Abstract
BackgroundWhile several studies have demonstrated that gay and bisexual men are at increased risk of suicide less attention has been given to the processes that generate the inherent inequity with the mainstream population. This study tested whether syndemic theory can explain the excess suicide burden in a sample of Canadian gay and bisexual men. Syndemic theory accounts for co-occurring and mutually reinforcing epidemics suffered by vulnerable groups due to the effects of social marginalization.MethodsThis study used data from Sex Now 2011, a cross-sectional survey of Canadian gay and bisexual men (n = 8382). The analysis measured the extent to which anti-gay marginalization and several psychosocial health problems are associated with suicide related ideation and attempts. Since psychosocial health problems were hypothesized to have an additive effect on suicide related ideation and attempts, the analysis calculated the effect of accumulated psychosocial health problems on suicide behavior.ResultsSuicide ideation and attempts were positively associated with each individual marginalization indicator (verbal violence, physical violence, bullying, sexual violence and work discrimination) and psychosocial health problems (smoking, party drugs, depression, anxiety, STIs, HIV risk and HIV). Furthermore, prevalence of suicide ideation and attempts increased with each added psychosocial health problem. Those who reported 3 or more had 6.90 (5.47–8.70) times the odds of experiencing suicide ideation and 16.29 (9.82–27.02) times the odds of a suicide attempt compared to those with no psychosocial health problems.ConclusionsThis investigation suggests that syndemics is a useful theory for studying suicide behavior among gay and bisexual men. Moreover, the findings highlight a need to address gay and bisexual men’s health problems holistically and the urgent need to reduce this population’s experience with marginalization and violence.
Highlights
While several studies have demonstrated that gay and bisexual men are at increased risk of suicide less attention has been given to the processes that generate the inherent inequity with the mainstream population
In exploring the particular psychosocial health problems that constitute this syndemic, we found that each was associated with suicide related ideation and behavior, but the largest effect was found in evaluating the cumulative number of problems—as predicted by syndemic theory
This study showed that psychosocial health problems have an additive effect on suicide, increasing the odds of suicide ideation and suicide attempts
Summary
While several studies have demonstrated that gay and bisexual men are at increased risk of suicide less attention has been given to the processes that generate the inherent inequity with the mainstream population. Minority stress model [6], psychological mediation model [7] and ecological systems models [8] have emerged in the suicide literature as three theories that potentially address the Ferlatte et al BMC Public Health (2015) 15:597 unique vulnerabilities of sexual minorities to suicide related ideation and behavior, though few of these have been tested with empirical data [5, 9] Another conceptual framework that may help explain the excess rate of suicide related ideation and behavior among gay and bisexual men may be found in syndemic theory. Syndemic theory distinguishes itself from other theories that link marginalization to negative health outcomes by its holistic lens - rather than seeing health outcomes, such as suicide and suicide related ideation and behavior, in isolation from other health problems, syndemic theory illuminates the synergistic interactions of multiple health problems and how these co-occurring epidemics affect communities and degrade the overall health status of a population
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