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Has depression surpassed HIV as a burden to gay and bisexual men’s health in the United States? A comparative modeling study

Social Psychiatry and Psychiatric Epidemiology volume 56, pages 273–282 (2021)Cite this article

Abstract

Background

While advances in HIV prevention and treatment have changed the epidemic for gay and bisexual men, another epidemic faces this population. Gay and bisexual men represent one of the highest risk groups for depression, which potentially poses quality-of-life and public health challenges comparable to those of HIV. The present study seeks to inform comprehensive care for sexual minority men by estimating and comparing the morbidity of HIV and depression for US gay and bisexual men.

Methods

In 2018, weighted counts of gay and bisexual men living with HIV and depression were derived from the CDC’s Medical Monitoring Project and the National Survey on Drug Use and Health, respectively. Years lived with disability for HIV and depression were calculated using the Global Burden of Disease Study’s disability weights.

Findings

Among gay and bisexual adult men in the US, the prevalence of past-year major depressive episodes is 14.17%, while the prevalence of HIV is 11.52%. We estimate that in calendar year 2015, major depressive episodes imposed 85,361 (95% CI 58,293–112,212) years lived with disability among US adult gay and bisexual men, whereas HIV posed 42,981 (95% CI 36,221–49,722) years lived with disability.

Interpretation

This analysis shows that depression morbidity currently exceeds that for HIV among US adult gay and bisexual men. While gay and bisexual men are frequently understood to be a high-risk population for HIV, including in guidelines for HIV prevention and treatment, the present analysis suggests that this population should also be considered high-risk for depression.

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Data availability

The data that support the findings of this study are publicly available from the Centers for Disease Control and Prevention, the Global Burden of Disease Study, and the Substance Abuse and Mental Health Services Administration.

Abbreviations

ART:

Antiretroviral therapy

CDC:

Centers for Disease Control and Prevention

NSDUH:

National Survey on Drug Use and Health

USPSTF:

United States Preventive Services Task Force

References

  1. Gates GJ (2011) How many people are lesbian, gay, bisexual, and transgender? The Williams Institute. https://williamsinstitute.law.ucla.edu/publications/how-many-people-lgbt/. Accessed Aug 2020

  2. Centers for Disease Control and Prevention. HIV Surveillance Report (2016) 28. https://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Accessed Sept 2018

  3. Coulter RW, Kenst KS, BowenScout DJ (2014) Research funded by the National Institutes of Health on the health of lesbian, gay, bisexual, and transgender populations. Am J Public Health 104(2):e105–e112

    PubMed  PubMed Central  Article  Google Scholar 

  4. Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States, 2010–2016. HIV Surveillance Supplemental Report 2019 24(1). https://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Accessed Aug 2020

  5. Whiteford HA, Ferrari AJ, Degenhardt L, Feigin V, Vos T (2015) The global burden of mental, neurological and substance use disorders: an analysis from the Global Burden of Disease Study 2010. PLoS One 10(2):e0116820. https://doi.org/10.1371/journal.pone.0116820

  6. Plöderl M, Tremblay P (2015) Mental health of sexual minorities. A systematic review. Int Rev Psychiatry 27(5):367–385

    PubMed  Article  Google Scholar 

  7. King M, Semlyen J, Tai SS, Killaspy H, Osborn D, Popelyuk D et al (2008) A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry 8(1):70

    PubMed  PubMed Central  Article  Google Scholar 

  8. Pachankis JE, Cochran SD, Mays VM (2015) The mental health of sexual minority adults in and out of the closet: a population-based study. J Consult Clin Psychol 83(5):890–901

    PubMed  PubMed Central  Article  Google Scholar 

  9. Bauchner H, Fontanarosa PB, Golub RM (2016) JAMA welcomes the US preventive services task ForceJAMA welcomes the US preventive services Task ForceEditorial. JAMA 315(4):351–352

    CAS  PubMed  Article  Google Scholar 

  10. Owens DK, Davidson KW, Krist AH, Barry MJ, Cabana M, Caughey AB, Curry SJ, Doubeni CA, Epling JW, Kubik M, Landefeld CS (2019) Screening for HIV infection: US preventive services task force recommendation statement. JAMA 321(23):2326–2336

  11. Siu AL, Force atUPST (2016) Screening for depression in adults: US preventive services task force recommendation statement screening for depression in adults screening for depression in adults. JAMA 315(4):380–387

    CAS  PubMed  Article  Google Scholar 

  12. Matejkowski J, Dugosh KL, Clements NT, Festinger DS (2015) Pilot testing of an online training for criminal justice professionals on medication-assisted treatment. J Addict Offender Couns 36(1):13–27

    Article  Google Scholar 

  13. Centers for Disease Control and Prevention. Behavioral and Clinical Characteristics of Persons with Diagnosed HIV Infection—Medical Monitoring Project, United States, 2015 Cycle (June 2015–May 2016). HIV Surveillance Special Report 20. https://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Published May 2018. Accessed Sept 2018

  14. Vos T, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, Abdulkader RS, Abdulle AM, Abebo TA, Abera SF, Aboyans V (2017) Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 390(10100):1211–1259

  15. Nance RM, Delaney JC, Simoni JM, Wilson IB, Mayer KH, Whitney BM et al (2018) HIV viral suppression trends over time among HIV-infected patients receiving care in the United States, 1997 to 2015: a cohort study. Ann Intern Med 169(6):376–384

    PubMed  PubMed Central  Article  Google Scholar 

  16. Sheehan DV, Harnett-Sheehan KR, BA. (1996) The measurement of disability. Int Clin Psychopharmacol 11(3):89–95

    PubMed  Article  Google Scholar 

  17. Ferrari AJ, Charlson FJ, Norman RE, Flaxman AD, Patten SB, Vos T et al (2013) The epidemiological modelling of major depressive disorder: application for the Global Burden of Disease Study 2010. PLoS ONE 8(7):e69637

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  18. Whiteford HA, Ferrari AJ, Degenhardt L, Feigin V, Vos T (2015) The Global burden of mental, neurological and substance use disorders: an analysis from the global burden of disease study 2010. PLoS ONE 10(2):e0116820

    PubMed  PubMed Central  Article  Google Scholar 

  19. Hottes TS, Bogaert L, Rhodes AE, Brennan DJ, Gesink D (2016) Lifetime prevalence of suicide attempts among sexual minority adults by study sampling strategies: a systematic review and meta-analysis. Am J Public Health 106(5):e1–12

    PubMed  PubMed Central  Article  Google Scholar 

  20. Hottes TS, Ferlatte O, Gesinka D (2015) Suicide and HIV as leading causes of death among gay and bisexual men: a comparison of estimated mortality and published research. Clin Public Health 25:513–526

    Google Scholar 

  21. Safren SA, Reisner SL, Herrick A, Mimiaga MJ, Stall RD (2010) Mental health and HIV risk in men who have sex with men. J Acquir Immune Defic Syndr (1999) 55(Suppl 2):S74–S77

    Article  Google Scholar 

  22. Reisner SL, Mimiaga MJ, Skeer M, Bright D, Cranston K, Isenberg D, Bland S, Barker TA, Mayer KH (2009) Clinically significant depressive symptoms as a risk factor for HIV infection among black MSM in Massachusetts. AIDS Behav 13(4):798–810

  23. Reisner SL, Mimiaga MJ, Safren SA, Mayer KH (2009) Stressful or traumatic life events, post-traumatic stress disorder (PTSD) symptoms, and HIV sexual risk taking among men who have sex with men. AIDS Care 21(12):1481–1489

  24. Hatzenbuehler ML, O'cleirigh C, Mayer KH, Mimiaga MJ, Safren SA (2011) Prospective associations between HIV-related stigma, transmission risk behaviors, and adverse mental health outcomes in men who have sex with men. Ann Behav Med 42(2):227–234

  25. Nanni MG, Caruso R, Mitchell AJ, Meggiolaro E, Grassi L (2015) Depression in HIV infected patients: a review. Curr Psychiatry Rep 17(1):530

    PubMed  Article  Google Scholar 

  26. Gonzalez JS, Batchelder AW, Psaros C, Safren SA (2011) 2011 Depression and HIV/AIDS treatment nonadherence: a review and meta-analysis. J Acquir Immune Defic Syndr (1999) 58(2):181–187

    Article  Google Scholar 

  27. O'Cleirigh C, Skeer M, Mayer KH, Safren SA (2009) Functional impairment and health care utilization among HIV-infected men who have sex with men: the relationship with depression and post-traumatic stress. J Behav Med 32(5):466–477

    PubMed  PubMed Central  Article  Google Scholar 

  28. Pachankis JE (2015) A transdiagnostic minority stress treatment approach for gay and bisexual men’s syndemic health conditions. Arch Sex Behav 44(7):1843–1860

    PubMed  PubMed Central  Article  Google Scholar 

  29. Burcusa SL, Iacono WG (2007) Risk for recurrence in depression. Clin Psychol Rev 27(8):959–85

  30. Bostwick WB, Boyd CJ, Hughes TL, McCabe SE (2010) Dimensions of sexual orientation and the prevalence of mood and anxiety disorders in the United States. Am J Public Health 100(3):468–475

    PubMed  PubMed Central  Article  Google Scholar 

  31. Hughes TL, Eliason M (2002) Substance use and abuse in lesbian, gay, bisexual and transgender populations. J Primary Prevent 22(3):263–298

    Article  Google Scholar 

  32. Gay and Bisexual Men’s Health: Guidelines and Recommendations: Centers of Disease Control and Prevention; 2018. https://www.cdc.gov/msmhealth/resources/guidelines-recommendations.htm. Accessed Sept 2018

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Acknowledgements

The authors would like to acknowledge the StatLab at Yale University Library for their consultation on this paper.

Funding

Daniel Bromberg was supported by funding from the National Institute of Mental Health (T32 MH20031). John Pachankis and David Paltiel were supported by funding from the National Institute of Mental Health (R01 MH109413). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health.

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Authors and Affiliations

  1. Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, 60 College St., New Haven, CT, 06520, USA

    Daniel J. Bromberg & John E. Pachankis

  2. Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, CT, USA

    Daniel J. Bromberg & John E. Pachankis

  3. Department of Health Policy and Management, Yale School of Public Health, Yale University, New Haven, CT, USA

    A. David Paltiel & Susan H. Busch

Authors
  1. Daniel J. Bromberg
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  2. A. David Paltiel
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  4. John E. Pachankis
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Contributions

All authors conceptualized and designed the protocol for this study. DJB conducted the analyses and wrote the manuscript for this study, with input from JEP, ADP, and SHB. All authors reviewed the manuscript and approved the final document for publication.

Corresponding author

Correspondence to John E. Pachankis.

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Conflict of interest

The authors declare that they have no competing interests. John E. Pachankis receives royalties from Oxford University Press for books related to LGBTQ-affirmative mental health treatments.

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Bromberg, D.J., Paltiel, A.D., Busch, S.H. et al. Has depression surpassed HIV as a burden to gay and bisexual men’s health in the United States? A comparative modeling study. Soc Psychiatry Psychiatr Epidemiol 56, 273–282 (2021). https://doi.org/10.1007/s00127-020-01938-1

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  • DOI: https://doi.org/10.1007/s00127-020-01938-1

Keywords

  • Depression
  • HIV/AIDS
  • Morbidity
  • Prevalence
  • Sexual and gender minorities