Using an intersectionality-based approach to evaluate mental health services use among gay, bisexual and other men who have sex with men in Montreal, Toronto and Vancouver

Ivan Marbaniang; Erica E. M. Moodie; Eric Latimer; Shayna Skakoon-Sparling; Trevor A. Hart; Daniel Grace; David M. Moore; Nathan J. Lachowsky; Jody Jollimore; Gilles Lambert; Terri Zhang; Milada Dvorakova; Joseph Cox; Engage Team Members

doi:10.1017/S2045796024000143

Epidemiology and Psychiatric Sciences (Jan 2024)

Using an intersectionality-based approach to evaluate mental health services use among gay, bisexual and other men who have sex with men in Montreal, Toronto and Vancouver

Ivan Marbaniang,
Erica E. M. Moodie,
Eric Latimer,
Shayna Skakoon-Sparling,
Trevor A. Hart,
Daniel Grace,
David M. Moore,
Nathan J. Lachowsky,
Jody Jollimore,
Gilles Lambert,
Terri Zhang,
Milada Dvorakova,
Joseph Cox,
Engage Team Members

Affiliations

Ivan Marbaniang: ORCiD; Department of Epidemiology, McGill University, Montreal, QC, Canada
Erica E. M. Moodie: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
Eric Latimer: Mental Health and Society Division, Douglas Research Centre, Montreal, QC, Canada Department of Psychiatry, McGill University, Montreal, QC, Canada
Shayna Skakoon-Sparling: Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada Department of Psychology, University of Guelph, Guelph, ON, Canada
Trevor A. Hart: Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
Daniel Grace: Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
David M. Moore: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada Department of Medicine, Division of Infectious Disease, University of British Columbia, Vancouver, BC, Canada
Nathan J. Lachowsky: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
Jody Jollimore: Community Based Research Centre, Vancouver, BC, Canada
Gilles Lambert: Institut National de Santé Publique du Québec, Montreal, QC, Canada
Terri Zhang: ORCiD; Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
Milada Dvorakova: Clinical Outcomes Research and Evaluation, Research Institute–McGill University Health Centre, Montreal, QC, Canada
Joseph Cox: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada Clinical Outcomes Research and Evaluation, Research Institute–McGill University Health Centre, Montreal, QC, Canada
Engage Team Members

DOI: https://doi.org/10.1017/S2045796024000143
Journal volume & issue: Vol. 33

Abstract

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Abstract Aims To cope with homonegativity-generated stress, gay, bisexual and other men who have sex with men (GBM) use more mental health services (MHS) compared with heterosexual men. Most previous research on MHS among GBM uses data from largely white HIV-negative samples. Using an intersectionality-based approach, we evaluated the concomitant impact of racialization and HIV stigma on MHS use among GBM, through the mediating role of perceived discrimination (PD). Methods We used baseline data from 2371 GBM enrolled in the Engage cohort study, collected between 2017 and 2019, in Montreal, Toronto and Vancouver, using respondent-driven sampling. The exposure was GBM groups: Group 1 (n = 1376): white HIV-negative; Group 2 (n = 327): white living with HIV; Group 3 (n = 577): racialized as non-white HIV-negative; Group 4 (n = 91): racialized as non-white living with HIV. The mediator was interpersonal PD scores measured using the Everyday Discrimination Scale (5-item version). The outcome was MHS use (yes/no) in the prior 6 months. We fit a three-way decomposition of causal mediation effects utilizing the imputation method for natural effect models. We obtained odds ratios (ORs) for pure direct effect (PDE, unmediated effect), pure indirect effect (PIE, mediated effect), mediated interaction effect (MIE, effect due to interaction between the exposure and mediator) and total effect (TE, overall effect). Analyses controlled for age, chronic mental health condition, Canadian citizenship, being cisgender and city of enrolment. Results Mean PD scores were highest for racialized HIV-negative GBM (10.3, SD: 5.0) and lowest for white HIV-negative GBM (8.4, SD: 3.9). MHS use was highest in white GBM living with HIV (GBMHIV) (40.4%) and lowest in racialized HIV-negative GBM (26.9%). Compared with white HIV-negative GBM, white GBMHIV had higher TE (OR: 1.71; 95% CI: 1.27, 2.29) and PDE (OR: 1.68; 95% CI: 1.27, 2.24), and racialized HIV-negative GBM had higher PIE (OR: 1.09; 95% CI: 1.02, 1.17). Effects for racialized GBMHIV did not significantly differ from those of white HIV-negative GBM. MIEs across all groups were comparable. Conclusions Higher MHS use was observed among white GBMHIV compared with white HIV-negative GBM. PD positively mediated MHS use only among racialized HIV-negative GBM. MHS may need to take into account the intersecting impact of homonegativity, racism and HIV stigma on the mental health of GBM.

Published in Epidemiology and Psychiatric Sciences

ISSN: 2045-7960 (Print); 2045-7979 (Online)
Publisher: Cambridge University Press
Country of publisher: United Kingdom
LCC subjects: Medicine: Internal medicine: Neurosciences. Biological psychiatry. Neuropsychiatry; Medicine: Public aspects of medicine
Website: https://www.cambridge.org/core/journals/epidemiology-and-psychiatric-sciences

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