Susan D Cochran

• Ph.D., MS
• Chair at University of California, Los Angeles

There is increasing attention to suicides that occur in view of others, as these deaths can cause significant psychological impact on witnesses. This study illuminates characteristics of witnessed suicides and compares characteristics of these deaths to non-witnessed suicides. We develop a codable definition of what constitutes witnessed (vs. non-w...

Objectives. To investigate differences in the documentation of mental health symptomology between male and female suicide decedents in the 2003–2020 US National Violent Death Reporting System (NVDRS). Methods. Using information on 271 998 suicides in the 2003–2020 NVDRS, we evaluated precoded mental health–related variables and topic model–derived...

The Latino population is one of the largest immigrant groups in the United States, with the majority being of Mexican descent. Whether immigrating to the US is positive for the well-being of Mexican immigrants and future generations is an important question. We examined how nativity status and quality of life indicators relate to life satisfaction...

Background: Prescription and illicit drugs are important social environmental variables in many suicides regardless of their role as an immediate cause of death. Objectives: To investigate the presence of prescription and illicit drugs, either through mention in the death record or toxicology reports, among suicides attributed to nonpoisonous ca...

Objectives: To examine post-traumatic stress disorder (PTSD) among Black adults in younger, middle, and older ages. Methods: Using nationally representative data from the National Survey of American Life, we estimated lifetime and 12-month prevalence of PTSD in Black men and women ages 18–34, 35–49, and 50+. We determined PTSD persistence and sever...

Objectives: To examine anxiety disorders in aging Black adults. Methods: Using nationally representative data from the National Survey of American Life, we estimated lifetime/12-month prevalence of anxiety disorders in Black men and women, age 50+ (N = 1561). Disorder-specific persistence and severity, functional impairment, and mental health servi...

Significance We introduce an approach to identify latent topics in large-scale text data. Our approach integrates two prominent methods of computational text analysis: topic modeling and word embedding. We apply our approach to written narratives of violent death (e.g., suicides and homicides) in the National Violent Death Reporting System (NVDRS)....

There is an escalating need for methods to identify latent patterns in text data from many domains. We introduce a new method to identify topics in a corpus and represent documents as topic sequences. Discourse Atom Topic Modeling draws on advances in theoretical machine learning to integrate topic modeling and word embedding, capitalizing on the d...

Objectives. To investigate racial/ethnic differences in legal intervention‒related deaths using state-of-the-art topic modeling of law enforcement and coroner text summaries drawn from the 2003–2017 US National Violent Death Reporting System (NVDRS). Methods. Employing advanced topic modeling, we identified 8 topics consistent with dangerousness in...

Coreference resolution is an important component in analyzing narrative text from administrative data (e.g., clinical or police sources). However, existing coreference models trained on general language corpora suffer from poor transferability due to domain gaps, especially when they are applied to gender-inclusive data with lesbian, gay, bisexual,...

To compare African American (AA) and non-Hispanic White men living in same residential areas for the associations between educational attainment and household income with perceived discrimination (PD). The National Survey of American Life (NSAL), a nationally representative study, included 1643 men who were either African American (n = 1271) or non...

Objectives Although lesbian, gay, bisexual, and transgender (LGBT) people have a higher prevalence of reporting a lifetime suicide attempt than non-LGBT people, suicide prevention research on access to lethal means (eg, firearms) among LGBT people is limited. Our study examined (1) the presence of firearms in the home and (2) among respondents with...

There is growing diversity within the Black population in the U.S., but limited understanding of ethnic and nativity differences in the mental health treatment needs of Black women. This study examined differences in the prevalence of psychiatric disorders, their persistence, and unmet treatment needs among Black women in the U.S. Data were from th...

We examined sexual orientation and sex differences in seven methods of suicide among adult suicides reported in the United States National Violent Death Reporting System (2012–2015; N = 59,075). Overall, most sexual minorities (i.e., lesbians, gay men, bisexuals) identified in the dataset used hanging (38%) followed by firearm (30%) and drug or poi...

(Reprinted with permission from the Bulletin of the World Health Organization).

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth are more likely to be bullied and to report suicidal thoughts and behaviors than non–LGBTQ youth.¹ Whether bullying is a more common antecedent among LGBTQ youth who die by suicide, however, is unknown. We investigated this question using postmortem records from the 2003-2017 National Vio...

The aim of this study was to investigate sexual orientation differences in gun ownership and gun safety beliefs among U.S. adults. We used information from the General Social Survey (2010–2016) to assess presence of guns in the household, personal gun ownership, and endorsement of a gun safety law among sexual minority (n = 195) versus heterosexual...

Objective: Social disadvantage is associated with markers of physiological dysregulation, which is linked to disease trajectories. Chronic experiences with discrimination are thought to result in the accumulation of physiological "wear and tear" known as allostatic load (AL) among socially marginalized populations such as sexual minorities. Using...

This study investigated ethnic and nativity differences in the chronicity and treatment of psychiatric disorders of African American and Caribbean Black men in the U.S. Data were analyzed from the National Survey of American Life, a population-based study which included 1859 self-identified Black men (1222 African American, 176 Caribbean Black men...

Background: Black and Latino minorities have traditionally had poorer access to primary care than non-Latino Whites, but these patterns could change with the Affordable Care Act (ACA). To guide post-ACA efforts to address mental health service disparities, we used a nationally representative sample to characterize baseline race-, ethnicity-, and n...

Extremely violent deaths among socially marginalized populations are often invisible to society. Furthermore, extrapolating what is known about violent deaths in majority populations to highly intersectionalized populations may be inaccurate and misleading. Indeed, the majority of research on women's experiences to date has focused on heterosexual...

Debate persists about whether parental sexual orientation affects children's well-being. This study utilized information from the 2013 to 2015 U.S., population-based National Health Interview Survey to examine associations between parental sexual orientation and children's well-being. Parents reported their children's (aged 4–17 years old, N = 21,1...

Objectives: The authors investigated sexual orientation differences in risk for mental health morbidity, functional limitations/disability, and mental health services use among adults interviewed in the nationally representative 2013-2014 National Health Interview Survey. Method: Respondents were 68,816 adults (67,152 heterosexual and 1,664 lesb...

To the Editor In an Original Investigation in a recent issue of JAMA Internal Medicine, Gonzalez et al,¹ using national health surveillance data, observed that lesbian, gay, and bisexual (LGB) adults experience health disparities that warrant clinician attention. These findings were described, incorrectly, as “the first to capture the disparity in...

Introduction: Sexual minority individuals have a higher risk of anxiety and depression compared with heterosexuals. However, whether the higher risk is spread equally across the sexual minority population is not clear. Aim: To investigate the association between sexual orientation and self-reported current anxiety and a history of diagnosis of d...

En la próxima undécima revisión de la Clasifcación Internacional de las Enfermedades y Problemas de Salud Relacionados (ICD-11) de la Organización Mundial de la Salud, se han propuesto cambios sustanciales a la clasificación de los trastornos mentales y conductuales relacionados con la sexualidad y la identidad de género de la ICD-10. Estos concier...

Background: Experiences of discrimination in health care settings may contribute to disparities in mental health outcomes for blacks and Latinos. We investigate whether perceived discrimination in mental health/substance abuse visits contributes to participants' ratings of treatment helpfulness and stopped treatment. Research methods: We used da...

In the World Health Organization's forthcoming eleventh revision of the International Classification of Diseases and Related Health Problems (ICD-11), substantial changes have been proposed to the ICD-10 classification of mental and behavioural disorders related to sexuality and gender identity. These concern the following ICD-10 disorder groupings...

Max et al.,1 investigating changes in self-reported tobacco use and household secondhand smoke (SHS) exposure in California, recently found good news: a reduction in SHS exposure over time, although lesbian, gay, and bisexual (LGB) nonsmokers remained at greater risk for SHS exposure than similar heterosexuals. As we reported in 2013,2 SHS exposure...

Minority sexual orientation is a predictor of suicide ideation and attempts, though its association with suicide mortality is less clear. We capitalize on Sweden’s extensively linked databases, to investigate whether, among married individuals, same-sex marriage is associated with suicide. Using a population-based register design, we analyzed suici...

To determine whether sexual minorities have an earlier mortality than do heterosexuals, we investigated associations between sexual orientation assessed in the 2001 to 2010 National Health and Nutrition Examination Surveys (NHANES) and mortality in the 2011 NHANES-linked mortality file. Mortality follow-up time averaged 69.6 months after NHANES. By...

Background: Minority sexual orientation is a robust risk indicator for self-reported suicidal ideation and attempts. However, little is known about patterns of medical care for intentional self-harm in this vulnerable population. We investigate sexual orientation-related differences in self-reported lifetime suicide symptoms and medical care for i...

This investigation explored suicide-related characteristics and help-seeking behavior by sexual orientation. Population-based data are from the California Quality of Life Surveys, which included 1,478 sexual minority (lesbian, gay, bisexual, and homosexually experienced individuals) and 3,465 heterosexual individuals. Bisexual women had a nearly si...

Previous studies have found that sexual orientation concealment affords escape from stigma and discrimination but also creates a psychological toll. While disclosure alleviates the mental burden of concealment, it invites the stress of navigating a new public identity. Population-based samples that include both "in" and "out" sexual minorities prov...

To investigate the association between food insecurity and intimate partner violence in a population-based sample of heterosexual women. Logistic regression was used to evaluate the association between three levels of food insecurity and intimate partner violence. Data from 6 years of the California Women's Health Survey. Randomly selected women (n...

The benefits of the patient-centered medical home (PCMH) over and above that of a usual source of medical care have yet to be determined, particularly for adults with mental health disorders. To examine qualities of a usual provider that align with PCMH goals of access, comprehensiveness, and patient-centered care, and to determine whether PCMH qua...

Many U.S. military women are exposed to unwanted sexual contact during military service, which can have important implications for mental health. Using data from the 2008 Department of Defense Survey of Health Related Behaviors, we employed multiple logistic regression methods to examine whether unwanted sexual contact was associated with stress, s...

Women in the US military report a high prevalence of sexual risk behaviours, such as binge drinking and new or multiple sexual partnerships. However, demographical differences pose challenges to making comparisons with civilians. Two public-use datasets were used to compare prevalence of sexual risk behaviours between sexually active military and c...

We explored changes in sexual orientation question item completion in a large statewide health survey. We used 2003 to 2011 California Health Interview Survey data to investigate sexual orientation item nonresponse and sexual minority self-identification trends in a cross-sectional sample representing the noninstitutionalized California household p...

The Philippines is one of seven countries in which HIV incidence has recently increased-much of this increase has been among men who have sex with men. Despite this trend, knowledge on sexuality and same-sex behaviors in the Philippines is limited. This study examines same-sex behavior, sexual outcomes, substance use, and psychological distress amo...

Background: Sexual orientation concealment may afford escape from stigma exposure, but also poses its own psychological toll. Coming out alleviates the mental burden of concealment but also invites the stress of navigating a new public identity. Population-based mental health surveys that include both “in” and “out” sexual minorities provide an ide...

Background: Black women experience higher rates of triple negative cancer, which is one of the most aggressive breast cancers where treatment adherence presents heightened priority. Side effects such as pain, nausea, fatigue, and hot flashes accompany corresponding treatments. Acupuncture has been shown as an effective treatment for such symptoms....

Background: Close relationships are protective for mental health reflecting both selective and structural factors (Hughes & Waite, 2009). Population-based studies of lesbian, gay, and bisexual (LGB) individuals commonly find reports of both same-sex (SS) and different-sex (DS) married/cohabiting relationships. Are DS relationships protective for LG...

Including sexual orientation questions in general population surveys has relatively recent origin.(1) But in a short time, their presence has profoundly altered what is known about health disparities affecting lesbians, gay men, bisexuals, and homosexually experienced heterosexuals. Because sexual orientation is a new survey construct, both methodo...

Using the California Quality of Life surveys, we examined suicidal ideation and attempts in 129 lesbian, gay, and bisexual (LGB) veterans and in 315 heterosexual veterans in 2008-2009 and 2012-2013. Although there were no significant differences in the past 12-month suicidal ideation and lifetime attempts, LGB veterans had higher odds of lifetime s...

The World Health Organization is developing the 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11), planned for publication in 2017. The Working Group on the Classification of Sexual Disorders and Sexual Health was charged with reviewing and making recommendations on disease categories rel...

Objectives: We investigated the possibility that men who have sex with men (MSM) and women who have sex with women (WSW) may be at higher risk for early mortality associated with suicide and other sexual orientation-associated health risks. Methods: We used data from the 1988-2002 General Social Surveys, with respondents followed up for mortalit...

Sexually transmitted infections (STIs) are prevalent in the US military. However, there are limited data on risk-factor differences between sexes. We used data from the 2008 Department of Defense Survey of Health Related Behaviors among active duty military personnel to identify risk factors for self-reported STIs within the past 12 months and mult...

Neighborhood characteristics have been shown to impact child well-being. However, it remains unclear how these factors combine with family characteristics to influence child development. The current study helps develop that understanding by investigating how neighborhoods directly impact child and adolescent behavior problems as well as moderate th...

Background: Social disadvantage has been linked to markers of physiological dysregulation, or Allostatic Load (AL). In particular, chronic experiences with discrimination are thought to result in cumulative accumulation of physiological wear and tear at the individual level among socially marginalized persons. Objectives: We use information availab...

Objectives: We investigated sexual orientation-related differences in tobacco use and secondhand smoke (SHS) exposure in a nationally representative sample of US adults. Methods: The 2003-2010 National Health and Nutrition Examination Surveys assessed 11 744 individuals aged 20 to 59 years for sexual orientation, tobacco use, and SHS exposure (c...

RESEARCH  Objectives. Recent studies suggest that lesbians and gay men are at higher risk for stress-sensitive psychiatric disorders than are heterosexual persons. We examined the possible role of perceived dis-crimination in generating that risk. Methods. The National Survey of Midlife Development in the United States, a nationally representa-tiv...

Psychological science offers a variety of methods to both understand and intervene when acts of potential racial or ethnic racism, bias or prejudice occur. The Trayvon Martin killing is a reminder of how vulnerable African American men and boys, especially young African American men, are to becoming victims of social inequities in our society. We e...

This chapter focuses on four key topics related to sexual orientation and mental health. First, it highlights several methodological issues that are relevant to understanding research on the associations between sexual orientation and mental health morbidity and its treatment. Second, it reviews findings from primarily population-based or systemati...

Knowledge of the US Public Health Syphilis Study at Tuskegee is sometime cited as a principal reason for the relatively low participation rates seen among racial/ethnic minorities, particularly African Americans, in biomedical research. However, only a few studies have actually explored this possibility. We use data from a random digit dial telepho...

Background: Individuals with minority sexual orientation are at somewhat elevated risk for common stress-related mental health disorders and are also more likely to seek mental health/substance abuse (MHSA) services than their heterosexual counterparts (Cochran & Mays, 2009). Given concerns about harmful effects of antigay discrimination in health...

Background: Research has convincingly shown that sexual minorities are at increased risk for several stress-related mental disorders when compared to their heterosexual counterparts (Cochran & Mays, 2009). However, little is known about their patterns of mental healthcare utilization. Objectives: We investigate sexual orientation and gender-related...

Background: Previous studies have explored the relationship between the legacy of the Tuskegee Syphilis Experiment and reluctance of minorities to participate in HIV/AIDS related treatment or clinical research with mixed results. The purpose of this study was to examine community generated beliefs and conspiracy theories about HIV/AIDS based in the...

Illicit drug and heavy alcohol use is more common among sexual minorities compared with heterosexuals. This difference has sometimes been attributed to more tolerant substance use norms within the gay community, although evidence is sparse. The current study investigated the role of perceived drug availability and tolerant injunctive norms in media...

Lesbians and bisexual women are more likely than other women to evidence a unique mix of common breast cancer risk factors. It is not known if this results in greater breast cancer mortality risk. We investigate possible sexual orientation-related differences in risk for fatal breast cancer in a large representative U.S. sample of married and cohab...

Policy and practice that meets the needs of California's rapidly growing older population requires accurate information on the full diversity of the population. In 2007, an estimated 170,000 (2.3%) adults in California ages 50-70 identified as lesbian, gay, or bisexual. Using data from the 2003-2007 California Health Interview Surveys, we present u...

Although recent attention has focused on the likelihood that contemporary sexual minority youth (i.e., gay, lesbian, bisexual [GLB]) are "coming out" at younger ages, few studies have examined whether early sexual orientation identity development is also present in older GLB cohorts. We analyzed retrospective data on the timing of sexual orientatio...

We investigated associations between minority sexual orientation and mortality among US men. We used data from a retrospective cohort of 5574 men aged 17 to 59 years, first interviewed in the National Health and Nutrition Examination Survey III (NHANES III; 1988-1994) and then followed for mortality status up to 18 years later. We classified men in...

Research has shown that sexual minority groups have higher prevalence rates of psychiatric disorders (both mental and substance use disorders) and that they may seek treatment at higher rates than heterosexuals. However, relationships between treatment need and treatment use are not well understood. This study examined the relationship of sexual or...

Research on the health of lesbian, gay and bisexual (LGB) adults generally overlooks the chronic conditions that are the most common health concerns of older adults. This brief presents unique population-level data on aging LGB adults (ages 50-70) documenting that they have higher rates of several serious chronic physical and mental health conditio...

Minority sexual orientation has been repeatedly linked to elevated rates of suicide attempts. Whether this translates into greater risk for suicide mortality is unclear. We investigated sexual orientation-related differences in suicide mortality in Denmark during the initial 12-year period following legalization of same-sex registered domestic part...

Despite strong indications of elevated risk of suicidal behavior in lesbian, gay, bisexual, and transgender people, limited attention has been given to research, interventions or suicide prevention programs targeting these populations. This article is a culmination of a three-year effort by an expert panel to address the need for better understandi...

Background: Anti-gay stigma has been linked to higher risk for mental health morbidity among LGB individuals (Meyer, 2003; Mays & Cochran, 2001; Cochran & Mays, 2009). Whether discrimination has similar harmful effects on general quality of life is unknown. Objectives: We investigate sexual orientation-related differences in quality of life from a...

Background: Lesbian, gay, and bisexual adults are at elevated risk for mental health and substance use disorders due in part to anti-gay stigma (Cochran & Mays, 2009). Little of this work (Cochran et al., 2007; Meyer et al., 2007), however, has examined whether there is greater excess risk among LGB ethnic/racial minorities who face dual sources of...

Background: Korean American men in the United States have the highest smoking prevalence and suffer from the highest proportion of smoking-related cancers in all large Asian American subgroups. Objective: To explore potential explanations for the ethnic differences in current smoking prevalence between Korean American and Chinese American men, incl...

Objective: To investigate the association between perceived neighborhood norms and binge drinking and illicit drug use among non-Hispanic Whites and Asian Americans; to test the interaction between norms and race or, among Asian Americans, nativity on these behaviors. Methods: Data from the 2002 National Survey on Drug Use and Health were used, inc...

Background: Minority sexual orientation is a risk indicator for depression (Cochran & Mays, 2009), presumably stemming from the harmful effects of antigay discrimination (Meyer, 2003; Mays & Cochran, 2001). Objectives: Here, we ask a somewhat different question: Does sexual orientation-related discrimination (SOD) show evidence of harming individua...

Background: Population-based surveys have repeatedly found that people reporting either same-gender sexual partners or sexual minority orientation are at higher risk for suicidal thoughts and/or attempts. However the severity of these attempts has not been studied. Objectives: We examine self-reported suicide thoughts, suicide attempts, and severit...

Inequities in marriage laws and domestic partnership benefits may have implications for who bears the burden of health care costs. We examined a recent period in California to illuminate disparities in health insurance coverage faced by same-sex couples. Partnered gay men are less than half as likely (42 percent) as married heterosexual men to get...

The love relationships of lesbians were investigated as part of a questionnaire study of a diverse sample of 127 lesbians. The majority of women said their current relationship was extremely close, personally satisfying, and egalitarian. Differences among women's values concerning relationships reflected two distinct dimensions: dyadic attachment a...

Women with minority sexual orientations (e.g., lesbian, bisexual) are more likely than heterosexual women to report histories of childhood maltreatment and attempted suicide; however, the importance of the timing of minority sexual orientation development in contributing to this increased risk is uncertain. This study investigated relationships bet...

Background Prior research has shown a higher prevalence of substance use and mental disorders among sexual minorities, however, the influence of sexual orientation on treatment seeking has not been widely studied. We use a model of help-seeking for vulnerable populations to investigate factors related to treatment for alcohol or drug use disorders...

We use two surveys to describe the demographic and attitudinal correlates of being in "Living Apart Together" (LAT), cohabiting, and marital relationships for heterosexuals, lesbians, and gay men. About one third of U.S. adults not married or cohabiting are in LAT relationships - these individuals would be classified as "single" in conventional stu...

This study examined alcohol drinking behaviors across ethnic subgroups of Asian college students by gender, foreign-born status, and college-related living arrangements. Univariate and ordinal logistic regression analyses were employed to explore male and female Asian subgroup differences in alcohol drinking behaviors. The sample included 753 male...

In recent population-based surveys, minority sexual orientation has been identified as a potential risk indicator for psychiatric morbidity. However, methodological limitations in the studies to date have led to concerns that current estimates are biased due to inadequate measurement of sexual orientation and uncontrolled confounding from prevalent...

In endometrial cancer, early detection is usually facilitated by the onset of abnormal bleeding: Despite this, patients at times evidence considerable delay between onset of abnormal bleeding and seeking medical care. The current study of 37 endometrial cancer patients used semi-structured interviews and questionnaires to evaluate physical, interpe...

Prior studies find that gay men and lesbians volunteer in HIV/AIDS service organizations at high rates. However, no population-based study has investigated the mechanisms involved. Using data from the General Social Survey, a nationally representative biennial survey that in 2002 and 2004 interviewed 2031 sexually experienced adults, the authors ex...