Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.
Community-Based Research Centre for Gay Men's Health, Suite 234 - 970 Burrard Street, Vancouver, BC, V6Z 2R4, Canada.
Arch Sex Behav. 2018 May;47(4):1145-1161. doi: 10.1007/s10508-017-1019-0. Epub 2017 Aug 18.
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.
男同性恋和双性恋者（GBM）比异性恋男性更有可能尝试自杀。这种差异通常用少数群体应激理论来解释；然而，从恐同耻辱到自杀行为的具体途径还知之甚少。我们旨在估计多种耻辱感结构与成年 GBM 自杀企图之间的关联，并衡量这些关联通过不同自杀风险因素的中介比例，从而确定干预的近端点。数据来自加拿大一项针对成年 GBM 的基于社区的调查。结构方程模型用于比较三个潜在结构（如歧视、骚扰等）之间的关联，以及预测性偏见（担心遇到恐同/双性恋偏见）和性取向隐瞒与自我报告的自杀企图（过去 12 个月）。对于直接、间接和总途径，根据大小和统计显著性估计系数。使用间接途径计算抑郁、药物/酒精使用和社会隔离介导的关联比例。在 7872 名受访者中，有 3.4%的人在过去 12 个月内有过自杀企图。实施性耻辱感的总关联最大，这种关联部分通过抑郁和药物/酒精使用来介导。预期偏见的总关联相对较小，通过抑郁和社会隔离来介导。隐瞒与抑郁介导的自杀企图呈负相关，但当通过社会隔离介导时，与自杀企图呈正相关。多种恐同耻辱感结构与自杀企图有关；然而，中介途径因结构而异，这表明需要综合多种策略来预防成年 GBM 中的自杀。
