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By TRENTON STRAUBE
Monday, September 11, 2006
High levels of depression among gay men magnify drug use and unprotected sex, a new report shows.
"We’ve all suspected for a long time that risk taking was related to depression," said Spencer Cox, executive director of the Medius Institute, a gay men’s health group in New York City. Cox authored the report, titled "Living on the Edge: Gay Men, Depression and Risk-Taking."
Simply put, depression increases the rate of risk-taking, Cox said. This is alarming because of the increased rate of depression among gay men. One study in the report found that 17 percent of participants had active symptoms of depression—about twice the rate of the general population.
According to "Living on the Edge," other studies show that the lifetime risk of depression is about three times higher for gay men. "Consequently, gay men have much higher levels of risk-taking behaviors," Cox said.
"Living on the Edge," released last Tuesday, examines at how these issues are related. It culls publicly available research published during the past two decades.
None of this news surprises Christopher Murray, LWSC, a counselor at The LGBT Center. "Every day we see men who are struggling with these battles taking place on multiple fronts," he said, adding that he just saw a client who was dealing with addiction and depression and another client who was dealing with anxiety and depression. "There’s no question that this constellation that gay men face makes it difficult for them to move forward."
"Depression on its own is a serious illness," Cox noted. "Even the fact that we have high rates of depression is scary."
The National Institutes of Mental Health estimates that depressive disorders affect 9.5 percent of Americans older than 18, or about 19 million people.
"Depression is under recognized," said The LGBT Center’s Murray. "We [the community] deal with high-profile issues like meth and HIV, but not the underlying diagnoses like depression and anxiety that are part of this dynamic."
Cox likens depression among gay men to obesity among Americans in general. "Just as overweight people have increased risks of cardiovascular disease, diabetes and other serious illnesses, gay men with depression and related disorders are at increased risk for a host of bad things."
The Big Question: Why?
"Living on the Edge" author Spencer Cox said that what’s more alarming is the report finds long-term risk-taking—not just the occasional slipup—and often among educated men.
Cox came to this conclusion, in part, while studying the data on syphilis infections from the late ’90s. "Statistics were suggesting that there is a sizable group of middle-class, white gay men well-connected to the gay community living in Chelsea and Hell’s Kitching and Brooklyn Heights who were getting a lot of syphilis and therefore probably HIV."
Cox pointed out that these aren’t guys who lack information on how to have safe sex. "Everybody thought the risk-taking was in young gay men and gay men of color," he said. It turns out, Cox said, that race is not the big variable, social networks are.
Cox cited a study of circuit party goers who were asked, "Have you had a drug overdose in the past year?" The average number of drug overdoses was about one in four, and of those, the average number of drug overdoses was 2.4. In other words, individuals were experiencing multiple overdoses.
All this begs the question: Why? If a person understands the dangers of drug use and unsafe sex, why would he engage in risky behavior? Cox, and doctors mentioned in his report, found that the answer is "a lot of psychosocial stuff: depression, anxiety, self-medicating, a coping style of running away from one’s problems."
In "Living on the Edge," Cox asked why depression happens much more frequently to gay men. "It may be," he wrote, "that gay men develop depression because of the stress and pain associated with the homophobia we encounter in our broader society.…Or perhaps depression in gay men is a function of the failure of the gay community to meet gay men’s needs. Some men may be at particular risk for depression because of the historical and social impact of the AIDS epidemic. Recent genetic models for homosexuality could even suggest the possibility of some biological predisposition.
"We need to understand why gay men have such high rates of depression rather than simply to accept it as a given," he wrote. "This will require a new commitment to studying and understanding gay men’s lives."
Solutions?
"Gay men have a lot to learn about mental health," Cox said. "My subjective impression is that we tolerate very high levels of anxiety and depression because they seemed normal for so long. We actually don’t necessarily know something’s wrong."
Cox said that education is key. "We need to know what the symptoms of generalized anxiety disorder are, what diagnostic tests and treatments are available, and what dysthymia is."
(Dysthymia is a mild chronic depression. An Australian study found that men with dysthymia are at higher risk than men with full-blown depression. "Guys with mild depression know something is wrong—they feel bored, sluggish—and they go out looking for a fix, they’re out partying," Cox said, adding that men with full-blown depression are probably at home sobbing in front of the television.)
The report offers ten recommendations that address the problem. They include:
Mental health care referrals should be integrated into programs aimed at preventing other diseases, such as HIV and syphilis.
Access to mental health specialists, such as psychiatrists, should be readily available and fully reimbursed, particularly for HIV-positive men.
Educational programs should offer service providers information about the specific issues that confront gay men.
"The big-picture idea is we need better mental health care," Cox said.
"Spenser Cox is calling health professionals to address these mental health issues," said Murray of The LGBT Center.
The Center, 208 W. 13th St., offers walk-in counseling from 10 a.m. to 6 p.m. weekdays. They can make referrals and see clients in group or individual settings, with a sliding scale.
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