For example, GBM men were approximately one and half times more likely to have reported being diagnosed with a substance use disorder during their lifetime than heterosexual men , and one and a half times more likely to have been dependent onalcohol or other substances in the past year . GBM also have higher rates of mental health issues than their heterosexual counterparts . In a review of 10 studies, Meyer found that gay men were twice as likely to have experienced a mental disorder during their lives as heterosexual men. More specifically, gay men were approximately two and a half times more likely to have reported a mood disorder or an anxiety disorder than heterosexual men. A review by King and colleagues found that lesbian, gay, and bisexual individuals were more than twice as likely as heterosexuals to attempt suicide over their lifetime and one and a half times more likely to experience depression and anxiety disorders in the past year, as well as over their lifetime.Few Canadian studies have explored population-based estimates for mental health outcomes among GBM. In one cross-sectional study of Canadian gay/“homosexual” and bisexual men using 2003 Canadian Community Health Survey data, Brennan and colleagues found participants were nearly three times as likely to report a mood or anxiety disorder than heterosexual men. Pakula & Shoveller conducted a more recent cross-sectional analysis that used 2007–2008 Canadian Community Health Survey data and found again that GBM were 3.5 times more likely to report a mood disorder compared with heterosexual males. These analyses used government-run population-based study data, which may limit self-disclosure of sexual minority status,marijuana growing racks and further relied on a single identity variable to measure sexual orientation, which ignores same-sex sexual behaviors. There is an inextricable yet varied relationship between an individual’s mental health and substance use. Substance use may lead to poorer mental health or, inversely, poor mental health may lead to increased substance use .

A variety of substances have been shown to be associated with negative mental health events or symptoms. For example, Clatts, Goldsamt, and Li found that a third of young MSM who used club drugs on a regular basis reported having attempted suicide, and almost half of those who had attempted suicide, did so multiple times over their lifetime. They also found that more than half of regular club drugs users had high levels of depressive symptoms. McKirnan and colleagues found that GBM who showed signs of depression were nearly twice as likely to smoke. Stall and colleagues identified a “dose-response” relationship between self-rated mental well being and alcohol related problems: GBM who self-rated their mental well-being as low were approximately three times more likely to have alcohol related problems and those who rated it as moderate were nearly twice as likely to have alcohol related problems. Respondents who scored as depressed were also one and half times more likely to report using multiple drugs and nearly twice as likely to report weekly drug use. Syndemics [clusters of mutually reinforcing epidemics that interact with one another to make overall burden of disease within a population worse ] has been used in research with GBM to explain how various psychosocial variables such as poly drug use, mental health conditions, and intimate partner violence increase the likelihood of acquiring HIV . However, nearly all of these studies have relied on convenience samples through online and venue-based recruitment; thus, they may not be representative of the larger underlying population of GBM. In order to address issues of representativeness and limitations of non-probability sampling in past research with GBM, we used respondent-driven sampling to estimate population parameters that are more representative than convenience samples . RDS is a type of chain-referral research technique in which participants are asked to recruit individuals from within their social networks in successive waves, and estimates population parameters using measures of network size and recruitment homophily. By utilizing RDS we sought to produce a more representative sample of the GBM population in Metro Vancouver in order to determine the prevalence of mental health issues and substance use as well as the association between these factors.We analyzed cross-sectional data from participants enrolled in the Momentum Health Study, a longitudinal bio-behavioral prospective cohort study of HIV-positive and HIV-negative GBM in Metro Vancouver, Canada.

The overall aim of this study was to examine the impact of a biomedical intervention—increased access to highly active antiretroviral therapy for HIV— on HIV risk behaviors among GBM. The present analysis utilized data collected from participants’ first study visit that occurred between February 2012 and February 2014. We used RDS to recruit GBM in the Greater Vancouver area . Initial seeds were selected in person through partnerships with community agencies or online through advertisements on GBM socio-sexual networking mobile apps or websites . These seeds were then provided with up to six vouchers to recruit other GBM they knew. All participants were screened for eligibility and provided written informed consent at the in-person study office in downtown Vancouver. A computer-assisted, self-administrated questionnaire was used to collect socio-demographic, psychosocial, and behavioral variables. Subsequently, a nurse-administered structured interview collected information on history of mental health and substance dependence diagnosis and treatment, and participants provided blood samples to test for HIV and other sexually transmitted infections . Participants received a $50 honorarium for completing the study protocol and an additional $10 for each eligible GBM they recruited into the study. All project investigators’ institutional Research Ethics Boards granted ethical approval. Moore and colleagues have published additional detail on the Momentum Health Study protocol.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. ,mobile grow rack 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 , 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 Disorders as 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. A number of salient social factors were identified as important determinants of 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.