Sexual Orientation Change Efforts (Soce) Strongly Reduce Suicidality: a Critique of Blosnich Et Al., 'Sexual Orientation Change Efforts, Adverse Childhood Experiences, and Suicide Ideation and Attempt Among Sexual Minority Adults, United States, 2016–2018', AJPH 110(7): 1024-1030

Abstract

Background: Sexual Orientation Change Efforts (SOCE) signifies therapy activities designed to change or reduce homosexual orientation. Recent studies claim that such therapies increase suicide risk by showing positive associations between exposure to SOCE and current or lifetime suicidality. However, the suicidality may have occurred or begun before exposure to SOCE, thereby rendering this causal claim partly or wholly mistaken. The purpose of this study was to test this possibility. Method: We replicated a representative study, Blosnich and colleagues’ recent analysis of a population sample of 1518 sexual minority persons, which had concluded from logistic regression models that SOCE “may compound or create … suicidal ideation and suicide attempts” and thus had “insidious associations with suicide risk”. Using information on SOCE timing that was available in the data but unreported, we adjusted the models for the time order of SOCE and suicidality. Results: After controlling for pre-SOCE suicidality, SOCE was not positive associated with any form of suicidality. For suicidal ideation, Blosnich et al. reported an adjusted odds ratio (AOR) of 1.92 (95% CI 1.01-3.64); the adjusted AOR was .44 (.20-.94). For suicide planning, Blosnich et al.’s AOR was 1.75 (1.01-3.06); adjusted was .60 (.32-1.14). For suicide attempts, Blosnich et al.’s AOR was 1.75 (.99-3.08), adjusted was .74 (.36-1.43). The majority of cases labeled “experienced SOCE” by Blosnich et al. consisted of persons expressing suicidal ideation, planning and/or attempts prior to experiencing SOCE. For these, undergoing SOCE sharply reduced suicidality. Compared to those not experiencing SOCE, suicide attempts were reduced 82% to 91% when SOCE followed a prior expression of suicidal ideation (AOR .18, .05-.63) or planning (AOR .13, .04-.45), however SOCE following an initial suicide attempts did not significantly reduce further attempts. Effects were stronger for those who were adults rather than for minors when experiencing SOCE. Conclusion: By violating the principle of temporal precedence in scientific inference, i.e., that a cause cannot occur after an effect, Blosnich et al. reversed the correct conclusion in these data. Experiencing SOCE therapy does not encourage higher suicidality, as they claim; rather, experiencing higher suicidality appears to encourage recourse to SOCE, which in turn strongly reduces suicidality, particularly initial suicide attempts. Restrictions on SOCE deprive sexual minorities of an important resource for reducing suicidality, putting them at substantially increased suicide risk.