All analyses were conducted using SAS R version 9.3 and adjusted by weights generated using RDSAT version 7.1.46 to reflect better population estimates. Descriptive statistics include crude frequencies and RDS-adjusted population parameters, the latter of which will be reported in-text. Multi-variable logistic regression was used to identify covariates for both dependent variables. AUDIT and HADS variables were excluded as independent variables from the multi-variable modeling given their relationship with the dependent variables. Model selections were conducted using a backward elimination technique based on two criteria and Type III p-values until the final model reached the optimum AIC . Removal of any categorical variable from the multi-vatiable models was confirmed through the use of a likelihood ratio test. All statistical tests were two sided and considered significant at α < .05.A total of 719 individuals participated in our study and were included in the analysis . Additional details regarding the RDS methods and results of this sample are published elsewhere . Crude and RDS-adjusted descriptive statistics for our overall sample are shown in Table 1. Overall, the mean age of participants was 36 years [Q1–Q3: 26–41 years], 80.7% identified as gay , 23.4% were HIV-positive, 68.0% identified as White, 74.5% were born in Canada, 51.9% lived in downtown Vancouver,vertical farming racks and 74.3% had an annual income less than $30,000. In terms of education, 65.6% had completed at least some education greater than high school, with only 19% currently enrolled in school.
Nearly a quarter of participants were living with HIV . Sexually, a median of three male anal sex partners were reported in the past six months, 8.7% reported having engaged in sex work in the past six months, and 62.8% reported no regular partner. Table 1 also shows descriptive statistics regarding mental health and treatment. For the two primary outcomes, 17.4% of GBM reported a lifetime doctor-diagnosed alcohol or substance use disorder and a further 35.2% reported any other lifetime doctor-diagnosed mental health disorder. As such, over half of GBM reported having been diagnosed with a mental health disorder in their lifetime . Moreover, 10.5% of GBM report three or more different mental health disorders. Non-exclusively, 42.4% had been diagnosed with depression, 25.9%with anxiety, 5.8% with bipolar disorder, and 0.7% with schizophrenia. In terms of substance use dependency, 6.9% had ever been diagnosed with alcohol use disorder specifically and 14.8% for another substance. At the time of survey, 24.0% were receiving treatment for a mental health disorder. Of the 179 GBM who reported currently receiving treatment for a mental health or substance-use disorder on the nurse-administered questionnaire, 177 provided information on what treatment they were receiving and 88.7% provided a specific medication name or class of medication. Specific medications were named for 130 participants, with antidepressants and anxiolytics being the most commonly reported followed by antipsychotics , anticonvulsants , and opioids . Ancillary treatments, which included psychotherapy, were only named for 24 GBM and likely underreported given the biomedical-focused question wording. Finally, Table 1 provides information on substance use in the past 6 months as well as scores on the Alcohol Use Disorders Identification Test and Hospital Anxiety and Depression Scale .
Overall, 47.1% reported recent use of cigarettes and 63.6% use of cannabis. In terms of other recent substance use, 34.3% of individuals reported using poppers, 29.5% cocaine, 21.1% crystal methamphetamine, 19.1% gammahydroxybutyrate , 18.9% reported using ecstasy, 17.3% erectile dysfunction drugs , 17.2% crack, 14.1% hallucinogens, 12.0% ketamine, 11.1% other opioids, 5.5% other stimulants, 5.2% benzodiazepines, 5.2% steroids, 4.6% heroin, 3.4% other prescription drugs, and 3.2% morphine. We sought to determine the prevalence of doctor diagnosed mental health conditions and self-reported substance use among GBM, as well as the association between these two domains, using cross-sectional data from the Momentum Health Study of GBM living in the Metro Vancouver, British Columbia, Canada. Substance use and mental health conditions were highly prevalent among GBM. As expected, there were strong associations found between a substance use disorder diagnosis and various substances in our study, which corroborate previous research regarding smoking and alcohol-related problems among GBM. Further, cigarette smoking and erectile dysfunction drugs were the only substances associated with any other mental health disorder diagnosis at the univariable level, and did not remain in the multi-variable model. Our findings suggest that GBM have higher rates of mental health disorders than the overall population. According to the 2012 Canadian Community Health Survey , a third of Canadians reported a mental health or substance use disorder diagnosed in their lifetime , while more than half of the participants in our sample reported any lifetime doctor-diagnosed mental health disorder.
Examining depression, anxiety, and drug abuse/dependence more specifically, our study reported population prevalence estimates approximately three times larger than the overall population: 8.7% of Canadians versus 25.9% of GBM report being diagnosed with anxiety in their lifetime, 11.3% of Canadians versus 42.4% of GBM report being diagnosed with depression in their lifetime, and 4.0% of Canadians versus 14.8% of GBM reported lifetime drug abuse or dependence. This discrepancy is greater than what was reported by Meyer and King et al. , which found the prevalence of mental health conditions in GBM to be approximately two times greater than in heterosexual men across multiple studies. However, neither Meyer nor King et al. included Canadian data in their analyses, nor did previous studies utilize RDS, making our findings more representative, at least for urban GBM in Metro Vancouver, Canada. Our use of respondent-driven sampling to generate population parameter estimates indicated that we had over-sampled White GBM and under-sampled low-income GBM, GBM with less formal education and bisexual-identified men. Our findings also indicate that GBM have higher rates of substance use than the overall population. According to the Canadian Tobacco Use Monitoring Survey , 18.4% of Canadian men are current smokers,which includes those who do not smoke daily , while in our study, 47.1% of GBM smoked cigarettes in the past 6 months. These percentages fall at the upper end of the 25–50% range in the review conducted by Ryan and colleagues , which looked at the prevalence of smoking across multiple studies of GBM and found that GBM were much more likely to smoke than their heterosexual counterparts. Our study found that recent cannabis use among GBM was higher than lifetime use in the Canadian population: 63.6% recently used in our study versus 41.5% lifetime use in the Canadian Alcohol and Drug Use Monitoring Survey . Other substances, such as cocaine and ecstasy, also had recent prevalence estimates at much greater magnitudes in our study at 29.5% and 18.9%, respectively, versus the 1.1% and 0.6% lifetime estimates found in CADUMS. These findings are consistent with the review by Hughes and Eliason ,ebb and flow table whom found that GBM are more likely to use substances than heterosexual men.AUDIT and AUDIT Consumption have been used previously in research with GBM to assess alcohol use. A larger proportion of GBM were categorized to be hazardous drinkers or possibly dependent on alcohol in our study versus other studies: 9% among older LGB adults and 15.4% among HIV-positive men who have sex with men . D’Augelli, Grossman, Hershberger, and O’Connell studied older lesbian, gay, and bisexual people and found a mean AUDIT score of 3.06, which is nearly half the median value of 6.0 in our study. For studies using the AUDIT-C that focused only on consumption patterns, hazardous drinking categorization was more prevalent: 71.4% among gay and bisexual youth aged 13–24 , 65.4% among gay men and 58.8% among bisexual men aged 18–25 , and 58% of adult GBM . These disparities in prevalence may be due to the age group or HIV-status specificity of the samples in other studies, differences in measurement approaches, benefits of using RDS to access hard-to-reach GBM subgroups, or may reflect a local phenomenon among GBM in Metro Vancouver.
Few studies have used the Hospital Anxiety and Depression Scale to measure anxiety and depression in GBM, allowing our study to provide some of the first estimates using this scale in a nonclinical population and with RDS-weighted population parameters. However, this also makes it difficult to compare the results of our study with others. Gray and Hedge found that only 40% of gay men were in the normal range for the HADSAnxiety measure and 77% of gay men were in the normal range for the HADS-Depression measure, which are similar to the percentages found in our study where 42.9% of GBM scored within normal range for the HADS-Anxiety measure and 80.9% scored in the normal range for the HADS-Depression measure. Many studies assessing anxiety and depression in GBM have used the Composite International Diagnostic Interview ; a nonclinical, structured interview often used in epidemiological surveys and is based on the diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disordersas well as the International Classification of Diseases. Cochran et al. found that 69% of GBM were not depressed and 97.1% were not anxious according to the CIDI, which differs from the 80.9% and 42.9% in our study for HADS-Depression and HADS-Anxiety respectively. The percentage of participants who scored within the normal range for the HADS-Depression measure in our study is similar to the percentage by Wang et al. , which was 80.8% versus 80.9% in our study, while the anxiety measure differed greatly which was 78.1% in their study versus the 42.9% in our study. While the HADS is easier to use because it is a self-administered questionnaire, the CIDI has been shown to demonstrate high validity as a diagnostic instrument , which could be useful in future studies of GBM mental health. Our study found that GBM with lower annual incomes were more likely to have been diagnosed with a substance use disorder. Income is considered to be one of the most important social determinants of health because it effects whether one may access nutritious food, housing, transportation, and other basic health prerequisites . This upstream determinant impacts one’s general and physical well being, which in turn may explain this greater burden of mental health disorders. Lastly, we found that participants who were currently students were less likely to have a substance use disorder than participants who were not. This may be due to students generally being younger in age, and as such are biased towards a shorter lifetime reporting period within which to have been diagnosed with any mental health conditions. Specific to being a sexual minority, GBM who were not out about their gay identity were less likely to report having any other mental health condition at the univariable level than those who were open about being gay. We posit that this may be due to the fact that individuals who are public regarding their sexual orientation are easier targets for harassment or discrimination. This is supported by findings from D’Augelli and Grossman , where GBM who came out at an earlier age and GBM who spent more years out of the closet were more likely to experience victimization than individuals who came out later or who spent less time out of the closet. More generally speaking, Meyer argues that experiences of victimization in the forms of stigma, prejudice, and discrimination that GBM experience may be the cause for the higher prevalence of mental health conditions in GBM populations and refers to this as minority stress . Stigma may also help explain why HIV-positive GBM were more likely to report a substance use disorder in our study. HIV-related stigma has been linked to poorer mental health in a meta-analysis by Logie and Gadalla and a review by Smit and colleagues . Readers should be cautious when interpreting our results. Most notably our results rely on participants’ retrospective self-report of recent substance use and sexual behavior and compare these data with lifetime mental health diagnoses. As such, we are limited in determining causal direction, but instead position these findings as a more representative profile of GBM who had ever been diagnosed with a mental health condition given our use of respondent-driven sampling. We did not conduct diagnostic interviews to account for undiagnosed conditions, and thus underestimated the true burden of mental health issues. We attempted to address current symptomology through the inclusion of AUDIT and HADS scores. However, given the paucity of validation studies for AUDIT, but particularly HADS within GBM populations, we caution the interpretation of these findings and call for new research validation studies with GBM populations.