About 88% of suicide attempters in samples of average youth taken for study do not report that their attempted suicide required medical attention(45), but the rate is lower for gay and bisexual male youth. Remafedi et al.(1991) reported that 21% (about twice the above rate) "of the suicide attempts (14/68) resulted in a medical or psychiatric hospitalization," but that a number of suicide attempts rated as having "high potential lethality" were not in this category. For the 68 suicide attempts performed by 41 suicide attempters in his samples of 137 GB youth, 54% of them "37/68 received risk scores in the 'moderate to high' lethality range. The remaining attempts were in the 'low risk' category... A rescue was initiated by the victim (24%) or by another person (76%) in the remaining 45 cases. Fifty-eight percent (26/45) of these cases received scores in the 'moderate to least' rescuable range. In other words, the predictable likelihood of rescue was moderate to low, despite the actual occurrence of an intervention." (31:871)14
If some of these attempts had resulted in suicide, it is doubtful that an investigating suicidologist would have been able to determine whether any of these victims were gay or bisexual males. This possibility would certainly apply for those males struggling with their homosexual orientation, especially when they are in the process of self-identification occurring at a mean age of 13.75(35) to 14.74(110). It is also known that many GLB suicide attempters, usually in treatment for the more serious suicides attempts, commonly do not reveal their homosexual orientation to therapists.
At the Hetrick and Martin Institute in New York, this reality was noted. "[W]e have had nine clients who were in treatment for suicide attempts but who had not yet told their therapists either that they were homosexual or that that was a factor in the suicide attempt(28:173). Uribe & Harbeck(1992) report that most suicide attempters in their high school based sample had sought help outside school and that, "without exception, those seeking help from private sources denied their sexual orientation to them." (37:22)
My experience with GLB youth suicide attempters in Calgary reveals the same pattern. After the suicide attempt, most of them did not volunteer such information to medical professionals, including mental health experts; and if this factor was broached by the worker, it was denied. As a result, mental health professionals have often not known one of the most important factors in the great distress of some: their sexual orientation.15 For similar reasons, suicidologists studying suicide victims will have great difficulty discovering the victim's possible homosexual orientation, and probably more so if adolescents are being studied. Many GLB survivors of serious suicide attempts often don't talk (until much later), and GLB youth who commit suicide may almost always take their "homosexual" secret to their graves.
Little work has been done to determine the percentage of suicides involving GLB people, and the major study was carried out by Rich et al.(1986). Moscicki(1995) cited this San Diego Suicide Study to dismiss the idea that gay males were more at risk for suicide by noting that "only 13 of the 383 consecutive suicides were gay."(14:32) This is true but, as commented on by Hendin (1995), all the known suicide victims determined to be gay were in the 21 to 42 age range, and it was highly unlikely that older gay males, and those younger than 21, do not also commit suicide(94:129). The implication is that the researchers may not have been highly skilled with respect to determining the homosexual orientation of suicide victims, especially if the [gay] victims were living closeted lives - as most younger and many older gay males would be doing. Therefore, the 13 gay suicide victims reported by Rich et al. would be a minimum, and the number of gay male victims in the 21-42 age group is probably underestimated.
Rich et al.(1986) recognized the above problem and, to at least have some resemblance to being a scientific study, the gay males who committed suicide were compared to the 106 straight victims in the same age range. Therefore, it was concluded that about 10% (11.8%) of suicide victims were definitely gay, which implied to Rich et al., given the assumed 10% figure for gay males, that they were no more at risk for suicide than heterosexual males(51:453). However, if we assume that the percentage of gay males in San Diego is about the same as Calgary (4% to 5%, see Appendix A), and that some of these males would not be gay-identifiable if they committed suicide (unless exceptional investigative work was done), it could be concluded, as a minimum estimate, that gay males are about three-times more likely to commit suicide than heterosexual males between the ages of 21 to 42.
Rich et al.(1986) also recognized the limitations of the analysis done on both group of male suicide victims. "A sample of 13 is hardly adequate to justify highly sophisticated statistical analysis or any major conclusion."(51:453) The results, however, even if deemed not to be statistically significant, do show interesting differences between gay and straight suicide victims.
Problems Gays (n = 13) Other (n = 106) ---------------------------------------------------------------- Drug and/or Alcohol 12/13 (92%) 79/106 (74%) Abuse Total Depressive 5/13 (36%) 41/106 (39%) Total Psychotic 6/13 (46%) 20/106 (19%) Previous Treatment 10/13 (77%) 55/105 (52%) Previous Suicide 8/12 (67%) 34/91 (37%) Attempt(s)From the above, it can be said that gay male victims of suicide were about 2.4 times more likely to have received a psychotic diagnosis, 1.5 times more likely to have received psychiatric treatment, and 1.8 times more likely to have attempted suicide. With respect to the suicide attempt data, an important fact related to this study was explained by Rich et al.(1986) "It is interesting to note, however, that only a slightly larger sample size of gays (18 cases) with the same ratio of attempts (67%) would have produced a significant difference from the comparisons."(51:456)
To support the idea that gay youth are not at higher risk for suicide, while nonetheless maintaining the possibility that they may be, Hendin(1995) noted the existence of a yet unpublished Shaffer study of adolescent suicide victims noted in a New Yorker magazine article(94:130). The study of 120 out of 170 youth suicides below the age of 20 was ultimately published in the 1995 Supplement of Suicide and Life-Threatening Behavior. One objective of the study was to determine the sexual orientation of victims, as based on "having had homosexual experiences or having declared a homosexual orientation. Three [male] teenagers [out of 120 males and females] and no controls [out of 145 males and females] met these criteria."(104:64) "In addition to the three suicides who were known to have homosexual experience, a further six suicides, including [one who had committed suicide with a known homosexual victim of suicide and were found holding hands], were known to be close friends with other gay teenagers. Three other suicides were reported to have been effeminate in their behavior."(104:69) "All three suicides had evidence of significant psychiatric disorder before death. In spite of opportunities for biased reporting, it is concluded that this study finds no evidence that suicide is a characteristic of gay youth..."(104:64) The study ended with: "It should be reassuring that the data reported here suggest that the painful experience of establishing a gay orientation does not lead disproportionately to suicide."(104:71).
For knowledgeable gay activists who have been struggling for social change in terms of decreasing the very harmful homophobia creating the "painful experience of establishing a gay orientation," the final sentence is not comforting. It is almost as is they are saying: "We understand the situation but, even if these youth may have high attempted suicide rates (which has not been confirmed), their abuse by society is not really bad enough to cause their over-representation in adolescent suicides." Such an attitude immediately raises suspicions concerning these researchers, amply justified with the realization that none of the 145 controls studied reported being gay or bisexual to them, or even reported having had homosexual experiences. Given the studies available on the subject revealing that at least 5% of male adolescents would be in these categories (Appendix C), the Shaffer et al.(1995) researchers certainly cannot be deemed skilled in accessing "homosexuality" information from teenagers. How skilled would they therefore be in determining the possible homosexual realities of dead GLB youth?
The caveats related to this study are located in Appendix C, the conclusion being that many questions related to this study must be answered before it can be granted any validity. However, given that three (out of 95) male suicide victims were identified to be homosexual, three were deemed to have been effeminate (with a high probability of being gay), 6 others were close friends with gay males, and considering it would be almost inconceivable that a heterosexual male would have a suicide pack with a gay male and die with him holding hands as one of the 6 did, suggest that some concealment exists. Therefore, up to 12% of males in this study could have been in the homosexual category, or more for reasons given in Appendix C.
The caveats related to the Shaffer et al.(1995) and Rich et al.(1986) study are many, and one could speculate that good insightful research work on suicide victims may one day produce the predictable over-representation of gay/bisexual males in the male youth suicide problem. There is certainly nothing in either study which would permit concluding that gay males are not more at risk for suicide than heterosexual males. In fact, if we err in favour of what these studies suggest, we would tentatively conclude that gay males are at least 2 to 3 times, and maybe 4 times more likely to commit suicide than heterosexual males.