This Article  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (26)  • Contact me when this article is cited  Related Content  • Related letter  • Similar articles in JAMA  Social Bookmarking   What's this?

Gary Remafedi, MD, MPH
University of Minnesota Medical School, Minneapolis

JAMA. 1999;282:1291-1292.

The US government's Report of the Secretary's Task Force on Youth Suicide, which appeared in 1989, sparked a controversy that continues to the present day. In his chapter on gay and lesbian youth suicide, Gibson projected that "gay youth are 2 to 3 times more likely to attempt suicide than other young people. They may comprise up to 30% of completed youth suicides annually."¹ Some experts rejected the conclusions as being drawn from biased samples.² Considerable work since then has addressed the putative association between sexual orientation and suicide.

The problem of suicide first surfaced as an incidental finding in pioneering research on homosexuality that identified a high prevalence of such attempts among young men.³ Two of the earliest studies of gay youths revealed that as many as 1 in 3 had attempted suicide.^4-5 The next generation of research specifically studied suicidality and sexual orientation in convenience samples.^{3, 6-14} Ten such studies found consistently high rates of attempts among homosexual youths—in the range of 20% to 42%. Six of the studies involved both women and men.^{7, 9-11,13-14} Three found women's attempt rates to be as high as or higher than those of boys.^{9, 13-14}

Of the 10 studies, 6 explored risks for suicide by comparing attemptors and nonattemptors. They found that suicide attempts were neither universal nor attributable to homosexuality per se, but they were significantly associated with gender nonconformity,³ early awareness of homosexuality,^{3, 8, 11, 14} stress,¹² violence,¹⁴ lack of support,^{8, 11, 14} school drop-out,¹² family problems,⁸ acquaintances' suicide attempts,¹² homelessness,¹² and substance abuse³ or other psychiatric symptoms.^{6, 11, 14}

While providing valuable descriptive information, the prior studies were limited by potential sample biases, the absence of comparison groups, or both—problems recently surmounted by controlled, population-based surveys. Five of 6 such studies involved representative samples of US secondary school students^15-19 and one, a community sample of young men from Calgary, Canada.²⁰ All found higher rates of attempted suicide among homosexual youths compared to their heterosexual peers. Surveys large enough to examine sex differences among Minnesota¹⁵ and Massachusetts students¹⁹ found a significant association between homosexuality and suicidality in males only. Suicide risk factors such as gender nonconformity may be particularly detrimental to boys.^{15, 19}

A unifying explanation for the prevalence of suicidality among homosexual youths remains to be determined, as does the extent to which attempts end in death. Two psychological autopsy studies^21-22 have tried to unearth the sexual orientation of suicide victims. One found that 11% (13/119) of the young men who died from suicide in San Diego from 1981 to 1983 were known to be gay, but of the women, none were known to be lesbians.²¹ A second New York suicide study involved adolescent suicides from 1984 to 1986 and found that 3.2% (3/95) of male suicides and none of the living controls were found to have had homosexual experiences.²² Studies of this type can be limited in their ability to ascertain sexual behavior and orientation posthumously.

Although the understanding of gay, lesbian, and bisexual youth suicide is increasing, many questions remain regarding sex and ethnic differences, predisposing social and psychiatric conditions, protective factors, and constructive interventions. Future population-based surveys should routinely inquire about sexual orientation to retest prior findings in diverse settings. Prospective, longitudinal studies are needed to examine the evolving risk of suicide across the lifespan of homosexual persons. As we continue to assess the problem, existing data are sufficiently compelling to teach clinicians about the association between suicidality and sexual orientation and to plan preventive interventions.

AUTHOR INFORMATION
Visit the MSJAMA Web site at http://www.ama-assn.org/msjama and the new Virtual Mentor.

Funding/Support: This work was supported in part by the University of Minnesota Adolescent Health Training Program, grant 5-T71-MC-00006-22, Maternal and Child Health Bureau, Health Resources and Services Administration.

REFERENCES
1. Gibson P. In: US Department of Health and Human Services. Report of the Secretary's Task Force on Youth Suicide: Prevention and Interventions in Youth Suicide. Vol 3. Rockville, Md: US Dept of Health and Human Services; 1989. 2. Muehrer P. Suicide and sexual orientation: a critical summary of recent research and directions for future research. Suicide Life Threat Behav. 1995;25(suppl):72-81. 3. Remafedi G, Farrow JA, Deisher RW. Risk factors for attempted suicide in gay and bisexual youth. Pediatrics. 1991;87:869-875. FREE FULL TEXT 4. Remafedi G. Adolescent homosexuality: psychosocial and medical implications. Pediatrics. 1987;79:331-337. FREE FULL TEXT 5. Roesler T, Deisher RW. Youthful male homosexuality. JAMA. 1972;219:1018-1023. FREE FULL TEXT 6. Nicholas J, Howard J. Better dead than gay: depression, suicide ideation, and attempt among a sample of gay and straight-identified males aged 18 to 24. Youth Stud Aust. 1998;17:28-33. 7. Harry J. Parasuicide, gender, and gender deviance. J Health Soc Behav. 1983;24:350-361. FULL TEXT | ISI | PUBMED 8. Schneider AG, Farberow NL, Kruks GN. Suicidal behavior in adolescent and young adult gay men. Suicide Life Threat Behav. 1989;19:381-394. ISI | PUBMED 9. Hunter J. Violence against lesbian and gay male youths. J Interpersonal Violence. 1990;5:295-300. 10. Hammelman TL. Gay and lesbian youth: contributing factors to serious attempts or considerations of suicide. J Gay Lesbian Psychother. 1993;2:77-89. 11. D'Augelli AR, Hershberger SL. Lesbian, gay, and bisexual youth in community settings: personal challenges and mental health problems. Am J Community Psychol. 1993;21:421-448. FULL TEXT | ISI | PUBMED 12. Rotheram-Borus MJ, Hunter J, Rosario M. Suicidal behavior and gay-related stress among gay and bisexual male adolescents. J Adolesc Res. 1994;9:498-508. ABSTRACT 13. Proctor CD, Groze VK. Risk factors for suicide among gay, lesbian, and bisexual youth. Soc Work. 1994;39:504-513. ISI | PUBMED 14. Hershberger SL, Pilkington NW, D'Augelli AR. Predictors of suicide attempts among gay, lesbian, and bisexual youth. J Adolesc Res. 1997;12:477-497. ABSTRACT 15. Remafedi G, French S, Story M, Resnick M, Blum R. The relationship between suicide risk and sexual orientation: results of a population-based study. Am J Public Health. 1998;88:57-60. FREE FULL TEXT 16. DuRant RH, Krowchuck DP, Sinal SH. Victimization, use of violence, and drug use at school among male adolescents who engage in same-sex behavior. J Pediatr. 1998;132:113-118. 17. Faulkner AH, Cranston K. Correlates of Same-sex sexual behavior in a random sample of Massachusetts high school students. Am J Public Health. 1998:88:262-266. 18. Garofalo R, Wolf RC, Kessel S, Palfrey J, DuRant RH. The association between health risk behaviors and sexual orientation among a school-based sample of adolescents. Pediatrics. 1998;101:895-902. FREE FULL TEXT 19. Garofalo R, Wolf C, Wissow LS, Woods WR, Goodman E. Sexual orientation and risk of suicide attempts among a representative sample of youth. Arch Pediatr Adolesc Med. 1999;153:487-493. FREE FULL TEXT 20. Bagley C, Tremblay P. Suicidal behaviors in homosexual and bisexual males. Crisis. 1997;18:24-34. PUBMED 21. Rich CL, Fowler RC, Young D, Blenkush M. San Diego suicide study: comparison of gay to straight males. Suicide Life Threat Behav. 1986;16:448-457. ISI | PUBMED 22. Shaffer D, Fisher P, Hicks RH, Parides M, Gould M. Sexual orientation in adolescents who commit suicide. Suicide Life Threat Behav. 1995;25(suppl):64-71.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

RELATED LETTER

Sexual Orientation and Suicide Risk Among Teenagers
Robert S. Bobrow and Alan J. Zametkin
JAMA. 2002;287(10):1265-1266.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Investigating Queer Future Meanings: Destructive Perceptions of "The Harder Path"
Goltz
Qualitative Inquiry 2009;15:561-586.
ABSTRACT  

Same-Sex Attraction Disclosure to Health Care Providers Among New York City Men Who Have Sex With Men: Implications for HIV Testing Approaches
Bernstein et al.
Arch Intern Med 2008;168:1458-1464.
ABSTRACT | FULL TEXT  

Nondisclosure of Sexual Orientation to a Physician Among a Sample of Gay, Lesbian, and Bisexual Youth
Meckler et al.
Arch Pediatr Adolesc Med 2006;160:1248-1254.
ABSTRACT | FULL TEXT  

Attempted suicide, psychological health and exposure to harassment among Japanese homosexual, bisexual or other men questioning their sexual orientation recruited via the internet.
Hidaka and Operario
J. Epidemiol. Community Health 2006;60:962-967.
ABSTRACT | FULL TEXT  

Asian/Pacific Islander Adolescent Sexual Orientation and Suicide Risk in Guam
Pinhey and Millman
Am. J. Public Health 2004;94:1204-1206.
ABSTRACT | FULL TEXT  

Sexual Orientation and Adolescents
Frankowski and and Committee on Adolescence
Pediatrics 2004;113:1827-1832.
ABSTRACT | FULL TEXT  

ON RELIABILITY AND CULTURAL COMPETENCE IN STUDIES OF SEXUAL MINORITY SUICIDALITY
Mathy
Am. J. Public Health 2002;92:1883-1883.
FULL TEXT  

Sexual Orientation and Suicide Risk Among Teenagers
Bobrow and Zametkin
JAMA 2002;287:1265-1266.
FULL TEXT