"These rates are staggering, and highlight the cost of pervasive anti-gay stigmatization and victimization," said Jay Paul, PhD, a specialist at UCSF's Center for AIDS Prevention Studies (CAPS) and lead author of the study published in the August issue of the American Journal of Public Health. "We cannot take these suicide attempts lightly, as almost half of the men in our study reported multiple attempts. Furthermore, a study such as this can only report suicide attempts; we can never enumerate the lives lost through completed suicides. "
A particularly troubling trend was found in this study. Looking retrospectively at different age groups of gay and bisexual men, there has been a shift whereby initial suicide attempts are happening at a younger age, the researchers found. For most of those men who were at least 25 years old in 1970, the suicide attempt took place after they were 25 years old. For younger men, who did not reach 25 years old until after 1990, most of them made the suicide attempt before they turned 25 years old. This has occurred despite no apparent change in the rate of attempted suicide, which has remained a constant twelve percent.
To understand this better, researchers examined possible predictors of such early attempts. They found that markers of "coming out" or identifying as gay or bisexual were strongly related to earlier suicide attempts, as were reports of repeated anti-gay harassment prior to age 17.
"Gay kids are coming out at an earlier age. While this is generally a positive trend and may be beneficial in the long run, it may also potentially increase the likelihood that these gay-identified kids are subjected to anti-gay victimization," said Paul.
Repeated anti-gay harassment was reported by 28 percent in the older age group; this rate had jumped to 52 percent in the youngest age group. "Gay youth who have neither the social supports nor the emotional resilience to cope with such pressures may turn to suicide. Youth who come out suffer from both institutional deficiencies in services directed to their needs, as well as issues of access to such services," Paul said.
"This increased suicide risk cannot be resolved solely by mental health interventions, but instead requires changes in the environment in which kids come to maturity such that societal discrimination and harassment are not tolerated," said Paul.
The study analyzed data collected in the Urban Men's Health Study, a telephone survey of men who have sex with men in San Francisco, New York, Chicago, and Los Angeles. These four cities were selected due to their importance as regional centers, being the source of two thirds of U.S. AIDS cases among men who have sex with men, and the estimated size and concentration of their population of men who have sex with men. This sample conducted between November 1996 and February 1998, interviewed 2881 men who have sex with men. The interviews covered numerous health issues; other findings (such as overall levels of risk behavior) have been reported elsewhere.
Co-authors are the study's co-principal investigators Joseph Catania, PhD, UCSF professor of medicine and Ron Stall, PhD, MPH, chief of the Behavioral Interventions Research Branch at the Division of HIV/AIDS Prevention at the Centers for Disease Control; and study co-investigators Lance Pollack, PhD; Judith Moskowitz, PhD, MPH; Jesse Canchola, MS, all with UCSF CAPS; and Thomas Mills, MD, MPH, now retired from UCSF.
This study was funded by grants from the National Institute of Mental Health, National Institute on Aging, Office of AIDS Research, and supplemental support came from the Division of HIV/AIDS Prevention at the Centers for Disease Control.