Are gay teens suicide prone? New study's weaknesses show that the answer isn't as easy to come by

THE BALTIMORE SUN

In a study just published in the journal Pediatrics and repeated in daily newspapers, gay teen-agers were "more than three times as likely" to have reported a suicide attempt than heterosexual peers - but the study, as even its lead author admits, has weaknesses that are prompting others to cast doubt on this finding.

Researchers have tried before to link suicide and sexual orientation but flawed methods led to flawed conclusions. Nevertheless, those flaws did not prevent dubious statistics from making their way into public consciousness and public policy. The primary weakness of this new study is that there is no general agreement on what constitutes a suicide attempt. In the study, it was left to the teens surveyed to define what it meant. The study also relies on self-reporting, so there was no independent verification that suicide attempts occurred. And the "validity and reliability" of the question on sexual orientation is unclear, as the authors admit, so that the population studied may not accurately reflect the true population of gay, lesbian and bisexual students in the survey.

Pediatrician Rob Garofalo, the study's lead author, argues that previous studies have been consistent with what his study shows and he stands by his work.

"I don't agree that (the weaknesses) invalidate the study," he says.

But Garofalo, who works with troubled youth, both heterosexual and homosexual, adds this: "I would like to get people to stop talking about statistical risks. My studies and previous studies show issues that have been long suspected by clinicians. We know that these kids are at increased risk.

"The question is, what are we going to do about it?"

That has been the rallying cry of advocates for gay teens for years - bolstered by disputed statistics. They've used the numbers to further their campaigns to provide gay teens with social services and school programs designed to counter ills from physical attacks by schoolmates to depression - all factors, they and some researchers have argued, that might ultimately lead a gay teen to a suicide attempt. Actress Ellen DeGeneres, in a TV interview, claimed that her "coming out" in her situation comedy was, in part, to bolster the psyches of gay teens who might be driven to suicide.

But does the fact that there are some gay teens who are troubled necessarily mean that they are more likely to be troubled than heterosexual teens? Or that those difficulties necessarily imply a risk for suicide?

As suicide risk statistics are quoted, they obscure the fact that the majority of homosexual teens - and heterosexual teens - do not kill themselves. There are, overall, 5,000 adolescent suicides in the United States every year.

"Most gay kids grow up healthy, that's something I want to stress," says Garofalo of Children's Hospital in Boston, which is affiliated with Harvard Medical School.

But he is equally sure that there is a "subset" of gay teens who are at risk for problems. Garofalo determined to embark upon his own study when he realized that there was no consensus on this.

The discussions revolving around gay teens and suicide have been so contentious within the research community that a conference was convened four years ago to address the alleged link between suicide and sexual orientation. Representatives of the national Centers for Disease Control and Prevention, the National Institute of Mental Health, the American Psychological Association, the American Association of Suicidology, and gay and lesbian advocacy and service groups dispelled any notion that there was a link.

Peter Muehrer, chief of the youth mental health program of the National Institute of Mental Health, evaluated studies for the conference. He says nothing in what he has read in this new study - despite the authors' assertions that it breaks new ground - convinces him that a link between gay teens and suicide has been shown.

Quantifying how many gay teens may be so troubled that they would consider killing themselves - and then comparing them to the general population - is a daunting and, as the editor of Pediatrics acknowledges, perhaps impossible project. The defense voiced time and again when these studies come into question gives pause - for science and for public policy.

"In common sense, do you think this group of children does not have an increase in suicide attempts?" asks Dr. Jerold Lucey, the editor of Pediatrics. "Anyone who knows anything about children and adolescents knows this is a troubled group."

But the critical question remains:

How do we know?

Are personal observations good enough to qualify as science? Are they enough to determine public policy?

The scientific obstacles in proving the assertion that gay teens are more at risk for suicide attempts, Muehrer argues, have yet to be overcome.

There is no general agreement on how to define an attempte suicide - is it merely a suicidal thought, a half-hearted attempt, or one that requires medical attention or is life-threatening? Also unclear is whether suicide attempts and completed suicides are related phenomena.

Then there are the difficulties in defining the term "sexual orientation." And there are also inherent weaknesses in relying - as this latest study does - on anonymous, self-reporting surveys where researchers must take a respondent's answer at face value.

As it is, the inability to define what constitutes an attempted suicide would seem to hamper any research inquiries into how often anyone tries to kill themselves.

"Because the term 'attempted suicide' potentially means so many different things, it runs the risk of meaning almost nothing at all," concluded a 1996 article in the journal of the American Association of Suicidology.

Even the new study's authors noted the difficulty of their research.

"Unfortunately," they wrote, "previous research designed to examine the risks and needs of [gay, lesbian and bisexual] youth is often hampered by societal stigmas about homosexuality and difficulties identifying a representative sample population."

Their work is different, the authors argued, because it was based on a "representative, school-based sample of adolescents."

Their research was culled from a survey of 4,159 Massachusetts ninth- to 12th-grade students. The questions on sexual orientation and suicide were part of the CDC's 1995 Youth Risk Behavior Survey. Using this survey data, researchers found that 2.5 percent of the students identified themselves as gay, lesbian or bisexual. Researchers then compared "health risk behavior" between teens who identified themselves as gay, lesbian or bisexual and their heterosexual counterparts.

In addition to increased risk for suicide, the authors claim that the data shows that gay teens were also more likely to have been "victimized and threatened and to have been engaged in a variety of risk behaviors," including "multiple substance use, and sexual risk behaviors."

Prompted by these findings, the authors say gay, lesbian and bisexual teens may need "intervention efforts" as children and adolescents to stave off a host of risky behaviors, including a propensity for suicide.

In the introduction to their report, the authors cite studies to support their contention that "gay, lesbian and bisexual adolescents face tremendous challenges growing up physically and mentally healthy in a culture that is often unaccepting."

One of those "studies" was a widely misrepresented report from a 1989 Task Force report on Youth Suicide by the U.S. Department of Health and Human Services. A licensed clinical social worker in San Francisco wrote the report and wrote that, based on his review of existing research, gay teens were "two to three times more likely" to attempt suicide. He went further, projecting that that might also mean that 30 percent of teen suicides were by gays.

Although it was not based on any original research - and the research it was based on was criticized for being decades-old, nonrepresentative and otherwise problematic - these "facts" are still in public circulation. Garofalo says they were included with his work only to provide background.

Garofalo, while agreeing with some of Muehrer's misgivings, says that this new study at least advances research on the topic by providing information taken from a representative sample - and not, as previously done, from among groups of already troubled gay teens.

"I think I was very clear in my paper about its limitations and strengths," he says. "We do the best we can as researchers."

Still, the limitations listed at the end of the Pediatrics journal article, in Muehrer's mind, are central to any discussion of this topic.

"This is something that has to be dealt with up front, not at the end of the article," Muehrer says.

"If you can't define what you're studying and if you can't show it's valid, how does it help us?"

This article was distributed by Universal Press Syndicate.

Pub Date: 5/10/98

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