adults, beginning in 1997, it was becoming more obvious that gay, lesbian and bisexual were all at risk for attempting suicide, the risk groups including adolescents who reported being unsure of the sexual orientation. As reported in the meta-analysis of mostly adolescent random surveys (Marshal et al., 2011), sexual minority youth were shown to be at increasing risk for the more serious forms of suicidality, thus highlighting that the Gibson estimate of a two- to three-times risk factor for attempting suicide was accurate or even underestimated.

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): 115-23. Full Text. Abstract: "SMY [Sexual Minority Youth] reported significantly higher rates of suicidality (odds ratio [OR] = 2.92) and depression symptoms (standardized mean difference, d = .33) as compared with the heterosexual youth. 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.'.

From the Marshal et al. (2011) results (that included random adolescent surveys dating back to 1993), it could also be said that, if sexual minority youth are at increasing risk for the more serious forms for suicidality, reaching about 4-times for suicide attempts that required medical attention, we could maybe reasonably expect that the risk for even more serious forms of suicidality would be greater than 4-times. In the Bagley & Tremblay (1997) study of randomly sampled male youth in Calgary [age = 18-27 years], Alberta, for example, a suicide attempt was defined as a serious attempt (life-threatening injuries) or "having the intent to die," with only 8 males out of 750 being in this category. Five out of the 8 suicide attempters were homosexually oriented males: 62.5% of male suicide attempters, this representing an approximate 13-times greater risk for such a serious suicide attempt, compared to their heterosexual counterparts).

Bagley C, and Tremblay P (1997). Suicidal behaviors in homosexual and bisexual males. Crisis, 18(1), 24-34. Research Highlights. PubMed Abstract. Earlier book version of the paper. PDF Download. 


The Ongoing "Gay Youth Suicide Myth" Propagation: 2000 to 2012


It is possible that sexual minority adolescents/youth are maybe about 10-times more at risk for dying by suicide (to be on the conservative side, given the evidence), but the study results have not changed the minds of the "Gay Youth Suicide Myth" believers. For example, here are related items available online in April 2012:



The Dr. Rich Savin-Williams' Print Media & Online "Gay Youth Suicide Myth" Activism & Related Activism by Others


  • Russell ST (2003). Sexual minority youth and suicide risk. American Behavioral Scientist, 46(9): 1241-1257. Abstract. PDF Download.
"A key risk indicator for suicide among adolescents is sexual minority status, that is, whether one engages in same-sex sexual behavior, has enduring emotional or sexual attractions to the same sex (usually termed sexual orientation), or claims a same-sex sexual identity as gay, lesbian, or bisexual. Until recently, this conclusion was controversial (e.g., Remafedi, 1999; Shaffer, 1993); some continue to argue against the accumulated evidence of suicide risk among sexual minority youth (Savin-Williams, 2001). However, numerous studies spanning the past quarter century have used varied designs and methods in multiple settings and have consistently demonstrated that sexual minority youth are among those most likely to report suicidality (suicidal thoughts, plans, and attempts)." (p. 1241)
Savin-Williams RC (2001). Suicide attempts among sexual-minority youths: population and measurement issues. Journal of Consulting and Clinical Psychology, 69(6): 983-91. PubMed Abstract.

Elias, Marilyn (2001). Gay teens less suicidal than thought, report says. USA Today, November 26. Full Text. Full Text. Full Text.
"Gay and lesbian teenagers are only slightly more likely than heterosexual kids to attempt suicide, contrary to past studies that suggest gay youths have about triple the rate of trying suicide, says a Cornell University psychologist [Savin-Williams] in a controversial report due next month. "
Study Related: Traditional Values Coalition (2009). Homosexual Urban Legend: 30% Of Teen Suicide Victims Are Homosexuals. Full Text.
"Another survey of 266 college men and women found that teens who think they are homosexuals were not much more likely to have attempted suicide than straight students. Homosexual students were more likely to have reported "attempts," but these turned out to be "thinking" about suicide rather than actually doing it. According to Savin-Williams, homosexual teen suicide statistics unfairly "pathologize gay youth, and that's not fair to them." Savin-Williams is not "anti-homosexual," but has apparently attempted to conduct honest research. In fact, Beth Reis, a pro-homosexual activist with the Safe Schools Coalition solicited a clarification from Savin-Williams on his research. Reis was concerned that his work might have been misreported in the media. It was not. Savin-Williams responded to her by noting: "When I solicit a broad spectrum of youths with same sex attractions, and not only those who openly identify as gay, lesbian, or bisexual while in high school, and asked in-depth questions about their suicide history, I found statistically no difference in the suicide attempt rate based on sexual attractions. Although same-sex attracted youths initially reported a higher rate of suicide attempts, on further probing this sexual attraction [difference] disappeared." Savin-Williams believes that pro-homosexual adults have done a disservice to homosexual teens by creating a "suffering, suicidal, tragic" script for them that often leads these troubled teens to report attempted suicides when these events did not occur. According to Savin-Williams, homosexuals do a disservice to "gay" teens when they "paint them with one rather narrow negative brush stroke." Homosexuals, however, have won great inroads into public schools by claiming that "gay" teens are killing themselves in record numbers. This 30% suicide claim is now gone-and activists are finally being forced to admit this fact-something they had refused to do for more than a decade."
  • Cornell psychologist on myths and realities facing gay teens (Video, 2010). Webpage with video featuring Dr. Savin-Williams. - Formal Announcement - a press release - by Cornell University of this "journalists-only" event: "Growing Up Gay in America: Cornell psychologist to explore the myths and realities facing ‘The New Gay Teenager’ at November Inside Cornell."
  • Lowery, George (2010). Savin-Williams sets media straight about today's gay youth. [Cornell University] Chronicle Online. Full Text.
"Current research, Savin-Williams said, finds that only a small subset of gay youth finds their sexuality so problematic that they would end their own lives because of it. The widespread belief that being young and gay is inherently dangerous risks spawning even more tragedy ("suicide contagion")."
  • Savin-Williams R (2010). The Gay Kids Are All Right. [Includes clarifications and responses by others. Good Men Project] Full Text.
"In response to the popular view that there is a gay youth suicide epidemic, it’s important to realize that there is no scientific evidence to support it. There is no scientific data that compares gay and straight youth on completed suicide rates."

Dr. Joe Kort, and expert on gay youth: "I want to thank you for being an advocate for gay youth Ritch, However, I have always disagreed with your perspective that things are better for gay youth BEFORE they come out. It is true that they negotiate the coming out process earlier and that they are better than those in my generation (I am 47). However, it is absolutely not true that before they come they are better. In my experience, it is exactly the same for gay and lesbian children today than it was when we were growing up. The cultural trauma of hiding one’s identity and being young gay and lesbian spies listening and witnessing the hate and bigotry (which is much more visible today then in the 1970′s) is a form of covert cultural sexual abuse. Coming out is still traumatic. Being out is much better these days and that is where I agree with you wholeheartedly... I think the fact that suicides of gay teens has not gone down in numbers let’s us know things are not much better. I have never heard reports that gay teens attempting or committing suicide are going down in numbers. I know they are not rising however–just receiving more media attention."

Ritch Savin-Williams says [to Joe Kort]: Just to be clear, in terms of your statement, “I think the fact that suicides of gay teens has not gone down in numbers let’s us know things are not much better. I have never heard reports that gay teens attempting or committing suicide are going down in numbers” I want to re-state my position. First, we have no data on gay teen suicides, so whether it has gone up, down, or stayed the same, we don’t know. Second, we do know that the reported suicide attempt has decreased dramatically over the past generation. Whether this is because of an actual decline or because our research is better (that is, perhaps it was never as high as reported by early studies), we do not know. [Last statement not true. Evidence indicates same or worse.]

Criticism of Savin-Williams: Simon, Max (2010). Since When Did Too Many Gay Kids Start Having Wonderful Childhoods We Could Ignore Kids Taught To Hate ThemselvesFull Text.

I’ve been trying all day long to avoid Cornell professor Dr. Ritch Savin-Williams arguing on The Good Men Project that, hey, lots of gay kids don’t have it so bad these days, and that’s why the message of “It Gets Better” might be misguided. Savin-Williams means well. That’s why he should denounce his own position. Citing a lack of evidence (or rather, old and bad evidence) to show that gay tweens and teens are not any worse off than straights, Savin-Williams attempts in “The Gay Kids Are All Right” to dismantle the message of telling gay youth that it gets better as adults, because many of these gay kids are actually having a lovely upbringing, and never realized they were supposed to hate themselves and get picked on.

  • O'Brien, Kathleen (2010). A debate on the issue of suicide among gay youth. Full Text.

More than three dozen studies indicate gay teens may be at higher risk for suicide, and a recent spate of gay teens taking their lives — in places from Tehachapi, Calif., to Cypress, Texas — had even U.S. Secretary of Education Arne Duncan taking note. The cluster of suicides, including Clementi’s, also gave new urgency to a push for stricter anti-bullying laws, and drew attention to a worldwide YouTube campaign assuring gay teens that “It Gets Better.” But Savin-Williams says the perception that to be gay is to risk being suicidal is a myth — and a dangerous myth at that. “It creates this image we have of gay youth, of what I call the ‘suffering suicidal youth.’ I worry a great deal that some may actually try suicide in order to really be gay,” he says... There are no data showing a disproportionate number of completed suicides among gays. “Zero,” he says.

  • Brody, Jane E (2011). Gay or Straight, Youths Aren’t So Different. New York Times. Full Text.
“I’m concerned about the message being given to gay youth by adults who say they are destined to be depressed, abuse drugs or perhaps commit suicide,” Ritch C. Savin-Williams, a professor of developmental psychology who is director of Cornell’s Sex and Gender Lab, said at a recent news briefing. “I believe the message may create more suicides, more depression and more substance abuse. I worry about suicide contagion. About 10 to 15 percent are fragile gay kids, and they’re susceptible to messages of gay-youth suicide.” In an interview, Dr. Savin-Williams said: “We hear only the negative aspects from research. We don’t hear about normal gay teens. It’s hard to get studies published when researchers don’t find differences. A large number of studies found no group differences between gay and straight youth, but these have not been published.” [Comment: A list of these studies should be requested. See the great suicidality differences - on the basis of multiple random samples - between sexual minority and heterosexual adolescents published by the CDC (2011) and tabulated on another webpage. On the same page, see also the suicidality results of the Marshal et al. (2011) meta-analysis.] ... Rather, recent studies show that the risk factors for suicide are identical for gay and straight youth. These, Dr. Savin-Williams said, include “prior mental illness, depression, bipolar disorder, dysfunctional families, breakups in relationships, suicide in the family and access to means.” [Comment: evidence for this may be lacking.] ... As for suicide, Dr. Diamond said: “What most commonly precipitates suicide attempts in both heterosexual and homosexual adolescents is being dumped by a romantic partner. Kids who lose someone they cared about need to be listened to in a sensitive way, offered support and comfort, and reassured that this is not their only chance of finding love.” [Comment: evidence for this may be lacking.] - Note: This article was cited as the basis for a similar article written for the Swiss French speaking people: Les jeunes gays pas plus malheureux que les autres (2011, Translation): A la suite de plusieurs cas de suicide, le focus est mis depuis plusieurs mois sur les discriminations subies par les ados LGBT. Or une étude américaine affirme qu'il n'existe pas de réelle différence entre jeunes homos et hétéros [Following several cases of suicide, the focus was set for several months on the discrimination suffered by LGBT teens. However, a U.S. study says there is no real difference between gay and straight youth].
Criticism of Savin Williams: Kincaid, Timothy (2011). Gay kids, socially stigmatized or “not so different”? Full Text.

I’m always a bit hesitant about the research of Lisa Diamond, associate professor of psychology and gender studies at the University of Utah. Her conclusions – frequently quoted (or misquoted) by proponents of change therapy – too often seem to be on the outer edge of conventional thinking and I am troubled that her methods of communication lend themselves too easily to misinterpretation. I really haven’t reached my own conclusion as to whether Diamond is a revolutionary genius or a nut. Or perhaps a bit of both. But I have developed an opinion about Dr. Ritch C. Savin-Williams, director of Cornell’s Sex and Gender Lab. In much of his writing, I appears to me that he starts with his conclusions and finds whatever is available to support them. Savin-Williams is married to the post-gay notion that today’s youth (or perhaps tomorrow’s) have fully integrated into society and do not experience orientation identity but rather are attracted to whom they are attracted without any sense that such attraction is informative (my paraphrase). While this seems naive to my personal experiences, it does meld well with Diamond’s hypotheses on sexual fluidity. In an article today in the New York Times health section, Diamond and Savin-Williams are the primary sources for the presentation of the idea that bullying and suicide of gay youth are over-blown fears and that most gay kids are just like straight kids. Some of their arguments have merit, others are just word games.

  • Butts, Charlie  (2010). 'Gay' suicide pandemic a myth, says educator. OneNewsNow.
A conservative attorney agrees with a Cornell University psychology professor who believes the idea that there is a homosexual youth suicide epidemic is a dangerous misconception. Following the recent suicides of four homosexual youths, Professor Ritch Savin-Williams stated he believes "it is important to point out...that there is absolutely no scientific evidence of an 'epidemic of gay youth suicide,' or even that gay youth kill themselves more frequently than do straight youth." Though he agrees the deaths are tragic, he decides they are rendered "even more tragic because they come at a time when growing up gay has never been better or easier." Cornell University's director of the Sex and Gender Lab further contends that "gender expression, not sexual orientation...is linked with decreased psychological wellbeing and is likely the result of bullying." So he deems it "irresponsible" to assert there is an epidemic of homosexual youth suicide because of the "be prepared to kill yourself" message it delivers. Matt Barber of Liberty Counsel agrees with the professor's assessment. "As we've known all along, this line that is being pushed by radical homosexual extremist pressure groups that somehow societal homophobia is responsible...this is purely propaganda," he argues. "And as this professor points out, this is the case."
  • Radford, Benjamin  (2010). Is There a Gay Teen Suicide Epidemic? Full Text.
One researcher, Cornell University's Ritch Savin-Williams, examined the two studies that had asserted the high gay teen suicide rate and found many methodological flaws. For example, the researchers failed to account for the fact that "most individuals with same-sex attractions do not identify themselves as gay," Savin-Williams wrote in the December 2001 issue of the Journal of Consulting and Clinical Psychology. "The net effect is that conclusions about suicide risk among sexual-minority youths are based not on same-sex attractions but on self-identification [and] researchers who rely solely on gay-identified youths might be omitting significant, more diverse and representative populations of youths with same-sex attractions." The study concluded that "the assertion that sexual-minority youths as a class of individuals are at increased risk for suicide is not warranted."


The Savin-Williams' 2001 Study: A Major Statistics-Related Perceptual Error. - Improper Use of Statistical methods. - Results Are Statistically Significant as Opposed to the Reported Statistical Non-Significance.

Soon after the Savin-Williams (2001) study appeared, a critique was written and it became a part of Appendix A in the paper "The Changing Social Construction of Western Male Homosexuality: Associations With Worsening Youth Suicide Problems" by Pierre Tremblay and Richard Ramsay (Full Text, Appendix A). The tables below represent an addition to the critique as related to the only male sample studied by Savin-Williams, from which his conclusions about sexual minority male suicidality were based. That is, sexual minority males were apparently not more at risk for a lifetime true suicide attempt compared to heterosexual males because statistical significance - p < 0.05 - was not the result of the analysis. Therefore, Savin-Williams (2001) was concluding that, because the null hypothesis (no difference between the two groups) was not rejected, this also means that the null hypothesis is true. This conclusion - a serious error - was explored on another webpage but, here, only one citation - Schlag (2011) - is used to highlight the problem:

2.5 Accepting the Null Hypothesis: Null hypotheses are rejected or not rejected. One does not say that the null hypothesis is accepted [as essentially said in Savin-Williams study]. Why? Not being able to reject the null hypothesis can have many reasons. It could be that the null hypothesis is true. It could be that the alternative hypothesis is true but that the test was not able to discover this and instead recommended not to reject the null [will be shown to apply in the  Savin-Williams study]. The inability of the test to discover the truth can be due to the fact that it was not sufficiently powerful, that other tests are more powerful [some results of these more powerful tests will be given for Savin-Williams study results]. It could be that the sample size is not big enough so that no test can be sufficiently powerful [applies in the Savin-Williams study for the Null Hypothesis test used].

Part 1: The Corrected Statistical Results for the Savin-Williams 2001 Study: All Male Suicide Attempters.


There were a total of 6 real suicide attempters in the sample: 5 in the sexual minority category (9.4%: 5 / 53) and one suicide attempter in the 100% heterosexual category (1.6%: 1 / 61). 



The Savin-Williams 2001 Study Results: University Students
Sexual Minority Males & 100% Heterosexual Males *

Categories
Sexual Minority Males
University Students
100% Heterosexual Males
University Students
N's
53
Small Non-Random Sample
61
Small Non-Random Sample
True, Life-
Threatening
Suicide Attempt
5
(Given as 9%, but is 9.43%)
1
(Given as: 2%, but is 1.64%)
Comment
Using the reported percentage, the estimated Risk Ratio = 4.5 (9% / 2%)
With the more precise percentages, Risk Ratio = 5.75 (9.43% / 1.64%)
Note: Only rounded percentages are given in the paper. Counts were not given and they are based on reported percentages, with the event counts later confirmed as accurate by Ritch Savin-Williams via personal communication.
Comment:
Effect Size
Related
OR: 6.25 (0.67 - 146.30)
The RR or OR were not reported in the paper. The RR for the data is:
5.75 (0.68, 129.99) - Fisher Two-/One-Sided Exact Test: p = 0.095, 0.074
Pearson Uncorrected: 3.46, p = 0.063 1
The OR is a measure of "effect size," with 6.5 being deemed a large or near-large effect size (Chen et al, 2010).

An appropriate measure of effect size for the study result would be Cohen's h that is related to arcsine difference (See: Related Information Page):
h = 2(arcsin √P1) - 2(arcsin √P2) = {2(arcsin √[9.43% = 0.0943])} - {2(arcsin √[1.64% = 0.0164])}= {2 x 0.312} - {2 x 0.128} = 0.368 = medium effect size. Cohen's recommendation for effect size magnitudes: 0.10 (small), 0.30 (medium), 0.50 (large).
The medium to maybe large effect size (OR related) would mean that the Savin-Williams' study results have practical or even clinical significance. Stated otherwise, it would be a very perceptually "significant" difference if, in a college male sample, there were six males who had attempted suicide, with only one suicide attempter (16.7% of attempters) in the group of 100% heterosexual males (n = 61), and 5 (83.3% of attempters) in the group of sexual minority males (n = 53). For this sample, the medium effect size counter the possibility or postulation that there are "no differences" between the two groups of males.
Study
Report

"No significant differences were found among gender/sexual orientation groups in true suicide attempts. Approaching significance, heterosexual men had lower rates than sexual minority men, X2 (1, N = 114) = 3.30, p < .10 ..." (p. 988), the exact p-value being 0.063 1 (not reported), that is close to statistical significance.
Stated otherwise, 'approaching significance, homosexual men had higher rates than heterosexual men.' The 'higher rate', however, is not mentioned. It would be 5.75 times more at risk.
Comment
'Power"
Related
For both a Pearson Corrected & Fisher Test to be statistically significant, the study sample would have required 6 suicide attempters in the sexual minority group.
RR: 6.91 (0.88, 152.00)
Fisher Two-/One-Sided Exact Test: p = 0.048, 0.038 1
Pearson Uncorrected: 4.61, p = 0.032 1
Conclusion: For this study sample, a greater attempted suicide risk factor of about magnitude "7" would have been required to produce statistically significant results.
Stated otherwise, the study would have low power. The study has power of 0.44 for a one- / two-sided Fisher exact test, p < 0.05 2
A power of 0.80 is recommended for studies. Low power means a probability of a Type II error: Declaring statistical nonsignificance when statistical significance may apply. Most important, this means that insufficient knowledge is available to declare a "no difference" between the two groups, with a likelihood that a statistically significant difference exists.
Note

The Pearson's Chi Squared Test is inappropriate to use when there are less than 5 counts in more than 20% of the event cells, that is 50% in this case. Recommendations: use Fisher Exact Test (e.g. Fisher Exact Test, Wikipedia)

Using the Conditional One-/Two-Sided Fisher Exact Test, however, is widely reported to produce conservative results:  producing statistically nonsignificant results when statistical significance would apply. The recommendation is to use the Unconditional Fisher Exact Test, other unconditional tests, or other tests that are more powerful. (e.g. Lydersen et al. (2009). See Information on a Related Webpage)
Other More Powerful Null
Hypothesis
Tests
Some Results from Unconditional Multinomial Null Hypothesis Tests 3

Unconditional Fisher Exact, One-Sided (Confidence Interval Method): p = 0.047
Z-Pooled (Confidence Interval Method. One-Sided) Chi Squared: p = 0.044


Note: Multinomial: 2 groups, same sample, being compared.
Binomial: 2 groups, separate/independent samples, being compared.


Mid-P Fisher Exact Test, One-Sided: p = 0.041 4
Mid-P Fisher Exact Test, One-Sided: p = 0.049 5

Arcsin Difference:
arcsin √P1 - arcsin √P2 =
arcsin √[9.43% = 0.0943] - arcsin √[1.64% = 0.0164]) =
0.312 - 0.128 = 0.184, One-Sided p =
0.0438 6
Conclusion: The study, as is, produced statistically significant results.
Sexual minority male university students are about 6-times more at risk for a lifetime life-threatening suicide attempt, compared to heterosexual males students.
Conclusion by researcher: "life-threatening true suicide attempts did not vary by sexual orientation" (p. 989). This conclusion would be in error.

1. Calculator:
http://statpages.org/ctab2x2.html
2. Calculator: Exact power for the Fisher Exact Test.
3. Calculator & Related Information: http://www.stat.ncsu.edu/exact/
4. TMP Calculator & Related Information: http://www.ugr.es/~bioest/software.htm
5.
SISA Calculator: http://www.quantitativeskills.com/sisa/statistics/twoby2.htm
6.
Calculated with TMP Program, Version 2 http://www.ugr.es/~bioest/software.htm
* Savin-Williams RC (2001). Suicide attempts among sexual-minority youths: population and measurement issues. Journal of Consulting and Clinical Psychology, 69(6): 983-991. PubMed Abstract.


Schlag, Karl H (2011). Exact Hypothesis Testing without Assumptions - New and Old Results not only for Experimental Game Theory. Conference presentation. PDF Download. PDF Download: 2010 Version.


Chen H, Cohen P, Chen S (2010). How Big is a Big Odds Ratio? Interpreting the Magnitudes of Odds Ratios in Epidemiological Studies. Communications in Statistics - Simulation and Computation, 39: 860–864. Abstract.
Our calculations indicate that OR = 1.68, 3.47, and 6.71 are equivalent to Cohen’s d = 0.2 (small), 0.5 (medium), and 0.8 (large), respectively, when disease rate is 1% in the nonexposed group; Cohen’s d < 0.2 when OR < 1.5, and Cohen’s d > 0.8 when OR > 5. It would be useful to values with corresponding qualitative descriptors that estimate the strength of such associations; however, to date there is no consensus as to what those values of OR may be. Cohen (1988) suggested that d = 0.2, 0.5, and 0.8 are small, medium, and large on the basis of his experience as a statistician, but he also warned that these were only “rules of thumb.” Better guidelines are needed to draw conclusions about strength of associations in studies of risks for disease when we use OR as the index of effect size in epidemiological studies. (p. 864)

Lydersen S, Fagerland MW, Laake P (2009). Tutorial in biostatistics: Recommended tests for association in 2×2 tables. Statistics in Medicine, 28(7): 1159-1175. Abstract. PDF Download.

Abstract: The asymptotic Pearson's chi-squared test and Fisher's exact test have long been the most used for testing association in 2X2 tables. Unconditional tests preserve the significance level and generally are more powerful than Fisher's exact test for moderate to small samples, but previously were disadvantaged by being computationally demanding. This disadvantage is now moot, as software to facilitate unconditional tests has been available for years. Moreover, Fisher's exact test with mid-p adjustment gives about the same results as an unconditional test. Consequently, several better tests are available, and the choice of a test should depend only on its merits for the application involved. Unconditional tests and the mid-p approach ought to be used more than they now are. The traditional Fisher's exact test should practically never be used (Emphasis added).

Recommendations: Exact tests have the important property of always preserving test size. Our general recommendation is not to condition on any marginals not fixed by design. In practice, this means that an exact unconditional test is ideal. Pearson’s chi-squared (z-pooled) statistic or Fisher–Boschloo’s statistic works well with an exact unconditional test. Further, such a test can be approximated by an exact conditional mid-p test or, in large samples, see, for example, the traditional asymptotic Pearson’s chi-squared test. However, when an exact test is chosen, an unconditional test is clearly recommended. The traditional Fisher’s exact test should practically never be used (p. 1174, Emphasis added).


Part 2: The Unreported Statistical Results for Male Suicide Attempters Who Had Received Medical Care.


There were a total of 3 suicide attempters who received medical care: 3 in the sexual minority category (5.7%: 3 / 53) and none in the 100% heterosexual category (0.0%: 0 / 61).


The Savin-Williams 2001 Study Results: University Students
Sexual Minority Males & 100% Heterosexual Males *

Categories
Sexual Minority Males
University Students
100% Heterosexual Males
University Students
N's
53
Small Non-Random Sample
61
Small Non-Random Sample
Suicide Attempters,
Received
Medical Care
3
(5.66%)
0
(0.00%)
Comment:
Effect Size
Related
With one "Zero" event cell, it is not possible to calculate a Risk Ratio or an Odds Ratio. However, the Peto Odds Ratio is an estimate of what the Odds Ratio may be: 8.93 (0.91 - 88.13) 1
The OR is a measure of "effect size," with 8.93 being deemed a large effect size (Chen et al., 2010).

A measure of effect size for the study result would be Cohen's h that is related to arcsine difference (See: Related Information Page):
h = 2(arcsin √P1) - 2(arcsin √P2) = {2(arcsin √[5.66% = 0.00])} - {2(arcsin √[0.00% = 0.00])}= {2 x 0.240} - {2 x 0.000} = 0.480 = medium / near-large effect size. Cohen's recommendation for effect size magnitudes: 0.10 (small), 0.30 (medium), 0.50 (large).
The near-large (Cohen's h) to large effect size (Peto OR related) would mean that the Savin-Williams' study results have practical or even clinical significance. Stated otherwise, it would be a very perceptually "significant" difference if, in a college male sample, the three males who had attempted suicide and received medical care were all in the sexual minority male category (n = 53), with none in the 100% heterosexual male category (n = 61). For this sample, the medium / large effect size counters the possibility or postulation that there are "no differences" between the two groups of males.
Study
Report

"No significant differences were found among gender/sexual orientation groups in true suicide attempts. Approaching significance, heterosexual men had lower rates than sexual minority men, X2 (1, N = 114) = 3.30, p < .10 ..." (p. 988)
Stated otherwise, 'approaching significance, homosexual men had higher rates than heterosexual men.' The 'higher rate', however, is not mentioned. It would be 5.75 times more at risk.
Note: The above applied for all real suicide attempters. If Savin-Williams had presented an analysis of only the suicide attempters who received medical attention, the following might have been written:
'No significant differences were found among gender/sexual orientation groups in true suicide attempts. Approaching significance, heterosexual men had lower rates than sexual minority men, X2 (1, N = 114) = 3.55, p < .10 ...', and not noting that the p < .10 is "0.06" that describes the closeness to statistical significance.
Comment
'Power"
Related
For both a Pearson Corrected & Fisher Test to be statistically significant, the study sample would have required 4 suicide attempters who received medical care to be in the sexual minority group. Results would be:
Fisher Two-/One-Sided Exact Test: p = 0.044, 0.044 2
Pearson Uncorrected: 4.77, p = 0.029 2
Note: For Study Counts: Fisher Two-/One-Sided Exact Test: p = 0.097, 0.097 2
The study would have low power. The study has power of 0.35 for a one- / two-sided Fisher exact test, p < 0.05 3
A power of 0.80 is recommended for studies. Low power means a probability of a Type II error: Declaring statistical nonsignificance when statistical significance may apply. Most important, this means that insufficient knowledge is available to declare a "no difference" between the two groups, with a likelihood that a statistically significant difference exists.
Note

The Pearson's Chi Squared Test is inappropriate to use when there are less than 5 counts in more than 20% of the event cells, that is 100% in this case. Recommendations: use Fisher Exact Test (e.g. Fisher Exact Test, Wikipedia)

Using the Conditional One-/Two-Sided Fisher Exact Test, however, is widely reported to produce conservative results:  producing statistically nonsignificant results when statistical significance would apply. The recommendation is to use the Unconditional Fisher Exact Test, other unconditional tests, or other tests that are more powerful. (e.g. Lydersen et al. (2009). See Information on Related Webpage)
Other More Powerful Null
Hypothesis
Tests
Some Results from Unconditional Multinomial Null Hypothesis Tests 4

Unconditional Fisher Exact, One-Sided (Confidence Interval Method): p = 0.047
Z-Pooled (Confidence Interval Method. One-Sided) Chi Squared: p = 0.034


Note: Multinomial: 2 groups, same sample, being compared.
Binomial: 2 groups, separate/independent samples, being compared.

Mid-P Fisher Exact Test, One-Sided, Two-Sided: p = 0.036, p = 0.064 5
Mid-P Fisher Exact Test, One-/Two-Sided: p = 0.049, p = 0.049 6

Arcsin Difference:
arcsin √P1 - arcsin √P2 =
arcsin √[5.66% = 0.0566] - arcsin √[0.00% = 0.00]) =
0.24 - 0.00 = 0.24, One-Sided p =
0.0355 7
Conclusion: Given the information available, it would be incorrect to conclude that suicide attempters who had received medical care did not vary by sexual orientation.

1. Calculator: DJR Hutchon: http://www.hutchon.net/ConfidORnulhypo.htm
2. Calculator:  http://statpages.org/ctab2x2.html
2. Calculated with WinPepi 11.17 - Download at http://www.brixtonhealth.com/.
3. Calculator: Exact power for the Fisher Exact Test.
4. Calculator & Related Information: http://www.stat.ncsu.edu/exact/
5. TMP Calculator & Related Information: http://www.ugr.es/~bioest/software.htm
6.
SISA Calculator: http://www.quantitativeskills.com/sisa/statistics/twoby2.htm
7.
Calculated with TMP Program, Version 2 http://www.ugr.es/~bioest/software.htm
* Savin-Williams RC (2001). Suicide attempts among sexual-minority youths: population and measurement issues. Journal of Consulting and Clinical Psychology, 69(6): 983-991. PubMed Abstract.


Conclusion Related to the Analyses

It would appear like almost all concepts advanced by Ritch Savin-Williams - as based on this 2001 study results - and especially for sexual minority males almost always reported by other researchers to have been at greater risk for having attempted suicide compared to heterosexual males - have not only been in error, but his beliefs are also based on highly flawed statistical analyses of his 2001 male study sample. See: Plöderl M, Kralovec K, Yazdi K, Fartacek R (2011). A closer look at self-reported suicide attempts: false positives and false negatives. Suicide and Life-Threatening Behavior, 41(1): 1-5. Abstract. Full Text... for a replication of what the Savin-Williams' conclusion should have been, i.e., the opposite of what he asserted.

We may now wonder about how such a flawed statistical analysis could ever be published in a journal of the American Psychological Association. Hints related to this problem are reported by Coe (2002) and Kelley (2012):
Coe, Robert (2002). It's the Effect Size, Stupid. What effect size is and why it is important. Paper presented at the Annual Conference of the British Educational Research Association, University of Exeter, England, 12-14 September 2002. Full Text.
"'Effect size' is simply a way of quantifying the size of the difference between two groups. It is easy to calculate, readily understood and can be applied to any measured outcome in Education or Social Science. It is particularly valuable for quantifying the effectiveness of a particular intervention, relative to some comparison. It allows us to move beyond the simplistic, 'Does it work or not?' to the far more sophisticated, 'How well does it work in a range of contexts?' Moreover, by placing the emphasis on the most important aspect of an intervention - the size of the effect - rather than its statistical significance (which conflates effect size and sample size), it promotes a more scientific approach to the accumulation of knowledge. For these reasons, effect size is an important tool in reporting and interpreting effectiveness. The routine use of effect sizes, however, has generally been limited to meta-analysis - for combining and comparing estimates from different studies - and is all too rare in original reports of educational research (Keselman et al., 1998). This is despite the fact that measures of effect size have been available for at least 60 years (Huberty, 2002), and the American Psychological Association has been officially encouraging authors to report effect sizes since 1994 - but with limited success (Wilkinson et al., 1999)."
Wilkinson L, Task Force on Statistical Inference, APA Board of Scientific Affairs (1999). Statistical Methods in Psychology Journals: Guidelines and Explanations. American Psychologist, 54(8): 594-604. Full Text. Full Text.

Kelley, Ken (2012). On Effect Size. Psychological Methods. In Press. PDF Download.
"For example, a Journal of Applied Psychology editorial states that “if an author decides not to present an effect size estimate along with the outcome of a significance test, [the editor] will ask the author to provide specific justification for why effect sizes are not reported. So far, [the editor has] not heard a good argument against presenting effect sizes” (Murphy, 1997, p. 4). Similarly, a Journal of Consulting and Clinical Psychology editorial states that, “evaluations of the outcomes of psychological treatments are favorably enhanced when the published report includes not only statistical significance and the required effect size but also a consideration of clinical significance” (Kendall, 1997, p. 3)." (p. 6)
Kendall PC (1997). Editorial. Journal of Consulting and Clinical Psychology, 65: 3-5.
Murphy KR (1997). Editorial. Journal of Applied Psychology, 82: 3-5.
Given the above information, it is now important to ask why the Savin-Williams study was allowed to be published in the Journal of Consulting and Clinical Psychology given that effect sizes, power, and clinical/practical significance issues were completely ignored. Most important, however, is the fact that a major 'crime' in statistics had been committed: equating statistical nonsignificance to a proof that the null hypothesis had been confirmed; that is, that there was a "no difference" between the groups compared.

The Savin-Williams 2001 study conclusion is based on the assumption that statistical nonsignificance (p ≥  .05) equates to 'a no differences' between the two compared groups, also meaning the acceptance of the Null Hypothesis (H0: “Zero difference”) and rejection of the Alternative Hypothesis (H1: “Nonzero difference”). Most statistical textbooks informs users of statistical methods about this erroneous conclusion. This serious error is highlighted by Tony Brady (2005/2008):
"Authors with 'negative' results (i.e. found no difference) should not report equivalence unless sufficiently proven - "absence of evidence is not evidence of absence.""

Brady, Tony (2005/2008). Reviewer's quick guide to common statistical errors in scientific papers [Elsevier advice to peer reviewers of scientific papers]. PDF Download. Full Text.

The Savin-Williams Small-Sample 2001 Flawed Study Conclusions Were Not Replicated in a Larger-Sample Austrian Study.


Plöderl M, Kralovec K, Fartacek R (2010). The relation between sexual orientation and suicide attempts in Austria. Archives of Sexual Behavior, 39(6): 1403-1414. Abstract: Previous studies indicate that homosexual or bisexual individuals are at a higher risk of attempting suicide compared to heterosexuals. To overcome biases in these studies, more rigorous definitions of "suicide attempts" and the assessment of multiple dimensions of sexual orientation are needed. In addition, studies from the German speaking region are sparse, especially those not recruiting participants from the gay or lesbian communities. We solicited self-reported suicide attempts among 1,382 Austrian adults recruited through structured snowball sampling from students' social networks. Suicide attempts were more frequently reported by those participants with homosexual or bisexual fantasies, partner preference, behavior, and self-identification, compared to their heterosexually classified counterparts. This was true for any dimension of sexual orientation and for suicide attempts with intent to die or suicide attempts that required medical treatment. Our Austrian study confirmed existing evidence that homosexual and bisexual individuals are at an increased risk for attempting suicide. This should be considered in suicide preventive efforts.
Excerpt: "It has, however, been argued that the increased suicide attempt risk among sexual minorities may be a product of methodological biases in these studies. For example, biased results may stem from vague definitions of‘‘suicide attempt.’’ Most studies only used a single item on suicide attempts, thus leaving it open to the study participants to decide what counts as a suicide attempt. When suicide attempts were more rigorously assessed, the difference in sexual orientation lost its significance in one study (Savin-Williams, 2001, Study 2), but not in another study, where the risk difference actually increased (Bagley & Tremblay, 1997). In the Savin-Williams (2001) study, participants were given follow-up questions to classify suicide attempts as ‘‘false attempts,’’ i.e., attempts that were not carried out and were only suicide plans or ‘‘true attempts,’’i.e., attempts that were carried out. No significant sexual orientation differences occurred after restricting the analysis to true suicide attempts. Bagley and Tremblay’s (1997) study is, to our knowledge, the only study that differentiated between suicidal gestures (with no clear intention to die and without a lethal method) and serious suicide attempts with a clear intention to die and/or the use of a potentially lethal method (Bagley, Wood, & Young, 1994). Notably, the intent to die is crucial for distinguishing suicide attempts from other suicide related behaviors (Silverman, Berman, Sanddal, O’Carroll, & Joiner, 2007). Using the ‘‘serious suicide attempt’’ variable resulted in a substantially greater sexual orientation difference than using the ‘‘suicidal gesture’’ variable. Given the mixed results of the two studies and the lack of related studies assessing intent to die, more research with improved assessments of suicide attempts is clearly needed. (1403-1404)
Excerpt / Last Paragraph: "The present study found increased lifetime rates of suicide attempts among Austrian men and women who reported homosexual or bisexual attraction, behavior, or self-identification, compared to their heterosexual counterparts.This increased risk remained for even more rigorous definitions of suicide attempts. The results were in line with previous studies and thus indicate that suicide risk is not a methodological artefact [as proposed by Savin-Williams (2001) on the basis of his flawed study] but really increased among sexual minority individuals. Therefore, suicide preventive efforts should include sexual minorities as target groups." (1413)
Savin-Williams, R. C. (2001). Suicide attempts among sexual-minority youths: Population and measurement issues. Journal of Consulting and Clinical Psychology, 69, 983–991. Abstract

Bagley, C., & Tremblay, P. (1997). Suicidal behaviors in homosexual and bisexual males. Crisis, 18, 24–34.
Research Highlights. Abstract. Earlier book version of the paper.

Bagley, C., Wood, M., & Young, L. (1994). Victim to abuser: Mental health and behavioral sequels of child sexual abuse in a community survey of young adult males. Child Abuse and Neglect, 18, 683–697. Abstract.

Silverman, M. M., Berman, A. L., Sanddal, N. D., O’Carroll, P. W., & Joiner, T. E. (2007). Rebuilding the tower of Babel: A revised nomenclature for the study of suicide and suicidal behaviors part 2: Suicide-related ideations, communications, and behaviors. Suicide and Life-Threatening Behavior, 37, 264–277. Reference. Abstract.
Related Presentations: Matarazzo BB, Gutierrez PM, Silverman MM (2012). The Self-Directed Violence Classification System (SDVCS) Training: What it is and why it matters. Developed in collaboration with the Centers for Disease Control and Prevention. PPT Presentation. - Brenner LA, Silverman MM, Betthauserr LM, Breshears RE, Bellon KK, Nagamoto HT (2010). Suicide Nomenclature. The "Suicide Prevention Conference" Presentation Incudes: Silverman MM (2010). A Brief History of the Development of a nomenclature and Classification System. PDF Download.


The Savin-Williams Small-Sample 2001 Flawed Study Conclusions Were Not Replicated in a Much Larger and More Representative Sample of American University Students.

The Study: Whitlock J, Knox KL (2007). The Relationship Between Self-injurious Behavior and Suicide in a Young Adult Population. Archives of Pediatrics and Adolescent Medicine, 161(7): 634-640. PubMed Abstract. Full Text. Full Text. Related Informaton & Related Publications. Related Information: "College Mental Health Issues and Suicide-Prevention Program Discussed" - Access via Google.
The Methodology as Described by Whitlock & Knox and as Recommended by Savin-Williams: "Lifetime suicidality was measured using a binary response item 34 that asked, “Have you ever seriously considered suicide or attempted suicide?” Respondents who answered affirmatively were asked to select any of 8 statements that applied to them. For purposes of these analyses, these statements were clustered into the following 4 categories: (1) ideation (“I thought seriously about it”), (2) plan (“I had a general plan but did not carry it out ”; “I had a method but did not carry it out”), (3) gesture (“I wrote a suicide note but did not leave it where it could be found”; “I wrote a suicide note and did leave it where it could be found”), and (4) attempt (“I made a serious attempt but no medical intervention occurred”; “I made a serious attempt that received medical attention”). Respondents with multiple responses were placed into only 1 of these categories based on the most serious of their response selections, since understanding lethality may be a critical discriminating factor among self-injurious individuals." (p.635)
The Study Sample: "Participants were drawn from a random sample of 8300 undergraduate and graduate students (33.7% of the total combined population) from 2 northeastern universities. All were sent a postcard inviting them to participate in a Web-based survey in the spring of 2005. Soon after, each received a personalized e-mail with a link to the survey. A total of 3069 (37.0%) students completed the survey. Cases in which a majority of the responses were missing or in which SIB [self-injurious behavior] or suicide status was indeterminable were omitted (n=194), resulting in 2875 (34.6%) cases retained for analysis. Sample demographics were largely representative of the overall student population, although there were significantly more women in the sample population than in the population from which they were drawn (56.3% vs 47.6%)." (p.635)
Sexual Minority Student Study Results: "In comparison to students identifying as straight, students reporting as gay or lesbian were 4.2 times (95% CI, 1.2-14.1) more likely to report attempting suicide..." (p. 638)  "Attempted Suicide" results for bisexual and questioning students were not reported.

Comment: It is likely that Ritch Savin-Williams (Cornell University) has known of the above gay & lesbian "attempted suicide" study result given that the lead researcher, Janice Whitlock, is also from Cornell University. No one has yet produced a paper that analyses and reports on the suicidality of sexual minority university students in the Whitlock & Knox (2007) study sample.


The Savin-Williams Small-Sample 2001 Flawed Study Conclusions May Well Not be Replicated in a Much Larger and More Representative Longitudinal 2007 to 2009 Sample of American University Students.

The Study: Whitlock J, Muehlenkamp J, Eckenrode J, Purington A, Baral Abrams G, Barreira P, Kress V (2013). Nonsuicidal Self-injury as a Gateway to Suicide in Young Adults. Journal of Adolescent Health, 52(4): 486-492.  PubMed Abstract.

The Methodology: Same suicidality information solicited as described above in the Whitlock & Knox (2007) study.
The Sexual Minority Related Study Results:


The Survey of Student Wellbeing (SSWB)
Suicidality Risks After Non-Suicidal Self Injury (NSSI)
Categories
Contribution of non-suicidal self-injury to later
suicide-related thoughts/behavior: Odds Ratios, 95% C.I.
Post NSSI development of any
suicide-related thoughts/behavior
Post NSSI development of suicide
behavior (excluding ideation)
Unadjusted
Model
Adjusted
Model
Unadjusted
Model
Adjusted
Model
Sexual
Orientation

Heterosexual
(Comparison Group)
1.0
1.0
1.0
1.0
Mostly
Heterosexual
1.5e (1-2.2) .7 (.4-1.1) 1.7e (1-2.7) .4 (.4-1.5)
Bisexual
3c (1.8-5.1) 1.3 (.6-2.5) 3.1c (1.6-6) 1.5 (.6-3.3)
Mostly gay/lesbian
or gay/lesbian
3.2c (1.8-5.7) 2.5e (1.2-5.3) 5.1c (2.8-9.3) 4.3c (1.9-9.6)
      c p < .001 -  e p < .05
Comments: For university students who had engaged in non-suicidal self injury in the past, the risk for later experiencing "suicide-related thoughts/behavior" or "suicide behavior" while at university was greatest for all non-heterosexual students (Unadjusted Models), and the greatest - at statistically significant levels - only for the "mostly gay/lesbian or gay/lesbian" group (Adjusted Models).
Note: When the least serious and most common form of suicidality (suicide ideation) is removed from the suicidality category, the risk for what remains (more serious forms of suicidality) increases even more for the "mostly gay/lesbian or gay/lesbian" group in the "Unadjusted Models" (ORs from 3.2 to 5.1) and the "Adjusted Models" (ORs from 2.5 to 4.3). This is consonant with multiple examples where sexual minority individuals have been reported to be more at risk for the more serious forms of suicidality. See: Related Webpage.

Data Source: Whitlock et al. (2013)
Sampling Information: "In 2007, 14,372 students from eight Northeast and Midwest public and private universities participated in aWeb-based study entitled the Survey of Student Wellbeing (SSWB). The sample was representative of the overall student population across all eight universities in terms of ethnicity, age, and socioeconomic status although more females than males participated (57.6% vs. 41.7%, 95% CI, 53.3 - 59.2; Z = 14.96, p < .001). Five of these universities agreed to allow participants the option of participating in a longitudinal study. Two of the five schools were private, two were public, and one was a mix of public and private. All but one are located in largely urban areas. Of 5,214 eligible respondents, 2,320 (44.5%) indicated willingness to participate in longitudinal study. A total of 1,810 (78%) of these participated at Time 2 (spring 2008). Of the eligible 1,810, a total of 1,466 participated at Time 3 (spring 2009). This represents 63.2% of the original sample (n = 2,320) willing to participate in longitudinal study. The final sample did not differ from the original cross-sectional sample of students from the original eight-college study by sex, ethnicity/race, age, sexual orientation, or socioeconomic status, NSSI history, or STB history. At baseline the longitudinal sample (n = 1,466) had an average age of 20.3 (SD = 4); was 59.9% female; 75.5% heterosexual, 16.1% mostly heterosexual, 4.5% bisexual, 3.9% gay/lesbian; 69.3% Caucasian, 4.8% African-American, 3.8% Hispanic,11.1% Asian, and 11% other; 72.2% had fathers who had completed college." (p. 487)

Note: In the above study, the varied forms of suicidality incidences could be compared between heterosexual students and sexual minority students (individually or combined) for the approximately 2 years following the initial intake of data (From the 2007 Wave 1 to the 2009 Wave 3). Data was likely also solicited that would permit suicidality incidence comparisons prior to 2007.

Appendix A


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

Excerpt:

Lesbian, Gay, Bisexual, and Transgender Populations

Studies over the last four decades suggest that LGBT individuals may have an elevated risk for suicide ideation and attempts. Attention to this disparity has been limited, in part because neither the U.S. death certificate nor the NVDRS identify decedents’ sexual orientation or gender identity. Thus, it is not known whether LGBT people die by suicide at higher rates than comparable heterosexual people.

Across many different countries, a strong and consistent relationship between sexual orientation and nonfatal suicidal behavior has been observed.229 A meta-analysis of 25 international population-based studies found the lifetime prevalence of suicide attempts in gay and bisexual male adolescents and adults was four times that of comparable heterosexual males.230 Lifetime suicide attempt rates among lesbian and bisexual females were almost twice those of heterosexual females. Lesbian, gay, and bisexual (LGB) adolescents and adults were also found to be almost twice as likely as heterosexuals to report a suicide attempt in the past year. A later meta-analysis of adolescent studies38 concluded that LGB youth were three times more likely to report a lifetime suicide attempt than heterosexual youth, and four times as likely to make a medically serious attempt. Across studies, 12 to 19 percent of LGB adults report making a suicide attempt, compared with less than 5 percent of all U.S. adults; and at least 30 percent of LGB adolescents report attempts, compared with 8 to 10 percent of all adolescents. To date, population-based studies have not identified transgender participants, but numerous nonrandom surveys show high rates of suicidal behavior in that population, with 41 percent of adult respondents to the 2009 National Transgender Discrimination Survey reporting lifetime suicide attempts.231

Most studies have found suicide attempt rates to be higher in gay/bisexual males than in lesbian/bisexual women, which is the opposite of the gender pattern found in the general population. As in the overall population, there is some evidence that the frequency of suicide attempts may decrease as LGB adolescents move into adulthood,232 although patterns of suicide attempts across the lifespan of sexual minority people have not been conclusively studied. Within LGB samples, especially high suicide attempt rates have been reported among African American, Latino, Native American, and Asian American subgroups.233235

Suicidal behaviors in LGBT populations appear to be related to “minority stress,”236 which stems from the cultural and social prejudice attached to minority sexual orientation and gender identity. This stress includes individual experiences of prejudice or discrimination, such as family rejection, harassment, bullying, violence, and victimization. Increasingly recognized as an aspect of minority stress is “institutional discrimination” resulting from laws and public policies that create inequities or omit LGBT people from benefits and protections afforded others.231, 237240 Individual and institutional discrimination have been found to be associated with social isolation, low self-esteem, negative sexual/gender identity, and depression, anxiety, and other mental disorders. These negative outcomes, rather than minority sexual orientation or gender identity per se, appear to be the key risk factors for LGBT suicidal ideation and behavior. An additional risk factor is contagion resulting from media coverage of LGBT suicide deaths that presents suicidal behavior as a normal, rational response to anti-LGBT bullying or other experiences of discrimination.

Further research is needed to explore the pathways to suicidal behaviors for transgender individuals, including the impact of prejudice and discrimination. Factors that foster and promote resilience in LGBT people include family acceptance,239 connection to caring others and a sense of safety,66 positive sexual/gender identity, and the availability of quality, culturally appropriate mental health treatment.58 Strategies for preventing suicidal behaviors in LGBT populations include: reducing sexual orientation and gender-related prejudice and associated stressors; improving identification of depression, anxiety, substance abuse, and other mental disorders; increasing availability and access to LGBT-affirming treatments and mental health services; reducing bullying and other forms of victimization that contribute to vulnerability within families, schools, and workplaces; enhancing factors that promote resilience, including family acceptance and school safety; changing discriminatory laws and public policies; and reducing suicide contagion.

Collaboration between suicide prevention and LGBT organizations is needed to ensure the development of culturally appropriate suicide prevention programs, services, and materials, and to facilitate access to care for at-risk individuals. A promising example is the development of guidelines for media in talking about suicide in LGBT populations241 created by a coalition of AFSP and several national LGBT organizations. Another critical need is closing knowledge gaps through additional research and improved surveillance. Efforts are underway to expand the inclusion of sexual orientation and gender identity measures in federal health and mental health surveys, and to develop and test procedures for postmortem identification of LGBT people in NVDRS.

Resources

American Foundation for Suicide Prevention: LGBT Initiative

www.afsp.org/index.cfm?page_id=6FB9BA00-7E90-9BD4-C33BD398EAAE73C0

This initiative works on suicide prevention among the LGBT population in a number of ways, including producing a conference, funding research grants, working to improve how the media covers anti-gay bullying, helping its chapter volunteers bring understanding of suicide into their local LGBT communities, and creating LGBT mental health educational resources and training tools.

Stop Bullying Website

www.stopbullying.gov

A website that provides information from various government agencies on what bullying is, what cyberbullying is, who is at risk, and how individuals can prevent and respond to bullying.

Suicide Prevention Among LGBT Youth: A Workshop for Professionals Who Serve Youth

SPRC

www.sprc.org/training-institute/lgbt-youth-workshop

This is a free workshop kit to help staff in schools, youth-serving organizations, and suicide prevention programs take action to reduce suicidal behavior among LGBT youth. It contains a Leader’s Guide, sample agenda, PowerPoint presentations, sample script, and handouts.

The Trevor Project

www.thetrevorproject.org

This national organization focused on crisis and suicide prevention among lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth provides a 24-hour, toll-free, crisis intervention phone line (1–866–488–7386); an online, social networking community for LGBTQ youth aged 13 to 24 and their friends and allies; educational programs for schools; and advocacy initiatives.