TY - JOUR
T1 - Effects of syndemic psychiatric diagnoses on health indicators in men who have sex with men
AU - Batchelder, Abigail W.
AU - Choi, Karmel
AU - Dale, Sannisha K.
AU - Pierre-Louis, Catherine
AU - Sweek, Elsa W.
AU - Ironson, Gail
AU - Safren, Steven A.
AU - O'Cleirigh, Conall
N1 - Funding Information:
Funding was provided by the National Institute of Mental Health (R01MH095624 to Conall O’Cleirigh). Abigail W. Batchelder was supported, in part, by National Institute on Drug Abuse (K23DA043418). ClinicalTrials.gov identifier: NCT01395979.
Publisher Copyright:
© 2019 American Psychological Association.
PY - 2019/6
Y1 - 2019/6
N2 - Objective: Syndemic theory posits that co-occurring problems (e.g., substance use, depression, and trauma) synergistically increase HIV risk in men who have sex with men (MSM). However, most investigations have assessed these problems additively using self-report. Method: In a sample of HIV-negative MSM with trauma histories (n = 290), we test bivariate relationships between four clinical diagnoses (substance use disorder [SUD]); major depressive disorder [MDD], posttraumatic stress disorder [PTSD], and anxiety disorders) and their additive and interactive effects on three health indicators (i.e., high-risk sex, visiting the emergency room [ER], and sexually transmitted infections [STIs]). Results: We found significant bivariate relationships between SUD and MDD (ξ2 = 4.85, p = .028) and between PTSD and MDD (ξ2 = 35.38, p = .028, p = .001) but did not find a significant relationship between SUD and PTSD (ξ2 = 3.64, p = .056). Number of diagnoses were associated with episodes of high-risk sex (incidence rate ratio [IRR] = 1.14, 95% CI [1.03, 1.26], p = .009) and visiting the ER (odds ratio = 1.27; 95% CI [1.01, 1.60], p = .040) but not with STIs. No interactions were found between diagnoses and health-related indicators. Conclusions: This is the first study to demonstrate additive effects of clinical diagnoses on risk behavior and health care utilization among MSM with developmental trauma histories. Results indicate the need to prioritize empirically supported treatments for SUD and MDD, in addition to trauma treatment, for this population.
AB - Objective: Syndemic theory posits that co-occurring problems (e.g., substance use, depression, and trauma) synergistically increase HIV risk in men who have sex with men (MSM). However, most investigations have assessed these problems additively using self-report. Method: In a sample of HIV-negative MSM with trauma histories (n = 290), we test bivariate relationships between four clinical diagnoses (substance use disorder [SUD]); major depressive disorder [MDD], posttraumatic stress disorder [PTSD], and anxiety disorders) and their additive and interactive effects on three health indicators (i.e., high-risk sex, visiting the emergency room [ER], and sexually transmitted infections [STIs]). Results: We found significant bivariate relationships between SUD and MDD (ξ2 = 4.85, p = .028) and between PTSD and MDD (ξ2 = 35.38, p = .028, p = .001) but did not find a significant relationship between SUD and PTSD (ξ2 = 3.64, p = .056). Number of diagnoses were associated with episodes of high-risk sex (incidence rate ratio [IRR] = 1.14, 95% CI [1.03, 1.26], p = .009) and visiting the ER (odds ratio = 1.27; 95% CI [1.01, 1.60], p = .040) but not with STIs. No interactions were found between diagnoses and health-related indicators. Conclusions: This is the first study to demonstrate additive effects of clinical diagnoses on risk behavior and health care utilization among MSM with developmental trauma histories. Results indicate the need to prioritize empirically supported treatments for SUD and MDD, in addition to trauma treatment, for this population.
KW - Comorbidity
KW - HIV
KW - Men who have sex with men (MSM)
KW - Mental health
KW - Syndemics
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U2 - 10.1037/hea0000724
DO - 10.1037/hea0000724
M3 - Article
C2 - 30973745
AN - SCOPUS:85064340239
VL - 38
SP - 509
EP - 517
JO - Health Psychology
JF - Health Psychology
SN - 0278-6133
IS - 6
ER -