title: Suicide related ideation and behavior among Canadian gay and bisexual men: a syndemic analysis.
abstract: BACKGROUND
  While several studies have demonstrated that gay and bisexual men are at increased risk of suicide less attention has been given to the processes that generate the inherent inequity with the mainstream population. This study tested whether syndemic theory can explain the excess suicide burden in a sample of Canadian gay and bisexual men. Syndemic theory accounts for co-occurring and mutually reinforcing epidemics suffered by vulnerable groups due to the effects of social marginalization.
  
  
  METHODS
  This study used data from Sex Now 2011, a cross-sectional survey of Canadian gay and bisexual men (n = 8382). The analysis measured the extent to which anti-gay marginalization and several psychosocial health problems are associated with suicide related ideation and attempts. Since psychosocial health problems were hypothesized to have an additive effect on suicide related ideation and attempts, the analysis calculated the effect of accumulated psychosocial health problems on suicide behavior.
  
  
  RESULTS
  Suicide ideation and attempts were positively associated with each individual marginalization indicator (verbal violence, physical violence, bullying, sexual violence and work discrimination) and psychosocial health problems (smoking, party drugs, depression, anxiety, STIs, HIV risk and HIV). Furthermore, prevalence of suicide ideation and attempts increased with each added psychosocial health problem. Those who reported 3 or more had 6.90 (5.47-8.70) times the odds of experiencing suicide ideation and 16.29 (9.82-27.02) times the odds of a suicide attempt compared to those with no psychosocial health problems.
  
  
  CONCLUSIONS
  This investigation suggests that syndemics is a useful theory for studying suicide behavior among gay and bisexual men. Moreover, the findings highlight a need to address gay and bisexual men's health problems holistically and the urgent need to reduce this population's experience with marginalization and violence.
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, Blusson Hall Room 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada. oferlatt@sfu.ca.|Community-Based Research Centre for Gay Men's Health, Vancouver, Canada. oferlatt@sfu.ca.
authors.forename: Olivier
authors.initials: O
authors.lastname: Ferlatte
authors.affiliation: Community-Based Research Centre for Gay Men's Health, Vancouver, Canada. joshun@cbrc.net.
authors.forename: Joshun
authors.initials: J
authors.lastname: Dulai
authors.affiliation: Community-Based Research Centre for Gay Men's Health, Vancouver, Canada. travissalway.hottes@mail.utoronto.ca.|Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. travissalway.hottes@mail.utoronto.ca.
authors.forename: Travis Salway
authors.initials: TS
authors.lastname: Hottes
authors.affiliation: Community-Based Research Centre for Gay Men's Health, Vancouver, Canada. terry@cbrc.net.
authors.forename: Terry
authors.initials: T
authors.lastname: Trussler
authors.affiliation: Community-Based Research Centre for Gay Men's Health, Vancouver, Canada. rick@cbrc.net.
authors.forename: Rick
authors.initials: R
authors.lastname: Marchand
mesh_terms: D000328:Adult; D001727:Bisexuality / Q000523:psychology* / Q000706:statistics & numerical data; D002170:Canada / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004192:Discrimination, Psychological; D006301:Health Services Needs and Demand; D018451:Homosexuality, Male / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D054526:Men's Health; D008603:Mental Health / Q000706:statistics & numerical data; D008875:Middle Aged; D011287:Prejudice / Q000523:psychology; D015995:Prevalence; D012749:Sexually Transmitted Diseases / Q000523:psychology; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data; D014754:Violence