What if another study came to print asserting that sexual orientation change efforts (SOCE) constituted harmful stressors to sexual minorities? What if a published letter to the editor in the same journal exposed gaping holes in the assessment? What if a reanalysis of the original study “in the strongest representative sample to date of sexual minority persons” revealed polar opposite findings: SOCE “strongly reduces suicidality” and that restrictions on SOCE may “deprive sexual minorities of an important resource for reducing suicidality, putting them at substantially increased suicide risk.” Now that would be something! And these things happened!

Blosnich et al., published a study in June 2020 using cross-sectional data from the Generations survey, providing “1518 nontransgender sexual minority adults.”[1]

They concluded, “Over the lifetime, sexual minorities who experienced SOCE reported a higher prevalence of suicidal ideation and attempts than did sexual minorities who did not experience SOCE.” Their recommendation was that SOCE exposure be minimized and affirming care provided to sexual minorities. But things didn’t look right.

A response letter led by Christopher Rosik (including Paul Sullins, Walter Schumm and me) was also published in the American Journal of Public Health.[2] Three main study flaws were noted. First, the authors lumped adverse childhood events as a total sum, including SOCE as one. Second, they should have considered whether those seeking SOCE did so due to already being more distressed. With no pre-SOCE control for existing suicidality, it was speculative for Blosnich to suggest SOCE caused harm. And third, the Generations study sampled only LGBT-identified individuals—therefore excluding sexual minorities who benefitted from SOCE, thus no longer identifying as LGBT—and used “a single-item measure of SOCE” which was “fraught with validity concerns.” Blosnich and team provided a rebuttal letter I would call dismissive.[3]

Paul Sullins put together a thorough reanalysis of the Generations and Blosnich data, including what was available to Blosnich but left out, “the time order of SOCE and suicidality,” thus controlling for pre-SOCE suicidality.[4] Sullins concluded, “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.” In fact, “SOCE was not positively associated with any form of suicidality.” SOCE strongly reduced suicidal ideation, planning and attempts, with even stronger effects for adults experiencing SOCE compared with minors doing the same.

Sullins provides a helpful summary of the studies claiming psychological harm from SOCE, including their serious flaws. Older evidence relied on small-sample qualitative studies, none of which actually measured suicidality, settling for inference, with causation from SOCE being “presumptive and speculative.” Cited as modern studies overcoming these limitations were Salway et al. (2020), Ryan et al. (2020), Meanley et al., and Blosnich. Yet despite their improvements, the four shared a critical defect: “each reports an association of SOCE with suicidality as if the former caused the latter, without examining the possibility that the suicidality may have preceded recourse to therapy.” Though Ryan et al. didn’t measure such timing, the other three “all made use of data that could have addressed this question, but chose not to do so.”

So, as Sullins explains, even the best modern anti-SOCE studies violate the principle of temporal precedence: the cause must precede the effect in cause-effect relationships. Simply correlating lifetime suicidality to temporally unplaced exposure to SOCE violates the “correlation alone is not causation” standard.

Sullins found that over half of those said to have had SOCE had pre-treatment suicidality, SOCE helped rather than harmed, and the degree of improvement was remarkable. Post-SOCE suicidal ideation odds went down by two-thirds for adults and one-third for minors. Post-SOCE reduction in suicide attempts was by four-fifths for adults with no reduction for minors. “When followed by SOCE treatment, suicide ideation was less than a fifth as likely to lead to a suicide attempt; suicide planning less than a seventh as likely; and an initial suicide attempt was over a third less likely to lead to second attempt. Minors undergoing SOCE were only about half as likely to attempt suicide after initial thoughts or plans of suicide, and no less likely after an initial suicide attempt, compared to their peers who did not undergo SOCE. On the other hand, adults who experienced SOCE intervention following suicidal thoughts or plans were 17-25 times less likely to attempt suicide.”

Moreover, Sullins asserted that the actual benefits of SOCE treatment on suicidality might have been underestimated in his study because the survey only included the LGBT-identified while excluding sexual minorities who do not so identify and perhaps had more positive reports of SOCE involvement.

Sullins concludes by comparing Blosnich’s ignoring of both the fact and importance of time order of SOCE to suicidality to hypothetically doing the same with anti-depressant medication. “Imagine a study that finds that most persons using anti-depressants also have had depressive symptoms, thereby concluding that persons ‘exposed’ to anti-depressants were much more likely to experience depression, and recommending that anti-depressants therefore be banned.” Now wouldn’t that be silly? Well, so were Blosnich’s erroneous and presumptuous conclusions that SOCE therapy was necessarily harmful rather than likely helpful to sexual minorities with suicidality.

[1] John R. Blosnich, Emmett R. Henderson, Robert W. S. Coulter, Jeremy T. Goldbach, Ilan H. Meyer, “Sexual Orientation Change Efforts, Adverse Childhood Experiences, and Suicide Ideation and Attempt Among Sexual Minority Adults, United States, 2016–2018”, American Journal of Public Health 110, no. 7 (July 1, 2020): pp. 1024-1030. https://doi.org/10.2105/AJPH.2020.305637

[2] Rosik CH, Sullins DP, Schumm WR, Van Mol A. Sexual Orientation Change Efforts, Adverse Childhood Experiences, and Suicidality. Am J Public Health. 2021 Apr;111(4):e19-e20. doi: 10.2105/AJPH.2021.306156. PMID: 33689444; PMCID: PMC7958055.

[3] Blosnich JR, Meyer IH, Goldbach JT, Henderson ER, Coulter R. Blosnich et al. respond. Am J Public Health. 2021;111(4):e20–e21. Acceptance Date: December 30, 2020. DOI: https://doi.org/10.2105/AJPH.2021.306165

[4] Sullins, Donald, SEXUAL ORIENTATION CHANGE EFFORTS (SOCE) *REDUCE* SUICIDE: CORRECTING A FALSE RESEARCH NARRATIVE (March 16, 2021). Available at SSRN: https://ssrn.com/abstract=3729353 or http://dx.doi.org/10.2139/ssrn.3729353