Skip to main content

Advertisement

SpringerLink
Log in

Suicidality and Sexual Orientation: Differences Between Men and Women in a General Population-Based Sample From The Netherlands

  • Published:
Archives of Sexual Behavior Aims and scope Submit manuscript

Homosexuality has been shown to be associated with suicidality and mental disorders. It is unclear whether homosexuality is related to suicidality, independently of mental disorders. This study assessed differences in lifetime symptoms of suicidality (death ideation, death wishes, suicide contemplation, and deliberate self-harm) between homosexual and heterosexual men and women, controlling for lifetime psychiatric morbidity. Interaction effects of age and the role of perceived discrimination were also examined. Data were collected on a representative sample of the Dutch population aged 18–64 years. Classification as heterosexual or homosexual was based upon reported sexual behavior in the preceding year. Of those sexually active, 2.8% of 2,878 men and 1.4% of 3,120 women had had same-sex partners. Homosexual men differed from their heterosexual counterparts on all four suicide symptoms (OR ranging from 2.58 to 10.23, with higher ORs for more severe symptoms), and on the sum total of the four symptoms; homosexual women only differed from heterosexual women on suicide contemplation (OR=2.12). Controlling for psychiatric morbidity decreased the ORs, but among men all associations were still significant; the significance for suicide contemplation among women disappeared. Younger homosexuals were not at lower risk for suicidality than older homosexuals in comparison with their heterosexual counterparts. Among homosexual men, perceived discrimination was associated with suicidality. This study suggests that even in a country with a comparatively tolerant climate regarding homosexuality, homosexual men were at much higher risk for suicidality than heterosexual men. This relationship could not only be attributed to their higher psychiatric morbidity. In women, there was no such clear relationship.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  • American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • Bailey, M. (1999). Homosexuality and mental illness. Archives of General Psychiatry, 56, 883–884.

    Article  PubMed  CAS  Google Scholar 

  • Bijl, R. V., Ravelli, A., & Van Zessen, G. (1998). Prevalence of psychiatric disorder in the general population: Results of the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Social Psychiatry and Psychiatric Epidemiology, 33, 587–595.

    Article  PubMed  CAS  Google Scholar 

  • Bijl, R. V., Van Zessen, G., Ravelli, A., De Rijk, C., & Langendoen, Y. (1998) The Netherlands Mental Health Survey and Incidence Study (NEMESIS): Objectives and design. Social Psychiatry and Psychiatric Epidemiology, 33, 581–586.

    Article  PubMed  CAS  Google Scholar 

  • Cochran, S. D., & Mays, V. M. (2000a). Relation between psychiatric syndromes and behaviorally defined sexual orientation in a sample of the US population. American Journal of Epidemiology, 151, 516–523.

    PubMed  CAS  Google Scholar 

  • Cochran, S. D., & Mays, V. M. (2000b). Lifetime prevalence of suicide symptoms and affective disorders among men reporting same-sex sexual partners: Results from NHANES III. American Journal of Public Health, 90, 573–578.

    PubMed  CAS  Google Scholar 

  • Cochran, S. D., Sullivan, J., & Mays, V. M. (2003). Prevalence of mental disorders, psychological distress, and mental services use among lesbian, gay, and bisexual adults in the United States. Journal of Consulting and Clinical Psychology, 71, 53–61.

    Article  PubMed  Google Scholar 

  • Cottler, L. B., Robins, L. N., Grant, B. F., Blaine, J., Towle, L. H., Wittchen, H.-U., et al. (1991). The CIDI-core substance abuse and dependence questions: Cross-cultural and nosological issues. British Journal of Psychiatry, 159, 653–658.

    PubMed  CAS  Google Scholar 

  • Diplacido, J. (1998). Minority stress among lesbians, gay men, and bisexuals: A consequence of heterosexism, homophobia and stigmatization. In G. M. Herek (Ed.), Stigma and sexual orientation: Understanding prejudice against lesbians, gay men, and bisexuals (pp. 138–159). Thousand Oaks, CA: Sage.

    Google Scholar 

  • Doll, L. S., Petersen, L. R., White, C. R., Johnson, E. S., & Ward, J. W. (1992). Homosexually and nonhomosexually identified men who have sex with men: A behavioral comparison. Journal of Sex Research, 29, 1–14.

    Google Scholar 

  • Fergusson, D. M., Horwood, L. J., & Beautrais, A. L. (1999). Is sexual orientation related to mental health problems and suicidality in young people? Archives of General Psychiatry, 56, 876–880.

    Article  PubMed  CAS  Google Scholar 

  • Friedman, R. C. (1999). Homosexuality, psychopathology, and suicidality. Archives of General Psychiatry, 56, 887–888.

    Article  PubMed  CAS  Google Scholar 

  • Gilman, S. E., Cochran, S. D., Mays, V. M., Hughes, M., Ostrow, D., & Kessler, R. C. (2001). Risk of psychiatric disorders among individuals reporting same-sex sexual partners in the National Comorbidity Survey. American Journal of Public Health, 91, 933–939.

    PubMed  CAS  Google Scholar 

  • Herek, G. M., Gillis, J. R., & Cogan, J. C. (1999). Psychological sequelae of hate-crime victimization among lesbian, gay and bisexual adults. Journal of Consulting and Clinical Psychology, 67, 945–951.

    Article  PubMed  CAS  Google Scholar 

  • Herrell, R., Goldberg, J., True, W. R., Ramakrishnan, V., Lyons, M., Eisen, S., et al. (1999). Sexual orientation and suicidality: A co-twin control study in adult men. Archives of General Psychiatry, 56, 867–874.

    Article  PubMed  CAS  Google Scholar 

  • Janssen, I., Hanssen, M., Bak, M., Bijl, R. V., De Graaf, R., Vollebergh, W., et al. (2003). Discrimination and delusional ideation. British Journal of Psychiatry, 182, 71–76.

    Article  PubMed  CAS  Google Scholar 

  • Jorm, A. F., Korten, A. E., Rodgers, B., Jacomb, P. A., & Christensen, H. (2002). Sexual orientation and mental health: Results from a community survey of young and middle-aged adults. British Journal of Psychiatry, 180, 423–427.

    Article  PubMed  Google Scholar 

  • Kessler, R. C., Borges, G., & Walters, E. E. (1999). Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Archives of General Psychiatry, 56, 617–626.

    Article  PubMed  CAS  Google Scholar 

  • Kessler, R. C., Mickelson, K. D., & Williams, D. R. (1999). The prevalence, distribution, and mental health correlates of perceived discrimination in the United States. Journal of Health and Social Behavior, 40, 208–230.

    Article  PubMed  CAS  Google Scholar 

  • Kessler, R. C., Wittchen, H.-U., Abelson, J. M., McGonagle, K. A., Schwarz, N., Kendler, K. S., et al. (1998). Methodological studies of the Composite International Diagnostic Interview (CIDI) in the US National Comorbidity Survey (NCS). International Journal of Methods in Psychiatric Research, 7, 33–55.

    Article  Google Scholar 

  • Kite, M. E., & Whitley, B. E. (1998). Do heterosexual women and men differ in their attitudes toward homosexuality? In G. M. Herek (Ed.), Stigma and sexual orientation: Understanding prejudice against lesbians, gay men, and bisexuals (pp. 39–61). Thousand Oaks, CA: Sage.

    Google Scholar 

  • Laumann, E. O., Gagnon, J. H., Michael, R. T., & Michaels, S. (1994). The social organization of sexuality: Sexual practices in the United States. Chicago: University of Chicago Press.

    Google Scholar 

  • Mays, V. M., & Cochran, S. D. (2001). Mental health correlates of perceived discrimination among lesbian, gay, and bisexual adults in the United States. American Journal of Public Health, 91, 1869–1876.

    PubMed  CAS  Google Scholar 

  • Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36, 38–56.

    Article  PubMed  CAS  Google Scholar 

  • Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697.

    Article  PubMed  Google Scholar 

  • Mills, T. C., Paul, J., Stall, R., Pollack, L., Canchola, J., Chang, Y. J., et al. (2004). Distress and depression in men who have sex with men: The Urban Men's Health Study. American Journal of Psychiatry, 161, 278–285.

    Article  PubMed  Google Scholar 

  • Neeleman, J., De Graaf, R., & Vollebergh, W. (2004). The suicidal process; prospective comparison between early and later stages. Journal of Affective Disorders, 82, 43–52.

    Article  PubMed  Google Scholar 

  • Otis, M. D., & Skinner, W. F. (1996). The prevalence of victimization and its effect on mental well-being among lesbian and gay people. Journal of Homosexuality, 30, 93–121.

    Article  PubMed  CAS  Google Scholar 

  • Remafedi, G. (1999). Suicide and sexual orientation. Nearing the end of controversy? Archives of General Psychiatry, 56, 885–886.

    Article  PubMed  CAS  Google Scholar 

  • Remafedi, G., French, S., Story, M., Resnick, M. D., & Blum, R. (1998). The relationship between suicide risk and sexual orientation: Results of a population-based study. American Journal of Public Health, 88, 57–60.

    Article  PubMed  CAS  Google Scholar 

  • Robins, L. N., Wing, J., Wittchen, H.-U., Helzer, J. E., Babor, T. F., Burke, J., et al. (1988). The Composite International Diagnostic Interview: An epidemiologic instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Archives of General Psychiatry, 45, 1069–1077.

    PubMed  CAS  Google Scholar 

  • Sandfort, T. G. M. (1998). Homosexual and bisexual behaviour in European countries. In M. C. Hubert, N. Bajor, & T. G. M. Sandfort (Eds.), Sexual behaviour and HIV/AIDS in Europe (pp. 68–105). London: UCL Press.

    Google Scholar 

  • Sandfort, T. G. M., Bos, H., & Vet, R. (2005). Lesbians and gay men at work: Consequences of being out. In A. M. Omoto & H. S. Kurtzman (Eds.), Sexual orientation and mental health: Examining identity and development in lesbian, gay, and bisexual people (pp. 225–244). Washington DC: American Psychological Association.

    Google Scholar 

  • Sandfort, T. G. M., De Graaf, R., & Bijl, R. V. (2003). Same-sex sexuality and quality of life: findings from the Netherlands mental health Survey and Incidence Study. Archives of Sexual Behavior, 32, 15–22.

    Article  PubMed  Google Scholar 

  • Sandfort, T. G. M., De Graaf, R., Bijl, R. V., & Schnabel, P. (2001). Sexual orientation and psychiatric disorders: Findings from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Archives of General Psychiatry, 58, 85–91.

    Article  PubMed  CAS  Google Scholar 

  • Sareen, J., Cox, B. J., Afifi, T. O., De Graaf, R., Asmundson, G. J. G., ten Have, M., et al. (2005). Anxiety disorders and risk for suicidal ideation and suicide attempts: A population-based longitudinal study of adults. Archives of General Psychiatry, 62, 1249–1257.

    Article  PubMed  Google Scholar 

  • Savin-Williams, R. C. (2001). Suicide attempts among sexual-minority youths: population and measurement issues. Journal of Consulting and Clinical Psychology, 69, 983–991.

    Article  PubMed  CAS  Google Scholar 

  • Semler, G., Von Cranach, M., & Wittchen, H.-U. (Eds.). (1987). Comparison between the Composite International Diagnostic Interview and the Present State Examination. Report to the WHO/ADAMHA Task Force on Instrument Development. Geneva: World Health Organization.

  • Skegg, K., Nada-Raja, S., Dickson, N., Paul, C., & Williams, S. (2003). Sexual orientation and self-harm in men and women. American. Journal of Psychiatry, 160, 541–546.

    Article  Google Scholar 

  • Social and Cultural Planning Office. (1996). Sociaal Cultureel Rapport [Social and Cultural Report]. The Hague, the Netherlands: SCP/Vuga.

  • Social and Cultural Planning Office. (2000). Sociaal en Cultureel Rapport 2000: Nederland in Europe [Social and Cultural Report 2000: Netherlands in Europe]. Rijswijk, the Netherlands: SCP.

  • Van de Meerendonk, B., Eisinga, R., & Felling, A. (2003). Application of Herek's Attitudes toward Lesbians and Gay Men Scale in the Netherlands. Psychological Reports, 93, 265–275.

    Article  PubMed  Google Scholar 

  • Van de Meerendonk, B., & Scheepers, P. (2004). Denial of equal rights for lesbians and gay men in The Netherlands, 1980–1993. Journal of Homosexuality, 47, 63–80.

    Article  PubMed  Google Scholar 

  • Van den Akker, P., Halman, L., & De Moor, R. (1994). Primary relations in Western societies. In P. Ester, L. Halman, & R. De Moor (Eds.), The individualizing society: Value change in Europe and North America (pp. 97–127). Tilburg, The Netherlands: Tilburg University Press.

    Google Scholar 

  • Van Heeringen, C., & Vincke, J. (2000). Suicidal acts and ideation in homosexual and bisexual young people: A study of prevalence and risk factors. Social Psychiatry and Psychiatric Epidemiology, 35, 494–499.

    Article  PubMed  CAS  Google Scholar 

  • Van Zessen, G., & Sandfort, T. (Eds.). (1991). Seksualiteit in Nederland: Seksueel gedrag, risico en preventie van AIDS [Sexuality in the Netherlands: Sexual behaviour, risks and prevention of AIDS]. Amsterdam: Swets & Zeitlinger.

    Google Scholar 

  • Weissman, M. M., Klerman, G. L., Markowitz, J. S., & Ouellette, R. (1989). Suicidal ideation and suicide attempts in panic disorder and attacks. New England Journal of Medicine, 321, 1209–1214.

    Article  PubMed  CAS  Google Scholar 

  • Widmer, E. D., Treas, J., & Newcomb, R. (1998). Attitudes toward nonmarital sex in 24 countries. Journal of Sex Research, 35, 349–358.

    Article  Google Scholar 

  • Wittchen, H.-U. (1994). Reliability and validity studies of the WHO-Composite International Diagnostic Interview (CIDI): A critical review. Journal of Psychiatric Research, 28, 57–84.

    Article  PubMed  CAS  Google Scholar 

  • Wittchen, H.-U., Burke, J. D., Semler, G., Pfister, H., von Cranach, M., & Zaudig, M. (1989). Recall and dating reliability of psychiatric symptoms: Test-retest reliability of time related symptom questions in a standardized psychiatric interview (CIDI/DIS). Archives of General Psychiatry, 46, 437–443.

    PubMed  CAS  Google Scholar 

  • Wittchen, H.-U., Lachner, G., Wunderlich, U., & Pfister, H. (1998). Test-retest reliability of the computerized DSM-IV version of the Munich Composite International Diagnostic Interview (M-CIDI). Social Psychiatry and Psychiatric Epidemiology, 33, 568–578.

    Article  PubMed  CAS  Google Scholar 

  • Wittchen, H.-U., Zhao, S., Abelson, J. M., Abelson, J. L., & Kessler, R. C. (1996). Reliability and procedural validity of UM-CIDI DSM-III-R phobic disorders. Psychological Medicine, 26, 1169–1177.

    Article  PubMed  CAS  Google Scholar 

  • World Health Organization. (1990). Composite International Diagnostic Interview (CIDI). Version 1.0. Geneva: World Health Organization.

Download references

ACKNOWLEDGMENTS

NEMESIS is conducted by the Netherlands Institute of Mental Health and Addiction (Trimbos Institute) in Utrecht. Financial support was provided by the Netherlands Ministry of Health, Welfare and Sports (VWS). The authors thank Jeffrey Weiss for his feedback on earlier versions of this manuscript.

Author information

Authors and Affiliations

  1. Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands

    Ron de Graaf Ph.D. & Margreet ten Have Ph.D.

  2. HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York

    Theo G. M. Sandfort Ph.D.

  3. Netherlands Institute of Mental Health and Addiction, Da Costakade 45, 3521, VS Utrecht, The Netherlands

    Ron de Graaf Ph.D.

Authors
  1. Ron de Graaf Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Theo G. M. Sandfort Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Margreet ten Have Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ron de Graaf Ph.D..

Rights and permissions

Reprints and permissions

About this article

Cite this article

de Graaf, R., Sandfort, T.M. & ten Have, M. Suicidality and Sexual Orientation: Differences Between Men and Women in a General Population-Based Sample From The Netherlands. Arch Sex Behav 35, 253–262 (2006). https://doi.org/10.1007/s10508-006-9020-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10508-006-9020-z

KEY WORDS:

Search

Navigation