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Arch Sex Behav. 2018 May;47(4):1145-1161. doi: 10.1007/s10508-017-1019-0. Epub 2017 Aug 18.

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.

Author information

1
Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada. travissalway.hottes@mail.utoronto.ca.
2
Community-Based Research Centre for Gay Men's Health, Suite 234 - 970 Burrard Street, Vancouver, BC, V6Z 2R4, Canada. travissalway.hottes@mail.utoronto.ca.
3
Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.
4
Institute for Work & Health, 481 University Avenue, Toronto, ON, M5G 2E9, Canada.
5
School of Nursing, University of British Columbia, Room 107 - Med Block C, 2176 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.
6
Department of Psychiatry, University of Toronto, 585 University Avenue, Toronto, ON, M5G 2N2, Canada.
7
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.
8
Offord Centre for Child Studies, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
9
Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada.
10
Community-Based Research Centre for Gay Men's Health, Suite 234 - 970 Burrard Street, Vancouver, BC, V6Z 2R4, Canada.

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.

KEYWORDS:

Gay and bisexual men; Mental health; Minority stress; Sexual orientation; Sexual stigma; Suicide

PMID:
28821997
DOI:
10.1007/s10508-017-1019-0

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