GAY AND BISEXUAL MALES
The Cochran and Mays (2000) study of (what would be) a subset of homosexually oriented males produced a replication of the above noted Odds Ratio results for males having attempted suicide, although this was not specified in the published study results for males ranging in age from 17 to 39 years. As noted below (with related discussion), the suicidality result for 'homosexual' males relative to 'heterosexual' males ('sexual orientation' based on sexual behavior) in the same sample were reversed in the 17 to 29 and 30 to 39 years of age groupings.
Sufficient data, however, was given
for the youngest group of males [mean age approximately equals 23.5 years,
sample taken from 1988-94, compared to mean age of 22.7 years, sample taken
in 1991-2 for the Bagley and Tremblay (1997) study of young adult males]
to calculate an "approximate" OR. The Odds Ratio for young adult 'homosexual'
males compared to 'heterosexual' males having attempted suicide in the
Cochran and Mays (2000) study is
CI, 6.4-24.2). In the same age grouping, the Odds Ratio for 'homosexual'
males (males reporting having had at least one same-sex partner) compared
to all other males is 13.8 (95% CI, 7.1-26.8).
These Odds Ratios are similar to the the ones (14.4, 14.9) generated for
the two studies noted above.
Abstract by authors: A stratified random sample of 750 males in Calgary, Canada, aged 18-27 years, were given questions on sexual activity and orientation. Mental health questions included a measure of suicidality and of acts of deliberate self-harm. A computerized response format, which has ben established as a good method method for eliciting sensitive personal data, ensured anonymity. Almost 13% of the males were classified as homosexual or bisexual on the basis of being currently homosexually active or by self-identification. Significant higher rates of previous suicidal ideas and actions were reported by homosexually oriented males accounting for 62.5% of suicide attempters. These findings, which indicate that homosexual and bisexual males are 13.9 times more at risk for a serious suicide attempt, are consonant with previous findings. The predominant reason for the suicidality of these young males may be linked to the process of "coming out," especially for those who currently have high levels of depression. These results underscore the need for qualified services rarely available to homosexually oriented youth.
The study essentially replicates the Bell & Weinberg (1978) suicidality results. To the age of 21 in this earlier study, and to the average age of 22.7 years in the Bagley and Tremblay (1997) study, homosexual/bisexual males were about 14-times more likely to have been suicide attempters than heterosexual males.
Homosexual/bisexual males are 2.94 times more at risk for self-harm activities than heterosexual males. (Note: In many studies of adolescent suicide problems, "self-harm" activities are often enough tabulated as suicide attempts.)
Sexually active homosexual and bisexual males are 6- and 11-times more at risk to have made a life-threatening suicide attempt than their heterosexual counterparts.
Celibate homosexual and heterosexual males have the highest current depression scores; celibate homosexual males have the highest scores.
The highest current depression scores for celibate homosexual males and the fact that 4 out of 5 (80%) suicide attempters in the homosexually oriented category are in the bisexual category or are celibate homosexual males, reflects/replicates the Bell and Weinberg (1978) mental health results for asexuals who had greater problems such as "more regret over their homosexuality," and were more likely to be "less exclusively homosexual and more covert than other respondents." (p. 134) Dysfunctionals also had more regrets over their homosexuality, but were highly sexually active and not coupled. Both groups were more depressed, tense, paranoid, depressed, lonely; and less self-accepting (p. 200-201).
Using the 2 X 2 Table located at - http://home.clara.net/sisa/twoby2.htm and the following data from the Bagley and Tremblay (1997) study - 5 attempters / 77 nonattempters (homosexual / bisexual) and 3 attempters / 665 non-attempters (heteorsexual) produces an OR (for attempting suicide) = 14.4 (95% CI, 3.4-61.4). The OR for "Self-Harm" (13 homosexual or bisexual males reporting self-harm / 69 not reporting self-harm, ; 37 heterosexual males reporting self-harm / 631 not reporting self harm, ; - produces an OR (for self-harm) = 3.2 (95% CI, 1.6 - 6.3). This information is not given in the study.
Bell A.P., and Weinberg, M.S. (1978) Homosexualities: a study of diversity among men & women. Simon and Schuster, N.Y.
The Sampling: The largest sample pool was of white predominantly homosexual males obtained via the following venues: Public Advertising (914), Bars (994), Personal Contacts (617), Gay Baths (249), Public Areas such as parks rest rooms, and streets (137), Homophile Organizations (222), Mailing Lists - with mail back cards (200), and private Bars (220). The total sample of white homosexual males (N = 3533) was then subjected to random sampling within contact cells to produce the final study sample of 575 white predominantly homosexual males. Obtaining the good (likely highly representative) study sample was accomplished because the researchers applied their great knowledge of homosexually oriented males to the sampling process. Therefore, the final study sample represented, as best as possible, the entirety of homosexually oriented males living in the San Francisco Bay Area. The sampling method also likely produced the most representative sample taken to date of white homosexually oriented males living in a North American city. The control sample of predominantly heterosexual males (N = 284) was obtained via stratified random sampling.
Although this study does not have "peer review" status because the results were published in two book (Homosexualities: a study of diversity among men & women (1978), and Sexual Preference (1981) by Bell, Weinberg, and Hammersmith - a two-volume book (one volume is the "Statistical Appendix"), some of the suicidality results of both white and African-American predominantly homosexual and heterosexual males did receive peer review status via the published study by Joseph Harry (1983).
For white males: Seriously contemplated suicide (37%); Suicide attempt lifetime incidence 105/575 (18.3%), re-attempter incidence (7% out of 18%, 39.9%), 47% first attempt before age of 21 years, 79% before age of 26 years; therefore, 47/79 (59.5%) of suicide attempts occurring before age 26 occurred before age of 22; 27% of all first attempts occurring before age 17, and 22% after age 25. Suicide attempt problem occurring throughout age groups, declining after age 25.
Proportion of first-time suicide attempters who are homosexually oriented based on two percentage estimates (5% and 10%) of the male population in the "wholly or predominantly homosexual" category.
Using a "5% homosexual/bisexual of the male population" estimate:
To age 17, 42.5%; to age 21, 41.6%; to age 25, 22%, to the average age of subjects (37 years), 23.4%.
Using a "10% homosexual/bisexual of the male population" estimate:
To age 17, 60.9%, to age 21, 60.1%; to age 25, 39.2%; to the average age of subjects (37 years), 39.3%
Compared to the control group of predominantly heterosexual males, predominantly homosexual males were:
To age 17, 14-times more likely to be a "first-time" suicide attempter: 4.9% vs .35%. Using the 2 X 2 Table located at - http://home.clara.net/sisa/twoby2.htm and the following attempter / non attempters data for the two group (38 / 547 and 1 / 283) , 95% CI - Odds Ratio: 2.0<14.5<107.0. Pearson's= 11.893 (p= 0.0005).
age 20, 13.6-times more likely to be a "first-time" suicide attempter:
vs .70%. Using the 2 X 2 Table located at - http://home.clara.net/sisa/twoby2.htm
and the following attempter / non attempters data for the two group (55
/ 520 and 2/282), 95% CI - Odds Ratio: 3.6<14.9<61.6. Pearson's=
24.093 (p= 0.0000)
To age 25, 5.8-times more likely to be a first-time suicide attempter: 14.4% vs 2.47%. Using the 2 X 2 Table located at - http://home.clara.net/sisa/twoby2.htm and the following attempter / non attempters data for the two group (83/492 and 7/277) , 95% CI - Odds Ratio: 3.0<6.7<14.6. Pearson's= 29.04 (p= 0.0000).
To average age of sample (37 years), 5.8-times more likely to be a suicide attempter: 18.4% vs 3.17%. Using the 2 X 2 Table located at - http://home.clara.net/sisa/twoby2.htm and the following attempter / nonattempters data for the two group (105/470 and 9/275) , 95% CI - Odds Ratio: 3.4<6.8<13.7. Pearson's= 37.619 (p= 0.0000).
The above figures are calculated from data given in Tables 21.14 and 21.15, p. 453-4.
Asexuals had greater problems such as "more regret over their homosexuality," and were more likely to be "less exclusively homosexual and more covert than other respondents." (p. 134) Dysfunctionals also had more regrets over their homosexuality, but were highly sexually active and not coupled. Both groups more depressed, tense, paranoid, depressed, lonely; and less self-accepting (p. 199-201).
The lifetime suicide attempt rate for white homosexual males was 18%, compared to 21% for Black homosexual males; their respective suicide re-attempter rate being 38.8% and 33.3%. Black homosexual males were 10.5-times more likely to have been suicide attempter than their heterosexual male counterparts.
43% of White homosexual male suicide attempters reported that their first attempt was relationship-related, meaning that these occurred after fully/somewhat becoming part of the gay community.
Cochran, Susan, and Mays, Vickie (2000). Lifetime prevalence of suicide symptoms and affective disorders among men reporting same-sex sexual partners: results from NHANES III. American Journal of Public Health, 90(4), 573-78. (A PubMed "abstract" link with a document delivery service.)
A subsample of the NHANES III sample (n = 3648 males 17- to 39-years-old) were interviewed in their homes (Note 1). They were "assessed for both prevalence of affective disorders and related symptoms and genders of their lifetime sexual partners." Only 2.2 percent of males (homosexually oriented) acknowledged having "any male sex partners in their lifetime," and they were reported to have a lifetime suicide attempt incidence of 19.3%, compared to a 3.6% incidence for males who only had female sexual partners, and a 0.5% incidence for males reporting having had no sexual partners. For homosexually oriented males, 98% of the ones reporting a suicide attempt were 17- to 29-years-old, but heterosexually active males who had attempted suicide did not have such an age range concentration. The incidence of suicide attempters were unrelated to age categories for heterosexually oriented males. Homosexually oriented males would therefore be 5.4 times (19.3 vs 3.6%) more likely to be suicide attempters than males reporting having had only female sex partners (CI 95%, OR: 2.21<5.36<12.98). The greater likelihood for recurrent Major Depression and for "any affective disorder" for homosexually oriented males compared to males reporting only females sex partners was 3.5 times (12.2 vs 3.5% - CI 95%, OR: 0.93<3.64<14.20) and 2.4 times (21.5 vs 8.8% - CI 95%, OR: 0.90<2.55<7.24), respectively. Homosexually oriented males also had significantly higher composite scores for suicide-related symptoms. (See second caveat and a re-calculation below.)
Note 1 - Caveat: Face-to-face interviews continue to be used as in the NHANES III study of 17- to 39-year-old males. Only 2.2 percent of males acknowledged having "any male sex partners in their lifetime" (p. 575), and similar methodologically flawed studies are then cited (given range of study results: "2% to 7%") to conclude that "this is consistent with the prevalence observed in NHANES III" (p. 577), thus creating the illusion of validity for their demographic results. Not mentioned, however, is that this range of demographic results suggests a possible 350 percent underestimating error for lowest results. Instead, it is asserted that "the willingness of men to report same-sex partners in a population-based survey such as NHANES is unknown; thus, the extent to which homosexually experienced men... declared no male sex partners cannot be determined" (p. 577). This assertion, however, is only made possible by not citing studies (e.g. Bagley and Tremblay, 1998; Turner et al., 1998) indicating the likelihood of producing significant underestimating errors when highly flawed methodology is used.
Note 2 - Caveat: It is reported fact that almost all same-sex active suicide attempters (98%) were below the age of 30 years, with little supplied with respect to explaining their relatively great absence for males 30 to 39 years of age. This anomaly may well be related to the AIDS factor given that its greatest effect (related illness and deaths) occurred in the 30- to 39-year-old category and during the sampling/study years: 1988-94. The authors did not address this issue in spite of the greatest difference in "suicide attempt" incidence not being between 'homo-sex' reporting males compared to 'hetero-sex'-only reporting males (19.3% vs. 3.6%: an "8.7 times" factor). The greatest difference is between 'homo-sex' reporting males in the 17-29 year-old vs. 30-39 year-old categories: 31.3% (14.7/47) vs. .98% (.3/31) - a "31.9-times" factor. These figures are based on weighted data supplied by the authors which also make possible an "estimated" re-calculation of "suicide attempt" data for males in the 17- to 29-year-old category (given below), thus producing results to the average age of about 23 years which can then be compared with the Bagley and Tremblay 1998 "suicide attempt" results for a sample of 18- to 27-year-old males with an average age of 22.7 years.
Re-Calculation of Data Using the 2 X 2 Table located at - http://home.clara.net/sisa/twoby2.htm: the following weighted data was used to calculate an approximation for the Odds Ratio [17- to 29-year old males reporting any lifetime same-sex partners [60.7% of 78) = 47)] versus same-age males reporting only lifetime female sex partners - (51.5% of 3214) = 1655)]. Respectively, in each category, suicide attempters versus non attempters are: 15/32 and 60/1595. For this group, the males reporting same-sex lifetime partners (maybe about 3% of these males), accounted for 20% (15/75) of all attempters in the 17-29 age category.
Data estimation for males reported having lifetime male partner(s): 78 males (age = 17-39) with a suicide attempt incidence of 19.3% produces 15 (15.1) suicide attempters (weighted). The authors note, however, that a weighted 98% of attempters are in the 17- to 29-year-old category, meaning that 2% of attempters are in the 30- to 39 age group. In whole numbers, this "2%" equals to 0.3 attempters, meaning that all weighted 15 attempters (14.7) are essentially in the 17- to 29-year-old category.
Data estimation for males reported only lifetime female sex partner(s): 3214 males (age = 17-39) with a suicide attempt incidence of 3.6% produces 116 (115.7) suicide attempters (weighted). The authors note that there were no statistical difference in the distribution of suicide attempters in the two age categories, which could mean there are differences, but the assumption for this "estimate" calculation is "equal distribution". Therefore, 51.5% of 115.7 attempters is 60 (59.6) attempters in the 17-29 age group.
Odds Ratio Calculation for males reporting lifetime same-sex partners compared to males reporting lifetime only female sex partner(s): 15/32 and 60/1595 (attempters / nonattempters), Pearson's= 86.828 (p < 0.0000) - 95% CI, Odds Ratio: 6.41<12.46<24.24. This result therefore applies for a sample of males ranging in age from 17 to 29, with a mean age, if weighted, of about 23 years. This result replicates the Odds ratio results of the Bagley and Tremblay (1997) study - 95% CI, OR: 3.4<14.4<61.4 - in a male sample ranging in age from 18 to 27 years (mean age = 22.7 years) for significantly homosexually oriented males verses other males with respect to their "suicide attempt" history. NOTE: If calculation were done from the actual data, the results should be quite similar.
For the males with a 17-29 years age range in the Cochran and Mays (2000) study, there is a greater likelihood factor of "8.7 times" [31.3% (14.7/47) versus 3.6% (60/1655)] for a suicide attempt by males who reported having male sex partner(s) compared to males reporting having only lifetime female sex partners.
Odds Ratio Calculation for males reporting lifetime same-sex partners versus males reporting only female sex partner(s) plus males reporting a celibate status: 15 / 32 (attempters / nonattempters) versus 61 [60 + 1] / 1796 [1595 + 201] - 95% CI, OR: 7.10<13.8<26.82. This result is almost identical to the Odds Ratio noted above in the Bagley and Tremblay (1997) study of males (95% CI, OR: 3.4<14.4<61.4), for significantly homosexually oriented males compared to other males with respect to their history of having attempted suicide. NOTE: If calculation were done from the actual data, the results should be quite similar. Also: The sampling of young adult males in both studies occurred at about the same time (1988-92 for the NHANES III study, and 1991-2 for the Calgary study), which means that both group of males being compared were of about the same age at the same time, their adolescent years being spread over about 1.5 decades: 1975 (approx.) to the end of 1980s / very early 1990s (approx.) and living in similar environments with respect to social attitudes vis-a-vis homosexuality.
For the males with a 17-29 years age range in the Cochran and Mays (2000) study, there is a greater likelihood factor of "9.2 times" [31.3% (14.7/47) versus 3.4% (61/1796)] for a suicide attempt by males who reported male sex partner(s) compared to males reporting only lifetime female sex partners and males reporting no sex partners.
Notes on the above data: 211 males (weighted) are reported to be in the "no sex partner" category, with 95.8% of these male (202 males) in the 17-29 age group, and only one suicide attempter is in the group - in the younger group as noted by the study authors. Therefore: 201 nonattempters and 1 attempter in the 17-29 age category was added to the data related to same-age males reporting only female sex partner(s).
The anomalous suicide attempt difference between male aged 17-29 and males aged 30-39:
After the weighting/controlling statistical processes, the 31 (78 - 47 = 31) 'homo-sex' reporting males 30 to 39 years of age have only 2% of attempters (.3 of an attempter) in the 'homo-sex' male category, which is equal to a lifetime suicide attempt incidence of 1%, compared to an estimated 3.6% incidence for 'hetero-sex' reporting males. Therefore, for males in this age category, it is 'hetero-sex' males who are about 4-times more likely to be suicide attempters, compared to 'homo-sex' males. This "1%" also means that the older (30-39 years) segment of the 'homo-sex' reporting males had a suicide attempt incidence about 31 times lower that their younger 'homo-sex' counterparts, and 19.3 times lower than the reported averaged "suicide attempt" incidence for all 'homo-sex' males, but this highly anomalous situation was not highlighted nor addressed by the authors. One important implication would be that 'homo-sex' reporting males in a certain decade not only almost stopped attempting suicide, but that they became much less at risk for attempting suicide than heterosexual males. This possibility, however, is unlikely given the consistent "higher risk" for attempting suicide study results for homosexually oriented males studied in samples dating back to 1969. Therefore, the "representation" likelihood of the older part of the 'homo-sex' male sample (30- to 39-year-old) is in question. The authors not only ignored this, but they also avoided discussing this serious problem occurring in data to be statistically analysed.
The NHANES III (National Health and Nutrition Examination Survey) "is a periodic population based health survey conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention" (p. 574). "S. D. Cochran conceived and designed the study, conducted the analysis, and co-wrote the manuscript. V. M. Mays cowrote the manuscript and contributed to the interpretation of study findings" (p. 577).