The Geneva gay men's health project : a community-research collaboration to assess and improve the health of gay men in Geneva, Switzerland

摘要

Comprehensive overviews of research in the late 1990s on health issues relevant to gay men, lesbians, bisexuals, and transgender people (LGBT) identified issues which appear to affect sexual minorities disproportionately, but the quality of the available data was deemed too poor to translate into policy initiatives. Dialogai, a gay organization in Geneva active in HIV prevention work, embarked on a community-research partnership with the Institute for Social and Preventive Medicine, University of Zurich, for the Geneva Gay Men's Health Project with the following objectives: gather information on gay men's health in order to educate itself and others, set priorities based on evidence, and introduce new interventions in response to community needs.ududAfter two rounds of focus groups and an extensive literature review phase, the first Geneva Gay Men's Health Survey (GGMHS)-patterned on national health interview surveys-was carried out in 2002 among 571 gay men recruited using randomized time-space sampling. In order to explore the possible existence of distinctive health needs among gay men along key public health indicators of health status, health-related behaviors, and health care utilization, we performed a post-hoc comparison with matched general population controls from the 2002 Swiss Health Survey. Gay men reported significantly more and severe physical symptoms (AOR=1.72-9.21), short-term disability (AOR=2.56), risk factors for chronic disease-i.e., high cholesterol, high blood pressure, high glucose, and smoking-(AOR=1.67-3.89), and greater health services utilization (AOR=1.62-4.28), even after adjustment for socio-demographic characteristics and health behaviors. The only exceptions to greater morbidity were greater attention to food choices (AOR=1.66) and less obesity (AOR=0.54) among gay men. ududGGMHS assessed common psychiatric disorders using the WHO Composite International Diagnostic Interview Short Form (CIDI-SF). Nearly half (43.7%) of the sample fulfilled diagnostic criteria for at least one of five DSM-IV disorders in the past 12 months: major depression 19.2%, specific and/or social phobia 21.9%, and alcohol and/or drug dependence 16.7%. Over one quarter of cases were comorbid with another kind of disorder. Despite chronicity, half the men with major depression and a third of the men with social and/or specific phobia actually self-reported the condition. Such men were 5 times more likely to have sought treatment, underscoring the importance of recognition in help-seeking. In all, only 35.7% of cases consulted a health care professional in the past 12 months for mental health. ududGGMHS assessed various forms of suicidality. Suicidal ideation (12 months/lifetime) was reported by 22%/55%, suicide plans 12%/38%, and suicide attempts 4%/19%. While lifetime prevalences and ratios are similar across age groups, men under 25 years reported the highest 12-month prevalences for suicidal ideation (35.4%) and suicide attempts (11.5%) and the lowest attempt ratio (1:3.1 for attempt to ideation). In order to bolster the findings for the youngest age group, we performed secondary analyses of two national adolescent health surveys from 2002-i.e., Swiss Multicenter Adolescent Survey on Health (SMASH) and Swiss Recruit Survey ud(ch-x)-comparing homo- and bisexually attracted young men directly with their heterosexual counterparts. Homo/bisexual men aged 16-20 years were significantly more likely to report 12-month suicidal ideation, plans, and attempts (OR=2.09-2.26) and lifetime suicidal ideation (OR=2.15) and suicide attempts (OR=4.68-5.36). ududGGMHS was repeated in 2007 and 2011 with a focus on mental health and assessed the understanding and experience of gay men using mental health literacy with features of cultural epidemiology. A depression vignette was labelled as such by 44.1% of the entire sample, and 61.9% of the men with major depression in the past 12 months. Discrimination (33.2%), acceptance/rejection by others (21.4%), and loneliness (24.9%) were the most common reasons given for greater susceptibility among gay men, yet men with major depression reported problems with love/relationship (32.5%) and work (28.9%) as the most common perceived causes of recent depression, and problems with love/relationship (21.9%), accepting one's homosexuality (21.1%), and family (20.2%) at initial outset. The highest proportions of gay men rated non-medical options such as a close friend (91.6%), relaxation exercises or meditation (84.4%), and physical activity (83.5%) as being helpful for the depression vignette, and seeing friends (17.2%) and doing sports (17.2%) were the most common non-professional activities mentioned spontaneously by men with major depression. While gay men share many commonalities in labelling, perceived causes, and help-seeking with general populations, several specificities in understanding and experience were identified. ududAs the first mental health intervention for a gay community, Blues-out is a depression awareness campaign modelled after the evidence-based European Alliance Against Depression. The pre-post intervention evaluation confirmed levels of recognition of depression and Blues-out comparable to those found in general populations. A third of the respondents (32.9%) recognized Blues-out in 2011. Such men were more likely to find specialists and psychological therapies helpful and correctly identify depression and gay men's greater risk for depression. Despite small effect sizes, significant net decreases (18 - 28%) were seen in lifetime suicide plans, 12-month suicidal ideation, self-reported lifetime depression, and 4-week psychological distress between 2007 and 2011. It should be a priority to test and implement public mental health interventions in such high prevalence populations. udud