Suicide Related Ideation and Behavior Among Canadian Gay and Bisexual Men: A Syndemic Analysis

Background 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. 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. Methods This 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. Results Suicide 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. Conclusions This 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

Geographic distribution of conversion therapy prevalence in Canada. Findings from a national cross-sectional survey, 2020 [version 1; peer review: 1 approved, 2 approved with reservations]

Background: Conversion therapy practices (CTPs) are discredited efforts that target lesbian, gay, bisexual, trans, queer, Two-Spirit, or other (LGBTQ2S+) people and seek to change, deny, or discourage their sexual orientation, gender identity, and/or gender expression. This study aims to investigate the prevalence of CTPs across Canadian provinces and territories and identify whether CTP bans reduce the prevalence of CTPs. Methods: We collected 119 CTPs from 31 adults (18+) in Canada who have direct experience with CTPs, know people who have gone to CTPs, or know of conversion therapy practitioners using a 2020 anonymous online survey. Mapping analysis was conducted using ArcGIS Online. CTP prevalence was compared between provinces/territories with and without bans using chi-square tests. Results: Three provinces and eleven municipalities had CTP bans. The prevalence of CTPs in provinces/territories with bans was 2.34 per 1,000,000 population (95% CI 1.65, 3.31). The prevalence of CTPs in provinces/territories without bans was 4.13 per 1,000,000 population (95% CI 3.32, 5.14). Accounting for the underlying population, provinces/territories with the highest prevalence of CTPs per 1,000,000 population were New Brunswick (6.69), Nova Scotia (6.50), and Saskatchewan (6.37). Conclusions: Findings suggest only 55% of Canadians were protected under CTP bans. The prevalence of CTPs in provinces/territories without bans was 1.76 times greater than provinces/territories with bans. CTPs are occurring in most provinces/territories, with higher prevalence in the west and the Atlantic. These findings and continued efforts to monitor CTP prevalence can help inform policymakers and legislators as society is increasingly acknowledging CTPs as a threat to the health and well-being of LGBTQ2S+ people

Knowledge gaps in existing research exploring sexual fluidity and mental health among young adults.

While there is a large body of evidence indicating that sexual minority youth experience inequitably high rates of mental health problems (e.g. depression, suicidality), we know little about how temporal changes in sexual attractions, identities and behaviour may impact mental health (and other) outcomes. In this essay, we review existing research regarding sexual fluidity and mental health among young adults in order to identify critical knowledge gaps with respect to an epidemiological understanding of the relationship between these factors. We describe three gaps that in turn inform a larger public health research agenda on this topic. First, there are a number of methodological challenges given that fluidity can occur over short or long periods of time and across multiple dimensions of sexual orientation (e.g. attractions, identities and behaviour) with various patterns (e.g. directionality of change). Tailored measures that accurately and inclusively reflect diversities of sexual fluidity trajectories are needed. Second, causal relationships between sexual fluidity and mental health remain uncertain and unquantified. Third, little is known about how features of context (e.g. gender norms and political climate) influence youth experiences with sexual fluidity and mental health. Finally, we propose a set of recommendations to address these knowledge gaps to improve the quality of epidemiological research involving young people

Depression and suicide literacy among Canadian sexual and gender minorities

The purpose of this study was to examine and compare depression and suicide literacy among Canadian sexual and gender minorities (SGM). Online surveys comprised of the 22-item depression literacy scale (D-LIT) and the 12-item literacy of suicide scale (LOSS) were completed by 2,778 individuals identifying as SGM. Relationships between depression and suicide literacy and demographic characteristics were evaluated using multivariable linear regression. Overall, SGM correctly answered 71.3% of the questions from the D-LIT and 76.5% of the LOSS. D-LIT scores were significantly lower among cisgender men and D-LIT and LOSS scores were lower among transgender women when compared to cisgender women. LOSS and D-LIT scores were significantly lower among SGM without a university degree (compared to those with a university degree) and among SGM from ethnic minority groups (compared to White SGM). D-LIT scores, but not LOSS scores, were significantly lower among Indigenous SGM compared to White SGM. The findings provide evidence of differences in suicide and depression literacy between SGM subgroups along multiple social axes. Interventions to increase depression and suicide literacy should be prioritized as part of a mental health promotion strategy for SGM, targeting subgroups with lower literacy levels, including cisgender men, transgender women, Indigenous people, racialized minorities, and those without a university degree

Experiences with Sexual Orientation and Gender Identity Conversion Therapy Practices among Sexual Minority Men in Canada, 2019–2020

Background “Conversion therapy” practices (CTP) are organized and sustained efforts to avoid the adoption of non-heterosexual sexual orientations and/or of gender identities not assigned at birth. Few data are available to inform the contemporary prevalence of CTP. The aim of this study is to quantify the prevalence of CTP among Canadian sexual and gender minority men, including details regarding the setting, age of initiation, and duration of CTP exposure. Methods Sexual and gender minority men, including transmen and non-binary individuals, aged ≥ 15, living in Canada were recruited via social media and networking applications and websites, November 2019—February 2020. Participants provided demographic data and detailed information about their experiences with CTP. Results 21% of respondents (N = 9,214) indicated that they or any person with authority (e.g., parent, caregiver) ever tried to change their sexual orientation or gender identity, and 10% had experienced CTP. CTP experience was highest among non-binary (20%) and transgender respondents (19%), those aged 15–19 years (13%), immigrants (15%), and racial/ethnic minorities (11–22%, with variability by identity). Among the n = 910 participants who experienced CTP, most experienced CTP in religious/faith-based settings (67%) or licensed healthcare provider offices (20%). 72% of those who experienced CTP first attended before the age of 20 years, 24% attended for one year or longer, and 31% attended more than five sessions. Interpretation CTP remains prevalent in Canada and is most prevalent among younger cohorts, transgender people, immigrants, and racial/ethnic minorities. Legislation, policy, and education are needed that target both religious and healthcare settings

Stigma, Stress, and Stories: Refining our Understanding of Suicidal Behavior among Adult Gay, Bisexual, and other Sexual Minority Men

Background: Sexual minority men are approximately four times more likely than heterosexual men to have attempted suicide. Epidemiologic evidence of this disparity is robust; however, research exploring how and why this disparity persists is sparse. Objective: To refine our understanding of suicidal behavior in adult sexual minority men, with the goal of improving relevant public health strategies to prevent suicide. Methods and aims: Data were drawn from adult sexual minority men who participated in: the population-based Canadian Community Health Survey (N=4675), a gay menâ s community-based national online survey (N=7872), and in-depth interviews with men who attempted suicide (N=7). Quantitative bias analysis was used to estimate the degree of misclassification of sexual orientation and associated bias in estimates of suicidal ideation among sexual minority men in general population-based surveys (Aim 1). Structural equation modeling was used to identify specific psychosocial challenges that mediate relationships between constructs of sexual stigma and recent suicide attempts (Aim 2). Dialogical narrative analysis was used to construct life narratives used by sexual minority men with histories of suicide attempts (Aim 3). Results: Disparities in suicidal ideation comparing bisexual (odds ratio[OR]=4.91) and gay (OR=3.63) to heterosexual men persisted after adjustment for misclassification bias but were attenuated, with greater attenuation for bisexual (adjusted OR=3.53) than for gay (adjusted OR=3.52) men. Three measured constructs of sexual stigma (enacted stigma, anticipated prejudice, and sexuality concealment) were associated with suicide attempts (pPh.D

Development of a computable phenotype to identify a transgender sample for health research purposes: a feasibility study in a large linked provincial healthcare administrative cohort in British Columbia, Canada

Objectives Innovative methods are needed for identification of transgender people in administrative records for health research purposes. This study investigated the feasibility of using transgender-specific healthcare utilisation in a Canadian population-based health records database to develop a computable phenotype (CP) and identify the proportion of transgender people within the HIV-positive population as a public health priority.Design The Comparative Outcomes and Service Utilization Trends (COAST) Study cohort comprises a data linkage between two provincial data sources: The British Columbia (BC) Centre for Excellence in HIV/AIDS Drug Treatment Program, which coordinates HIV treatment dispensation across BC and Population Data BC, a provincial data repository holding individual, longitudinal data for all BC residents (1996–2013).Setting British Columbia, Canada.Participants COAST participants include 13 907 BC residents living with HIV (≥19 years of age) and a 10% random sample comparison group of the HIV-negative general population (514 952 individuals).Primary and secondary outcome measures Healthcare records were used to identify transgender people via a CP algorithm (diagnosis codes+androgen blocker/hormone prescriptions), to examine related diagnoses and prescription concordance and to validate the CP using an independent provider-reported transgender status measure. Demographics and chronic illness burden were also characterised for the transgender sample.Results The best-performing CP identified 137 HIV-negative and 51 HIV-positive transgender people (total 188). In validity analyses, the best-performing CP had low sensitivity (27.5%, 95% CI: 17.8% to 39.8%), high specificity (99.8%, 95% CI: 99.6% to 99.8%), low agreement using Kappa statistics (0.3, 95% CI: 0.2 to 0.5) and moderate positive predictive value (43.2%, 95% CI: 28.7% to 58.9%). There was high concordance between exogenous sex hormone use and transgender-specific diagnoses.Conclusions The development of a validated CP opens up new opportunities for identifying transgender people for inclusion in population-based health research using administrative health data, and offers the potential for much-needed and heretofore unavailable evidence on health status, including HIV status, and the healthcare use and needs of transgender people

Rainbow Canada Open Data

The Rainbow Index is a measure or collection of data that assesses and presents information about the legal, policy, and human rights situation for individuals with diverse sexual orientations and gender identities in a specific region or country. The index covers six topics: family, gender recognition, asylum, hate crime, equality, and freedom of assembly and association. We evaluated 2SLGBTQI policy changes in Canada over time, creating a Rainbow index score for each year, from 1975 to 2019. Some parts of the index are also applicable to policies at the provincial/territorial level, therefore, we also created a partial index for all provinces and territories. Read more about the index and the methodology behind it on our websit

Tuberculosis Screening and Active Tuberculosis among HIV-Infected Persons in a Canadian Tertiary Care Centre

RATIONALE: HIV infection increases the risk of reactivation of latent tuberculosis (TB). The present study evaluates how latent TB is detected and treated to determine the effectiveness of screening in HIV-infected patients with diverse risk profiles