Body image and associated factors among sexual minority men: A systematic review

Research suggests that the risk of body image concerns among sexual minority men is high. Recent work has increasingly examined body image in relation to psychological, interpersonal, and behavioral constructs, but these findings have yet to be consolidated and critically examined to identify potential risk and protective factors. The present study sought to systematically review and synthesize published findings on body image among sexual minority men. A total of 136 articles published between January 2011 and March 2022 were included. Sexual minority men were generally reported to have more negative body image compared to heterosexual men, yet findings varied across body image constructs. In correlational work, body image was often examined in relation to disordered eating, mental health, internalization of appearance ideals, objectification, sexual behavior and relationships, gay community identification and discrimination, and health concerns (e.g., HIV, AIDS). Robust relationships emerged among body image and stigma variables, including internalized homophobia and harassment related to LGBTQ+ presentation and intersecting minority identities. Sociocultural, objectification, and minority stress theories were employed to interpret findings and to delineate future directions grounded in intersectional approaches. Additional work focused on the role of stigma and discrimination in the development of these concerns across the lifespan is needed.

Further support for the validity of the social appearance anxiety scale (SAAS) in a variety of German-speaking samples

PURPOSE

Eating disorders (ED) and social anxiety disorder are highly comorbid with potentially shared symptoms like social appearance anxiety (SAA) referring to a fear of being negatively evaluated by others' because of overall appearance. SAA constitutes a risk factor for eating psychopathology and bridges between EDs and social anxiety disorder.

METHODS

The present studies examined internal consistency, factor structure, test-retest reliability, gender and age invariance, convergent validity and differences between individuals with and without an ED of a German version of the social appearance anxiety scale (SAAS) in four independent samples (n₁ = 473; n₂ = 712; n₃ = 79; n₄ = 33) including adolescents and patients with EDs.

RESULTS

Consistently, the SAAS showed excellent internal consistency (ωs ≥ 0.947) and a one-factorial structure. Convergent validity was shown via high correlations of the SAAS with social anxiety (e.g., social interaction anxiety r = 0.642; fear of negative evaluation rs ≥ 0.694), body image disturbance measures (e.g., shape concerns rs ≥ 0.654; weight concerns rs ≥ 0.607; body avoidance rs ≥ 0.612; body checking rs ≥ 0.651) and self-esteem (r = -0.557) as well as moderate correlations with general eating psychopathology (e.g., restrained rs ≥ 0.372; emotional r = 0.439; external eating r = 0.149). Additionally, the SAAS showed gender and age invariance and test-retest reliability after 4 weeks with r = 0.905 in Study 2 and was able to discriminate between individuals with and without an ED in Study 4.

CONCLUSION

Hence, the German version of the SAAS can reliably and validly assess SAA in female and male adolescents or adults with or without an ED. Additionally, the SAAS might be used in a therapeutic context to especially target patient groups suffering from EDs with comorbid social anxiety.

LEVEL OF EVIDENCE

Level III: Evidence obtained from cohort or case-control analytic studies.

Relationship between sociodemographics, healthcare providers' competence and healthcare access among two-spirit, gay, bisexual, queer and other men who have sex with men in Manitoba: results from a community-based cross-sectional study

OBJECTIVE

Little is known about barriers to healthcare access for two-spirit, gay, bisexual and queer (2SGBQ+) men in Manitoba.

DESIGN

Data were drawn from a community-based, cross-sectional survey designed to examine health and healthcare access among 2SGBQ+ men.

SETTING

Community-based cross-sectional study in Manitoba, Canada.

PARTICIPANTS

Community-based sample of 368 2SGBQ+ men.

OUTCOMES

Logistic regression analyses assessed the relationship between sociodemographics, healthcare discrimination, perceived healthcare providers' 2SGBQ+ competence/knowledge and two indicators of healthcare access (analytic outcome variables): (1) having a regular healthcare provider and (2) having had a healthcare visit in the past 12 months.

RESULTS

In multivariate analyses, living in Brandon (adjusted OR (AOR)=0.08, 95% CI 0.03 to 0.22), small cities (AOR=0.20, 95% CI 0.04 to 0.98) and smaller towns (AOR=0.26, 95% CI 0.08 o 0.81) in Manitoba (compared with living in Winnipeg), as well as having a healthcare provider with poor (AOR=0.19, 95% CI 0.04 to 0.90) or very poor competence/knowledge (AOR=0.03, 95% CI 0.03 to 0.25) of 2SGBQ+ men's issues (compared with very good competence) was associated with lower odds of having a regular healthcare provider. Living in Brandon (AOR=0.05, 95% CI 0.02 to 0.17) and smaller towns (AOR=0.25, 95% CI 0.67 to 0.90) in Manitoba (compared with living in Winnipeg) was associated with lower odds of having a healthcare visit in the past 12 months, while identifying as a gay man compared with bisexual (AOR=12.57, 95% CI 1.88 to 83.97) was associated with higher odds of having a healthcare visit in the past 12 months.

CONCLUSIONS

These findings underscore the importance of reducing the gap between the healthcare access of rural and urban 2SGBQ+ men, improving healthcare providers' cultural competence and addressing their lack of knowledge of 2SGBQ+ men's issues.

Microaggression and everyday resistance in narratives of refugee resettlement

The mental health of resettled refugees is not only affected by the trauma they experience before and while fleeing persecution, but also by experiences during the resettlement process. Drawing on a qualitative study of refugees' experiences of mental wellbeing in a small Canadian city this paper documents participants' experiences of microaggression and everyday resistance. In our analysis, we refer to the metaphor of uprooting that is often used to describe the totality of refugee displacement. In our expansion of the metaphor, microaggression re-uproots resettled refugees by challenging their right to be where they are. Using acts of everyday resistance, participants in our sample attempted to set down roots in the resettlement context despite microaggressions. Participants' acts of everyday resistance are captured under five themes: rejecting victimhood, rejecting burden narratives, ignorance as an explanation, the transience of vulnerability, and setting down roots. This study contributes to the literature that de-emphasizes the vulnerability narrative of refugee mental health by demonstrating the role of personal agency in refugees' experiences of their own wellbeing.

Associations between body dissatisfaction and self-reported anxiety and depression in otherwise healthy men: A systematic review and meta-analysis

INTRODUCTION

It is unknown whether male body dissatisfaction is related to anxiety and depression. This study investigates whether there is an association between body dissatisfaction and self-reported anxiety and/or depression in otherwise healthy adult males.

METHOD

A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta Analyses as the reporting guideline. Four databases including CINAHL complete, Health Source: Nursing/Academic Edition, MEDLINE and PsycINFO were searched for observational studies with a correlational design. Studies were appraised using the Appraisal tool for Cross-Sectional Studies to measure quality and risk of bias. Data were extracted from studies to analyse and synthesise findings using content analysis and random effects meta-analyses in male body dissatisfaction and anxiety, depression, and both anxiety and depression.

RESULTS

Twenty-three cross-sectional studies were included in the review. Nineteen studies found positive correlations between male body dissatisfaction and anxiety and/or depression. Meta-analyses of Pearson's correlation coefficients found statistically significant associations with body satisfaction for anxiety 0.40 (95% CI 0.28 to 0.51) depression 0.34 (95% CI 0.22 to 0.45) and both anxiety and depression outcomes 0.47 (95% CI 0.33 to 0.59). The quality appraisal found study samples were homogeneous being mostly ascertained through academic institutions where participants were predominantly young, Caucasian and with relatively high educational attainment. Measures of body satisfaction focused predominantly on muscularity and thinness.

DISCUSSION

This study provides the first pooled estimates of the correlation between body dissatisfaction and anxiety and depression in men. Findings need to be interpreted with respect to the samples and outcomes of the included studies. It is recommended that future research should increase the diversity of men in studies. Studies should measure a wider range of body dissatisfaction types found in men.

CONCLUSION

The findings demonstrate that an association between male body dissatisfaction and anxiety and depression is likely to exist. Future research should address the temporal relationship between body dissatisfaction and anxiety and depression.

Validation of the Social Appearance Anxiety Scale in Patients With Systemic Sclerosis: A Scleroderma Patient-Centered Intervention Network Cohort Study

OBJECTIVE

Systemic sclerosis (SSc) is an autoimmune disease that can cause disfiguring changes in appearance. This study examined the structural validity, internal consistency reliability, convergent validity, and measurement equivalence of the Social Appearance Anxiety Scale (SAAS) across SSc disease subtypes.

METHODS

Patients enrolled in the Scleroderma Patient-centered Intervention Network Cohort completed the SAAS and measures of appearance-related concerns and psychological distress. Confirmatory factor analysis (CFA) was used to examine the structural validity of the SAAS. Multiple-group CFA was used to determine whether SAAS scores can be compared across patients with limited and diffuse disease subtypes. Cronbach's alpha was used to examine internal consistency reliability. Correlations of SAAS scores with measures of body image dissatisfaction, fear of negative evaluation, social anxiety, and depression were used to examine convergent validity. SAAS scores were hypothesized to be positively associated with all convergent validity measures, with correlations significant and moderate to large in size.

RESULTS

A total of 938 patients with SSc were included. CFA supported a 1-factor structure (Comparative Fit Index 0.92, Standardized Root Mean Residual 0.04, and Root Mean Square Error of Approximation 0.08), and multiple-group CFA indicated that the scalar invariance model best fit the data. Internal consistency reliability was good in the total sample (α = 0.96) and in disease subgroups. Overall, evidence of convergent validity was found with measures of body image dissatisfaction, fear of negative evaluation, social anxiety, and depression.

CONCLUSION

The SAAS can be reliably and validly used to assess fear of appearance evaluation in patients with SSc, and SAAS scores can be meaningfully compared across disease subtypes.