Prevalence of sexual victimization and correlates of forced sex in Japanese men who have sex with men

Factors associated with help-seeking regarding sexual orientation concerns among Japanese gay and bisexual men: results from a cross-sectional survey

OBJECTIVE

This study investigates Japanese gay and bisexual men's experiences of seeking help for emotional support from others regarding their sexual orientation concerns. It examines the relationship between their help-seeking and presence of gay and bisexual peers, duration between questioning their sexual orientation and accepting it, and experience of coming out to family members by multiple logistic regression analysis.

RESULTS

We conducted a cross-sectional survey using a self-reported paper questionnaire. There were 360 valid responses. Eighty-two respondents (22.8%) had experience of help-seeking for emotional support, and this was associated with age, occupation, presence of gay/bisexual friends, and experience of coming out to family members about their sexual orientation. Respondents sought the most help from their male friends (70.0%), followed by female friends (25.0%), mothers (17.5%), and the Internet (16.3%). Even after controlling for age and occupation, experience of help-seeking for emotional support was higher among participants who had gay/bisexual friends when they were aware of their sexual orientation, took < 1 year from questioning to realizing their sexual orientation, and had come out to their family about their sexual orientation.

Suicidal ideation, plan, and attempt among men who have sex with men in Nepal: Findings from a cross-sectional study

Men who have sex with men (MSM) are at increased risk for suicide, with a much higher prevalence of suicidality than the general population. While there is a growing interest in the identification of risk factors for suicidal behaviors globally, the understanding of the prevalence and risk factors for suicidal behaviors among MSM in the context of low- and middle-income countries is almost non-existent. Therefore, this study aimed to investigate suicidal ideation, plan, and attempts, and related factors among MSM in Nepal. A cross-sectional respondent driven survey was conducted on 250 MSM between October and December 2022. Bivariate and multivariable logistic regression was used to evaluate independent correlates of suicidal behaviors of MSM. Overall, the lifetime prevalence of suicidal ideation, plans, and attempts among MSM in this study were 42.4%, 31.2%, and 21.6%, respectively. MSM with depressive symptoms (aOR = 5.7, 95% CI = 2.4-14.1), advanced education (higher secondary and above; aOR = 2.9, 95% CI = 1.4-6.1), and smoking habit (aOR = 2.5, 95% CI = 1.2-5.3) were at increased risk for suicidal ideation. Similarly, those with depressive symptoms (aOR = 2.2, 95% CI = 1.1-4.8) and advanced education (aOR = 2.7, 95% CI = 1.2-5.7) were more likely to plan suicide, whereas young MSM were significantly more prone to attempting suicide (aOR = 2.7, 95% CI = 1.3-5.8). Interestingly, MSM with moderate to severe food insecurity were 2-3 times more likely to think about, plan, or attempt suicide (ideation: aOR = 3.5, 95% CI = 1.6-7.7; plan: aOR = 3.7, 95% CI = 1.6-8.3; attempt: aOR = 2.2, 95% CI = 1.1-4.6). The results suggest the importance of early assessment of suicidal behaviors among MSM and the need for tailored interventions to simultaneously address mental health problems and food insecurity to reduce suicide-related problems among Nepalese MSM.

The global prevalence of suicidal ideation and suicide attempts among men who have sex with men: a systematic review and meta-analysis

BACKGROUND

This study aimed to determine the global prevalence of suicidal ideation and attempts among men who have sex with men (MSM) as a systematic review, and meta-analysis.

METHODS

For this meta-analysis, a search in four international databases (PubMed, Scopus, Web of Science, and EMBASE) was designed, and performed. In the next step, the information extraction checklist was prepared based on the study authors' opinions, and the quality of the articles was evaluated using the Newcastle-Ottawa scale (NOS) checklist. Data meta-analysis was performed using STATA16 software with a significance level below 0.05.

RESULTS

The results showed the prevalence of suicidal ideation, and suicide attempts among MSM was 21% (95% CI 17%-26%), and 12% (95% CI 8%-17%), respectively. The results of the subgroup analysis showed that the prevalence of suicidal ideation in the population of MSM living with Human immunodeficiency virus (HIV) was 40% (95% CI 35%-45%), and the prevalence of suicide attempts among MSM with HIV was 10% (95% CI 1%-27%). The prevalence of suicidal ideation in European MSM, and the prevalence of suicide attempts among American MSM were higher than other MSM in other geographical areas.

CONCLUSION

Considering that the prevalence of suicidal ideation and attempts among these people is many times higher than that among men in the general population, developing programs for the prevention of mental disorders with special attention to suicide is necessary for these people. Screening programs are also recommended for early diagnosis and prevention of suicide among these people.

Chemsex and chemsex associated substance use among men who have sex with men in Asia: A systematic review and meta-analysis

BACKGROUND

The prevalence of chemsex has been reported by multiple systematic reviews among men who have sex with men (MSM) focussing predominantly on the Global North. An Asian perspective with meta-analytical evidence is missing. This meta-analysis summarised the prevalence of substance use associated with chemsex, and chemsex activity among MSM and MSM sub-populations in Asia, as well as the likelihood for chemsex among MSM living with or without HIV.

METHODS

We utilized PubMed, Web of Science and medRxiv to search for literature describing chemsex and its associated substance use among MSM and MSM sub-populations in Asia from January 1, 2010 to November 1, 2021 to conduct three meta-analyses with both frequentist and Bayesian approaches.

RESULTS

We identified 219 studies and included 23 in the meta-analysis. Based on the frequentist models, methamphetamine was the default substance associated with chemsex among MSM in Asia (prevalence = 0.16, 95 %CI:0.09-0.22), followed by GHB/GBL (prevalence = 0.15, 95 %CI:0.03-0.27) and ketamine (prevalence = 0.08, 95 %CI:0.04-0.12), but hardly any cocaine (prevalence = 0.01, 95 %CI:0.00-0.03). Compared to a general MSM population (prevalence = 0.19, 95 %CI:0.15-0.23), MSM engaging in transactional sex showed a higher prevalence of chemsex (MSM sex work clients [prevalence = 0.28, 95 %CI:0.11-0.45]; MSM sex worker [prevalence = 0.28, 95 %CI:0.17-0.26]). MSM living with HIV also showed higher odds of chemsex activity (OR = 3.35, 95 %CI:1.57-7.10), compared to MSM living without HIV. Both meta-analytic models converged, indicating robust evidence.

CONCLUSIONS

Our meta-analyses showed that chemsex is not uncommon among MSM, and MSM engaging in transactional sex in Asia. We confirmed that MSM living with HIV have a higher likelihood of engaging in chemsex, too. Chemsex prevention and management strategies in Asia should be adjusted accordingly.

A nomogram of suicidal ideation among men who have sex with men in China: Based on the integrated motivational-volitional model of suicidal behavior

Introduction

Men who have sex with men (MSM) are a high-risk group for suicide, with a much higher prevalence of suicidal ideation (SI) than the general population and male population. The aim of this study was to explore the risk factors influencing the development of SI and to develop and validate a nomogram among MSM.

Methods

A cross-sectional study was conducted in 915 MSM from Shanghai, Shenyang, Shenzhen and Kunming, China using the snowball sampling method. The integrated motivational-volitional (IMV) model of suicidal behavior was used as a theoretical framework to collect different potential influencing factors of SI including diathesis-environment-life events factors and psychosocial factors. The risk factors of SI were screened by logistic regression analysis, and a nomogram for predicting SI were developed. Model properties including discrimination, calibration and decision curves were evaluated to validate the prediction model.

Results

882 MSM were included in the statistical analysis, with a lifetime prevalence of SI of 34.4% (303/882). Logistic regression analysis showed that age group, sexual orientation disclosure, high-risk sexual behavior, entrapment, defeat and interpersonal needs were associated with SI. A nomogram was constructed based on the above six predictors. AUC values of ROC for prediction model were 0.761 (0.641-0.770) and 0.754 (0.565-0.822) in the training set (n = 662) and validation set (n = 220), respectively. And there was no statistical difference of the AUC values between the two sets (P > 0.05). The calibration plots of the prediction model in both sets fit well with the ideal model (P > 0.05). The decision curves demonstrated that the threshold probability of prediction model in training set was 1-85%, whereas in validation set was 1-63%.

Conclusions

The lifetime prevalence of SI among Chinese MSM is high. The nomogram can serve as a useful tool to predict the development of SI among MSM. Defeat, entrapment and interpersonal needs, as significant predictors of SI, can be measured to identify SI in advance. Early assessment of SI and the enhancement of psychosocial interventions are important to prevent suicide-related behaviors. Future studies could incorporate more variables of interest to refine the prediction model to better guide behavioral and psychological intervention strategies among MSM.

Associations between sexual assault and suicidal thoughts and behavior: A meta-analysis

OBJECTIVE

The goal of the present study was to conduct a quantitative review to determine the degree to which specific forms of suicidality (i.e., lifetime and past-year suicidal ideation and attempts) are associated with sexual assault (SA). It also examined whether the strength of the association between SA and suicidality was moderated by sample characteristics or the type of suicidality assessed.

METHOD

A subset of studies (25 samples and 36 effects, reflecting N = 88,376 participants) from a prior meta-analysis assessing associations between SA and psychopathology was examined. Included studies provided the prevalence of suicidality in subsamples that had and had not been exposed to SA and/or an odds ratio comparing the prevalence in these groups. Random effects metaregression models aggregated prevalence estimates and odds ratios for lifetime and past-year suicidal ideation and suicide attempts in individuals in SA and no-SA groups. Analyses also examined whether sample characteristics (i.e., percent women, college sample) or type of suicidality moderated the magnitude of odds ratios.

RESULTS

Subsamples exposed to SA reported a substantially higher prevalence of suicidality (27.25%) compared with unassaulted subsamples (9.37%). There were significantly higher rates of lifetime and past-year suicidal ideation, and lifetime suicide attempts in assaulted subsamples than in unassaulted subsamples. No tested moderators had significant associations with the strength of the relationship between SA and suicidality.

CONCLUSION

Findings underscore the robust relationship between SA and both suicidal ideation and attempts and suggest that identifying moderators and mediators that explain it is a key directive for future research. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Major Depression Among Young Men Who Have Sex with Men in Beirut, and Its Association with Structural and Sexual Minority-Related Stressors, and Social Support

Guided by the minority stress model, we assessed depression and its relationship to structural and sexual minority-related stressors and social support in a sample of 226 young (age 18-29 years) men who have sex with men in Beirut, Lebanon. The sample was recruited with long-chain peer referrals and administered a survey that included the PHQ-9 measure of depression. 16% had current major depression based on our PHQ-9 criteria, and 33% reported any lifetime history of suicidal ideation (including 8% who had made an attempt); 69% had experienced any sexual minority-related discrimination in the past year. In bivariate analysis, structural (unemployment, no legal resident status) and sexual minority-related (greater number of types of discrimination experienced, greater discomfort with one's sexual orientation) stressors were associated with major depression, as was lower social support. Discomfort with one's sexual orientation was the only correlate of major depression when controlling for other stressors, social support and socio-demographics. These findings highlight a high level of depression, and the potential for community building and social solidarity for mitigating the effects of stressors based in personal security, internalized stigma and discrimination.

Association of recent gay-related stressful events and emotional distress with suicidal behaviors over 12 months in Chinese men who have sex with men

INTRODUCTION

The study was designed to assess the association of gay-related stressful events (GRSEs) and emotional distress with suicidal behaviors over a 12-month period in Chinese men who have sex with men (MSM).

METHODS

A total of 807 MSM were recruited using a respondent-driven sampling method from 4 cities in northeastern China. The GRSEs were measured using the Gay-related Stressful Life Events Scale, depression using the Self-rating Depression Scale, and anxiety using the Self-rating Anxiety Scale.

RESULTS

A total of 26.0% of study participants experienced GRSEs during the 3 months, and their average Self-rating Depression Scale and Self-rating Anxiety Scale scores were significantly lower than the national norms. Over a 12-month period, the prevalence of suicidal ideation, plan, and attempt was 9.7%, 4.0%, and 3.0%, respectively, each of which is at least 3 to 4 times greater than that of male adults in the general population of China. Multiple logistic regression analysis showed that GRSEs significantly increased the risk of suicidal ideation (odds ratio [OR] = 2.3, 95% confidence interval [CI], 1.4-3.7) and plan (OR = 2.8, 95% CI, 1.3-6.0). Depressive symptoms significantly increased the risk of suicidal ideation (OR = 3.5, 95% CI, 2.1-5.8), plan (OR = 4.4, 95% CI, 2.0-9.6), and attempt (OR = 5.6, 95% CI, 21.94.8). Anxiety symptoms (OR = 3.4, 95% CI, 1.4-8.4) and cohabitation with a same sex partner (OR = 3.0, 95% CI, 1.2-7.9) significantly increased the risk of suicide attempt.

DISCUSSION

More efforts to reduce GRSE are worth investigating as a strategy to reduce suicidal thoughts and behaviors in Chinese MSM.

Longitudinal course of eating disorders after transsexual treatment: a report of two cases

Background

Several reports have been published on patients with gender dysphoria and eating disorders. However, there have been few reports on the longitudinal course of eating disorders after gender reassignment surgery (GRS)/gender confirmation surgery (GCS).

Case presentation

We report two Japanese cases of transsexual persons with eating disorders who underwent GRS/GCS, one male-to-female (MtF) and one female-to-male (FtM). Case 1 was a 35-year MtF person who had a 14-year-course of bulimia nervosa that developed after GRS. Case 2 was a 35-year FtM person with anorexia nervosa who underwent GCS 9 years before.

Conclusions

We found that the treatment of our transsexual patients influenced the course of their eating disorders for a long period, which could be attributable partly to the cultural situation in Japan, an East Asian country. It is possible that many gender identity problems and identity problems in general persist even after surgery and treatment; therefore, continual clinical support should be provided for patients with gender dysphoria and eating disorders even after hormonal therapy or GRS/GCS.

Sexual assault victimization and psychopathology: A review and meta-analysis

Sexual assault (SA) is a common and deleterious form of trauma. Over 40years of research on its impact has suggested that SA has particularly severe effects on a variety of forms of psychopathology, and has highlighted unique aspects of SA as a form of trauma that contribute to these outcomes. The goal of this meta-analytic review was to synthesize the empirical literature from 1970 to 2014 (reflecting 497 effect sizes) to understand the degree to which (a) SA confers general risk for psychological dysfunction rather than specific risk for posttraumatic stress, and (b) differences in studies and samples account for variation in observed effects. Results indicate that people who have been sexually assaulted report significantly worse psychopathology than unassaulted comparisons (average Hedges' g=0.61). SA was associated with increased risk for all forms of psychopathology assessed, and relatively stronger associations were observed for posttraumatic stress and suicidality. Effects endured across differences in sample demographics. The use of broader SA operationalizations (e.g., including incapacitated, coerced, or nonpenetrative SA) was not associated with differences in effects, although including attempted SA in operationalizations resulted in lower effects. Larger effects were observed in samples with more assaults involving stranger perpetrators, weapons, or physical injury. In the context of the broader literature, our findings provide evidence that experiencing SA is major risk factor for multiple forms of psychological dysfunction across populations and assault types.

Correlates of Forced Sex Among Young Men Who Have Sex With Men in Yangon and Monywa, Myanmar

Forced sex at an early age is associated with a variety of negative factors including increased illness, high-risk sexual and substance-use behaviors, and mental and psychological stress. These sequelae may be compounded for men who have sex with men (MSM), especially young MSM and those with feminine gender identity and expression. This survey examined the prevalence and associations of forced sex among young MSM in two cities in Myanmar. In 2013-2014, surveys using respondent-driven sampling collected data on 200 young MSM in Yangon and 200 in Monywa. One quarter of young MSM in Yangon and 21 % in Monywa reported ever experiencing forced sex. In a multivariable model, having problems with family members and having any MSM friends with many partners had higher odds of experiencing forced sex. Having maternal acceptance of same-sex attraction (compared to acceptance by both parents) and becoming aware of their same-sex attraction at or above the age of 16 had lower odds of experiencing forced sex. Focused research is needed to understand the family and other social dynamics affecting vulnerability to forced sex, as well as specific sexual risks associated with forced sex among young MSM, including HIV acquisition and transmission risks.

Suicidal ideation among MSM in three West African countries: Associations with stigma and social capital

BACKGROUND

Suicidal ideation is understudied among men who have sex with men (MSM) across Sub-Saharan Africa.

AIMS

This study aimed to explore social capital and sexual behavior stigma associated with suicidal ideation among MSM in the West African nations of The Gambia, Burkina Faso and Togo.

METHODS

Participants were recruited using respondent-driven sampling and snowball sampling across multiple cities (n = 1555) from July 2011 to August 2013. During a single study visit, participants completed a survey. Logistic regression models were used to assess bivariate and multivariable associations with suicidal ideation.

RESULTS

The prevalence of lifetime suicidal ideation was 13% overall and ranged 6%-17% across study sites. After adjusting for potential confounders, MSM who reported stigma as a result of having sex with men were more likely to report suicidal ideation. Physical and sexual violence was strongly associated with suicidal ideation, including being physically harmed (adjusted odds ratio (aOR) = 2.94, 95% confidence interval (CI) = 1.91, 4.52), tortured (aOR = 3.86, 95% CI = 2.17, 6.86) and raped (aOR = 3.07, 95% CI = 2.05, 4.60). In contrast, increasing social participation with the broader community was associated with decreased report of suicidal ideation (aOR = 0.91, 95% CI = 0.85, 0.99).

CONCLUSION

Sexual behavior stigma should be addressed to improve mental health among MSM in Western Sub-Saharan Africa.

HIV's Syndemic Links With Mental Health, Substance Use, and Violence in an Environment of Stigma and Disparities in Japan

A syndemics orientation has become a valuable lens through which to understand the complex system dynamics of HIV, HIV's links to other social and health problems, and the design of effective, comprehensive interventions. Using data from a broader ethnographic study of HIV epidemics in the Kansai Region and Tokyo Metropolitan Area of Japan, I found that HIV was synergistically linked with poor mental health, substance use, and violence, suggesting the existence of at least three syndemics. These occurred in an environment of stigma and social and health disparities, particularly for men who have sex with men, transgender persons, immigrants, and people living with HIV. Integrated interventions, led by Japan's HIV nongovernmental organizations and supported by the government, should more aggressively target stigma, which underlies most of the syndemic connections. Quantitative research should build upon the ethnographically derived associations shown here and test whether there are additive syndemic effects.

Prevalence and risk factors for lifetime suicide ideation, plan and attempt in Chinese men who have sex with men

BACKGROUND

To describe the level and risk factors for suicidal behaviors in Chinese men who have sex with men (MSM).

METHODS

A total of 807 MSM were recruited using a respondent-driven sampling method from Anshan, Benxi, Dandong, and Shenyang cities in northeastern China.

RESULTS

Chinese MSM had lifetime prevalences of suicide ideation (18.3%), plan (8.7%) and attempt (4.6%) that were about 2.8, 5.8 and 5.8 times greater than that of male adults in the general population of China. The MSM with any psychiatric disorders were 4-7 times more likely to think about, plan or attempt suicide than those MSM with no disorder, and there was a clear relationship between the number of comorbid disorders and suicidal behaviors. Multiple regression analysis showed that major depression, bipolar disorder, dysthymia and alcohol use disorder significantly increased the risk for suicide ideation, but not for suicide attempt. Drug dependence disorder, panic disorder and generalized anxiety disorder significantly increased the risk for suicide attempt, but not for suicide ideation. More advanced education reduced the risk of suicidal behaviors, sexual orientations revealed to or discovered by family members or friends significantly increased risk of these suicidal behaviors.

CONCLUSIONS

Chinese MSM have significantly increased risk for suicidal behaviors, mental disorders and their comorbidities could be the largest risk factors for the elevated suicidal behaviors in Chinese MSM. Reducing the family and social stigma and rejection of homosexual behavior and early detection and effective treatment of psychiatric disorders and their comorbidities in MSM may help to decrease suicidal behaviors of Chinese MSM.