Older Gay Men and the Risk of Suicide | The Doctor Weighs In

By: Loren A. Olson, MD

Suicidal thinking is a common but treatable problem in older gay and bisexual men. Choosing the right therapist is critical.

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Photo Source: Adobe Stock Photos

Suicide rates in the United States have surged in recent years, while in other countries the rates have fallen. Although this rise was particularly steep for women, it increased substantially for all middle-aged Americans, a group whose suicide rate had been stable or falling since the 1950s. This article will focus in particular on suicide in older gay men

Risk factors for suicide

A confluence of risk factors may lead to suicide, including:

  • serious mental and physical health conditions including pain
  • access to lethal means
  • stressful life events including divorce or unemployment;
  • relationship issues
  • financial problems
  • trauma and abuse
  • suicide of family or friends.

Suicide in gay and bisexual men

The majority of gay/bi men maintain good mental health. However, compared to other men they are at greater risk for mental health problems.

There is a paucity of research in this area. Of note, however, is a 2002 study published in the American Journal of Public Health found that 12% of urban gay and bisexual men had attempted suicide, a rate three times higher than the overall rate for American men. Almost half reported multiple attempts.

One common theme that underlies most successful suicides is a sense of hopelessness.

Predicament suicide

Some psychiatrists have described predicament suicide. In the absence of a diagnosable mental health condition but faced by circumstances from which individuals cannot find an acceptable escape, suicide begins to appear as the least worst option.

A decision to come out in midlife might represent such a predicament. Older men may feel that they are sacrificing everything they once valued and that there is no one with whom they can speak about it.

Dr. Whitney Carlson, a Seattle-based geriatric psychiatrist said,

“Some individuals decide this is as far as they want the road to take them. Many of them are completely rational and accurate in their assessment of their situations. If they are lucky, they will cross paths with someone who can offer hope. For some, this does not represent depression but perhaps, rational choice.”

Some might consider suicide a logical choice for someone who has a painful, chronic and terminal condition when all hope for recovery has disappeared. Depression can be chronic and is extraordinarily painful. While it may seem hopeless, it is not because it is treatable.

Suicide in older gay men

Most research on suicide has been done on youth with an increasing emphasis in recent years on bullying, but very little research has explored gay, middle-aged men and suicide.

Several things account for mental health issues for older gay men:

  • Homophobia, stigma, and discrimination
  • Loneliness and social isolation
  • Lack of trust in healthcare providers
  • Lower income
  • Alcoholism and illegal drug use
  • HIV

One study found that the age of serious suicide attempts by gay/bi men coincided with major coming out milestones. At whatever age a person first begins to seriously question their sexual orientation, that conflict has been implicated in the lead up to the suicide attempt. When coming out milestones are reached at a later age, the first suicide attempt for gay/bi/questioning men occurred at an older age.

The impact of loneliness

Loneliness is epidemic in the United States. It carries with it risks to our mortality. The mortality risks are comparable to smoking and alcoholism and exceed those of physical inactivity and obesity.

We have never been so connected with others through social media while at the same time remaining so isolated from face-to-face contact with others. But loneliness and depression, while related, are not the same thing.

The keys to fighting loneliness are identifying with a larger social group, having frequent and unplanned interactions with others, and having a chum with whom one can share the most painful of our conflicts.

Conformity to masculine norms

A recent study found that strict conformity to masculine norms had implications for negative mental health outcomes, including depression, anxiety, substance abuse, and poor body image.

The three characteristics most closely associated with poor outcomes were:

  • self-reliance
  • power over women
  • sexual promiscuity

Boys are taught to be self-reliant by gender police who continuously remind them to take it like a man when they transgress from this norm. For gay men, this is often accompanied by a sense of shame: I am bad, therefore, I don’t deserve help.

On the other hand, according to a recent study, highly traditional, masculine men (not admitting vulnerability, fighting, and not crying) were more likely to die by suicide than men who did not identify as strongly with such stereotypes.

The researcher stated, “High-traditional masculinity makes people’s coping strategies rigid, so when they’re under stress, they may not show that flexibility and adaptability of things like losing a job or a relationship.”

Other risk factors

A consistent correlation exists between suicide and race and socioeconomic factors. Those from a racial minority or living in poverty have poorer outcomes and higher risks of successful suicide.

Many of the challenges that lead gay/bi/questioning men to consider suicide are not immutable. As more and more people have come out in recent years, social attitudes toward homosexuality have changed albeit with significant backlash.

One of the most necessary changes is to deconstruct the requirement for self-reliance and reconstruct a new sense of masculinity.

Getting help

Most gay and bi men can cope successfully if they have access to the right resources. Medications may be indicated particularly if there is significant insomnia or a failure to function in most areas of one’s life.

Counseling may be helpful but choose carefully. Therapists who are knowledgeable and affirming provide helpful therapeutic experiences. A good therapist will not impose their values on their counselees.

On the other hand, counseling from therapists who focus on changing sexual orientation or encourage hiding it is unhelpful and sometimes damaging. People who seek counseling from religious advisors who considered homosexuality sinful have a higher risk of suicide than those who counsel with affirming religious groups.

Care-seekers are often intimidated by their perception of an imbalance of power in the counseling relationship. But, remember, you have a right to interview the therapist about their attitudes and training before making a commitment to therapy.

Coming out is a process

As I describe in my book Finally Out: Letting Go of Living Straight, coming out is not an event but a process. Not everyone has to come out to every person in every circumstance.

Having a supportive group of family and friends is very important. For those struggling with conflicts about sexual orientation, it is important to reach out to someone you trust who can offer hope.

When families are not accepting, developing a “family of choice” may be essential. The Internet has helped men isolated in rural areas or cultures with strong prohibitions against homosexuality, and it allows for an anonymous discussion of questions concerning sexuality.

Medications may be indicated particularly if there is significant insomnia or a failure to function in most areas of one’s life. Counseling may be helpful but choose carefully. A good therapist will not impose their values on their counselees.

Care-seekers are often intimidated by their perception of an imbalance of power in the counseling relationship. But, remember, you have a right to interview the therapist about their attitudes and training before making a commitment to therapy.

The bottom line

Suicidal thinking is a common but treatable problem in gay and bisexual men and boys. Choosing the right therapist is critical.

This post was first published on June 3, 2017. The author reviewed and updated the post for republication on February 14, 2020.

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Dr. Loren A. Olson completed his undergraduate degree at the University of Nebraska at Lincoln NE and then continued his education in medical school at the University of Nebraska Medical Center in Omaha. He spent an internship year at Bryan Memorial Medical Center in Omaha. After medical school, he spent four years in the Navy as a Flight Surgeon during the Viet Nam era. After his discharge, he entered his psychiatry residency at Maine Medical Center in Portland Maine. During his final year he served as Chief Resident in Psychiatry. He has been board certified by the American Board of Psychiatry and Neurology since 1975.

Dr. Olson is a Distinguished Life Fellow American Psychiatric Association for exceptional service to the profession of psychiatry. He has received awards from the American Psychiatric Association for his writing and editing from the APA. Dr. Olson received the Exemplary Psychiatrist Award from the National Alliance on Mental Illness.

Dr. Olson has presented at the World Congress of Psychiatry in Prague, the Gay and Lesbian Medical Association, and the Association of Gay and Lesbian Psychiatrists. He is also a member of the American Medical Association. Dr. Olson “retired” from Innovative Psychiatric Services in June 2018. His love for the practice of psychiatry, pulled him out of retirement to work as an independent contractor for United Community HealthCare in Des Moines. His most recent position has been practicing adult outpatient psychiatry for Mercy One Psychiatry in Waterloo, Iowa.

Dr. Olson came out as gay at the age of forty and began to wonder if his experience coming out in midlife was like others who came out later in life. His research let to the publication Finally Out, first published in 2011 with a second edition published in 2017. The second edition won the Ben Franklin Gold Award for the best LGBT non-fiction book from the Independent Book Publishers Association in 2018.

After the publication of Finally Out, Dr. Olson began speaking to groups throughout the United States and Canada. Not only did he speak about his story but also through personal interviews and correspondence, expanded his exposure to the lives of hundreds of mature gay men from many different cultures and socio-economic groups around the world.

Dr. Olson has always enjoyed the challenges of writing, initially focusing on subjects related to psychiatry. After coming out, his primary interests have been writing about LGBT experiences and the challenges and opportunities that come with growing older.

Dr. Olson’s essays in Psychology Today have been accessed over one million times. He has also written for The Advocate, Huffington Post, Medium, and many other local and national newspapers

He has been interviewed many times for the print, radio and TV media, including an appearance on ‘Good Morning America.”

Loren A Olson MD is a gay father, psychiatrist, popular speaker, and author of Finally Out. Dr. Olson helps people find ways to keep emotional pain from becoming needless suffering.

Dr. Olson’s former wife, Lynn, and his now-husband, Doug, have been known to cook Thanksgiving dinner together for their children and grandchildren. Their children and grandchildren just shrug their shoulders and smile when asked why they have two grandmothers and three grandfathers.

Originally published at https://thedoctorweighsin.com on February 14, 2020.

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