Journal of Affective Disorders 87 (2005) 35 – 42

www.elsevier.com/locate/jad

Research report

Gender role, sexual orientation and suicide risk

Kathleen Kara Fitzpatricka, Stephanie J. Eutona, Jamie N. Jonesa, Norman B. Schmidtb,*
a
The Ohio State University, USA
b
Florida State University, Department of Psychology, Tallahassee, FL 32306, USA
Received 2 August 2004; accepted 28 February 2005
Available online 12 May 2005

Abstract

Background: There has been interest in the relationship between homosexuality, gender role and suicide risk. Though
homosexuals are more likely to identify as cross-gender, research has not simultaneously examined sexual orientation and
gender role in assessing suicide risk. In the current study, the unique and interactive effects of sexual orientation and gender role
were assessed in regard to suicidal ideation, related psychopathology and measures of coping.
Methods: 77 participants were recruited from an undergraduate psychology subject pool (n = 47) or from gay, lesbian and
transgender student organizations (n = 30) and assessed on measures of gender role, homosexuality, and psychopathology.
Results: Consistent with expectations, cross-gender role (i.e., personality traits associated with the opposite sex) is a unique
predictor of suicidal symptoms. Moreover, gender role accounted for more of the overall variance in suicidal symptoms,
positive problem orientation, peer acceptance and support, than sexual orientation. After accounting for gender role, sexual
orientation contributed little to the variance in suicidal symptoms, associated pathology and problem-solving deficits. There was
no support for gender role by sexual orientation interaction effects.
Limitations: The cross-sectional nature of the data limits statements regarding causality.
Conclusions: Cross-gendered individuals, regardless of sexual orientation, appear to have higher risk for suicidal symptoms.
Researchers and clinicians should assess gender role in evaluations of youth samples.
D 2005 Elsevier B.V. All rights reserved.

Keywords: Gender role; Sexual orientation; Suicide; Mood

Suicide is the third leading cause of death for
young adults ages 15–24, and the second leading
cause for ages 25–34 (Anderson, 2002). The fact
that suicide represents a significant threat to the health
and well-being of the nation’s youth is highlighted by
* Corresponding author. Tel.: +1 850 644 1707; fax: +1 850 644
7739.
E-mail address: schmidt@psy.fsu.edu (N.B. Schmidt).
0165-0327/$ - see front matter D 2005 Elsevier B.V. All rights reserved.
doi:10.1016/j.jad.2005.02.020
the recent Surgeon General’s Call to Action to Pre-
vent Suicide (The United States Public Health Service,
1999). Indeed, while the suicide rate for the general
population had decreased from 1952 to 1996, the
rate of suicide for young adults had nearly tripled
(The United States Public Health Service, 1999).
Despite increased research on the topic of suicide
(Brent et al., 1986, 1999), much remains to be
done.
36 K.K. Fitzpatrick et al. / Journal of Affective Disorders 87 (2005) 35–42
Suicide exists on a behavioral and psychological
continuum, ranging from completed suicides to
suicide attempts to suicidal ideation. While com-
pleted suicide clearly represents the most extreme
form of suicidal behavior, suicide attempts and
suicidal ideation represent important public health
problems. For example, suicidal ideation and sui-
cide attempts are significant risk factors for com-
pleted suicide (Kovacs et al., 1993; Stoelb and
Chiriboga, 1998).
Despite the significant problems posed by sui-
cide, it may be preventable through effective
intervention by both mental and medical health
professionals. In an attempt to aid detection and
prevention, a great deal of research has been con-
ducted in an effort to identify risk factors for suicide
(Brent et al., 1999). In a review of literature on suicide
risk, Stoelb and Chiriboga (1998) presented a process
model for adolescent risk for suicide that identified
homosexuality, among other factors, as potentially
important to the development of suicidal ideation,
attempts and completed suicide (Stoelb and Chiri-
boga, 1998).
Relatively little research has focused on the rela-
tionship of homosexuality and suicide and the data
are not entirely consistent. The first major study to
examine homosexuality and suicide found that 30%
of the sexual minorities (gay, lesbian and bisexual
participants) reported attempting suicide at least
once, compared to only 13% of the heterosexual
young adults (Safren and Heimberg, 1999). Of the
attempters, 58% of the sexual minority group, com-
pared to 33% of the heterosexual group, indicated
they truly wanted to die during their attempt. Finally,
20% of sexual minority group thought about suicide
often or very often, whereas no one in the heterosex-
ual group reported this level of ideation (Safren and
Heimberg, 1999). Other studies have found increased
suicide risk specific to only male (Garofalo et al.,
1999) or only female homosexuals (Wichstrom and
Hegna, 2003). Finally, other studies have failed to find
any consistent overall association between homosexu-
ality and suicide leading to debate about the role of
sexual orientation above and beyond the risk con-
ferred by psychopathology and other associated fac-
tors (Muehrer, 1995).
One method of attempting to resolve some of the
ambiguity in these findings is to consider factors
that many confound the relationship between sexual
orientation and suicide. One potential confounding
factor is gender role because it is associated with
homosexuality (Lippa, 2000) and gender role is
related to suicide risk (Street and Kromrey, 1995).
Gender role in often defined as the relative degree
of an individual’s feminine or masculine psycholo-
gical traits, and it is typically assessed with the
Bem Sex Role Inventory (BSRI; Bem, 1974). A
prototypic feminine gender role is characterized as
affectionate, yielding, emotional and dependent,
whereas a masculine gender role is typically identified
as analytic, assertive, competitive and dominant.
Androgyny is defined as high levels of both masculine
and feminine traits whereas cross-gendered refers to a
mismatch between actual gender and gender role
(Bem, 1974). Research suggests that homosexual indi-
viduals are more likely to adopt a cross-gendered role.
For example, Lippa (2000, 2002) found that gay men
and lesbian women are more likely to have personality
traits associated with the opposite sex. Moreover, a
cross-gendered role appears to convey risk for suicide.
Street and Kromrey (1995) found that cross-gender
identified individuals endorsed higher levels of suici-
dal ideation compared to androgynous and gender
adherent individuals. The reasons for this relationship
are not entirely clear though there is some suggestion
that cross-gendered individuals possess less adaptive
coping skills (Brems and Johnson, 1988; Radecki and
Jaccard, 1996).
Previous relevant work on suicide has only
focused gender role or sexual orientation. In the
current study, the unique contributions of sexual
orientation and gender role orientation on suicide
risk and associated psychopathology, as well as the
interaction of these two factors, were evaluated.
Given that a cross-gender role is related to decreased
coping and resilience as well as social rejection
(Brems and Johnson, 1988; Lippa, 2000, 2002), it
was hypothesized that this gender role would be
uniquely predictive of suicide risk as well as related
psychopathology and problem-solving/coping defi-
cits. Consistent with the majority of prior work, it
was also hypothesized that sexual minority status
should confer a unique risk for suicidal symptoms.
Finally, given that gender role and sexual orientation
are hypothesized to be partially independent risk
factors for suicide, the combination of cross-gender
 K.K. Fitzpatrick et al. / Journal of Affective Disorders 87 (2005) 35–42
role and sexual minority orientation is expected to
potentiate risk, relative to all other groups.
1. Methods
1.1. Participants
The sample consisted of 77 participants recruited
from the undergraduate psychology subject pool
(n = 47) or from gay, lesbian and transgender student
organizations (n = 30). Volunteers from the psychol-
ogy subject pool were given credit to partially fulfill a
research requirement for the class, or were paid
$20, and other volunteers were paid $20. Within
the sample, 31 were male and 46 were female.
Participants in this report were recruited as part of
a larger study assessing suicide. Participants ranged
in age from 16 to 34 though the majority (n = 69)
were between the ages of 18 and 24. Fifty-seven
participants were Caucasian, 5 were Asian/Pacific
Islander, 4 were Black, 3 were Hispanic, 3 identified
as other, and 5 did not report on ethnicity. Addition-
ally, 34 participants were currently experiencing sui-
cidal ideation, 43 reported no ideation; 42 identified as
heterosexuals, 34 identified as a sexual minority, and
1 person did not report on sexual orientation (this
person was excluded from final analyses). In the
heterosexual group, 39 were exclusively heterosexual
and 4 were heterosexual with some homosexual
experience. Participants identifying as exclusively het-
erosexual and heterosexual with some homosexual
experience were not significantly different on any
measure, so the two groups were combined into the
heterosexual group for analyses. Thirteen participants
were exclusively homosexual, 10 were homosexual
with some heterosexual experience, and 10 identified
as bisexual; no significant differences were found
between participants identifying as exclusively
homosexual, homosexual with some heterosexual
experience or bisexual on any measure, so the
three groups were combined for final analyses into
the sexual minority group. For gender role identifi-
cation, 21 participants were classified as androgy-
nous, 27 as cross-gendered, and 30 as gender-
adherent. Consistent with the specific hypothesis
that only cross-gendered individuals were at
increased risk for psychopathology, the androgynous
37
and gender-adherent individuals were combined for
relevant analyses.
1.2. Materials
1.2.1. The Bem Sex Role Inventory (BSRI)
The BSRI (Bem, 1974) is a well-validated mea-
sure of psychological gender role identification. In
the present report, scores on the BSRI determine
placement into gender role groups (androgynous,
feminine, masculine, cross-gendered masculine or
cross-gendered feminine) based on guidelines in the
Bem Sex Role Manual (Bem, 1974). In addition, a
continuous score of gender-adherent vs. cross-gen-
dered behavior was computed by scaling masculinity
and femininity for males and females. Scores ranged
from 7 to 7, with positive scores indicating greater
levels of gender-adherence, while lower scores indi-
cated cross-gendered role.
1.2.2. The Measure of Sexual Orientation
The Measure of Sexual Orientation (Safren and
Heimberg, 1999) is a self-report, single item measure
ranging from exclusively heterosexual (1), heterosex-
ual with some homosexual experience (2), bisexual
(3), homosexual with some heterosexual experience
(4), exclusively homosexual (5). This measure was
used to determine sexual orientation (heterosexual or
sexual minority).
1.2.3. The Beck Suicide Scale (BSS)
The BSS (Beck et al., 1979) is a well-validated
measure assessing a broad spectrum of behaviors
and attitudes related to suicide risk (Beck and Steer,
1993).
1.2.4. The Beck Depression Inventory (BDI)
The BDI is a widely used measure of symptoms of
depression (Beck et al., 1961). Because item 9, which
measures suicidal ideation, overlaps with other mea-
sures creating spurious correlations, it was excluded
from analyses.
1.2.5. The Beck Hopelessness Scale (BHS)
The BHS (Beck et al., 1974) is a well-validated
scale designed to measure the degree to which an
individual’s cognitions are dominated by negative
future expectancies (Beck et al., 1974).
38 K.K. Fitzpatrick et al. / Journal of Affective Disorders 87 (2005) 35–42
1.2.6. The Social Problem Solving Inventory
(SPSI-R:L)
The SPSI-R:L (Maydeu-Olivares et al., 2000) is a
52-item self-report inventory assessing problem orien-
tation and problem-solving skills. It is shown to
have adequate reliability and validity with adults
(D’Zurilla and Nezu, 1990). The inventory has five
subscales, all with fairly good internal consistency
(Positive problem orientation (PPO) a = .76, Negative
problem orientation (NPO) a = .91, Rational problem
solving (RPS) a = .93, Impulsivity/carelessness style
(ICS) a = .84, Avoidance style (AS) a = .88).
1.2.7. The Reasons for Living Inventory (RFL-A)
The RFL-A (Osman et al., 1998) is a 32-item self-
report inventory. Five subscales are measured in
the inventory. Internal consistency and reliability
of the five subscales is as follows: Future optimism
(FO) a = .91, a = .94, Suicide-related concerns (SRC)
a = .93, a = .94, Family Alliance (FA) a = .93, a = .95,
Peer acceptance and support (PAS) a = .89, a = .92,
Self-Acceptance (SA) a = .93, a = .95.
1.2.8. Structured Clinical Interview for Diagnosis for
Axis I DSM-IV Disorders—Patient Edition (SCID-I/P)
The SCID-I/P (First et al., 1994) provides current
and past DSM-IV diagnoses for Axis I disorders.
SCID interviews were conducted by advanced level
graduate students with extensive training in structured
interview assessments. Diagnostic discrepancies were
discussed in weekly case conference and in super-
vision with a licensed psychologist. Diagnostic relia-
bility checks were conducted by independent, random
reviews of SCID data and indicated perfect agreement
for all primary diagnoses.
1.3. Procedure
The structured diagnostic interview and the self-re-
port measures were all completed during one session. A
researcher remained on hand to assist the participants
with completing the measures as needed. All partici-
pants completed a bno suicide contractQ and were
given a list of campus and community referral sources
as well as copies of the signed consent form and sui-
cide contract. Study materials and procedures were
reviewed by The Ohio State University Office of Re-
search Risks and Protections (IRB Protocol 00B0152).
2. Results
2.1. Gender role and sexual orientation group
differences
When sexual orientation and gender role were
crossed, creating a 2 (heterosexual vs. sexual min-
ority)  2 (cross-gendered vs gender-adherent/andro-
gynous) matrix, a majority of individuals endorsed a
gender-adherent or androgynous gender orientation
(49/76: 64%), regardless of sexual orientation. Con-
sistent with prior research, those endorsing a sexual
minority orientation were somewhat more likely to be
identified as cross-gendered (17/33: 51%) compared
to their heterosexual peers (10/43: 23%).
ANOVAs were conducted for descriptive purposes
on both sexual orientation (heterosexual and sexual
minority groups) and gender roles (combined androgy-
nous/gender-adherent and cross-gender groups). Ana-
lysis of demographic variables revealed no significant
differences between sexual minority and heterosexual
youth groups. However, cross-gendered individuals
were significantly older (M = 21.42, S.D. = 4.46) than
gender-adherent individuals (M = 19.43, S.D. = 2.34).
As a result, age was entered as a covariate in the
regression analyses.
The sample endorsed a relatively high rate of psy-
chopathology, with 52.2% endorsing an Axis I dis-
order based on the SCID-IV interview. Primary
diagnosis included: 26.1% of the sample endorsed
mood disorders, 17.0% endorsed anxiety disorders,
6.1% endorsed substance abuse or dependence,
while 3% reported eating disorders. Sexual minority
youth endorsed significantly greater lifetime preva-
lence rates of mood disorder than their heterosexual
peers [ F(1, 76) = 7.51, p b .01], but there were no
significant group differences for any other diagnostic
category ( p’s N .05). There were no overall prevalence
differences across gender role groups for any specific
disorder ( p’s N .05).
To allow for comparisons with prior research, group
differences on measures of psychopathology were
assessed using ANOVAs. Despite differences in life-
time depression, there were no significant group differ-
ences between sexual minority and heterosexual youth
on any of the psychopathology indices. There were also
no differences between sexual minority and heterosex-
ual youth on measures of problem solving except that
 K.K. Fitzpatrick et al. / Journal of Affective Disorders 87 (2005) 35–42 39

sexual minority members showed lower family alliance F(1, 77) = 6.92, p b .01 and F(1, 77) = 8.192, p b .01,
ratings [FA: F(1, 76) = 9.34, p b .01]. respectively].
ANOVAs assessing gender role group differences
were conducted comparing the combined gender role 2.2. Evaluating the unique and combined contribu-
groups (androgynous and gender-adherent) with tions of gender role and sexual orientation
cross-gendered individuals on measures of psycho-
pathology (see Table 1). Those endorsing a cross- To investigate the primary study hypotheses, mea-
gendered role endorsed a significantly greater number sures of suicidal ideation, depression and hopelessness
of suicidal symptoms than the combined gender group were predicted using stepwise regression models, with
[ F(1, 77) = 4.63, p b .05] but the group differences in sexual orientation and gender role as independent
depression and hopelessness did not reach signifi- variables. First, age was entered as a covariate.
cance [ F(1, 77) = .86, p N .10; F(1, 77) = 2.44, p N .10, Next, sexual orientation and gender role were entered
respectively]. Assessment of problem solving indi- simultaneously into the model to assess the indepen-
cated that cross-gendered individuals showed lower dent effect of each on the dependent variables. Finally,
scores on the SPSI:R, related to Positive Problem a gender role  sexual orientation interaction term was
Orientation [ F(1, 77) = 4.708, p b .05], and Rational entered into the model.
Problem Solving [ F(1, 77) 4.734, p b .05]. Cross- In regard to psychopathology measures, a cross-
gendered individuals also showed relatively lower gender role was uniquely associated with increased
levels of family and peer support [RFL-A Family suicide symptoms [R 2 = .06, p b .05] with a trend
Alliance and Peer Acceptance and Support subscales; toward predicting hopelessness [R 2 = .04, p b .10].
However, gender role did not predict BDI scores
[R 2 = .01, p N .10]. Sexual orientation was not found
to uniquely predict any of the psychopathology
Table 1
Mean scores and standard deviations for gender roles: psycho- indices. There were no significant interactions.
pathology and problem solving In terms of the problem solving indices, gender
Measure Combined gender Cross-gendered role uniquely predicted more impaired positive pro-
roles blem orientation for cross-gendered individuals [PPO:
M S.D. M S.D. R 2 = .08, p b .05] whereas sexual orientation did not
Beck Suicide Scale* 3.31 5.30 6.62 8.07
[R 2 = .03, p N .10]. Similarly, being cross-gendered
Beck Depression Inventory 10.41 9.78 12.73 11.49 uniquely predicted lower levels of peer acceptance
Beck Hopelessness Scale 5.33 5.30 7.46 6.30 and support [PAS: R 2 = .11, p b .05] whereas sexual
Social Problem Solving 12.41 2.71 11.47 2.52 orientation did not [R 2 = .00, p N .10]. However, both
Inventory: Revised Total sexual minority status and cross-gender role signifi-
Positive Problem 11.15 3.93 9.19 3.38
Orientation*
cantly predicted decreased family alliance [FA:
Negative Problem 15.09 9.74 18.07 10.43 R 2 = .11, p b .05; R 2 = .19, p b .05, respectively].
Orientation There were no significant interactions.
Rational Problem Solving* 43.23 11.46 37.19 11.59
ICS 9.29 6.08 11.50 7.55
Approach Avoidance 10.50 5.71 8.81 4.45
Strategy
3. Discussion
Reasons for 4.53 1.04 4.09 1.20
Living-Adolescent Total Consistent with expectations, cross-gender role
Future Optimism 4.66 1.33 4.42 1.36 orientation is a unique predictor of suicidal symptoms.
Suicide Related Concerns 4.03 1.60 4.30 1.50 Moreover, gender role accounted for more of the
Family Alliance** 4.75 1.34 3.81 1.72
Peer Acceptance 4.87 1.13 4.09 1.15
overall variance in suicidal symptoms, positive pro-
and Support** blem orientation, peer acceptance and support, than
Self Acceptance 4.30 1.53 3.90 1.58 sexual orientation. After accounting for gender role,
* p b .05. sexual orientation contributed little to the variance in
** p b .01. suicidal symptoms, associated pathology and pro-
40 K.K. Fitzpatrick et al. / Journal of Affective Disorders 87 (2005) 35–42
blem-solving deficits. Interestingly, and inconsistent
with prediction, there did not appear to be any sig-
nificant interactions between gender role and sexual
orientation, suggesting that the combination of these
variables did not confer greater risk than either one of
them separately.
Cross-gendered individuals endorsed significantly
greater rates of suicidal symptoms than their andro-
gynous and gender-adherent counterparts. This fin-
ding appears to be specific to suicidal ideation and
behaviors, given that gender roles did not predict
depression, hopelessness, or problem-solving abilities
on the SPSI:R. As noted above, much of the litera-
ture has focused on gender role and coping or pro-
blem-solving abilities. Specifically, cross-gendered
individuals have shown cognitive rigidity in problem
solving and difficulty in abstract thinking relevant to
problem solving. However, the current study did not
support these problem-solving deficits, perhaps
because the SPSI:R focuses on behaviors and affect,
rather than specific cognitive errors or attributions in
problem solving. As such, it may be that cross-
gendered role is related specifically to suicide
through cognitive mechanisms or variables not ade-
quately assessed in the present study. For example,
some underlying vulnerability or factor could
account for both cross-gendered role and suicide
symptoms.
In contrast to the findings on gender role, those
related to sexual orientation and psychopathology
run counter to anecdotal evidence and the mixed
clinical literature. This literature has suggested that
sexual orientation confers some risk for suicidal
ideation and psychopathology (Safren and Heim-
berg, 1999; Proctor and Groze, 1994; D’Augelli et
al., 1998; D’Augelli and Hershberger, 1993; Hersh-
berger and D’Augelli, 1995). While sexual minority
youth did report higher lifetime prevalence rates of
mood disorders, compared to their heterosexual
peers, this did not appear to translate into current
depressive or dysphoric symptomology. The current
study suggests that sexual orientation contributed
little to psychopathology. In addition, sexual orienta-
tion was not consistently related to problem-solving
deficits. Much of the previous research examining
sexuality and suicide has focused on younger sam-
ples (e.g., high school students) (Safren and Heim-
berg, 1999; Proctor and Groze, 1994; D’Augelli et al.,
1998; D’Augelli and Hershberger, 1993; Hershberger
and D’Augelli, 1995). It may be that sexual minority
status contributes to suicidal ideation and behavior
only among a younger sample. The current findings
may not reflect the average experience of many
sexual minority youth, given the population from
which they were drawn.
Findings from the Reasons For Living Inventory
(RFL-A) were particularly interesting. Unlike the
other measures of problem-solving abilities or
skills, the RFL-A provides a measure of coping,
or protective factors against suicide. In the current
study, the RFL-A subscale Family Alliance was
significantly related to both sexual orientation as
well as gender role. This is consistent with previous
literature suggesting sexual minority youth experi-
ence a greater degree of family conflict and isola-
tion as a result of their sexual orientation (Proctor
and Groze, 1994; D’Augelli et al., 1998; D’Augelli
and Hershberger, 1993; Hershberger and D’Augelli,
1995). However, while previous research has sug-
gested that cross-gendered individuals may have gen-
erally poorer coping skills (Radecki and Jaccard,
1996; Brems and Johnson, 1988), it has not been
specifically shown that they may also experience
heightened family conflict and a decreased sense of
family alliance, as the current study suggests. In gen-
eral, these findings suggest that both sexual minority
and cross-gendered young adults are faced with a
significant deficit in available coping resources, com-
pared to heterosexual, gender-adherent and androgy-
nous young adults.
Cross-gendered individuals also endorsed lower
overall rates of peer acceptance and support on the
RFL-A. This is certainly consistent with the hypoth-
esis that adoption of cross-gender roles is likely to
result in social isolation. It also suggests, however,
that cross-gendered individuals experience an even
greater obstacle that includes both peer and family
rejection. As a result, they may be more likely to
experience a suicidal crisis in the face of any signifi-
cant change to their existing social structure or support
system, as they likely have fewer social resources
upon which to draw.
Despite support for some of the main hypotheses of
this study, there are several important study limitations
that should be considered. First, the modest sample
size results in limited power to detect significant
 K.K. Fitzpatrick et al. / Journal of Affective Disorders 87 (2005) 35–42
effects. For example, the current study may have been
too small to assess the combined impact of sexual
minority and cross-gendered status. Although no cur-
rent interaction effects were found for these variables,
a larger sample may be able to more adequately assess
the combined impact of this bdouble-minorityQ status
on measures of psychopathology. Similarly, it would
be interesting to evaluate gender differences in these
effects but the modest sample precludes such ana-
lyses. Future, larger studies should consider these
analyses.
Second, the current study selected a population of
sexual minority youth based on self-identification as
gay, lesbian, bisexual, transgender and/or queer. This
may bias results, as there is some suggestion in the
literature that same-sex partner sexual relationships
may be a better predictor of associated psychopathol-
ogy and suicidal ideation than self-identification as
gay, lesbian or bisexual (Wichstrom and Hegna,
2003). In addition to soliciting an boutQ population,
recruitment occurred primarily through campus and
community support organizations, rather than clinical
resources. As such, this population may have been
benefiting from increased social support and
decreased levels of psychopathology. While lifetime
prevalence rates of diagnosis were not significantly
different between heterosexual and sexual minority
youth overall, there was a discrepancy in diagnosis
rates with mood disorders, with slightly over 40% of
the sexual minority youth endorsing symptoms of a
mood disorder compared to only 14% of heterosexual
youth. For most, the mood episodes were limited in
duration and specific to significant life stress, most
typically during the time of self-identification and/or
bcoming outQ as a sexual minority, which is consistent
with Wichstrom and Hegna’s (2003) longitudinal
study.
Third, the current work was limited in terms of
assessment of gender role and sexual orientation.
Future work should consider expanding these assess-
ments. In particular, the Femininity scale of the Cali-
fornia Personality Inventory (Gough, 1987) has been
found to provide better discrimination of gender role
behavior relative to the BSRI.
Based on previous literature, sexual minority
youth appear more likely to experience a suicidal
crisis around issues of coming out (Safren and Heim-
berg, 1999; Proctor and Groze, 1994; D’Augelli et al.,
41
1998; D’Augelli and Hershberger, 1993; Hershberger
and D’Augelli, 1995), which would necessitate the
identification of risk factors and application of a
developmentally appropriate intervention, targeting
younger adolescents. Similarly, it may be that the
relationship between gender roles and psycho-
pathology changes as a result of development. A
developmental focus may be more appropriate in
future studies, including a longitudinal assessment
of the impact of sexual orientation on overall
psychological functioning. Of particular interest
would be the elucidation of the relationship
between sexual orientation, gender roles and psy-
chopathology across the lifespan. Researchers con-
ducting longitudinal research on suicidal behavior
may do well to incorporate measures of sexuality
and gender roles.
Acknowledgements
This paper was supported, in part, by a research
grant from the Ohio Department of Mental Health
(741314).
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