Adolescents Who Attempt Suicide-Reply

In Reply.—  Dr Snelling raises an issue that has been inadequately studied: the relationship of homosexuality and youth suicidal behavior. To date, none of the few systematic, well-designed research studies conducted on completed adolescent suicide have identified being gay as a contributory risk factor.^1-4 Nor has sexual orientation been identified as a risk factor in studies of large series of adult suicides.^5,6Suicide attempters and completers are two groups characterized by different risk factors that sometimes overlap. Studies of adult homosexuals have demonstrated higher rates of certain risk factors for suicide, including substance abuse, previous psychiatric treatment, and prior suicide attempts among gays than for comparison groups,^7,8 suggesting that the suicide rate might be higher for gays. Other studies of adult outpatients have found higher rates of suicide attempts in homosexuals as compared with heterosexuals.⁹ However, many of these studies have a small sample size, lack