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Turpin RE, Rosario AD, Dyer TV. Substance Use and Suicide Attempts Among Adolescent Males Who Are Members of a Sexual Minority: A Comparison of Synthesized Substance-Use Measures. Am J Epidemiol 2020; 189:900-909. [PMID: 32280963 DOI: 10.1093/aje/kwaa055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 11/12/2022] Open
Abstract
Adolescent sexual minority males (ASMM) are among the highest risk groups for suicide in the United States, with substance use as a significant risk factor. We tested for an association between substance use and suicidality among ASMM from the 2015 and 2017 Youth Risk Behavior Survey (n = 849). We compared several approaches to synthesizing measures of marijuana, cocaine, heroin, ecstasy, methamphetamines, synthetic marijuana, and prescription drug abuse, including several categorized and continuous indices, latent class analysis based on any use of each substance, and latent profile analysis based on use frequency. Using all approaches, substance use was positively associated with suicide attempts independent of covariates. A continuous cumulative index was the best fit to our data (quasi-information criterion = 853.9969) and detected the largest association, with the highest prevalence of suicide attempts among ASMM who used all substances compared with those who used none (adjusted prevalence ratio = 3.35, 95% confidence interval: 2.41, 4.66). A 3-latent-class model had the second best fit to the data (quasi-information criterion = 878.4464), with the highest prevalence of suicide attempts (adjusted prevalence ratio = 2.54, 95% confidence interval: 1.80, 3.57) among the high-substance-use class compared with the low-use class. Substance use is an especially important focal point for targeted interventions reducing suicidality among ASMM.
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Turpin RE, Rosario A, Wang MQ. Victimization, depression, and the suicide cascade in sexual minority youth. J Ment Health 2020; 29:225-233. [PMID: 32191163 DOI: 10.1080/09638237.2020.1739250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Suicidality remains disproportionately prevalent among sexual minority youth, necessitating novel methods of understanding suicide risk in this population. Victimization and depression are especially salient suicide risk factors.Aims: We aimed to test if victimization and depression were associated with suicidality at each step of a suicide cascade: Ideation, planning, and suicide attempts.Method: In sample of sexual minorities from the 2015 and 2017 Youth Risk Behavior Survey, we tested nine measures of victimization and depression associated with three outcomes in succession: Suicidal ideation among the full sample (n = 3357), suicide planning among those with ideation (n = 1475), and suicide attempts among those who planned suicide (n = 1073).Results: Depression was associated with suicidal ideation (aPR = 3.93, 95% CI 3.36-4.60), planning (aPR = 1.38, 95% CI 1.12-1.69), and attempts (aPR = 1.78, 95% CI 1.32-2.41) in successive subsamples. Victimization measures had different associations with suicidality at each successive stage, with the strongest associations observed with suicidal ideation in the general sample and suicide attempts among those who planned suicide.Conclusions: This may have implications for anti-victimization intervention effectiveness at each stage of suicidality. Additional research into this association among transgender and gender non-conforming youth is recommended.
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Affiliation(s)
- Rodman E Turpin
- Department of Epidemiology and Biostatistics, University of Maryland at College Park, School of Public Health, College Park, MD, USA
| | - Andre Rosario
- Department of Psychiatry and Behavioral Sciences, Howard University Hospital, Washington, DC, USA
| | - Min Qi Wang
- Department of Behavioral and Community Health, University of Maryland at College Park, School of Public Health, College Park, MD, USA
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Ferlatte O, Oliffe JL, Salway T, Broom A, Bungay V, Rice S. Using Photovoice to Understand Suicidality Among Gay, Bisexual, and Two-Spirit Men. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:1529-1541. [PMID: 31152366 DOI: 10.1007/s10508-019-1433-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 02/13/2019] [Accepted: 02/25/2019] [Indexed: 05/24/2023]
Abstract
This study explored the drivers of suicidality from the perspectives of gay, bisexual, and two-spirit men (GB2SM) with a history of suicidality. Twenty-one GB2SM participated in this photovoice study taking photographs to depict and discuss their previous suicidality. Data were collected from in-depth individual interviews in which participants discussed their photographs and in turn offered verbal/narrative accounts of suicidality. Drawing on intersectionality, analyses of the photographs and interview data revealed three interconnected themes. First, adverse childhood events and negative adolescent experiences were described as the root causes of mental health struggles and suicidality. Second, violence and homophobia had disrupted these men's education and employment opportunities and some participants detailed how their lack of capital and challenges for maintaining employment shaped their suicidality. Third, a sociality of stigma and sense of isolation compounded experiences of suicidality. The three themes overlapped and were shaped by multiple intersectional axes including sexuality, class, ethnicity, and mental health status. The findings have implications for services and health professionals working with GB2SM who need to thoughtfully consider life-course trajectories and multiple social axes when assessing and treating GB2SM experiencing suicidality. More so, because these factors relate to social inequities, structural and policy changes warrant targeted attention.
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Affiliation(s)
- Olivier Ferlatte
- School of Nursing, University of British Columbia, Vancouver, BC, Canada.
- British Columbia Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
| | - John L Oliffe
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Travis Salway
- British Columbia Center for Disease Control, Vancouver, BC, Canada
- School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada
| | - Alex Broom
- School of Social Sciences, University of New South Wales, Sydney, Australia
| | - Victoria Bungay
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Simon Rice
- Orygen, The National Centre for Excellence in Youth Mental Health, Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
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Ferlatte O, Oliffe JL, Louie DR, Ridge D, Broom A, Salway T. Suicide Prevention From the Perspectives of Gay, Bisexual, and Two-Spirit Men. QUALITATIVE HEALTH RESEARCH 2019; 29:1186-1198. [PMID: 30547726 DOI: 10.1177/1049732318816082] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Although gay, bisexual, and two-spirit men (GBTSM) experience high rates of suicidality, there have been few empirical studies of prevention initiatives and policies that could address or reverse this major social problem. This article reports on a photovoice study of 29 GBTSM who had a history of suicidality or lost a fellow GBTSM to suicide. We focused our analysis on participants' perspectives on suicide prevention. Participants described four key considerations for GBTSM suicide prevention: (a) recognizing and addressing enduring homophobia, biphobia, and mental illness stigma; (b) provision of low-barrier, long-term, and GBTSM-affirming counseling; (c) de-isolation through peer support and community connection; and (d) fostering creativity and cultural resilience. By engaging GBTSM affected by suicide through photographs that depict their experiences and points of view, in this study, we offer concrete recommendations to reduce suicidality among GBTSM.
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Affiliation(s)
- Olivier Ferlatte
- 1 The University of British Columbia, Vancouver, British Columbia, Canada
| | - John L Oliffe
- 1 The University of British Columbia, Vancouver, British Columbia, Canada
| | - Dennis R Louie
- 1 The University of British Columbia, Vancouver, British Columbia, Canada
| | - Damien Ridge
- 2 University of Westminster, London, United Kingdom
| | - Alex Broom
- 3 University of New South Wales, Sydney, New South Wales, Australia
| | - Travis Salway
- 1 The University of British Columbia, Vancouver, British Columbia, Canada
- 4 British Columbia Center for Disease Control, Vancouver, British Columbia, Canada
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Ulanja MB, Lyons C, Ketende S, Stahlman S, Diouf D, Kouamé A, Ezouatchi R, Bamba A, Drame F, Liestman B, Baral S. The relationship between depression and sexual health service utilization among men who have sex with men (MSM) in Côte d'Ivoire, West Africa. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2019; 19:11. [PMID: 30832673 PMCID: PMC6399955 DOI: 10.1186/s12914-019-0186-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 01/09/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND In Cote D'Ivoire, there has been limited coverage of evidence-based sexual health services specifically supporting men who have sex with men (MSM). To date, there has been limited study of the determinants of engagement in these services including multiple intersecting stigmas and depression. METHODS 1301 MSM aged 18 years and older, were recruited using respondent-driven sampling in Abidjan, Yamoussoukro, Gagnoa and Bouake, Cote d'Ivoire from January 2015 to October 2015. Inclusion criteria included anal sex with another man in the past 12 months were to complete a structured questionnaire including the Patient Health Questionnaire (PHQ)-9 to screen for depression. Chi-Square tests were used to test difference in healthcare utilization across variables, and multiple logistic regression was used to test the association between depression and health care utilization represented by HIV and sexually transmittable infection testing and treatment. RESULTS Depression (aOR:1.40, 95% CI: 1.07-1.84), being aged 25-29 years (aOR:1.84, 95% CI: 1.11-3.03),unemployed (aOR:0.64, 95% CI: 0.42-0.98), being a student (aOR:0.67, 95% CI: 0.48-0.96), being identified as male (aOR:0.44, 95% CI: 0.29-0.67), and identifying as homosexual (aOR:0.74, 95% CI:0.56-0.99) were significantly associated with utilization of sexual health care services in the final multivariable model. Healthcare enacted stigma (aOR: 1.55, 95% CI: 1.03-2.33) was associated with utilizing sexual health care services, but perceived healthcare stigma, social stigma and family stigma were not. CONCLUSION Given higher levels of depressive symptomatology among those engaging in sexual health care services, this engagement represents an opportunity for service integration which may have synergistic benefits for both sexual and mental health. Moreover, MSM in Cote D'Ivoire who had engaged in sexual health services were more likely to report having experienced health-care enacted stigma. Taken together, these results reinforce the need for stigma mitigation interventions to support sustained engagement in HIV prevention, treatment and care services as a means of reducing health disparities among MSM in Cote d'Ivoire.
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Affiliation(s)
- Mark B Ulanja
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, E7146, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Carrie Lyons
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, E7146, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Sosthenes Ketende
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, E7146, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Shauna Stahlman
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, E7146, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | | | | | | | | | | | - Ben Liestman
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, E7146, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Stefan Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, E7146, 615 N. Wolfe Street, Baltimore, MD, 21205, USA. .,Programme National de Lutte contre le Sida, Ministère de la Santé et de la Lutte contre le Sida, Abidjan, Côte d'Ivoire.
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Salway T, Plöderl M, Liu J, Gustafson P. Effects of Multiple Forms of Information Bias on Estimated Prevalence of Suicide Attempts According to Sexual Orientation: An Application of a Bayesian Misclassification Correction Method to Data From a Systematic Review. Am J Epidemiol 2019; 188:239-249. [PMID: 30188991 DOI: 10.1093/aje/kwy200] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 08/27/2018] [Indexed: 11/13/2022] Open
Abstract
Multiple epidemiologic studies demonstrate a disparity in suicide risk between sexual minority (lesbian, gay, bisexual) and heterosexual populations; however, both "exposure" (sexual minority status) and outcome (suicide attempts) may be affected by information bias related to errors in self-reporting. We therefore applied a Bayesian misclassification correction method to account for possible information biases. A systematic literature search identified studies of lifetime suicide attempts in sexual minority and heterosexual adults, and frequentist meta-analysis was used to generate unadjusted estimates of relative risk. A Bayesian model accounting for prior information about sensitivity and specificity of exposure and outcome measures was used to adjust for misclassification biases. In unadjusted frequentist analysis, the relative risk of lifetime suicide attempt comparing sexual minority with heterosexual groups was 3.38 (95% confidence interval: 2.65, 4.32). In Bayesian reanalysis, the estimated prevalence was slightly reduced in heterosexual adults and increased in sexual minority adults, yielding a relative risk of 4.67 (95% credible interval: 3.94, 5.73). The disparity in lifetime suicide attempts between sexual minority and heterosexual adults is greater than previously estimated, when accounting for multiple forms of information bias. Additional research on the impact of information bias in studies of sexual minority health should be pursued.
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Affiliation(s)
- Travis Salway
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin Plöderl
- Department of Crisis Intervention and Suicide Prevention, Paracelsus Medical University, Salzburg, Austria
- Department of Clinical Psychology, University Clinic of Psychiatry, Psychotherapy, and Psychosomatics, Paracelsus Medical University, Salzburg, Austria
| | - Juxin Liu
- Department of Mathematics and Statistics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Paul Gustafson
- Department of Statistics, University of British Columbia, Vancouver, British Columbia, Canada
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Salway T, Gesink D, Ibrahim S, Ferlatte O, Rhodes AE, Brennan DJ, Marchand R, Trussler T. Evidence of Multiple Mediating Pathways in Associations Between Constructs of Stigma and Self-Reported Suicide Attempts in a Cross-Sectional Study of Gay and Bisexual Men. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:1145-1161. [PMID: 28821997 DOI: 10.1007/s10508-017-1019-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 03/11/2017] [Accepted: 06/17/2017] [Indexed: 06/07/2023]
Abstract
Gay and bisexual men (GBM) are more likely to attempt suicide than heterosexual men. This disparity is commonly interpreted using minority stress theory; however, specific pathways from antigay stigma to suicidal behavior are poorly understood. We aimed to estimate associations between multiple constructs of stigma and suicide attempts among adult GBM, and to measure the proportion of these associations mediated by distinct suicide risk factors, thus identifying proximal points of intervention. Data were drawn from a Canadian community-based survey of adult GBM. Structural equation modeling was used to compare associations between three latent constructs-enacted stigma (e.g., discrimination, harassment), anticipated prejudice (worry about encountering antigay/bisexual prejudice), and sexuality concealment-and self-reported suicide attempts (last 12 months). Coefficients were estimated for direct, indirect, and total pathways and evaluated based on magnitude and statistical significance. The proportion of associations mediated by depression, drug/alcohol use, and social isolation was calculated using indirect paths. Among 7872 respondents, 3.4% reported a suicide attempt in the past 12 months. The largest total association was observed for enacted stigma, and this association was partially mediated by depression and drug/alcohol use. The total association of anticipated prejudice was relatively smaller and mediated by depression and social isolation. Concealment had an inverse association with suicide attempts as mediated by depression but was also positively associated with suicide attempts when mediated through social isolation. Multiple constructs of antigay stigma were associated with suicide attempts; however, mediating pathways differed by construct, suggesting that a combination of strategies is required to prevent suicide in adult GBM.
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Affiliation(s)
- Travis Salway
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.
- Community-Based Research Centre for Gay Men's Health, Suite 234 - 970 Burrard Street, Vancouver, BC, V6Z 2R4, Canada.
| | - Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
| | - Selahadin Ibrahim
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
- Institute for Work & Health, 481 University Avenue, Toronto, ON, M5G 2E9, Canada
| | - Olivier Ferlatte
- School of Nursing, University of British Columbia, Room 107 - Med Block C, 2176 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Anne E Rhodes
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
- Department of Psychiatry, University of Toronto, 585 University Avenue, Toronto, ON, M5G 2N2, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, St. Joseph's Healthcare Hamilton, West 5th Campus, Administration - B3, 100 West 5th, Hamilton, ON, L8N 3K7, Canada
- Offord Centre for Child Studies, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - David J Brennan
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Rick Marchand
- Community-Based Research Centre for Gay Men's Health, Suite 234 - 970 Burrard Street, Vancouver, BC, V6Z 2R4, Canada
| | - Terry Trussler
- Community-Based Research Centre for Gay Men's Health, Suite 234 - 970 Burrard Street, Vancouver, BC, V6Z 2R4, Canada
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Characteristics of Stress and Suicidal Ideation in the Disclosure of Sexual Orientation among Young French LGB Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020290. [PMID: 29414915 PMCID: PMC5858359 DOI: 10.3390/ijerph15020290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 02/02/2018] [Accepted: 02/04/2018] [Indexed: 11/24/2022]
Abstract
Background: Lesbians, gays, and bisexual people (LGB) present high levels of suicidal ideation. The disclosure of sexual orientation is a stressful experience which presents a high suicide risk. Research has not paid sufficient attention to stress during this disclosure in order to understand suicide among LGB people. The aims of this study were to investigate: (1) the characteristics of stress during this revelation, more precisely cognitive appraisal, emotions, and coping; and (2) associations between these characteristics and suicidal ideation. Method: A total of 200 LGB young adults answered the “Stressful situation assessment questionnaire”, focusing on the most stressful disclosure of sexual orientation they have ever experienced. Results: Avoidance coping is a good predictor of suicidal ideation, and mediates the association between primary appraisal (risk “Harm myself and others”) and suicidal ideation. Conclusions: Our study illustrates the need to better understand stress during the disclosure of sexual orientation to prevent and care for suicide risk among LGB young adults.
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