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:

  • As an older gay male I am really tired of the propaganda blaming gay male depression and suicide on the rest of society. Let’s be honest, it is the gay lifestyle itself that causes depression. This gets even worse as one grows older.
    One simply can not blame society for one’s loneliness when one has had thousands of sexual partners. Let’s face it, young gay men have plenty of opportunities to meet other gay men. It is never societal pressure that prevents them from exchanging names or starting a relationship. It is always gay male fickleness. Gay males think the object of their desire is perfect before they have it/him, then worthless after they have it/him.
    I’d go so far as to say that this trait is inseparable from homosexuality, as I have notic Ed it in myself and every other gay male I’ve ever met. Gay males are also rather cowardly, reluctant to make a first move in the first place while also running in fear of any real intimacy. You simply won’t find a vgl young gay male with a web profile that says ” seeking LTR,. Nope, they feel their value in the sexual marketplace is too great, that they should not be asked to remove themselves from the market for anyone.
    It is only later in life, when no one wants them, that they will have a profile that says seeking FWB, or (gasp) LTR.
    A lifetime of reducing oneself to a cold sexual object is sure to take it’s toll. I knew several such people who couldn’t handle being over 40, and killed themselves, intentionally and through supposedly accidental overdose’s. I’ve seen the lifestyle destroy men in their 20s and 30s.
    Being young and attractive and gay will mean one will get a lot of attention. But it also means one will soon have given himself away too many times so that the attention ceases and shifts to a new face in the crowd. Those one hasn’t given oneself to will also be jealously attacked with backbiting and gossip.
    Any gay man who is honest will admit that what I have written is true.
    So, let’s stop blaming society ,our unhappiness is solely our own doing. In fact, I’d go so far as to say that gays do better when there is social pressure against them, for only then, when other gays are hard to come by, will they not throw each other away like used tissues.
    As for gay men that somehow stuck around past their sell by date, yes, unless you have an interest or hobby that is fulfilling for you, suicide is a logical choice. Very few gay men though, have such things these days .Gay culture, which is nothing but hook up web sites, porn sites, cruising locations, etc, have occupied virtually all of their free time, they even built their professional lives around it, choosing non demanding clerical and retail positions.

    • With Respect to Max- Though I agree with much of what you have said – there is a flaw here — that assumption that if we don’t agree with you that somehow we are not being truthful with ourselves. At that point your argument seems more reflective of judgement and perhaps some self-hatred….that you think we all share. I am lonely. This is true. But I have felt, in my life profound love have experienced other gay men who have shaped my understanding of myself and the world I live in – for whom I am forever grateful. That doesn’t change that I feel isolation (even surrounded by true friends) from time to time. But if wisdom has shown me anything – it is this (and I agree with you here) that I cannot blame my isolation or loneliness on society – because society is not responsible for my choices. However, because we do not all share the same histories, actions or behaviors. I’m am 57 – and like you have lost friends and have seen my sex life change, and dating life dwindle and a knowing the young gay kid in me is no longer alive. This adjustment is unsettling at best – But so many other things have changed in me….My expectations, my values, and what I find to be meaningful in life has also been part of the evolution. You paint the majority of Gay people as the embittered figure at the end of the bar – sitting alone – in despair and longing for a humane and friendly voice….this is true for some, but not for all. I believe everyone truly wants to be seen, heard, experienced. Recognized that we have lived and are alive. The negative things that face the aging population are not limited to gay men and each experience may have commonality, but are not necessary the same for everyone growing older. Finally — I truly take issue with your term “lifestyle” — What that mean? I have never understood this I have been in gay culture since the early 80’s…Apparently, I never got the rule book on this – is there a lifestyle? OR is there cultural and societal norms that change from generation to generation (gay or not)? Ultimately – the “Lifestyle of Gay people” is is a talking point of homophobes and boxes in everyones “life experience” as somehow being the same. IT ISN”T. For instance: You and I – though we have similar life events – have no doubt made different choices, taken different actions, and seasoned our wisdom from different perspectives – making us who we are now – we may not have lived the “lifestyle” at all like the other. Respect. My gay brother — Continued Peace, Love, and Success. JHI

  • Being alone has taken the toll on me. As each day gets harder to face I know my time is limited. I fought a hard fight just wanting to have a partner but I was not given the gift of looks. And my big heart is not enough to to attract a great guy! How time does not cure a broken heart!

    • Yeah this is 100% truth. I’m petrified of 40. How do you think I came across this article? (37, Washington, DC)

  • I don’t know if anyone is still reading this, but I find this discussion very relevant to myself. I’m a 53 year old man in the central US, gay, very isolated and lonely. Most of my hobbies and interests, such as mechanical work and motorcycle riding, are traditionally “straight” things, so most gay men don’t find me interesting to talk to, yet straight men whose friendship I’d enjoy understandably put up a bit of a barrier when they find out I’m gay – much the same as they might feel uncomfortable getting too friendly with a single woman they’re not attracted to because they don’t want to create expectations of something they don’t want.

    When Michael mentions finding pleasure and fulfillment from within, I can understand this point, but this is somewhat dependent on having a significant amount of money. Yes, if you can buy nice stuff, take trips or enjoy having adventures, you can do a lot to salve over any negative feelings you might be having. I can see both sides of that because ten years ago I was better off financially than I am now.

    Relative to some of the advice given, if you can afford a therapist or have a friend who cares to listen, yeah, that probably helps. As for social groups, I’ve attempted to link up with, for instance, a gay motorcycle riding club in a distant city (because there’s nothing like this near me), traveling 250 miles in hopes of finding people with similar interests – thinking it might be fun even if I could only make it there a few times a year. What I got was a “who the hell are you” attitude that made me feel more lonely than I would have felt if I had been by myself. The ones at the top of the club pecking order all had fancy riding gear and $30,000 custom bikes. It was all of the BS of a gay bar, but just adapted to motorcycles.

    The main reason I’m writing this is in case someone similar might see it and we could possibly develop a friendship. But I’d be glad to talk to anyone who’d like to comment.

    • I totally hear where you are coming from. I am 56 and facing same challenges as single gay male.

  • Thanks Loren. I just saw your reply. I don’t disagree with your suggestions. I’ve found meaning in my work as an historian and have participated in social groups for older gay men and I have met men online. I go to a great gay therapist periodically with whom I am completely honest, including about my wish to find a way to end my life. What I don’t have is friends. I do try to interact with the men I meet, but they treat me like a sort of therapist as they describe their latest sexual escapades or unburden themselves to me in texts and occasional phone calls about their personal doubts and fears. They aren’t able to make me feel like i’m heard when I explain my feelings, though I don’t even hint at my suicidal thoughts with them. The more sane and balanced gay men I meet are coupled and understandably want to socialize with other gay male couples. They politely decline my social invitations. Without the prospect of sex, I can’t get any men to spend any time with me. I’m not going to have sex with men I’m not sexually interested in for the sake of getting a man to meet me. I still have some sexual desires but not for the men I meet. Strangely enough, these men express an interest in sex even as they let me know that they don’t actually find me attractive. They only want sex with me because I’m available. I have good health and might go on like this for years but I feel as if I’m finished with life. I’ve lived a full life in many ways, including having several meaningful sexual relationships..one lasted for 7 years. I’ve learned important lessons about being human and living in the world. I feel a sense of having completed the challenges of life and am grateful for those experiences. I see being able to choose to end my life as a reward for having made it this far. Am I just afraid of facing one more new challenge, namely, learning how to face the final stages of my life alone? I know that no one wants to face this reality, but I can’t see what I would gain by learning how to remain independent until I’ve reached some arbitrary age when it would be ‘acceptable’ to society for me to die. The prospect of mere survival isn’t enough. If there was a sure-fire way that I could end my life quickly and predictably, I’d go for it. It’s only the prospect of surviving any attempts that keeps me from trying. I don’t expect the world to change to suit me, but I can’t see how I could ever enjoy my place in the world. Thanks for providing this forum as a place where I can openly acknowledge my feelings.

  • I think there can be times when suicide is rational, for example, when someone is facing a terminal, painful illness with no hope of recovery. Many of us would agree that a person suffering like that might justifiably begin to think of suicide as a way to end that awful pain.

    Loneliness and depression often occur together, but they are not the same thing, as I wrote in an article for Psychology Today called, “Loneliness is a Killer, ” https://www.psychologytoday.com/blog/finally-out/201712/loneliness-is-killer-why-dont-we-talk-about-it

    But loneliness and depression are not like chronic illnesses for which there is nothing that can be done. This is why, in these situations, suicide may LOOK rational but it is not rational because both conditions need not be permanent and, therefore, as hopeless as they appear. These conditions only APPEAR that they will go on forever, but if one can hold on and make some changes, the pain can subside.

    The three things one must do are:
    1. Become identified with a larger group – social, religious, political, Alcoholics Anonymous or anything that gives your life meaning

    2. Become a part of a smaller group with frequent, unplanned interactions – For older gay men, Prime Timers Worldwide, for example, often provides those opportunities, but there are many others as well

    3. Find a chum, someone with whom you can bare your soul and share your secrets. In some cases, it may mean a therapist, at least for a while.
    But what I detect in your comment, Matt, is a negative mindset that says, “I’ve tried all that. None of those things will help. It’s pointless.” It certainly can FEEL that way. But somewhere out there is another human being who is looking for you, too. But in order to find him/her, you must begin to believe that he/she is out there, somewhere.

    • I’ve done what you’ve suggested, Loren. Over and over. Time after time. In many cities and on multiple continents.

      And now I’m done.

  • I think that suicide can be rational. I’m not depressed, but I have no desire to continue to live either. My friends are all far away and I have little in common with them anymore, the only sexual relationship available are casual/anonymous hookups, and I spend almost all my time alone. I’m ignored at gay social events or meet men who are deeply troubled and need far more than I could ever give them. If anyone cared about me or needed me in any way I might feel differently. I don’t see the point in struggling with my health and finances just to reach some arbitrary number of years. Isn’t it better that I control the circumstances of my death while I’m still able to do so?

    • I completely agree with this statement, particularly the second-to-last sentence.

      I often wonder for what reason(s) society has for keeping people alive who don’t wish to be. Do governments really need that marginal tax revenue? Is it to prove some theoretical point?

      If one is struggling and will continue to struggle, is staying alive just being done in service of some other person’s or society’s worldview? That doesn’t seem fair. If I’m living the struggle and I’ve personally had enough, it should be my choice when it’s time to go. I simply don’t think people who have their lives “in order” quite understand the pain of those who don’t.

    • I think suicide can sometimes be a rational choice, but I also know that most of the time it isn’t.

      If I ever have a painful, terminal illness, I’d like to be able to make a decision about how, when, and where that happens. And circumstances wouldn’t necessarily need to be as dramatic as that. Most of us who are old don’t worry about dying but we do worry about the circumstances of our dying.

      People who suffer from depression who’ve also had kidney stones, painful childbirth, or cancer, have told me that they would take those over depression any time.

      The difficulty is determining when it’s a rational choice and when the choice is irrational. I know that some who are depressed see the decision as rational but later when symptoms are relieved, they can see the error of their thinking.

      Most societies that support euthanasia agree that a doctor is allowed by law to end a person’s life by a painless means, as long AS THE PATIENT AND FAMILY AGREE. The point of this is not to take away the individual’s right to make that decision, but to have some input from a potentially more objective source.

      I have no objection to someone’s taking their own life providing their decision is not based on distorted thinking that can be treated and reversed.

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