Stigma, Stress, and Stories: Refining our Understanding of Suicidal Behavior among Adult Gay, Bisexual, and other Sexual Minority Men

Background: Sexual minority men are approximately four times more likely than heterosexual men to have attempted suicide. Epidemiologic evidence of this disparity is robust; however, research exploring how and why this disparity persists is sparse. Objective: To refine our understanding of suicidal behavior in adult sexual minority men, with the goal of improving relevant public health strategies to prevent suicide. Methods and aims: Data were drawn from adult sexual minority men who participated in: the population-based Canadian Community Health Survey (N=4675), a gay menâ s community-based national online survey (N=7872), and in-depth interviews with men who attempted suicide (N=7). Quantitative bias analysis was used to estimate the degree of misclassification of sexual orientation and associated bias in estimates of suicidal ideation among sexual minority men in general population-based surveys (Aim 1). Structural equation modeling was used to identify specific psychosocial challenges that mediate relationships between constructs of sexual stigma and recent suicide attempts (Aim 2). Dialogical narrative analysis was used to construct life narratives used by sexual minority men with histories of suicide attempts (Aim 3). Results: Disparities in suicidal ideation comparing bisexual (odds ratio[OR]=4.91) and gay (OR=3.63) to heterosexual men persisted after adjustment for misclassification bias but were attenuated, with greater attenuation for bisexual (adjusted OR=3.53) than for gay (adjusted OR=3.52) men. Three measured constructs of sexual stigma (enacted stigma, anticipated prejudice, and sexuality concealment) were associated with suicide attempts (pPh.D