title: Outcomes associated with anxiety and depression among men who have sex with men in Estonia.
abstract: BACKGROUND
  Evidence supports that gay, lesbian, and transgender populations are at increased risk for mental health problems. The current study was conducted to estimate the prevalence of anxiety and depressive symptoms and related factors among men who have sex with men (MSM) in Estonia. This is the only known study of its type in the Eastern European region.
  
  
  METHODS
  In 2013, an Internet-based survey was conducted among men who have sex with men, collecting data on socio-demographics, sexuality, drug and alcohol use, mental health, suicidality, and internalized homonegativity.
  
  
  RESULTS
  265 MSM completed the questionnaire (median age 31 years, 90% Estonian, 71% from the capital; 73% employed full-time, 42% with at least college education; 44% in a steady relationship; 72% gay, 23% bisexual; 23% reported illegal drug use in the last 12 months). One third met criteria for problem drinking and depressive symptoms with one quarter for anxiety symptoms. Suicidality was 44% reported lifetime suicidal thoughts and 11% with at least one suicide attempt.
  
  
  CONCLUSIONS
  The study instruments, EST-Q and CAGE, only measure symptoms and are not diagnostic tests. A non-random sample which could possibly include persons with easier internet access. Self-reported data and cross-sectional study design are prone to issues with recall bias and temporality.
  
  
  CONCLUSIONS
  With demonstrated high rates of anxiety, depression, drinking, and drug use among MSM which is consistent with similar studies in Western countries, further research could help determine effective MSM focused interventions to address the broad spectrum of issues among MSM.
authors.affiliation: West Virginia University, School of Public Health, Morgantown, WV, USA. Electronic address: rdparker@hsc.wvu.edu.
authors.forename: R David
authors.initials: RD
authors.lastname: Parker
authors.affiliation: Infectious Diseases and Drug Monitoring Department, National Institute for Health Development, Hiiu 42, Tallinn 11619, Estonia.
authors.forename: Liilia
authors.initials: L
authors.lastname: Lõhmus
authors.affiliation: Infectious Diseases and Drug Monitoring Department, National Institute for Health Development, Hiiu 42, Tallinn 11619, Estonia.
authors.forename: Anti
authors.initials: A
authors.lastname: Valk
authors.affiliation: West Virginia University, School of Public Health, Morgantown, WV, USA.
authors.forename: Cara
authors.initials: C
authors.lastname: Mangine
authors.affiliation: Infectious Diseases and Drug Monitoring Department, National Institute for Health Development, Hiiu 42, Tallinn 11619, Estonia.
authors.forename: Kristi
authors.initials: K
authors.lastname: Rüütel
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology / Q000523:psychology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology / Q000523:psychology*; D004957:Estonia / Q000453:epidemiology; D005783:Gender Identity; D018451:Homosexuality, Male / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D019966:Substance-Related Disorders / Q000523:psychology; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Anxiety; Depression; Estonia; Men who have sex with men; Substance use