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The Heterosexual Homosexuality Factor in Adolescent and Young Adult Suicidality. Dimensions of Suicide Conference: Exploring Cause and Effect

Previous Related Conference Alerts Since 1995: Most professionals involved with North American adolescent and young adult suicidality should/must know... that gay, lesbian, and bisexual identified people have been at greater risk for suicidality, the risk generally increasing for the more serious forms of suicidality. See the tabulated results for more than 110 studies (including transgender studies) available at

Generally "unknown" or "unsuspected": More adolescent / young adult suicide attempters (compared to gay, lesbian, bisexual – GLB - identified individuals) are likely in this category: heterosexual identified (especially if they report some same-sex attraction or sexual behavior), and their suicidality risks increases if "assumed" to be homo-sexual and targeted for anti-GLB harassment/abuse (See tabulated results for Seattle Adolescents and University students in this Alert.)... that may be an anti-gender violation sexism issue (1, 2, 3, 4). Their higher suicidality risk may also be related to a "No Man's Land" status in a world of common gender and sexual orientation binary perceptions.

Gaydar & Gender Nonconformity (GNC): It is reported that GNC attributes are most often used to suspect / assume that a person is homosexually oriented, with a higher likelihood that GNC individuals will experience ongoing dislike, rejection/exclusion, harassment, bullying & violence (5-7) that often begins in early childhood when such abuses are NOT related to sexual orientation issues, but also/only to gender role violations (7-9). Hence, reports of anti-GLB harassment/violence by individuals are often a likely proxy for the higher probability that some GNC attributes exist.

Gender Nonconformity (GNC) & Suicidality Risk: Researchers have reported that it is gender non-conforming GLB identified youth who are at greater risk for experiencing reprimands, harassment, abuses, violence, with the likelihood of high risk for having attempted suicide (e.g. 5, 11-12). However, more research of the exceptional kind is needed on heterosexual identified (likely GNC) individuals targeted for anti-GLB harassment and related suicidality. Fitzpatrick et al (2005) concluded: “Cross-gendered [college students], regardless of sexual orientation, appear to have higher risk for suicidal symptoms. Researchers and clinicians should assess gender role in evaluations of youth samples.” (13) Gender role issues such as GNC continue to be ignored in mainstream youth suicidology.

Binary Belief Factor: In a world of believed (often enforced) binaries (e.g.  sex: male/female, sexual orientation: heterosexual / homosexual), those not being as expected - meaning that they are in a "No Man's Land" - such as gender role violators - or bisexual people - have been reported to have the most mental health problems and higher rates of suicidality. This was the focus of a presentation by Tremblay & Ramsay (2003: 14). The same also applied for Bi/Multi-Racial adolescents in Oregon, compared to adolescents reporting only a one-'race' identity (Ramsay & Tremblay, 2004: 15). Such issues remain generally unrecognized and ignored in mainstream youth suicidology. Heterosexual identified people with GNC attributes or with some same-sex attraction - possibly acted on - would likely feel - or be made to feel - like they are in a “No Man’s Land.” Related Information: Tremblay & Ramsay (2004: 16).

Attempted Suicide: Males - 1995 Seattle Youth Risk Behavior Survey

Attempted Suicide: Females - 1995 Seattle Youth Risk Behavior Survey

*Attempted suicide incidence in the past 12 months by heterosexual, gay (G), and bisexual (B) adolescent males (Table 1) - or heterosexual, lesbian (L), and bisexual (B) females (Table 2) - who were or were not the "target of offensive comments or attacks" related to their presumed homosexual orientation at school or on the way to school. "Attempt(s) with Med. Attention" means one or more suicide attempts associated with having received medical attention. Saewyc (2002: 17) made the data on males and females available to the authors. About 89% of students answered both the questions related to sexual orientation and anti-GLB harassment.
Ethic Composition of Study Sample: 34% European-American, 26% Asian American, 18% African-American, 1% American Indian, 14% multi-ethnic, and 3% other. Respondents were evenly distributed from Grades 9 to 12. Almost equal numbers of males and females (Saewyc, 2000: 18).
1. Risk Ratios are calculated with a 95% Confidence Interval by the authors of the Alert. They represent comparisons with "not targeted" heterosexual male values or heterosexual female values for the Row Variable. "ns" = not significant.
2. Risk Ratios (95% Confidence Intervals) for being targeted for anti-GLB harassment, compared to Heterosexual males or Heterosexual females. For GB Males compared to "Unsure" Males: RR = 1.6<2.6<4.1. For LB Females compared to "Unsure" Females: RR = 2.1<3.0<4.4

Suicidality Results: University of Washington Students

Information related to victimization in the past year was solicited: victimization types & number, on and off campus, including on the basis of the assumption that one is non-heterosexual (GLB). Generally, non 100% heterosexual were most at risk for suicidality, with some exceptions, noting also a low count problem (subgroup sizes and suicidality counts). Result from regression analyses revealed that victimization on the basis of the assumption that one is GLB was implicated in suicidality for both sexual minority and heterosexual identified students.

It is doubted that heterosexual identified individuals reporting same-sex attractions or same-sex sexual activities would be “out” about this aspect of their lives, but some were nonetheless targeted for anti-gay comments / harassment. This likely happened because they were manifesting some gender nonconformable attributes, as such individuals were reported to have in the Dunne et al. (2000) study of Twins in Australia: “A continuous measure of childhood gender nonconformity (CGN) was sensitive to slight variations in homosexual attraction and behavior. In particular, among both men and women who identified as heterosexual, there were significant differences between “complete” heterosexuals and those who admitted to only one or a few same-sex behaviors but no homosexual attraction. Among men, CGN scores distinguished between heterosexuals who admitted to same-sex behavior only and those who admitted to some homosexual attraction. The sexual subgroups also differed on a measure of gender atypicality in adulthood.” (21)

Note: Only 12 of the 528 students had attempted suicide in the past year: 2 males and 10 females. “The Homosexuality Factor” is associated with the 2 male suicide attempters (100%) and 5 out of the 10 female suicide attempters (50%), for a total of 7 out of 12 suicide attempters (58.2%). Suicide attempts requiring medical attention were reported by 2 females, both also acknowledging some same-sex attraction or behavior.  A similar result was reported by Bagley & Tremblay (1997) from a random sample of 750 young adult males in Calgary: Five out of the 8 serious suicide attempters (62.5%) were either homosexual or bisexual identified (n = 3) or they were heterosexual identified and reported same-sex sex in the past 6 months (n = 2) (22).


1. Jenness V, Kendal B (1994). Antiviolence Activism and the (In)Visibility of Gender in the Gay /Lesbian and Women's Movements. Gender and Society 8(3): 402-423. Abstract.
2. Wilets J (1997). Conceptualizing Private Violence against Sexual Minorities as Gendered Violence: An International and Comparative Law Perspective. Albany Law Review, 60(3): 989-1050.
3. Tomsen S, Mason G (2001). Engendering Homophobia: Violence, Sexuality and Gender Conformity. Journal of Sociology, 37(3): 265-287. Abstract.
4. Namaste K (1996). Genderbashing: sexuality, gender, and the regulation of public space. Environment and Planning D: Society & Space, 14: 221-240. Abstract.
5. California Safe Schools Coalition & 4-H Center for Youth Development (2004). Safe Place  to Learn: Consequences of Harassment Based on Actual or Perceived Sexual Orientation and Gender Non-Conformity and Steps for Making Schools Safer.
6. Smith TE, Campbell L (2005). Self-perceived Gender Typicality and the peer Context during adolescence. Journal of Research on Adolescence, 16(1): 91-103.
7. Horn SS (2007). Adolescents’ Acceptance of Same-Sex Peers Based on Sexual Orientation and Gender Expression. Journal of Youth and Adolescence, 36(3): 363-371. Abstract.
8. Smetana JG (1986). Preschool children's conceptions of sex-role transgressions. Child Development, 57(4): 862-871. Abstract & First Page.
9. Blakemore JEO (2003). Children’s beliefs about violating gender norms: Boys shouldn’t look like girls, and girls shouldn’t act like boys. Sex Roles, 48(9): 411–19.

10. Bontempo DE, D'Augelli AR (2002). Effects of at-school victimization and sexual orientation on lesbian, gay, or bisexual youths' health risk behavior. Journal of Adolescent Health, 30(5): 364-74.
11. D'Augelli AR, Grossman AH, Salter NP, Vasey JJ, Starks MT, Sinclair KO (2005). Predicting the suicide attempts of lesbian, gay, and bisexual youth.  Suicide & Life Threatening Behavior, 35(6): 646-60.

12. Remafedi G, Farrow J, Deisher R (1991). Risk factors for attempted suicide in gay and bisexual youth. Pediatrics, 87(6): 869-75. . Tabulated Results.
13. Fitzpatrick KK, Euton SJ, Jones JN, Schmidt NB (2005). Gender role, sexual orientation and suicide risk. Journal of Affective Disorders, 87(1): 35-42. Abstract.
14. Tremblay P, Ramsay R (2003). Socially Constructed Binaries & Youth Suicidality. Presentation Segment from "Bi/Multi-Racial Adolescent Males at Risk for Suicidality." CPS (Centre for Suicide Prevention) Research Symposium, April, Calgary, Alberta.
15. Ramsay R, Tremblay P (2004). Bi/Multi-Racial & Aboriginal Adolescents At High Risk For Suicidality: Oregon 1999 Youth Risk Behavior Survey. PowerPoint Presentation: International Congress: Innovative Practices For Suicide Prevention. May, Montreal, Quebec.
16. Tremblay P, Ramsay R (2004). The Changing Social Construction of Western Male Homosexuality: Associations With Worsening Youth Suicide problems. Poster Presentation, Diversity & Health Conference, November, Calgary, Alberta. . Related paper: or
17. Saewyc E (2002). The 1995 Seattle Youth Risk Behavior suicidality results – separated for males & females - and based on sexual identification / self-labeling measures were made available via email. Some results for males and females analyzed together have been available in publications and online since 1996. See: Link to "Eighty-Three Thousand Youth" in PDF format by Reis B, Saewyc E (1999) at:
19. Saewyc EM, Singh N, Reis E, Flynn T (2000). The Intersections of Racial, Gender and Orientation Harassment in School and Health Risk Behaviors Among Adolescents. Poster presentation at The Annual Meeting of the Society of Adolescent  Medicine, March, Alexandria, Va. Presentation PDF sent to authors.

20. Murphy HE (2007).  Suicide Risk Among Gay, Lesbian and Bisexual College Youth. PhD Dissertation. College of Education, University of Washington. Dissertation at UMI:
1. Dunne MP, Bailey JM, Kirk KM, Martin NG (2000). The subtlety of sex-atypicality. Archives of Sexual Behavior, 29(6): 549-65. Abstract.
22. Bagley C, Tremblay P (1997). Suicidality problems of gay and bisexual males: Evidence from a random community survey of 750 men aged 18 to 27. In: Chris Bagley and Richard Ramsay (Eds). Suicidal Behavior in Adolescents and Adults, 177-193. Aldershot, England: Ashgate. Internet: or A slightly different version is published in 1977 Crisis, 18(1): 24-34.

For Additional Alert Information

Additional Information

Table 4 - BEM: Femininity / Masculinity Categories & Suicidality
Gay And Bisexual Male Youth: Age 14 - 21 Years
Remafedi, Farrow & Deisher (1991)
Femininity / Masculinity
Androgynous: 31%
Undifferentiated: 26%
% of Males
in Category
31% + 26% = 57%
(42/137) / (35/137)
Attempted Suicide
Percent Incidence
Androgynous = 26%, Undifferentiated = 34%
(23/77 = 30% ) 1
(3/28) 2, 3
Attempted Suicide
Percent Incidence
Feminine = 48%, Androgynous = 26%, Undifferentiated = 34%
(38/108 = 35.2% )
(3/28) 4
Bem Sex Role Inventory: Feminine: High F, Low M scores- Masculine: Low F, High M scores

Androgynous High F & M scores - Undifferentiated: Low F & M scores

Greater risk (95% Confidence Intervals) for attempting suicide: 1. "Feminine" Category vs. this Category - RR = .98<1.6<2.7 (c2 = 3.3, p = .068); 2. "Feminine" Category vs. this Category - RR = 1.4<4.5<14.0 (c2 = 9.8, p = .002); "Androgynous / Undifferentiated" Category vs. this Category - RR = .91<2.8<8.6 (c2 = 4.0, p = .044); 4. "Feminine / Androgynous / Undifferentiated" Category vs. this Category - RR = 1.1<3.3<9.9 (c2 = 6.3, p = .012). See Note 13 for Odds Ratios.

Table 5 - Child/Adolescent Femininity / Masculinity Self-Rating Categories
Suicidality of White Predominantly Homosexual Males: First Time 
Suicide Attempts to Age 20 and After Age 20 - Bell et al. (1981) Data
Femininity / Masculinity
0 - 1
Feminine / Masculine
2 - 3
4 - 6
% of Males
in Category
Attempted Suicide
10.9% 1
4.9% 2, 3
Attempted Suicide
To Age 20
4.9% 4
Attempted Suicide
After Age 20
10.6% 5
Calculations from Data Set (Tremblay & Ramsay, 2002): Femininity to Masculinity Scale: 0 to 6. Study Sample Taken in 1969 by Bell & Weinberg (1978).

Greater risk (95% Confidence Intervals) for attempting suicide: 1. "0-1" F-M Category vs. this Category - RR = 1.1<2.0<3.6 (c2 = 4.8, p = .027); 2. "0-1" F-M Category vs. this Category - RR = 2.1<4.4<9.3 (c2 = 17.4, p < .0000); 3. "2-3" F-M Category vs. this Category - RR = 1.2<2.2<4.2 (c2 = 6.3, p = .012); 4. "0-3" F-M Category vs. this Category - RR = 1.4<2.6<4.8 (c2 = 10.1, p = .001); 5. "0-3" F-M Category vs. this Category - RR = .42<.71<1.2 (c2 = 1.6, p = .20).

Bell A, Weinberg M (1978). Homosexualities: A Study of Diversity Among Men and Women. New York: Simon & Shuster.

Bell A, Weinberg M, Hammersmith S (1981). Sexual Preference: Its Development in Men and Women. Bloomington, Indiana: Indiana University Press.

Tremblay P, Ramsay R (2002). Statistical results generated via SPSS-10 by Thomas G. Albright, Systems Analyst/Programmer at the Kinsey Institute for Research in Sex, Gender and Research. January 9 and 11, 2002.