title: Psychosocial syndemic associated with increased suicidal ideation among men who have sex with men in Shanghai, China.
abstract: OBJECTIVE
  We intended to verify the syndemic effect of psychosocial health conditions on suicidal ideation among men who have sex with men (MSM) in Shanghai, China; design a comprehensive framework for the identification of the MSM with suicidal ideation; and provide suggestion for suicidality intervention among MSM.
  
  
  METHODS
  A cross-sectional study was conducted among 547 MSM in 4 districts in Shanghai. Sociodemographic, psychosocial, and suicidal ideation information of the participants was collected. Logistic regressions were performed to assess the relationship between psychosocial variables and suicidal ideation and to verify the syndemic effect of psychosocial factors.
  
  
  RESULTS
  Of the MSM sample, 10.6% reported suicidal thoughts in the past year. In univariate analysis, depression, anxiety, loneliness, impulsivity, involuntary subordination (IS), social support, and risky sex were associated with suicidal ideation. Multivariate analysis found that IS (ORm = 2.92, 95% confidence interval [CI] = 1.55-5.51) and risky sex (ORm = 3.79, 95% CI = 1.44-9.97) remained significant. The MSM with more than 5 psychosocial health problems were nearly 4 times more likely (adjusted odds ratio = 4.68, 95% CI = 2.23-9.80) to have had suicidal ideation in the past year.
  
  
  CONCLUSIONS
  The study confirmed the syndemic effect of psychosocial health problems in magnifying the risk of suicidality among MSM. More integrated and holistic approaches in the identification of high-risk groups and intervention of suicidality among MSM are needed.
authors.affiliation: School of Public Health, Shanghai Jiao Tong University.
authors.forename: Rui
authors.initials: R
authors.lastname: Li
authors.affiliation: School of Public Health, Shanghai Jiao Tong University.
authors.forename: Yong
authors.initials: Y
authors.lastname: Cai
authors.affiliation: School of Public Health, Shanghai Jiao Tong University.
authors.forename: Ying
authors.initials: Y
authors.lastname: Wang
authors.affiliation: School of Public Health, Shanghai Jiao Tong University.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Sun
authors.affiliation: Zhong Shan Hospital, School of Medicine, Fu Dan University.
authors.forename: Chengdi
authors.initials: C
authors.lastname: Zhu
authors.affiliation: School of Public Health, Shanghai Jiao Tong University.
authors.forename: Yilin
authors.initials: Y
authors.lastname: Tian
authors.affiliation: School of Public Health, Shanghai Jiao Tong University.
authors.forename: Xueqin
authors.initials: X
authors.lastname: Jiang
authors.affiliation: School of Continuing Education, Shanghai Jiao Tong University.
authors.forename: Feng
authors.initials: F
authors.lastname: Gan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000523:psychology; D002681:China; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology; D004291:Dominance-Subordination; D018451:Homosexuality, Male / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D007175:Impulsive Behavior; D016015:Logistic Models; D008132:Loneliness / Q000523:psychology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012309:Risk-Taking; D012725:Sexual Behavior / Q000523:psychology; D012944:Social Support; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology*; D055815:Young Adult; D000092864:Suicide Prevention