Evidence for increased suicide attempts and suicidal ideation among homosexuals and bisexuals, obtained from population-representative samples, has been extensively cited elsewhere within this section. This page is about there being no reliable evidence that nonheterosexuals are correspondingly relatively overrepresented among those that successfully commit suicide. Various considerations suggest that elevated suicide attempts and suicidal ideation among nonheterosexuals are additional manifestations of elevated psychiatric morbidity among them.
In 1989, a task force established by the Secretary of the U.S. Department of Health and Human Services drafted a report on youth suicide. The report mentioned an estimate by homosexual activist Paul Gibson that up to 30% of annual youth suicide victims may comprise of homosexuals.1 Homosexuals have frequently cited this statistic even though the government disavowed this report and removed it from circulation. Gibson noted that homosexual youth are about 3 times as likely to attempt suicide compared to heterosexual youth, and believing that 10% of the population is homosexual, he estimated that 30% of youth who commit suicide are homosexual.
Imagine a group, some members of which commit suicide and succeed on their first attempt. If one were to take a random sampling of this group and ask about suicide attempts in lifetime, one would come across a prevalence of 0% because anybody who attempted suicide died. Clearly, a 0% suicide attempt rate obtained herein does not imply a 0% suicide rate. However, if in the same group, those who commit suicide succeed on their first attempt, which immediately follows suicidal ideation, then a sampling of this group would reveal a 0% rate of both suicide attempts and suicidal ideation. May we suppose that none belonging to this group ever think about suicide? At the other extreme, a group, some members of which think about killing themselves but attempt suicide without success, would achieve a suicide rate of 0%. This should suffice to point out the mistake made by Gibson.
Young women attempt suicide at rates 2-9 times higher than young men, but young men commit suicide at a rate 6 times higher than young women.2
The discrepancy between the prevalence of suicide attempts and actual suicides is greater among adolescents than adults. For instance, according to CDC estimates, approximately 86 Americans commit suicide everyday whereas 1,500 Americans attempt suicide everyday, i.e., suicide attempts are approximately 18 times more common than actual suicides.3 On the other hand, injurious suicide attempts by adolescents are about 100 times more common than actual suicides.4 In short, a high prevalence of suicide attempts does not necessarily imply a high suicide rate. Do homosexuals constitute a great proportion of individuals that successfully commit suicide?
There are no clear finds that homosexuals are overrepresented among suicide victims:
One can say with reasonable confidence that even if one could show that homosexual men are somewhat relatively overrepresented among suicide victims, the discrepancy between attempted suicides and successful suicides would still be much greater among homosexual men than among heterosexual men. In Rich et al.’s study above, 67% of the deceased homosexuals had previously attempted suicide, whereas only 37% of the deceased heterosexuals in the same age range had previously attempted suicide; this discrepancy would have been statistically significant had the sample size been larger, and these figures suggest that the heterosexual group was more successful at committing suicide than the homosexual group. Besides, the authors did not find any homosexual among the deceased youth. Given such considerations, Paul Gibson’s 30% statistic is even more remarkable because the only way 30% of suicides could consist of homosexuals would be if a much greater proportion of homosexual suicide attempters were successful compared to heterosexual suicide attempters.
An oft-repeated claim is that elevated suicidality in homosexuals results from societal prejudice and rejection, leading to the internalization of homophobia. However, other parts of this section present plenty of data that argues against this notion, including results from studies that have statistically controlled for risk factors. One expects societal rejection to lead to sadness or depression, and depression, in turn, leads to hyposexual behavior in normal individuals. However, homosexuals manifest increased promiscuity. In this regard, Durant et al. reported that among male adolescents reporting one or more same-sex partners; alcohol, marijuana, and smokeless tobacco use at school; not attending school because of fear; having been threatened or injured with a weapon at school; and weapon carrying at school accounted for 15.8% of the variance in the number of male sexual partners, or 17.2% of the variance after the inclusion of suicide attempts or cigarette smoking, i.e., more partners correlate with increased risky behaviors among male homosexuals.13
In a comparison of 59 mostly non-white male runaways between the ages of 12 and 18 years with 60 mostly non-white homosexual and bisexual males attending a community agency and within the same age range, both groups had initiated sexual activity at a mean age of 12.6 years and the runaways had had a median of 11 women sexual partners whereas the nonheterosexual youth had had a median of 7 male sexual partners.14 One wouldn’t blame so-called homophobia for precocious sexuality and promiscuity among heterosexual runaway youth and caution is required before one does so for homosexual youth. On the other hand, homeless nonheterosexual adolescents are worse than homeless heterosexual adolescents with respect to frequency of leaving home, victimization, substance use, psychopathology, and promiscuity.15
Is their a simple relationship between prejudice plus discrimination and suicidality? African-Americans experience elevated discrimination, prejudice, incarceration, persistent poverty, social isolation and lack of community resources, yet have a lower suicide rate than whites.16 Compared to the white suicide rate, the African-American suicide rate was 28% lower under Jim Crow laws in 1950 and 24% lower during 1995-1998.17 Likewise, Jan Smuts, South Africa’s Prime Minister for a few years during apartheid, commented on the care-free, good tempered nature of sub-Saharan Africans, the only happy people he came across.18 In addition, an American Association of University Women study concerning self-esteem among school children showed that African-Americans had the highest self-esteem; African-American girls had higher self-esteem than white boys, and African-American boys turned out to be the most confident and ambitious of all, exceeding white boys in their desire to become doctors, scientists, governors, and senators.19, 20 The higher self-esteem of African-Americans compared to whites is a robust find;21, 22 and this includes self-concept of physical attractiveness, physical ability and even competence in reading, science and social studies, but [in a few studies] not math.23, 24
Obese individuals experience discrimination with respect to college admission, renting a residence, and have a harder time attracting mates.25 While some homosexuals can conceal their homosexuality, the obese cannot hide their obesity. In a sample of 8,889 individuals from 13,800 randomly selected individuals, ages 18-64 years, 31% were overweight and an additional 11% obese.26 Increasing overweight worsened physical health but not emotional health. Among those with chronic illnesses, the additional presence of obesity significantly worsened physical but not emotional well-being.
In short, prejudice plus discrimination do not have a simple relationship with suicidality. How about mood disorders? Homosexuals manifest elevated mood disorders and so do anorexic women. In an examination of death records representing over 5 million women, 571 deaths resulted from anorexia nervosa, and among the dead anorexic women, 1.4% had committed suicide compared to 4.1% among 1,713 age- and ethnicity-matched controls.27 Therefore, mood disorders do not necessarily correspond to successful suicides.
Suicide attempts among adolescents and youth in the general population are associated with delinquency/criminality, or psychiatric illness in self or parents, or substance use,28 all of which are more prevalent among homosexuals. Surely, no one would blame so-called homophobia for such associations among heterosexuals. Additionally, in spite of American society becoming more accepting of homosexuality, the prevalence of suicide attempts among male homosexuals and bisexuals has remained constant across birth cohorts, and the mean age at initial attempts has declined.29
Elevated suicidal ideation/attempts among homosexuals can be grouped along with other risky practices indulged in by homosexuals(sexual behaviors, Table 3 here) that places them at greater risk for self-harm. The most common form of deliberate self-harm is self-poisoning.30 In one study, only 41% of a sample of 34 individuals who had deliberately poisoned themselves claimed suicidal intent, and in only one case did a close friend or relative agree that the self-poisoning was motivated by suicidal intent.31
Given the considerable relative overrepresentation of homosexuals among individuals with borderline personality disorder (BPD), which represents an extreme along a continuum,32, 33 and that one manifestation of this disorder is repeated suicide attempts,34 elevated suicidal ideation and attempts among homosexuals should be considered as another example of greater psychiatric morbidity among them that is not readily explicable in terms of societal prejudice. BPD is not the only mental disorder that manifests elevated suicidality. In an examination of 236 cases of multiple personality disorder (MPD), 72% had attempted suicide but only 2.1% had been successful.35 In this sample, the most common previous diagnoses were for affective disorders (63.7%), personality disorders (57.4%), anxiety disorders (44.3%) and schizophrenia (40.8%). Note that although MPD is typically a dubious diagnosis,36 the psychiatric morbidity described as MPD correlates with elevated suicide attempts. In addition, in a 6- to 12-year follow-up study of 500 psychiatric outpatients, these individuals had an unnatural (suicide, homicide) death rate three and a half times higher than expected (conditions highly predictive of unnatural deaths were alcoholism, antisocial personality disorder, drug addiction, and homosexuality.), but in spite of a history of repeated suicide attempts, hysteria was not associated with elevated unnatural mortality.37
One should note that very few sane individuals who decide to commit suicide and then attempt it would fail. I recall an attempted suicide by a friend of mine. He was distraught over his girlfriend having dumped him. He bought rat and roach poison, consumed the rat poison, then went to a friend’s house, told him about what had happened and what he had done, and then proceeded to drink the roach poison. His friend knocked away the canister of roach poison, grabbed him, and rushed him to a nearby hospital. The doctors managed to save him. It is noteworthy that this individual has an above average IQ and it should be obvious to even someone with below average IQ that had he gone deep inside the woods after consuming the rat poison, by the time they would have found him, his body would have been decomposing for a while. In another example, a young male homosexual had attempted suicide about 13 or 14 times and claimed to be no fool who didn’t know how to do it right.[^# Remafedi G. Adolescent homosexuality: psychosocial and medical implications. Pediatrics 1987;79(3):331-7.^] In one such attempt, he crashed his mother’s car at 150 mph into a guardrail. However, had he crashed the car into a thick concrete wall or an 18-wheeler, he would have sealed his fate.
It appears that when suicidal decisions and attempts are made in a fit of insanity, they conflict with an innate attempt on the part of the organism to protect oneself, thereby leading to lame attempts at suicide, which are often unsuccessful. Consistent with elevated suicide attempts/ideation among homosexual and bisexual men as an example of psychiatric morbidity is the find that half of the suicide attempters in a probability sample of 2,881 MSM in four large American cities had attempted suicide repeatedly.38 In this sample, 21% had made a suicide plan, 12% had attempted suicide, and most first-time suicide attempts were before age 25 years.