Gay adolescents and suicide: understanding the association

Adolescence,  Fall, 2005  by Robert Li Kitts

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During a lecture at the same university noted, a public health physician asked, "What are some risk factors for adolescent suicide?" After waiting for everyone else's response, I finally said, "homosexuality." The physician was unsure about this answer and turned to the psychiatrist who currently held a fellowship in child and adolescent psychiatry. To my surprise, he stated, "I do not think so."

An Increased Risk

Being a gay adolescent is a significant risk factor for suicidal thoughts and attempts. More than 15 different studies conducted within the last 20 years have consistently showed significantly higher rates of suicide attempts, in the range of 20 to 40%, among gay adolescents (Gould et al., 2003; Goldfried, 2001; Heimberg & Safren, 1999; Paul et al., 2002; Russell & Joyner, 2001; D'Augelli et al., 2001; Remafedi, 1999; Lock & Steiner, 1999; Garofalo et al., 1999; Borowsky et al., 2001; Udry & Chantala, 2002). Russell and Joyner (2001) were the first to use nationally representative data to support this association. In a study involving over 6,000 adolescent girls and over 5,000 adolescent boys, they concluded that adolescents with a same-sex orientation were more than twice as likely to attempt suicide.

How many suicides occur without learning whether the person was gay? People commit suicide leaving family and friends asking, "Why?" Could it be because of a secret they could not bear revealing--such as being gay? One study involving 350 gay adolescents between the ages of 14 and 21 reported that 54% made their first suicide attempt before coming out to others, 27% made the attempt during the same year they came out, and 19% made the attempt after coming out (D'Augelli et al., 2001).

Since being a gay adolescent is a risk factor for suicide, it needs to be addressed within the medical community. Physicians can help by raising the issue when appropriate on rounds, in case conferences, or during lectures. Addressing the issue of sexuality with adolescents can be made easier and more effective if the physician understands why it is so unbearable for some adolescents to reveal their sexuality or to live with being gay.

Understanding the Association

Being gay in-and-of-itself is not the cause of the increase in suicide. The increased risk comes from the psychosocial distress associated with being gay. Six studies reported by Remafedi (1999) found that suicide attempts were significantly associated with psychosocial stressors, including gender nonconformity, early awareness of being gay, victimization, lack of support, school dropout, family problems, acquaintances' suicide attempts, homelessness, substance abuse, and other psychiatric disorders. Some of these stressors are also experienced by heterosexual adolescents, but they have been shown to be more prevalent among gay adolescents (Gould et al., 2003; Goldfried, 2001; Russell & Joyner, 2001; Russell et al., 2002; Fergusson et al., 1999; Garofalo et al., 1998; DuRant et al., 1998). In Russell and Joyner's (2001) study using national data, adolescents who reported same-sexual orientation also reported significantly more substance abuse, depression, acquaintances' suicide attempts, and victimization. Thus, physicians can be more helpful in improving gay adolescents' quality of life by understanding their psychosocial stress load and its impact on suicide risk.