Older Gay Men and the Risk of Suicide

By Loren A. Olson, MD | Published 4/1/2021 39

older gay men suicide

Photo source: Adobe Stock Photos

Suicide rates in the United States have surged in recent years,1 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.

New Dr. Salber‘s Review Notes appear at the end of the story.

Risk factors for suicide

A confluence of risk factors2 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.3 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 that found that 12% of urban gay and bisexual men had attempted suicide, a rate three times higher than the overall rate for American men.4 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.5 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 bad 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.

Related content: Is Suicide Ever a Rational Choice?

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.6 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 epidemic7 in the United States. It carries with it risks to our mortality.8 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 2017 study found that strict conformity to masculine norms had implications for negative mental health outcomes9, including depression, anxiety, substance abuse, and poor body image.

The three characteristics most closely associated with poor outcomes were:

  • self-reliance
  • belief in 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 study10, 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 race11 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.12

More content from this author: Body Dysmorphic Disorder: Obsession With a Flaw Interferes With Life

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.13 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 suicide14 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.

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References

  1. Kirsten Weir. Worrying trends in U.S. suicide rates. American Psychological Association – March 2019, Vol 50, No. 3 https://www.apa.org/monitor/2019/03/trends-suicide
  2. Kirsten Weir. Worrying trends in U.S. suicide rates. American Psychological Association – March 2019, Vol 50, No. 3 https://www.apa.org/monitor/2019/03/trends-suicide
  3. Mental Health, Gay and Bisexual Men’s Health. Centers for Disease Control and Prevention.   Mental Healthhttpss://www.cdc.gov/msmhealth/mental-health.htm
  4. Jay P. Paul, PhD, Joseph Catania, PhD, Lance Pollack, PhD, Judith Moskowitz, PhD, et al.

    Suicide Attempts Among Gay and Bisexual Men: Lifetime Prevalence and Antecedents.  2002 August; 92(8): 1338–1345.

  5. Saxby PridmoreStephane AuchinclossGarry Walter. Predicament suicide: an update
    NIH, PubMed. Australas Psychiatry 2015 Aug;23(4):411-4. https://pubmed.ncbi.nlm.nih.gov/26023168/
  6. Ilan H. Meyer, Ph.D., Merilee Teylan, MPH, Sharon Schwartz, Ph.D.  The Role of Help-Seeking in Preventing Suicide Attempts among Lesbians, Gay Men, and Bisexuals. Suicide and Life-Threatening Behavior© 2014 The American Association of Suicidology
    httpss://www.columbia.edu/~im15/papers/meyer-2014-suicide-and-life.pdf
  7. The “Loneliness Epidemic”. Health Resources & Services Administration. Last reviewed: Jan 2019. https://www.hrsa.gov/enews/past-issues/2019/january-17/loneliness-epidemic
  8. Stephen C. Schimpff, MD, MACP.  Loneliness: A Danger to Your Health, The Doctor Weighs In Aug 2019 https://thedoctorweighsin.com/loneliness-danger-health/
  9. Y. Joel Wong, Moon-Ho Ringo He, Shu-Yi Want, I.S. Keino Miller.  Meta-Analyses of the Relationship Between Conformity to Masculine  Norms and Mental Health-Related Outcomes, American Psychological Association 2016 https://www.apa.org/pubs/journals/releases/cou-cou0000176.pdf
  10. Daniel Coleman, Ph.D.William Feigelman, Ph.D.Zohn Rosen, Ph.D. Association of High Traditional Masculinity and Risk of Suicide DeathSecondary Analysis of the Add Health Study, AMA Psychiatry. 2020;77(4):435-437.
    https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2760513
  11. Sally C. Curtin, M.A., Margaret Warner, Ph.D.,  Holly Hedegaard, M.D., M.S.P.H. 

    Suicide Rates for Females and Males by Race and Ethnicity: United States, 1999 and 2014,  National Center for Health Statistics, Centers for Disease Control and Prevention https://www.cdc.gov/nchs/data/hestat/suicide/rates_1999_2014.htm

  12. Suicide and silence: why depressed men are dying for somebody to talk to.  The Guardian, Aug 2014. https://www.theguardian.com/society/2014/aug/15/suicide-silence-depressed-men 

  13. Ilan H. Meyer, Ph.D., Merilee Teylan, MPH, Sharon Schwartz, Ph.D.  The Role of Help-Seeking in Preventing Suicide Attempts among Lesbians, Gay Men, and Bisexuals. Suicide and Life-Threatening Behavior© 2014 The American Association of Suicidology
    httpss://www.columbia.edu/~im15/papers/meyer-2014-suicide-and-life.pdf
  14. Ilan H. Meyer, Ph.D., Merilee Teylan, MPH, Sharon Schwartz, Ph.D.  The Role of Help-Seeking in Preventing Suicide Attempts among Lesbians, Gay Men, and Bisexuals. Suicide and Life-Threatening Behavior© 2014 The American Association of Suicidology
    httpss://www.columbia.edu/~im15/papers/meyer-2014-suicide-and-life.pdf

*********

Medical Reviewer Notes by Dr. Salber

Dr. Olson’s discussion of suicide in older gay men has provided valuable insights to many of our readers since it was first published in 2017 (and updated in 2020). Many readers, primarily gay men, have left comments about their own views of suicide – some being quite dark as may be expected when someone is living in the depth of despair.

Dr. Olson has responded to many of these comments. His replies add to our understanding of this important issue. I encourage you to continue on and read the comments as they provide additional insight into the issue of suicide in older gay men.


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

Loren A. Olson, MD

Website: http://www.lorenaolson.com/

Loren A. Olson, M.D. is a board-certified psychiatrist who obtained his medical degree from the University of Nebraska Medical Center in Omaha, Nebraska, in 1968. He spent four years in the United States Navy as a Flight Surgeon. After his discharge from the military, he completed a psychiatric residency at Maine Medical Center in Portland, Maine.

Awards and Recognitions

• His proudest professional achievement was the patient-nominated Exemplary Psychiatrist Award from the National Alliance on Mental Illness.

• He has received several awards for his writing.

• His book, Finally Out, won the IBPA Ben Franklin Award for BEST LGBT Non-fiction.

Clinical Focus

His clinical focus has been on the treatment of major mental disorders. His philosophy of treatment includes addressing biological issues, developmental experiences, and current life circumstances. He believes healing occurs when treatment is delivered with genuine warmth, accurate empathy, and unconditional positive regard for everyone.

Associations and Clinical Membership

• Dr. Olson is a Distinguished Life Fellow of the American Psychiatric Association.

Publications and Books

• 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 just released another book, Finally Out: Letting Go of Living Straight

Dr. Olson is married to his life-partner Doug, of thirty-four years. Before Doug’s retirement, they raised grass-fed beef on their farm in Iowa. He has two daughters and six grandchildren from his previous marriage. They all continue to expand their definition of family.

Dr. Olson considers himself to be an expert in retiring, “I’ve done it so many times.” During his current “retirement,” he continues to practice psychiatry part-time and writes extensively for various platforms.

Comments:

  • Michael,

    So pleased to hear. What all of us struggle with when we consider coming out are the stereotypes. We grow up surrounded by them and internalize them. Then we compare who we are to that standard, which results in a lot of guilt and shame. But shame doesn’t survive in the presence of those who accept us for who we really are. Safe travels.

    • standard is standard for a reason. out of standard means you don’t fit in the standard, also for a reason.
      Ignoring standard brought many people to margine and solitude. 95% is a great standard which 5% never want to submit to.
      Death wish is a one of many consequences of refusing standard. Simply because one doesn’t fit in.

  • I found that as I got older that my greatest happiness came from within-I absolutely positively let nothing or no-one bother me. I go on vacations by myself, buy things for myself, enjoy things more than when I was younger; sure I would love to have someone, but then again, who’s to say that that’s the ultimate “prize”. I had a Fabulous doctor who helped me re-shape my thinking process an make it work more efficiently for me, to be happy, be more full of life, to love myself, because thats what really matter… I will be leaving on yet another adventure soon, I can’t wait… ))

  • maybe you could use a picture of older gay guys to go with story. This is a big part of the problem in gay society. We cannot even have a conversation about older gays without the misrepresenting them with young gay guys.

  • BWright and Michael O’Hanlon

    Dr. Salber has asked me to respond to both of you and I will do so. Both comments are very important and I want to answer them with a thoughtful response and that will take a bit longer than I have today. But the bottom line for both of you is that there is hope. Depression is treatable. The two most important things to find joy in later life are 1. Finding a sense of something that is meaningful to do, 2. Connecting with people who accept you.

    We’ll talk more about both in a later message. I also have some references to some other essays I’ve written, and at the risk of sounding like I’m promoting myself to much, some of these answers are in my book, FINALLY OUT: LETTING GO OF LIVING STRAIGHT. Chapter 11 is all about aging and how to get through it.

    Loren Olson

    • As promised, I want to respond to the previous posts from BWright and Michael O’Hanlon because these are important questions that I have been asked about many times. Neither of you are at all unique in what you have experienced.

      When I turned sixty years old, I also went through a difficult time for some of the same reasons you’ve mentioned. I had lost my mother, step-father, and a brother within six months, and some friends had died. I needed a knee and a shoulder replacement. My career had plateaued and I thought it was on the decline. I had some difficulty with erectile dysfunction. All I could see for the future was a series of continued losses.

      Then after I spoke in Houston, a man raised his hands in the air and said, “I’m 82 and this is the best time in my life.” I thought, What does he know that I need to know? One of my favorite sayings (sometimes attributed to Buddha) is: Pain is inevitable; suffering is optional. In other words, I couldn’t change the fact that I was sixty and that I had experienced many losses, but I was suffering because that was all I could think about. I began to re-focus my thinking on age as an adventure with opportunities I had never had and may not have again.

      One of the “opportunities” is the power to re-shape our thinking. We can deconstruct an old, outdated value system and develop a new one consistent with the person we believe that we are, not one based on others’ expectations of us. I wrote about it in this essay in Psychology Today.

      Sometimes we think of coming out as an event, but it is a process. I don’t believe we must come out to everyone in every circumstance. Being honest about our sexual orientation is liberating for us personally but it can damage relationships that are important. BW, since you’re 65, your parents must be in their 80s. They lived in an era when gay men and women were sent to prison and considered deviant and predatory. Coming out to them may have unintended consequences for them and for you. I appreciate your wish to be honest with them; they may even already suspect it. But once it is out in the open, it demands a response, and you have no control over what that response might be. You have been considering this for years; they only just would begin to think about it.

      In considering a decision like this, where risks and outcomes are uncertain, we tend to magnify the negative and minimize the positive. It is certainly possible that your parents might respond, “We love you anyway you are.” But there is no guarantee. No optimal decision exists, but each of us must decide for ourselves what is a satisfactory resolution, how far and to whom to come out. You have already experienced a lot of losses. Do you wish to risk the loss of your parents’ support at a time when you really need some?

      Financial and medical problems are one of the major source of difficulty for us as we grow older. I’ve been both poor and financially secure, and I can tell you that financial security does not guarantee happiness. I am absolutely convinced that happiness during our later years depends primarily (after our basic needs are met) upon having something that gives your life meaning and having friends (gay or straight) who accept us as we are.

      Doctors are just people and we are as diverse as the rest of the population. Two things are critical: he/she is well-trained and that you feel you connect with them. Men less than women talk about their depressions, but a good doctor is one place to start. All medications have risks and the more meds you take, the higher the risks. A doctor cannot possibly remember all the drug interactions and less frequent side-effects. Patients must advocate for themselves. A good place to check for drug interactions can be found here. I refer to it frequently when I treat patients. Having a companion go to your medical appointments with you will also result in better medical care.

      Many of the things you mentioned, BWright, are considered “non-specific symptoms,” meaning they could be attributed to many things. Depression could account for some; medications for others. And there are other possibilities as well. This can make treating them somewhat complicated, but treatment is possible once the cause(s) are discovered.

      Struggling with prostate problems and erectile dysfunction (ED) are indeed a potential curse/pain but don’t suffer needlessly. See your doctor about the prostate problems. While medical problems and medications can cause some of the problems related to ED, often the problems are psychological, too. At the first sign of some difficulty with erections, men often begin to worry that they are losing their ability to function sexually, and then the worrying about the problem becomes an even bigger problem. I have addressed this in Finally Out Tips. But important research shows that while sex drive, ejaculation and erections may diminish as we age, sexual satisfaction can remain constant. The important message is that good sex does not demand that we have a world-class erection!

      Suicide sometimes begins to seem rational when faced with a serious predicament, but it is a permanent solution to what in most cases is a temporary problem. I can’t tell you what the solutions are, BWright, but I can tell you that I believe there are solutions although sometimes finding them can be painfully slow.

      Having the right persons to talk to is critical. Your primary care physician can be a good one, but is important that your doctor accept your sexual orientation. If your doctor doesn’t know or doesn’t accept your sexuality, he/she will give you bad advice. Here is a resource for finding a supportive health care provider. Younger physicians may be more open and affirming about sexual orientation, but not necessarily. The same things hold true for finding a supportive counselor. The Association of LGBTQ Psychiatrists also has a referral directory.

      Michael, most of us who are older have had the experience of either feeling we were sitting on the sidelines in the LGBTQ community or have been invisible to them. For many of us, dancing the night away and drinking excessively has lost its charm. We need gay spaces, where we can talk together and hear each other. Many larger communities have options for that. One international organization that provides these opportunities is Prime Timers Worldwide, with about 80 local chapters; they also have an independent group for those who live too far away from chapters. Another online resource to find connections is on Facebook, which also might be a good place for you, BWright, to find someone to chat with.

      I would also like to try to dispel a myth about younger/older men. Not all young gay men who like older men are looking for a “sugar daddy” to take care of them, and not all older men who like younger men are looking for a “trophy partner.” Age can be a factor in sexual orientation. I would take exception to your young friend’s statement “younger faeries often band together to defend themselves.” Older gay men are not predators, at least the majority, and young “faeries” have nothing to protect themselves from; my husband is fifteen years younger than me and we’ve been together for thirty years. And many of these younger men who like older men, prefer to be in the presence of older men, as one said to me, “I like older men because they have rounded corners.” We do have a bias in our culture and a focus on youth, but part of that is because those of us who are older have not raised our voices and said, “Hey, I’m queer, too. Notice me!”

      Gay, straight or other, ageism is a factor because of stereotypes. Stereotypes exist in a world of “those other people.” They exist when one outside group attempts to define another. One characteristic of the “other” is elevated to master status and generalized to an entire population; it is the basis of all prejudice. But we are also the victims of those stereotypes because we have internalized them, too. If we believe that as older gay men and women we’re on a period of decline to nothingness, we are our own victims of the stereotype.

      I am 74 now. When I was young, 74 was considered very old. But now, I am considered a survivor, and I have a life expectancy of another 12 years. I feel an urgency of time, but it allows me to choose to do things I really want to and not do other things that I once thought I had to do. I have moved things from my bucket list to an un-bucket list. I no longer feel pressured to climb the ladder to the top. I don’t go to cocktail parties unless I know I’m going to like the people who are there. I don’t need to “network,” to find people who can move me further up the ladder. I don’t sit through boring lectures. I don’t read lengthy essays unless they really have something important to say. I hope you’re still reading this one. Make this the best time in your life.

  • as an older Austrlian man who came out in his 40s my early expreices of queer culture were largely postive as I marvelled about how men formed relationships across ethnic and age barriers . I have recently tuned 60 and I find myself becoming more and more invisible in the youth obsessed English speaking cultures I know. Thankfully this is not the same in Latin and Asian countries or even in Europe generally.

    At a number of recent events even some of my younger close gay friends ignored me in the pursuit of the younger prettier and more mobile.
    These events have included radical faery gatherings festivals and social weekends despite making a considerable effort on each occasion in such ways as cost sharing cooking, volunteer working transport and or teaching for free

    i asked a younger fairy friend about this -he said younger faeries often band together to defend themselves from unwelcome sexual attentions from older faeries

    have you considered depression in older gay men is caused by rejection and /or ageism in the gay community

    regards Eureka

    • The ageism is coming from both sides. What’s wrong with men closer to you in age?

  • This hit the nail on it’s head.. At 65 years of age my mental being is reshaping . On one hand I wish to announce to my parents that I am and desire to become gay, on the other hand I wish not to disclose my feelings for the fear of being totally rejected or disinherited. I got trapped in the finance crisis and lost a 30 year old business and then my home, after that my health unexpectantly took a turn. I lost my hearing over night at 55, within the time frame of the business and home loss. I was left with out Insurance coverage , I had no income and was denied both unemployment and disability! The stress of that led to HBP and health issues. I had to resort to the state’s Medicare for low income. I also had to take a early retirement to draw the SS at 62. A loss of about $550 to $700 per month and that was ordered because of SSI. I am thankful having my vehicle paid for before this happened and my living contents, but downsizing including selling personal items at a great loss. I can not take another form of work/employment because of my hearing and now HBP related medical issues. My cardiologist treated me lake a free clinic street person and prescribed medication that made matters most with side effects including depression, weigh gain, insomnia, weakness, and non energetic. Only through an ER visit the attending ER doctor asked what meds I was prescribed, after unveiling the meds, He said “this meds are killing you ” Thank god that called for a different primary Care doctor, with his guidance I am recovering . NOW it’s the man curse of the prostrate and ED. which is even more depressing ! So I have not ruled out suicide and think about it often, I can not bare the thought of hurting my parent or my brothers as well some friends. This message really acknowledge that yes there is a MAJOR issue among the older gay/bi/trans/ community. The problems of just surviving living accommodations, food, medical services and medications is overwhelming at times.. But importantly having the right person to just talk to !

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