Lifetime Doctor-Diagnosed Mental Health Conditions and Current Substance Use Among Gay and Bisexual Men Living in Vancouver, Canada

Abstract

Background Studies have found that gay, bisexual, and other men who have sex with men (GBM) have higher rates of mental health conditions and substance use than heterosexual men, but are limited by issues of representativeness. Objectives To determine the prevalence and correlates of mental health disorders among GBM in Metro Vancouver, Canada. Methods From 2012–2014, the Momentum Health Study recruited GBM (≥16 years) via respondent-driven sampling (RDS) to estimate population parameters. Computer-assisted self-interviews (CASI) collected demographic, psychosocial, and behavioral information, while nurse-administered structured interviews asked about mental health diagnoses and treatment. Multivariate logistic regression using manual backward selection was used to identify covariates for any lifetime doctor-diagnosed: 1) alcohol/substance use disorder, and 2) any other mental health disorder. Results Of 719 participants, 17.4% reported a substance use disorder and 35.2% reported any other mental health disorder; 24.0% of all GBM were currently receiving treatment. A lifetime substance use disorder diagnosis was negatively associated with being a student (AOR=0.52, 95%CI:0.27–0.99) and an annual income ≥$30,000 CAD (AOR=0.38, 95%CI:0.21–0.67) and positively associated with HIV-positive serostatus (AOR=2.54, 95%CI:1.63–3.96), recent crystal methamphetamine use (AOR=2.73, 95%CI:1.69–4.40) and recent heroin use (AOR=5.59, 95%CI:2.39–13.12). Any other lifetime mental health disorder diagnosis was negatively associated with self-identifying as Latin American (AOR=0.25, 95%CI:0.08–0.81), being a refugee or visa holder (AOR=0.18, 95%CI:0.05–0.65), and living outside Vancouver (AOR=0.52, 95%CI:0.33–0.82), and positively associated with abnormal anxiety symptomology scores (AOR=3.05, 95%CI:2.06–4.51). Conclusions Mental health conditions and substance use, which have important implications for clinical and public health practice, were highly prevalent and co-occurring.

The additive effects of depressive symptoms and polysubstance use on HIV risk among gay, bisexual, and other men who have sex with men

“…Clinical guidelines developed for the AUDIT suggest that scores >20 warrant treatment of alcohol dependence, scores 16–19 warrant counseling and continued monitoring, and lower scores require limited to no intervention (Miller, 2014). Balancing the sensitivity and specificity of these categorizations, the AUDIT scale was dichotomized in the present study with values between 0 and 15 indicating “low or medium risk” and scores between 16 and 40 indicating “harmful use and possible dependence” (Lachowsky et al, 2017).…”

“…A recent meta-analysis of 22 epidemiological studies reported that individuals who used illicit drugs had 3.8 times greater odds of reporting depression (Lai et al, 2015). Similarly, recent examinations of the relationship between substance use and poor mental health among GBM found that depression was associated with 3.5 times greater odds of reporting a doctor-diagnosed substance use disorder (Lachowsky et al, 2017). Together these findings highlight significant intercorrelations between substance use and mental health – a phenomena which has come to be identified with syndemics theory (Stall et al, 2003).…”

A longitudinal analysis of cannabis use and mental health symptoms among gay, bisexual, and other men who have sex with men in Vancouver, Canada

“…This framework highlights the role of stigma, prejudice, and discrimination in perpetuating experiences of chronic stress among sexual minority individuals, which may ultimately precipitate adverse mental health and substance use (Goldbach et al, 2014), and has been shown to contribute to increased cannabis use among gbMSM (Goldbach et al, 2015). Similarly, rates of mental health conditions are higher in the gbMSM population compared with heterosexual individuals and the general population (Bränström & Pachankis, 2018;Fredriksen-Goldsen et al, 2013;Lachowsky et al, 2017;Mustanski et al, 2010). Results from a Canadian national survey demonstrated that the risk of mood or anxiety disorders is significantly greater among gay and bisexual men relative to heterosexual men (Brennan et al, 2010).…”

Changes in mental health and drug use among men who have sex with men using daily and event-driven pre-exposure prophylaxis: Results from a prospective demonstration project in Amsterdam, the Netherlands

“…We also observed no decrease in the proportion with anxiety and depressive disorders. Previous studies have shown associations between internalizing disorders, such as depression, and drug use in GBMSM [21] . Nevertheless, it is unclear why the proportion of those with drug-use disorder was declining while that of anxiety or depression did not change during PrEP use.…”