D’Augelli, 1995). Awareness of their exposure to stressful events has spawned a growing research literature on whether they face an increased risk of suicidality.

Young homosexual or bisexual males are at greater risk than heterosexuals for suicide attempts, but findings are less clear regarding suicide completion (McDaniel et al., 2001). According to two population-based studies in San Diego (Rich et al., 1986a) and New York City (Shaffer et al., 1995), rates of suicide completion do not appear to be higher for gay men and lesbians than for heterosexuals. These two studies were the first psychological autopsy studies to assess retrospectively the sexual orientation of those who completed suicide. Such assessment can be inaccurate because individuals may conceal their sexual orientation and because baseline prevalence for homosexuality in the relevant comparison population is difficult to obtain. A recent review of these studies determined that firm conclusions were unwarranted (McDaniel et al., 2001).

For suicide attempts, several recent population- and school-based studies provide strong support for a relationship between sexual orientation and suicidal behavior in males. Population-based studies of homosexual or bisexual males (ages 18 to 40 or so) found them to be 5–14 times more likely than heterosexual males to have reported a suicide attempt (Bagley and Tremblay, 1997; Cochran and Mays, 2000). Similarly, five studies of high school students in several states found elevated rates of suicide attempts among males engaging in same-sex behavior compared to their heterosexual peers (DuRant et al., 1998; Faulkner and Cranston, 1998; Garofalo et al., 1998; Garofalo et al., 1999; Remafedi et al., 1998), with relative risk calculated at 2- to 5-fold. Strikingly, most of the school-based studies among gay or bisexual adolescents found about 30 percent had attempted suicide. In young adult and middle-aged homosexuals, the prevalence is lower but still significantly elevated compared to controls (Cochran and Mays, 2000; Herrell et al., 1999).

Most studies on suicidality in homosexuals document the elevation of risk in young males (McDaniel et al., 2001), not young females. This contrasts with the general population, in which female teenagers and young adults attempt suicide more frequently than do males. The reasons for this reversal are not well understood (McDaniel et al., 2001). However, a recent nationally representative study (Russell and Joyner, 2001) of adolescents found increased risk for suicide ideation and attempts for both males and females when factors such as depression, hopelessness, and substance use were controlled. The authors speculate this difference may have arisen because the study measured self-reported same-sex romantic attraction/relationships, not self-identification as gay or lesbian.

Several studies explored the reasons behind the elevated risk of suicidality in homosexual or bisexual men. A longitudinal study of chil-



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