Changing Social Construction of Western Male Homosexuality:
Associations With Worsening Youth Suicide problems."
- Poster Presentation at the "Diversity & Health" Conference (Calgary, Alberta: November 12, 2004) is the same as for the 2004 CASP Conference, with one addition.
- Higher Suicidality Incidences and Greater Mental Health Problems for Bisexual Adolescents and Adults.
- Information Handout made available at the "AAS
(American Association of Suicidology) 38th Annual Conference," Broomfield,
Colorado: April 2005.
- A Meta-Analysis by Meyer (2003) reports that sexual minority individuals are at greater risk for mental disorders.
"The Changing Social Construction of Western Male Homosexuality:
Associations With Worsening Youth Suicide problems."
- Parts of Poster
- Related Paper
Title Page: "The Changing Social Construction of Western Male Homosexuality: Associations With Worsening Youth Suicide problems"
A Short History
1995 CASP Conference, Pierre Tremblay presents first comprehensive paper in Canada on a subject highlighted in its title: "The Homosexuality Factor In The Youth Suicide Problem." Available online. Based on a 1993, 1994 self-published 200-page monograph distributed in Alberta (200 copies, parts online). "Update" in 1996.
1996: the first web ‘site’ in the world dedicated to "Gay/Bisexual Male Youth Suicide Problems" was online and greatly expanded in subsequent years. It now has its own domain: http://www.youth-suicide.com. Continues to be the most comprehensive site on the subject in combination with partner site at: http://fsw.ucalgary.ca/ramsay/homosexuality-suicide/
1997: Calgary-based random sample study of young adult males produces first published article that strongly suggests young adult homosexually oriented males (YAHOM) may account for more than 50% of Youth Suicides (Bagley and Tremblay, 1997). These males accounted for 62.5 percent of serious suicide attempters (based on serious intent to die and/or severity of attempt). Their Odds Ratio (OR = 14.4, to mean age of 22 years) replicated Bell & Weinberg, 1978: OR=14.9, to age of 20 years for predominantly homosexual males). Also replicated for 17-29 year-old age group results in Cochran and Mays, 2000, NHANES III male study sample: OR=13.4, males reporting same-sex sexual partners).
2000: Tremblay presents invited paper at The 11th Annual Sociological Symposium: "Deconstructing Youth Suicide," San Diego State University. The presented theoretical construct was the result of multiple conversations with Richard Ramsay and was authored with his assistance. The paper is titled "The social construction of male homosexuality and related suicide problems: research proposals for the Twenty First Century."
2001-2003: Ramsay & Tremblay are updating the paper with information and research results produced by themselves and others, but this information is not published. This process continues and an interim paper is now being made available.
2003: Denmark (One of the most homo-accepting countries in the western world) produces the first published suicide outcomes for adults in registered same-sex partnerships. Compared to opposite-sex married couples, their odds for committing suicide is about 4-times greater (Qin et al., 2003).
2004: Tremblay & Ramsay present results at two conferences on "Anti-Gay Harassment" in Oregon high schools (usually based on presumed homosexuality based on detected gender non-conformity attributes) and the role it plays in the suicidality of Aboriginal (one race), Aboriginal (Multi-Race), and other Multi-Race adolescent males. Results are based on Binary Logistic Regression Analyses that use generally unknown/unused methodologies required to address low counts problems in data set when analysing minority ethnic groups. These low counts result, in part, from the insidious and harmful white racism of professionals who design the studies and related data sets. Using 50 independent variables, "anti-gay harassment in schools" was the most significant predictor of the most serious forms of suicidality for these males: multiple suicide attempts and/or attempts associated with receiving medical attention. Note: There is a paucity of research on Multi-Race people. Nothing is available on attempting suicide by young North American Multi-Race males. Next to nothing is available on the relationships of homophobia with suicidality for young North American Aboriginal males and Muti-Race males, except for anecdotes suggesting very strong associations. Being Aboriginal (also at greater risk for involvement in male prostitution) was a predictor of "having attempted suicide" in Vancouver’s Vanguard AIDS/HIV Cohort Studies: Men Who Have Sex With Men.
2004 Poster Presentation at the CASP Conference in Edmonton, Alberta: "The Changing Social Construction of Western Male Homosexuality: Associations With Worsening Youth Suicide problems." Related Paper With Same Title.
Sexual Minorities: A History of
Outright “Harm” (The Mental Disorder Label for Homosexuality) to
Harmful Common “Avoidance” & “Indifference” in Health/Medicine, Psychiatry, Psychology,
Community Psychology, Family Therapy, and Social Work! Slow Recent Changes! Why?
http://people.ucalgary.ca/~ramsay/ or http://people.ucalgary.ca/~ptrembla/ or http://www.youth-suicide.com
Parts of Poster Presentation
14. Addition Made for "Diversity and Health: Connectiong Research, Policy and Practice" Conference (Calgary, Alberta: November 12, 2004).
The above panel was edited due
to lack of space. The original Script with a Bibliography:
Family Therapy, Social Work and Health / Medicine:
A History of Slow Changes from Outright “Harm”
to Harmful “Avoidance” & “Indifference.” Why?
“Outright and Indifference” Harm by Mental Health Professions: to 1973/1992
The profession of psychiatry decreed adult homosexuality as a “Mental
Disorder”, sanctioning unquestioned harmful practices for many decades
until it was finally declassified as a disorder from the DSM (Diagnostic
Statistical Manual of Mental Health Disorders in 1973/74 and completely
removed in 1986. However, it remained a mental disorder until 1992 for
those using the ICD: WHO’s International Classification of Diseases and
Related Health Problems (Herek, 1998-2004). Adolescent
homosexuality, on the other hand, had been viewed as a normal part of adolescence
that was not pathologised nor minoritised by developmental psychologists.
By the early 1970s, however, “silence” about this subject became the rule
(Spurlock, 2002), almost as if the attribute should
NOT exist, or that its place in human development applied to so few (giving
it a rare “sexual minority” status) that it could be ignored. This outcome
left for psychologists and other mental health professions to foster harmful
practices of avoidance and indifference.
Avoidance & Indifference: 1973-2000 (For a summary, see: Tremblay & Ramsay, 2003a)
American/Canadian Psychology (1994): What contemporary psychology had been doing to advance the knowledge and understanding of homosexual development is best summed up in the title of a paper “"I only read about myself on bathroom walls": the need for research on the mental health of lesbians and gay men” (Rothblum, 1994). Some recent improvements have been described by Phillips et al. (2003) and Morrow (2003), the latter noting that serious problems still exist: “Lesbian, gay, and bisexual (LGB) concerns continue to be underrepresented in the counseling literature, although progress was made in the 1990s in the content and quantity of literature dealing with these issues. Despite progress in several areas, the scholarship on specific marginalized groups within the LGB community is particularly sparse: LGB people of color, bisexual women and men, lesbian women, LGB people with disabilities, and transgendered individuals.” Phillips et al. (2003) also noted the lack of “attention to within-group differences (e.g., bisexual people and LGB people of color).”
Family Therapy (1997): “Twenty years and still in the dark?” by Clark & Seovich in the Journal of Marital and Family Therapy, 1997. This was a content analysis of articles pertaining to gay, lesbian, and bisexual issues in marriage and family therapy journals. Very little published on “gay/lesbian” issues (0.6% of articles). Bisexuality was almost totally ignored. This reflects the recent common (hegemonic?) belief that sexual orientation is binary in nature. On individuals is either heterosexual or homosexual.
Social Work (2001): Coverage of Gay and Lesbian Subject Matter in 12 mainstream Social Work Journals by Van Voorhis & Wagner in the Journal of Social Work Education, 2001. The most coverage (two-thirds) in four najor social work journals from 1988 to1997 was AIDS-related. Heterosexism is the rule as Voorhis & Wagner (2002) noted in a paper with a telling title: “Among the Missing: Content on Lesbian and Gay People in Social Work Journals.” Bisexuality is almost totally ignored. In a 1998 Interview, Ann Hartman reports: “"I remember one of my friends overheard several of the male deans at a social work Dean's meeting communicating with each other saying, 'The lesbians are taking over the field.' I am sure there is still plenty going on underground, as you can imagine. For instance five or six years ago there was a concerted, but rather quiet effort led by some of the deans to keep homosexuality out of the Council on Social Work Education guidelines" (Miller, 1998).
Community Psychology (2003): Special GLBT Issue in American Journal of Community Psychology, 31(3/4). D'Augelli (2003: 345) describes the lack of coverage of GLB issues in community psychology: "...little work was done by community psychologists on LGB issues until the very late 1990s. Harper and Schneider (2003: 244-5) reported on two studies of GLB content in major community psychology journals: no more than one percent of published articles had been related to GLB issues. Bisexuality is almost totally ignored.
Health/Medicine: Healthy People 2010 (USA): In 1998, “outrage at the exclusion of lesbian, gay, bisexual, and transgendered health issues in an 800-page federal health plan, the Gay and Lesbian Medical Association [GLMA] has announced a plan of action…” When inclusion happened: "This marks the first time, LGBT health concerns, other than HIV, have been addressed in any significant way," said Patricia Dunn, GLMA policy director. "This is a major step forward in national health policy. Such issues as the lack of adequate research, barriers to quality health care, and insensitivity to LGBT people within the medical community, are finally being addressed" (GLMA News Release, 1998, 2000) Canada: The first Health Canada sponsored meeting of invited individuals concerned about GLBT health issues (T = Two-Spirited, Transgernder Issues Not Included) occurred in 2001 at McGill University.
Inclusion in Healthy People 2010 eventually occurred as reported in GLMA News Release (2000), which reported on the publication of a related White Paper (Dean L, et al., 2000): “Both Dunn and Carter believe that the GLMA-Columbia white paper begins to address the serious deficit of public knowledge about the health care needs of LGBT people. The GLMA-Columbia white paper is a precursor to an even more comprehensive companion piece on LGBT health that will follow the final Healthy People 2010 document to be published by the Department of Health and Human Services (DHHS) later this year.” For a companion document, see: Gay and Lesbian Medical Association and LGBT health Experts (2001). Many problems, however, still are to be overcome as indicated in the title of O'Hanlan’s paper “Advocacy for Women's Health Should Include Lesbian Health” (O’Hanlon, 2004) that maybe should have been titled “Advocacy for Women's Health Should Include Health Issues for Lesbian and Bisexual Females” to make sure the whole continuum of Women’s Health is included.
Note on Bisexuality: The avoidance/exclusion/erasure of bisexuality
issues was reported by Yoshino (2000) in the109-page
law paper “The epistemic contract of bisexual erasure.” For relevant quotations,
see Tremblay (2000). For a summary of the “bisexuality”
situation, see Tremblay & Ramsay (2000).
For the “at risk” status of adolescents and adults in the “bisexual” categories
presented in a Power Point presentation form and within the context of
other “at risk” population (including the “at risk” situation of Multi-Race
people) who are category/boundary violators/criminals in our all-too-common
“binary” perceptions of things, see Tremblay & Ramsay (2003).
Researchers often have the same harmful biases of populations they may
be studying and collaborating with, and they may therefore participate
in harming certain minority groups. For example, using the word “gay” to
describe all sexual minority individuals is a way that those who describe
themselves as “gay” privilege themselves over homo-oriented individuals
or sub-groups they have marginalised and harmed. In an attempt to prioritise
“bisexuality” with respect to some “at risk” issues such as mental health
and suicidality, Tremblay & Ramsay (2003b)
gave the following title to the male sexual minority suicidality information
pages: “Bisexual / Gay / Queer Male Suicidality” as a highlighted contrast
to the title at the companion web site by Tremblay (1996-2004):
“Youth Suicide Problems: Gay/Bisexual Male Focus!”
D'Augelli, Anthony R (2003). Coming Out in Community Psychology: Personal Narrative and Disciplinary Change. American Journal of Community Psychology, 31(3/4): 343-54. (PubMed Abstract)
Dean L, et al (2000). Lesbian, Gay, Bisexual, and Transgender Health: Findings and Concerns. Journal of the Gay and Lesbian Medical Association (JGLMA), 4(3): 101-151. Internet Download Page: http://www.glma.org/pub/jglma/vol4/3/index.shtml .
Gay and Lesbian Medical Association and LGBT health experts (2001). Healthy People 2010 Companion Document for Lesbian, Gay, Bisexual, and Transgender (LGBT) Health. San Francisco, CA: Gay and Lesbian Medical Association. Internet Download Page: http://www.glma.org/policy/hp2010/index.shtml
GLMA News Release (2000). Internet: http://www.boymeetsboy.com/news/releases/n00125hpwp.html
GLMA News Release (1998). Internet: http://www.glma.org/news/releases/n2010.html
Harper GW, Schneider M (2003). Oppression and Discrimination Among Lesbian, Gay, Bisexual, and Transgendered People and Communities: A Challenge for Community Psychology. American Journal of Community Psychology, 31(3/4): 243-52. (PubMed Abstract)
Herek GM (1998-2004). Facts About Homosexuality and Mental Health. Internet: http://psychology.ucdavis.edu/rainbow/html/facts_mental_health.html
Malley M, Tasker F (1999). Lesbians, gay men and family therapy: a contradiction of terms? Journal of Family Therapy, 21(1): 3-29. Abstract.
Miller J (1998). A narrative interview with Ann Hartman. Part One: Becoming a social worker. Reflections: Narratives of Professional Helping, 4(3), 56-69.
Morrow SL (2003). Can the Master’s Tools Ever Dismantle the Master’s House? Answering Silences With Alternative Paradigms and Methods. The Counseling Psychologist, 31(1): 70-77.
O'Hanlan KA, Dibble SL, Hagan Esq HJJ, Davids R (2004). Advocacy for Women's Health Should Include Lesbian Health. Journal of Women's Health, 13(2): 227-234. Abstract.
Phillips JC, Smith GS, Mindes EJ (2003). Methodological and content review of lesbian-, gay-, and bisexual-related articles in counseling journals: 1990-1999. The Counseling Psychologist, 31(1): 25-62. Abstract.
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)
Spurlock, John C (2002). From reassurance to irrelevance: adolescent psychology and homosexuality in America. History of Psychology, 5(1): 38-51. Abstract.
Tremblay (2000). The Binary & Bisexual Erasure: A Hatred of Bisexual People in Gay Communities? Internet: http://www.youth-suicide.com/gay-bisexual/racism-gay-lesbian/bisexual-bisexuality-hatred.htm
Tremblay (1996-2004). Youth Suicide Problems: Gay/Bisexual Male Focus! Internet: http://www.youth-suicide.com/gay-bisexual/
Tremblay P, Ramsay (2003b). Bisexual / Gay / Queer Male Suicidality. Internet: http://people.ucalgary.ca/~ptrembla/homosexuality-suicide/index.htm - or - http://fsw.ucalgary.ca/ramsay/homosexuality-suicide/
Tremblay P, Ramsay R (2003a). GLBTQ Information Site: Warnings, Acknowledgments, Authors. Internet: http://people.ucalgary.ca/~ptrembla/gay-lesbian-bisexual/information.htm - or - http://fsw.ucalgary.ca/ramsay/gay-lesbian-bisexual/information.htm
Tremblay P, Ramsay R (2003). Socially Constructed Binaries &Youth Suicidality. A part of the “Bi- Multi-Racial Males At Risk for Suicidality” presentation at the CSP (Centre For Suicide Prevention) Symposium. Calgary: April, 2003. Internet: http://people.ucalgary.ca/~ptrembla/homosexuality-suicide/binary/multiracial.htm - or - http://fsw.ucalgary.ca/ramsay/homosexuality-suicide/binary/multiracial.htm
Tremblay P, Ramsay R (2000). The social construction of male homosexuality, related suicide problems and research proposals for the Twenty First Century. Paper presented by Pierre Tremblay at The 11th Annual Sociological Symposium: "Deconstructing Youth Suicide," San Diego State University - March 17, 2000. Internet: http://people.ucalgary.ca/~ptrembla/homosexuality-suicide/construction/gay-youth-suicide-san-diego.htm - or - http://www.youth-suicide.com/gay-bisexual/gay-youth-suicide-san-diego.htm . Related section: Note 5: http://www.youth-suicide.com/gay-bisexual/gay-suicide-notes.htm#note2 .
Van Voorhis R, Wagner M (2001). Coverage Of Gay And Lesbian Subject Matter In Social Work Journals. Journal of Social Work Education, 37(1): 147-159. Abstract.
Van Voorhis R, Wagner M (2002). Among the Missing: Content on Lesbian and Gay People in Social Work Journals. Social Work, 47(4): 345-54. PubMed Abstract.
Yoshino, Kenji (2000). The epistemic
contract of bisexual erasure. Stanford Law Review, 53(2), 353-461.
. Interview with Kenji Yoshino by Carole Bass (1999): Both Ends Against
the Middle: How gays and straights make bisexuals invisible. Internet:
- or http://personals.valleyadvocate.com/articles/biout2.html. Abstract.
Higher Suicidality Incidences and Greater Mental Health Problems for Bisexual Adolescents and Adults.
For the graphing of the results from three studies, see 2003 PowerPoint Presentation: Slides 9-11 (Alternate Link). Or access each slide separately via the link at the end of each study referenced below.
Robin L, Brener ND, Donahue SF, Hack T, Hale K, Goodenow C (2002). Associations between health risk behaviors and opposite-, same-, and both-sex sexual partners in representative samples of Vermont and Massachusetts high school. Archives of Pediatrics & Adolescent Medicine, 156(4): 349-55. (PubMed Abstract) Link to the Graphing of Study Results.
Paul JP, Catania J, Pollack L, Moskowitz J, Canchola J, Mills T, Binson D, Stall R (2002). Suicide attempts among gay and bisexual men: lifetime prevalence and antecedents. American Journal of Public Health, 92(8): 1338-45. (PubMed Abstract) Link to the Graphing of Study Results.
Jorm AF, Korten AE, Rodgers B, Jacomb PA, Christensen H (2002).
orientation and mental health: results from a community survey of young
and middle-aged adults. Br J Psychiatry. 2002 May;180:423-7. (PubMed
Abstract) Link to the Graphing
of Study Results.
Title Page (Full Page Size PDF)
Adults At Risk For...
AAS Conference Information Handout (Links Added):
Sexual Minority* Suicidality/Suicide: The “At Risk” Evidence
- The general consensus in literature reviews (1, 2, 3, and others) is that white sexual minority male youth are at greater risk for attempted suicide (lifetime or in the past year) than their heterosexual counterparts: Odds Ratios = 2 to 14. Greater risk is suspected for suicide but sexual orientation data in research studies is either flawed or it is not available to make such a determination (1, 2, 3). White sexual minority male youth appear to have increasing risk from less to more serious forms of suicidal behavior: ranging from suicide ideation, planning a suicide attempt & self-harm to suicide attempts resulting in injuries requiring medical attention (See Panel 6, 7). Evidence suggests their overrepresentation in male youth suicidality statistics (5) (See Panel 11). The situation for white sexual minority female youth is not as clear, but higher risk is indicated. The same applies for non-white (including multi-racial) sexual minority youth in western countries.
- Evidence shows that “the great majority” of suicide attempts (including first suicide attempt) by white sexual minority individuals occur after age 21, thus suggesting that white sexual minority adults are also at high for suicidal behavior, and maybe suicide (5) (See Panels 2, 12). The Danish study (Qin, et al. 2003) reports breakthrough results supporting the “higher risk for suicide” proposition, at least for registered same-sex couples. Interestingly, Denmark has been very tolerant and accepting of homosexuality, and more so than in most western countries where greater risk may apply. From Qin et al. 2003: "...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]".
- When compared to studies that have established “at risk” factors for suicidality and suicide in the general population, the likelihood of greater “suicide” risk in white sexual minority adults could have been suspected from a cursory meta-analysis of sexual minority studies reporting comparable “at risk” incidences for mental disorders (lifetime, over a one-year period). A rigorous meta-analysis has produced compelling evidence of their higher risk for mental disorders compared to heterosexual individuals, with even greater odds ratios produced in the more representative (random) study samples (3). “Minority stress” may be implicated in these elevated incidences for mental disorders and suicidality. Summary of Meyer's Meta-Analysis Results.
- Related problems are evident in three studies that report bisexual adolescents or adults (rarely separated in analyses from gay and lesbian identified individuals) to be at the greatest risk for suicidality and/or impaired mental health (5) (Related Section), but research on this sexual minority group continues to be neglected. Transgender individuals have also been neglected in mainstream and minority populations mental health and suicidality research.
- Generally, mainstream studies of adolescent and adult suicidality and mental health continue to ignore “sexual orientation” issues. This indifference replicates the situation that has existed in the more popular journals of the helping professions. There is a documented history of poor coverage of minority sexual orientation issues (5). “Ignoring the evidence” and/or dismissing the evidence has been common practice (4, 5).
- Another related problem is evidence that being targeted for anti-gay harassment in schools (generally based on one’s detected/suspected gender nonconformity) are implicated in adolescent suicidality, especially for males not self-identified as gay or bisexual (5) (See Panels 6, 7). However, published research results are unavailable where relevant data exists, and this form of harassment is generally ignored in school and community bullying studies.
- Note: Research instruments such as the CDC’s official 2005 Youth Risk Behavior Survey continue to omit questions needed to indicate/determine the sexual orientation and gender identities of study participants, in spite of the associated high odds ratios expected in multivariate suicidality analyses. The survey instrument also does not include questions related to varied forms of harassment/bullying experienced by adolescents, including anti-gay/lesbian harassment. (Download Page for the YRBS Questionnaire and related Information: http://www.cdc.gov/HealthyYouth/yrbs/index.htm)
*”Sexual Minority” determinations in published studies have been based on one or more of the following: 1. Self-identification as gay, homosexual, queer, lesbian, and/or bisexual. - 2. Reporting same-sex sexual partners as an adolescent or adult. - 3. Being currently or recently engaged in same-sex sexual activities. 4. Reporting same-sex romantic attractions. – 5. Determination that study participants are predominantly homosexual/heterosexual or bisexual using the Kinsey 0-6 heterosexual to homosexual sexual-behavior/sexual-fantasy scales, or self-ratings by study participants on similar scales.
1. McDaniel JS, et al. (2001). The relationship between sexual orientation and risk for suicide: research findings and future directions for research and prevention. Suicide and Life-Threatening Behavior, 31 Supplement: 84-105. Abstract.
2. Russell, ST (2003). Sexual minority youth and suicide risk. American Behavioral Scientist, 46(9): 1241-1257. Abstract.
3. Meyer, IH (2003). Prejudice, Social Stress, and Mental Health in Lesbian, Gay, and Bisexual Populations: Conceptual Issues and Research Evidence. Psychological Bulletin, 129(5): 674-697. Summary.
4. McAndrew S, Warne T (2004). Ignoring the evidence dictating the practice: sexual orientation, suicidality and the dichotomy of the mental health nurse. Journal of Psychiatric and Mental Health Nursing, 11(4): 428-34. Abstract.
5. Tremblay P, Ramsay R (2004). The Changing Social Construction of Western Male Homosexuality: Associations With Worsening Youth Suicide Problems. Poster Presentation & Associated Interim Paper. CASP (Canadian Association For Suicide Prevention) Conference, Edmonton, Alberta. All information referenced is located at: http://www.youth-suicide.com/ : This Web Page.
6. Qin P, et al. (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.
Sexual Minority Individuals Are at Higher Risk for Mental Disorders.
|Combined Mantel–Haenszel weighted odds ratios and 95% confidence intervals for lifetime and 1-year prevalence of mental disorders in lesbian, gay, and bisexual versus heterosexual populations. Each calculated combined Mantel–Haenszel weighted odds ratio is displayed between the upper and lower bounds of its respective 95% confidence interval. Odds ratios were recalculated from aggregated data using the Statcalc procedure of the statistical software Epi Info (Centers for Disease Control and Prevention, 2001). This procedure does not adjust for demographics characteristics or any other control variables (e.g., sampling weights) that may be necessary to arrive at unbiased population estimates. These statistics are provided to allow synthesis of the risk for lesbian, gay, and bisexual versus heterosexual respondents in the studies, but they cannot be used as accurate estimates of adjusted population odds ratios. N = Number of Studies. Figure 2 by Meyer, 2003: 688.|
|Combined Mantel–Haenszel weighted odds ratios and 95% confidence intervals for lifetime prevalence of mental disorders in studies of lesbian, gay, and bisexual versus heterosexual populations that used random and nonrandom samples. Each calculated combined Mantel–Haenszel weighted odds ratio is displayed between the upper and lower bounds of its respective 95% confidence interval. Odds ratios were recalculated from aggregated data using the Statcalc procedure of the statistical software Epi Info (Centers for Disease Control and Prevention, 2001). This procedure does not adjust for demographics characteristics or any other control variables (e.g., sampling weights) that may be necessary to arrive at unbiased population estimates. These statistics are provided to allow synthesis of the risk for lesbian, gay, and bisexual versus heterosexual respondents in the studies, but they cannot be used as accurate estimates of adjusted population odds ratios. N = Number of Studies. Figure 3 by Meyer, 2003: 689.|
Meyer, IH (2003). Prejudice, Social Stress, and Mental Health in Lesbian, Gay, and Bisexual Populations: Conceptual Issues and Research Evidence. Psychological Bulletin, 129(5): 674–697.