1. Mental health morbidity among gay and bisexual men
APHA
11/2007
Mental health morbidity among gay and bisexual men
Susan Cochran, PhD, MS
UCLA School of Public Health
and
Vickie Mays, PhD, MSPH
UCLA
Work supported by the National Institute of Mental Health, National Institute of Drug Abuse, Lesbian Health Fund, Institute for Gay and Lesbian Strategic Studies

2. Overview How has the methodology of this work changed?
What are some of the emerging findings on sexual orientation and mental health?
Why might sexual orientation be a risk indicator for mental health morbidity?

3. Waves of gay mental health research studies
Sampling
Findings
Wave 1:
(up to 1973)
Case studies recruited from psychiatric settings
High rates of many disorders
Wave 2:
(1957 to 1980’s)
Small convenience samples recruited via personal networks, bars, bath houses
No differences in rates of most disorders, excess alcoholism and drug use
Wave 3:
(mid 1980’s to 1998)
Large samples recruited via multiple convenience-based strategies, early pop-based sampling
Inconsistent evidence of greater risk for some disorders

4. Prevalence of depressive distress by sexual orientation across surveys of varying methodology
*Siegel et al., 1994
**Cochran & Mays, 1994

5. Waves of lesbian/gay mental health research studies
Sampling
Findings
Wave 1:
(up to 1973)
Case studies recruited from psychiatric settings
High rates of many disorders
Wave 2:
(1957 to 1980’s)
Small convenience samples recruited via personal networks, bars, bath houses, feminist meetings
No differences in rates of most disorders, excess alcoholism and drug use
Wave 3:
(mid 1980’s to 1998)
Large samples recruited via multiple convenience-based strategies, early pop-based sampling
Inconsistent evidence of greater risk for some disorders
Wave 4:
(1998 on)
General population-based methods, twin studies, cohort studies, yoked sampling
Greater risk for some disorders in most studies

6. Prevalence of depressive distress by sexual orientation across surveys of varying methodology
*Siegel et al., 1994
**Cochran & Mays, 1994
***Paul et al., 2002
****Cochran & Mays, 2007

7. Overview How has the methodology of this work changed?
What are some of the emerging findings on sexual orientation and mental health?
Why might sexual orientation be a risk indicator for mental health morbidity?

8. Positive Histories of Suicide Attempts
APHA
11/2007
Positive Histories of Suicide Attempts
Among Males by Sexual Orientation—USA Studies
Adolescents
Adults
Clearly shows higher risk
Different time frames: lifetime (Remafedi et al., 1998; Herell et al., 1999; Cochran & Mays, 2000; Gilman et al., 2001), 7 year (Fergusson et al, 1999), and 1 year periods (Faulkner & Cranston, 1998; Garofalo et al., 1998).
4 on left are adolescent studies of males and females
3 on right are adult males with only far right including adult females
consistent with general findings of higher suicide attempt rates in adolescents

9. APHA
11/2007
1 year prevalence of Major Depression by sexual orientation across 5 USA epidemiologic surveys

10. 1 year prevalence of Generalized Anxiety Disorder by sexual orientation across 4 USA epidemiologic surveys

11. 1 year prevalence of Panic Attack by sexual orientation across 4 USA epidemiologic surveys

12. 1 year prevalence of Drug Dependency by sexual orientation across 5 USA epidemiologic surveys

13. 1 year prevalence of Alcohol Dependency by gender and sexual orientation across 6 USA epidemiologic surveys

14. Overview How has the methodology of this work changed?
What are some of the emerging findings on sexual orientation and mental health?
Why might sexual orientation be a risk indicator for mental health morbidity?

15. Prevalence of perceived day-to-day frequency of discrimination occurring “sometimes” or “a lot” reported by midlife men
*p < .05
Mays & Cochran, 2001

16. Prevalence of self-reported HIV infection in 2 California Surveys
California Men’s Health Survey: Followback to the 2001 CHIS
California Quality of Life Survey: Followback to the 2003 CHIS
From: Xia et al., 2006
From: Cochran & Mays, 2007
Estimated HIV prevalence among MSM: 19.1% (95% CI: 12.8% to 25.3%)
Estimated HIV prevalence among MSM: 17.3% (95% CI: 11.3% to 23.3%)

17. Family structures differ by sexual orientation in California—Proportion living with spouse or partner
Data from the 2001 California Health Interview Survey (Cochran, Mays, Brown, & Ponce, 2004)

18. Closing Thoughts Methodological improvements have altered the field
Sexual orientation is associated with a somewhat greater risk for psychiatric morbidity
The reasons for this are still unclear
Is this due to social adversity, individual exposures, or differences in the quality of social structures?
Nevertheless, most gay and bisexual men are happy with their lives

19. *comparison between men significant at P < .05 level
APHA
11/2007
Percent of American men reporting being “very” or “pretty happy” by genders of sexual partners over varying timeframes, General Social Surveys * * * *
*comparison between men significant at P < .05 level
From: Nellos et al., 2005