Archives of Sexual Behavior

, Volume 47, Issue 4, pp 1145–1161 | Cite as

Evidence of Multiple Mediating Pathways in Associations Between Constructs of Stigma and Self-Reported Suicide Attempts in a Cross-Sectional Study of Gay and Bisexual Men

  • Travis Salway
  • Dionne Gesink
  • Selahadin Ibrahim
  • Olivier Ferlatte
  • Anne E. Rhodes
  • David J. Brennan
  • Rick Marchand
  • Terry Trussler
Original Paper


Gay and bisexual men (GBM) are more likely to attempt suicide than heterosexual men. This disparity is commonly interpreted using minority stress theory; however, specific pathways from antigay stigma to suicidal behavior are poorly understood. We aimed to estimate associations between multiple constructs of stigma and suicide attempts among adult GBM, and to measure the proportion of these associations mediated by distinct suicide risk factors, thus identifying proximal points of intervention. Data were drawn from a Canadian community-based survey of adult GBM. Structural equation modeling was used to compare associations between three latent constructs—enacted stigma (e.g., discrimination, harassment), anticipated prejudice (worry about encountering antigay/bisexual prejudice), and sexuality concealment—and self-reported suicide attempts (last 12 months). Coefficients were estimated for direct, indirect, and total pathways and evaluated based on magnitude and statistical significance. The proportion of associations mediated by depression, drug/alcohol use, and social isolation was calculated using indirect paths. Among 7872 respondents, 3.4% reported a suicide attempt in the past 12 months. The largest total association was observed for enacted stigma, and this association was partially mediated by depression and drug/alcohol use. The total association of anticipated prejudice was relatively smaller and mediated by depression and social isolation. Concealment had an inverse association with suicide attempts as mediated by depression but was also positively associated with suicide attempts when mediated through social isolation. Multiple constructs of antigay stigma were associated with suicide attempts; however, mediating pathways differed by construct, suggesting that a combination of strategies is required to prevent suicide in adult GBM.


Suicide Gay and bisexual men Minority stress Sexual stigma Mental health Sexual orientation 



The authors wish to thank the Investigaytors and other staff and volunteers of the Community-Based Research Centre who helped with the design and recruitment of the Sex Now survey. The Sex Now survey is funded by the Vancouver Foundation. Travis Salway was supported by a Vanier Canada Graduate Scholarship. David J. Brennan is partially funded by an Ontario HIV Treatment Network Applied HIV Research Chair.

Compliance with ethical standards

Ethical standard

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Travis Salway
    • 1
    • 2
  • Dionne Gesink
    • 1
  • Selahadin Ibrahim
    • 1
    • 3
  • Olivier Ferlatte
    • 4
  • Anne E. Rhodes
    • 1
    • 5
    • 6
    • 7
  • David J. Brennan
    • 8
  • Rick Marchand
    • 2
  • Terry Trussler
    • 2
  1. 1.Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
  2. 2.Community-Based Research Centre for Gay Men’s HealthVancouverCanada
  3. 3.Institute for Work & HealthTorontoCanada
  4. 4.School of NursingUniversity of British ColumbiaVancouverCanada
  5. 5.Department of PsychiatryUniversity of TorontoTorontoCanada
  6. 6.Department of Psychiatry and Behavioural NeurosciencesMcMaster University, St. Joseph’s Healthcare HamiltonHamiltonCanada
  7. 7.Offord Centre for Child StudiesHamiltonCanada
  8. 8.Factor-Inwentash Faculty of Social WorkUniversity of TorontoTorontoCanada

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