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 to 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 [confidence interval]: 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.

KEYWORDS:

• Anxiety
• depression
• drug use
• mental illness
• sexual minority
• syndemics

Acknowledgments

The authors thank our community colleagues at the Health Initiative for Men, YouthCO HIV & Hep-C Society of BC, and Positive Living BC for their support. The authors also thank the research participants for sharing their important data with the Momentum Health Study.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Funding

This work was supported by the Canadian Institutes for Health Research [107544]; and the National Institutes for Health, National Institute for Drug Abuse [R01DA031055]. Nathan J. Lachowsky was supported by a CANFAR/CTN Postdoctoral Fellowship Award. David M. Moore is supported by a Scholar Award from the Michael Smith Foundation for Health Research (#5209). Julio S. G. Montaner is supported with grants paid to his institution by the British Columbia Ministry of Health and by the US National Institutes of Health (R01DA036307). He has also received limited unrestricted funding, paid to his institution, from Abbvie, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck, and ViiV Healthcare.