Faced with exposure to stigma-related stressors throughout their lives, gay and bisexual men are nearly twice as likely as their heterosexual peers to experience major depressive or anxiety disorders.
And because these disorders are associated with drug and alcohol abuse, lack of condom use and sexually compulsive behaviors, gay and bisexual men are also at increased risk for HIV infection.
To address this widespread public health issue, a new $3.9 million grant has been awarded to a Yale School of Public Health researcher and colleagues to study the efficacy of a mental health intervention that they developed. It targets young gay and bisexual men and helps them cope with stigma-related stress to reduce their risk of mental-health disorders, including alcohol and drug abuse and HIV-risk behaviors. The National Institute of Mental Health awarded the grant.
The research team has already conducted a multi-year pilot study. They consulted community health providers and at-risk gay and bisexual men to create an intervention that teaches skills to counteract the harmful effects of stigma-related stress. Sixty-three young men received the intervention, and the findings indicate that participants experienced improved mental and sexual health. With the new grant, researchers are planning to launch a larger trial with a higher level of control.
“If this next stage of testing works as we expect it to, we will have strong evidence about how to effectively treat gay and bisexual men’s mental health problems and their associations with HIV risk,” said John Pachankis, Ph.D., associate professor and the study’s principal investigator.
Pachankis said researchers have found ample support for the idea that the disproportionate mental health problems faced by many gay and bisexual men have their roots in early and ongoing experiences with stigma-related stress, such as teasing by peers, feelings of not fitting in, social isolation, a lower sense of self-worth and anticipated rejection. This sets the stage, he said, for “mental health problems in adulthood and stress in navigating ways of life that don’t conform to a standard template.”
The 10-session intervention designed by Pachankis and his group includes cognitive-behavioral techniques that teach men skills to counteract the effects of stigma-related stress. For example, men who internalize negative lessons about themselves might avoid romantic connections with other men. “We helped these men learn to recognize the origin of these behaviors, tolerate strong emotions, and engage in more personally meaningful and rewarding behavior,” Pachankis said.
We helped these men learn to recognize the origin of these behaviors, tolerate strong emotions, and engage in more personally meaningful and rewarding behavior
John Pachankis
The study will be conducted in New York City and Miami and involve 250 young men who are depressed or anxious and at risk for HIV and other problems. The intervention will be tested against more traditional community treatment methods and basic HIV testing and counseling.
“We will focus on identifying the mechanism through which treatment works,” Pachankis said. “We want to be able to answer the question, why this treatment works so that therapists working in the community can know how to address these mechanisms in their own work.”
The study is expected to take five years. If the results are successful, Pachankis said that he would like to see this type of evidence-based treatment become the norm for treating gay and bisexual men who are experiencing mental and sexual health problems.
Pachankis’ research team includes Dr. Steven Safren, University of Miami; Dr. Mark Hatzenbuehler, Columbia University; Dr. David Paltiel and Dr. Denise Esserman, Yale School of Public Health; and students and postdocs at Yale’s Center for Interdisciplinary Research on AIDS.
To learn more about the group’s work, visit esteem.yale.edu.