Mental Health Service Use in a Sample of Gay, Bisexual, and other Men who have Sex with Men Living in Middlesex County, Ontario, Canada: An Exploratory Analysis
Publication: Canadian Journal of Community Mental Health
6 January 2017
Abstract
Risks of mental health issues (e.g., depression, anxiety/mood disorders, and suicidality) are found to be elevated among Canadian gay, bisexual, and men who have sex with men (GB-MSM). We studied factors impacting mental health care use in a community sample of 202 GB-MSM in London-Middlesex, Ontario. Our results show that, for the entire sample, experiences of both homophobia and internalized homonegativity are associated with increased prevalence of mental health service use over the past year, and suggest that service use is lower among immigrant GB-MSM than among those born in Canada. Implications for mental health and social service providers are discussed.
Résumé
Les risques de problèmes de santé mentale (p, ex. la dépression, l’anxiété, les troubles de l’humeur et les tendances suicidaires) se trouvent à être élevé parmi les canadiens gais, bisexuels et les hommes ayant des relations sexuelles avec d’autres hommes (GB-HARSAH). Nous avons étudié les facteurs qui influencent l’utilisation des soins de santé mentale dans un échantillon communautaire de 202 GBHARSAH à London-Middlesex, en Ontario. Nos résultats montrent que, pour la totalité de l’échantillon, les expériences d’homophobie et d’homonégativité intériorisée sont associées avec une augmentation de la prévalence d’utilisation des services de santé mentale pendant l’année précédente. Ils suggèrent également que l’utilisation des services est moins élevée parmi les GB-HARSAH immigrants quand ils sont comparés à ceux qui sont nés au Canada. Les implications pour les fournisseurs de services sociaux et de santé mentale sont discutées.
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References
Adam, B. (1999). Moral regulation and the disintegrating Canadian state. In B. Adam (Ed.), The Global Emergence of Gay and Lesbian Politics: National Imprints of a Worldwide Movement (pp. 12–29). Philadelphia, PA: Temple University Press.
Aday, L. A., & Cornelius, L. (2006). Designing and Conducting Health Surveys: A Comprehensive Guide. San Francisco, CA: Jossey-Bass.
Ali J. S., McDermott S., and Gravel R. G. Recent research on immigrant health from Statistics Canada’s population surveys Canadian Journal of Public Health 2004 95 3 9 -13
Allen, M. (2015). Police-reported hate crime in Canada. Retrieved from http://www.statcan.gc.ca/pub/85-002-x/2015001/article/14191-eng.pdf
Berg R. C., Ross M. W., Weatherburn P., and Schmidt A. J. Structural and environmental factors are associated with internalised homonegativity in men who have sex with men: Findings from the European MSM Internet Survey (EMIS) in 38 countries Social Science & Medicine 2013 78 61 -69 https://doi.org/10.1016/j.socscimed.2012.11.033
Brennan D. J., Ross L. E., Dobinson C., Veldhuizen S., and Steele L. S. Men’s Sexual Orientation and Health in Canada Canadian Journal of Public Health 2010 101 3 255 -58
Brennan-Ing M. and Seidel L. “I’m created in God’s image, and God don’t create junk”: Religious participation and support among older GLBT adults Journal of Religion, Spirituality & Aging 2013 25 2 70 -92 https://doi.org/10.1080/15528030.2013.746629
Bruce D. and Harper G. W. Operating without a safety net: Gay male adolescents and emerging adults’ experiences of marginalization and migration, and implications for theory of syndemic production of health disparities Health Education & Behavior 2011 38 4 367 -378 https://doi.org/10.1177/1090198110375911
Burgess D., Lee R., Tran A., and van Ryn M. Effects of perceived discrimination on mental health and mental health services utilization among gay, lesbian, bisexual and transgender persons Journal of LGBT Health Research 2007 3 4 1 -14 https://doi.org/10.1080/15574090802226626
Bursac Z., Gauss C. H., Williams D. K., and Hosmer D. W. Purposeful selection of variables in logistic regression Source Code for Biology and Medicine 2008 3 17 1 -8 https://doi.org/10.1186/1751-0473-3-17
Cahill S., Valadez R., and Ibarrola S. Community-based HIV prevention interventions that compat anti-stigma for men who have sex with men and for transgender women Journal of Public Health Policy 2013 34 1 69 -81 https://doi.org/10.1057/jphp.2012.59
Carman M., Corboz J., and Dowsett G. W. Falling through the cracks: The gap between evidence and policy in responding to depression in gay, lesbian and other homosexually active people in Australia Australian and New Zealand Journal of Public Health 2012 36 1 76 -83 https://doi.org/10.1111/j.1753-6405.2012.00828.x
Chakraborty A., McManus S., Brugha T. S., Bebbington P., and King M. Mental health of the non-heterosexual population of England The British Journal of Psychiatry 2011 198 2 143 -148 https://doi.org/10.1192/bjp.bp.110.082271
Cochran S., Sullivan J., and Mays V. Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay and bisexual adults in the United States Journal of Consulting and Clinical Psychology 2003 71 1 53 -61 https://doi.org/10.1037/0022-006X.71.1.53
Currie M. R., Cunningham E. G., and Findlay B. M. The Short Internalized Homonegativity Scale: Examination of the factorial structure of a new measure of internalized homophobia Educational and Psychological Measurement 2004 64 6 1053 -1067 https://doi.org/10.1177/0013164404264845
D’Anna L. H., Nguyen H. H. D., Reynolds G. L., Fisher D.G., Janson M., Chen C., and Malotte C. K. The relationship between sexual minority verbal harassment and utilization of health services: Results from the Countrywide Risk Assessment Survey (CRAS) 2004 Journal of Gay & Lesbian Social Services 2012 24 2 119 -139 https://doi.org/10.1080/10538720.2012.669696
Davidson, A. (2015. Social determinants of health: A comparative approach. Don Mills, ON: Oxford University Press Canada.
De Maio F. G. and Kemp E. The deterioration of health status among immigrants to Canada Global Public Health 2010 5 5 462 -478 https://doi.org/10.1080/17441690902942480
Díaz R. M., Ayala G., Bein E., Henne J., and Marin B. V The impact of homophobia, poverty, and racism on the mental health of gay and bisexual Latino men: Findings from 3 US cities American Journal of Public Health 2001 91 6 927 -932 https://doi.org/10.2105/AJPH.91.6.927
DiFulvio G. Sexual minority youth, social connection and resilience: From personal struggle to collective identity Social Science & Medicine 2011 72 10 1611 -1617 https://doi.org/10.1016/j.socscimed.2011.02.045
Dillman, D. A. (2007). Mail and Internet Surveys: The Tailored Design Method. Hoboken, NJ: John Wiley & Sons, Inc.
Elhai J. D., Schweinle W., and Anderson S. M. Reliability and validity of the Attitudes Toward Seeking Professional Psychological Help Scale—Short Form Psychiatry Research 2008 159 3 320 -329 https://doi.org/10.1016/j.psychres.2007.04.020
Ferlatte O., Salway Hottes T., Trussler T., and Marchand R. Evidence of a syndemic among young Canadian gay and bisexual men: Uncovering the association between anti-gay experiences, psychosocial issues, and HIV risk AIDS & Behavior 2014 18 7 1256 -1263 https://doi.org/10.1007/s10461-013-0639-1
Fredriksen-Goldsen, K. I. (2007). Caregiving with Pride. Binghamton, NY: Haworth Press.
Fredriksen-Goldsen K. I., Emlet C. A., Kim H. J., Muraco A., Erosheva E. A., Goldsen J., and Hoy-Ellis C. P. The physical and mental health of lesbian, gay male, and bisexual (LGB) older adults: The role of key health indicators and risk and protective factors The Gerontologist 2013 53 4 664 -675 https://doi.org/10.1093/geront/gns123
Freund, R. J., & Littell, R. C. (1986). SAS System for Regression, 1986 Edition. Cary, NC: SAS Institute Inc.
Gelberg L., Andersen R. M., and Leake B. D. The Behavioral Model for Vulnerable Populations: Application to medical care use and outcomes for homeless people Health Services Research 2000 34 6 1273 -1302
Gerhards J. Non-discrimination towards homosexuality, the European Union’s policy and citizens’ attitudes toward homosexuality in 27 countries International Sociology 2010 25 1 5 -28 https://doi.org/10.1177/0268580909346704
Grella C. E., Greenwell L., Mays V. M., and Cochran S. D. Influence of gender, sexual orientation, and need on treatment utilization for substance use and mental disorders: Findings from the California Quality of Life Survey BMC Psychiatry 2009 9 52 https://doi.org/10.1186/1471-244X-9-52
Gushulak B. D., Pottie K., Hatcher Roberts J., Torres S., DesMeules M., and Canadian Collaboration for Immigrant and Refugee Health Migration and health in Canada: Health in the global village Candian Medical Association Journal 2011 183 12 E952 -E958 https://doi.org/10.1503/cmaj.090287
Hatzenbuehler M. L., Pachankis J. E., and Wolff J. Religious climate and health risk behaviors in sexual minority youths: A population-based study American Journal of Public Health 2012 102 4 657 -663 https://doi.org/10.2105/AJPH.2011.300517
Herrick A.L., Lim S.H., Wei C., Smith H., Guadamuz T., Friedman M.S., and Stall R. Resilience as an untapped resource in behavioral intervention design for gay men AIDS and Behavior 2011 15 Supplement 1 25 -29 https://doi.org/10.1007/s10461-011-9895-0
Herrick A. L., Stall R., Chmiel J. S., Guadamuz T. E., Penniman T., Shoptaw S., and Plankey M.W. It gets better: Resolution of internalized homophobia over time and associations with positive health outcomes among MSM AIDS and Behavior 2013 17 4 1423 -1430 https://doi.org/10.1007/s10461-012-0392-x
Hosmer Jr, D. W., Lemeshow, S., & Sturdivant, R. X. (2013). Applied Logistic Regression. Hoboken, NJ: John Wiley & Sons.
Hutchison B. and Glazier R. Ontario’s primary care reforms have transformed the local care landscape, but a plan is needed for ongoing improvement Healthcare Policy 2013 32 4 695 -703 https://doi.org/10.1377/hlthaff.2012.1087
Isacco A., Yallum N. K., and Chromik L.C. A review of gay men’s health: Challenges, strengths, and interventions American Journal of Lifestyle Medicine 2012 6 1 45 -62 https://doi.org/10.1177/1559827611402580
King M., Semlyen J., See Tai S., Killaspy H., Osborn D., Popelyuk D., and Nazareth I. A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people BMC Psychiatry 2008 8 70 https://doi.org/10.1186/1471-244X-8-70
Kirmayer L. J., Narasiah L., Munoz M., Rashid M., Ryder A. G., Guzder J., and Pottie K. Common mental health problems in immigrants and refugees: General approach in primary care Canadian Medical Association Journal 2011 183 12 E959 -E967 https://doi.org/10.1503/cmaj.090292
Knoble N. B. and Linville D. Outness and relationship satisfaction in same-gender couples Journal of Marital and Family Therapy 2012 38 2 330 -339 https://doi.org/10.1111/j.1752-0606.2010.00206.x
Landridge D. Gay affirmative therapy: A theoretical framework and defence Journal of Gay & Lesbian Psychotherapy 2007 11 1-2 27 -43 https://doi.org/10.1300/J236v11n01_03
Lewis N. M. Rupture, resilience, and risk: Relationships between mental health and migration among gayidentified men in North America Health & Place 2014a 27 212 -219 https://doi.org/10.1016/j.healthplace.2014.03.002
Lewis N. M. Moving “out,” moving on: Gay men’s migrations through the life course Annals of the Association of American Geographers 2014b 104 2 225 -233 https://doi.org/10.1080/00045608.2013.873325
Lewis N. M., Bauer G. R., Coleman T.A., Blot S., Pugh D., Fraser M., and Powell L. Community cleavages: Gay and bisexual men’s perceptions of gay and mainstream community acceptance in the post-AIDS, post-rights era Journal of Homosexuality 2015 62 9 1 -27 https://doi.org/10.1080/00918369.2015.1037120
MacIntosh H., Reissing E. D., and Andruff H. Same-sex marriage in Canada: The impact of legal marriage on the first cohort of gay and lesbian Canadians to wed Canadian Journal of Human Sexuality 2010 19 3 79 -90
Makoroka, L. (2014). Health Service Utilization among Men who Have Sex with Men (MSM) who Live in Toronto: Secondary Analysis of a Cross-sectional Study (Master’s thesis, McMaster University, Hamilton, Ontario, Canada). Retrieved from https://macsphere.mcmaster.ca/bitstream/11375/16235/1/Thesis-LMakoroka.pdf
Malyon A. K. Psychotherapeutic implications of internalized homophobia in gay men Journal of Homosexuality 1982 7 59 -69
Meyer I. H. Minority stress and mental health in gay men Journal of Health and Social Behavior 1995 36 1 38 -56
Meyer I. H. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence Psychological Bulletin 2003 129 5 674 -697 https://doi.org/10.1037/0033-2909.129.5.674
Morrison M. A. Psychological health correlates of perceived discrimination among Canadian gay men and lesbian women Canadian Journal of Community Mental Health 2011 30 2 81 -98 https://doi.org/10.7870/cjcmh-2011-0018
Munro L., Travers R., St. John A., Klein K., Hunter H., Brennan D., and Brett C. A bed of roses?: Exploring the experiences of LGBT newcomer youth who migrate to Toronto Ethnicity and Inequalities in Health and Social Care 2013 6 4 137 -150 https://doi.org/10.1108/EIHSC-09-2013-0018
Myers, T., & Remis, R. S. (2011). M-Track: Enhanced surveillance of HIV, sexually-transmitted and blood-borne infections and associated risk behaviours among men who have sex with men in Canada. Retrieved from http://librarypdf.catie.ca/pdf/ATI-20000s/26403.pdf
Newcomb M. E. and Mustanski B. Internalized homophobia and internalizing mental health problems: A metaanalytic review Clinical Psychology Review 2010 30 8 1019 -1029 https://doi.org/10.1016/j.cpr.2010.07.003
Ontario Human Rights Commission (2009). Policy and guidelines on racism and discrimination. Retrieved from http://www.ohrc.on.ca/en/resources/Policies/RacismPolicy/view
Pakula B. and Shoveller J. A. Sexual orientation and self-reported mood disorder diagnosis among Canadian adults BMC Public Health 2013 13 209 https://doi.org/10.1186/1471-2458-13-209
Peter T., Taylor C., and Chamberland L. A queer day in Canada: Examining Canadian high school students’ experiences with school-based homophobia in two large-scale studies Journal of Homosexuality 2015 62 2 186 -206 https://doi.org/10.1080/00918369.2014.969057
Pixton S. Experiencing gay affirmative therapy: An exploration of clients’ views of what is helpful Counselling and Psychotherapy Research 2003 3 3 211 -215 https://doi.org/10.1080/14733140312331384372
Ross M. W., Berg R. C., Schmidt A. J., Hospers H. J., Breveglieri M., Furegato M., and The European MSM Internet Survey (EMIS) Network Internalised homonegativity predicts HIV-associated risk behavior in European men who have sex with men in a 38-country cross-sectional study: Some public health implications of homophobia BMJ Open 2013 3 e001928 https://doi.org/10.1136/bmjopen-2012-001928
Rosser B. S., Bockting W. O., Ross M. W., Miner M. H., and Coleman E. The relationship between homosexuality, internalized homo-negativity, and mental health in men who have sex with men Journal of Homosexuality 2008 55 2 185 -203 https://doi.org/10.1080/00918360802129394
Rutherford K., McIntyre J., Daley A., and Ross L. E. Development of expertise in mental health service provision for lesbian, gay, bisexual and transgender communities Medical Education 2012 46 903 -913 https://doi.org/10.1111/j.1365-2923.2012.04272.x
SAS Institute, Inc. (2011). Version 5.1 of the SAS Enterprise Guide for Windows. Cary, NC.
Savin-Williams R. C., Joyner K., and Rieger G. Prevalence and stability of self-reported sexual orientation identity during young adulthood Archives of Sexual Behavior 2012 41 1 103 -110 https://doi.org/10.1007/s10508-012-9913-y
Select Committee on Mental Health and Addictions. (2010). Navigating the journey to wellness: The comprehensive mental health and addictions action plan for Ontarians. 2010. Retrieved from http://www.ontla.on.ca/committeeproceedings/committee-reports/files_pdf/Select%20Report%20ENG.pdf
Silverstein C. The implications of removing homosexuality from the DSM as a mental disorder Archives of Sexual Behaviour 2009 38 2 161 -163 https://doi.org/10.1007/s10508-008-9442-x
Smith M. Social movements and judicial empowerment: Courts, public policy, and lesbian and gay organizing in Canada Politics & Society 2005 33 2 327 -353 https://doi.org/10.1177/0032329205275193
Statistics Canada. (2008). Canadian Community Health Survey (CCHS). Retrieved from http://www.statcan.gc.ca/cgi-bin/imdb/p2SV.pl?Function=getSurvey&SurvId=3226&SurvVer=1&InstaId= 15282&InstaVer=4&SDDS=3226&lang=en&db=imdb&adm=8&dis=2
Statistics Canada. (2013). Health regions and peer groups. Retrieved from http://www.statcan.gc.ca/pub/82-402-x/2013003/regions/hrpg-eng.htm
Statistics Canada. (2014). Health Profile, December 2013. Retrieved from http://www12.statcan.gc.ca/healthsante/82-228/details/page.cfm?Lang=E&Tab=1&Geo1=HR&Code1=3544&Geo2=PR&Code2=35&Data=Rate&SearchText=Middlesex-London%20Health%20Unit&SearchType=Contains&SearchPR=01&B1=All&Custom=&B2=All&B3=All
Su, J., Lin, W., & Merck & Co., Inc. (2007). Using macro and ODS to overcome limitations of SAS procedures. Retrieved from http://www.lexjansen.com/nesug/nesug07/cc/cc26.pdf
Tjepkema M. Health care use among gay, lesbian and bisexual Canadians Health Reports 2008 19 1 53 -64
Wilkerson J.M., Smolenski M., Brady S. S., and Rosser B. S. Religiosity, internalized homonegativity and outness in Christian men who have sex with men Sexual and Relationship Therapy 2012 27 2 122 -132 https://doi.org/10.1080/14681994.2012.698259
Williams, C., & Lester, B. (2007). LGBT2SQ Health Forum Report. London, ON: AIDS Committee of London.
Zimet G. D., Dahlem N. W., Zimet S. G., and Farley G. K. The Multidimensional Scale of Perceived Social Support Journal of Personality Assessment 1988 51 1 30 -41 https://doi.org/10.1207/s15327752jpa5201_2
Zou G. Y. A modified Poisson regression approach to prospective studies with binary data American Journal of Epidemiology 2004 159 7 702 -706 https://doi.org/10.1093/aje/kwh090
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Canadian Journal of Community Mental Health
Volume 35 • Number 3 • December 2016
Pages: 1 - 24
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Version of record online: 6 January 2017
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Todd A. Coleman, Greta R. Bauer, Gloria Aykroyd, Leanne Powell, and Daniel Pugh. 2016. Mental Health Service Use in a Sample of Gay, Bisexual, and other Men who have Sex with Men Living in Middlesex County, Ontario, Canada: An Exploratory Analysis. Canadian Journal of Community Mental Health.
35(3): 1-24. https://doi.org/10.7870/cjcmh-2016-035
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