«Das Leben ist schwieriger als für die Heteros. Probleme haben wir alle, und Schwulsein ist halt noch eins mehr auf der Liste. Und wenn die Liste voll ist, stürzt du ab (Depression). Klingt einfach, ist aber die Realität. Wenn man die Probleme nicht mehr bewältigen kann, wird alles sehr kompliziert… »
The quotes in the image are responses to open questions asked of participants in 2007 and 2011 on depression. Since participation was on an anonymous basis, the first names used are fictitious.
The 2002 gay health survey was one of the first studies to highlight poor psychological health among gay and bisexual men. All studies done since then on gay men’s health shows that they are particularly affected by mental health problems such as anxiety disorders, depression, and substance abuse and that they also are at a higher suicide risk than the general male population.
This is not necessarily written in stone, however, as seeking professional help and changing certain behaviors can reduce these problems or eliminate them entirely. We are only now beginning to address the psychological health of the general population. Mental health problems are still often stigmatized or minimized. This is further complicated when it comes to gay men because as late as 1992 homosexuality itself was considered a mental disease by the WHO.
For gay men, the first symptoms of these disorders often crop up during childhood and adolescence and are experienced repetitively or in a chronic fashion by many men throughout their lives. Given the high rate of mental suffering and number of people affected by these disorders, these problems are not just individual health issues but rather involve the entire gay community.
Given the magnitude and seriousness of these problems, mental health and suicide were studied in-depth as part of the gay health survey in 2007 and 2011.
We must draw a distinction between psychological or mental symptoms and psychological or mental disorders. Symptoms are not illness but they might be the sign of a disorder. Anyone can feel these symptoms at one point or another over their lifetimes. If a person suffers from symptoms in an on-going fashion over more than 2 weeks and they keeps a person from living in their daily lives, they should contact their primary care physician or Checkpoint to verify they are not suffering from a mental disorder.
This graphic shows a percentage of gay men suffering from mental health problems compared with gay men in Europe. The percentage of gay men impacted by these disorders in the past 12 months is equal to the percentage of the general population impacted over a lifetime. Social anxiety (fear of being seen by others, particularly while talking in public) and specific phobias (fear of blood, fear of flying on airplanes, and certain animals) are features of anxiety disorder.
All studies done on LGBT populations in the worldworldwide come to the conclusion that gay mental health is where the negative impact of the stigmatization of homosexuality, societal and community discrimination and social isolation is strongest. These social determinants of health have a negative impact on psycho-social resources such as accepting one’s homosexuality, self-esteem, the feeling of control and greatly increase the risk of suicide.
Alcohol and certain drugs, often used to ease mental suffering, are not good long-term treatment options and can actually worsen those disorders and lead to dependence.
The diagnostic tool incorporated in the baseline survey questionnaire (CIDI) revealed that 34% of gay and bisexual men had suffered from clinical depression and/or anxiety in the year prior to the survey. 25% more suffered from major symptoms that diminished their quality of life. Even though in Geneva the percentage of men in the general population who claim to suffer from average or major mental problems (15% in 2012) is higher than the Swiss average, the rates for gay men are much higher.
If a depressive episode lasts over several years, then we are talking about chronic depression.
Gay men who suffer from depression, diagnosed by the tool incorporated in the questionnaire (CIDI), were questioned about the age where they felt these symptoms for the first time. The median age for the first appearance of symptoms is 16 years old.
Only slightly over half of gay men suffering from depression knew were aware of it. A person who is not aware of what they are suffering from will be less likely to seek help. This phenomenon is not exclusive to gay men and can be seen throughout the entire population. This indicator shows how important it is for de-stigmatization and awareness campaigns on mental disorders and ways to cope with them to exist for both the general population and specific populations such as LGBT people. This is why the Blues-out project was created.
Less than half of gays suffering from depression and less than a third suffering from anxiety seek professional help despite the existence of treatments. The team of health providers at Checkpoint has noted that certain gay men have difficulty distinguishing whether their bad feelings have to do with the way they live their lives or if it is illness. It is not easy to ask for help, particularly when it comes to mental suffering which is still stigmatized. Talking about these types of mental suffering implies being able to talk freely about one’s sexual orientation, relationships and desires to one’s therapist and requires access to gay-friendly health care providers.
Suffering in silence is never a good solution and it increases the risk of becoming a chronic disorder and thus much more difficult to heal.
This table shows the main causes given for depression as perceived by affect gay men during their first or last depressive episode. For the first depressive episode at the median age of 16, love and relationship problems, difficulty accepting one’s homosexuality and family problems with the family are practically on the same level. For the latest depressive episode, love and relationship issues and work-related problems clearly dominate. These causes, except for the difficulty accepting one’s homosexuality, are not specific to gay men but it is possible they suffer from them to a greater degree.
Difficulty accepting one’s homosexuality, which gay men also refer to as self-acceptance, reflects the very intense personal, and interpersonal stress that many gay men go through, particularly as adolescents, when they realize they are gay. This remains an issue throughout their lifetimes due to the stigmatization. Stress levels depend very much on the reaction of those around them, particularly when it comes to family and their religious beliefs. Numerous testimonies collected in many studies show that it is not the experience of being gay which poses a problem, but rather discovering desires, emotions and feelings which lead to being labeled with demeaning terms that undermine one’s personal dignity. The concept of stigmatization (E. Goffman) is thus probably the most accurate explanation of the risks that gay men face throughout their lifetimes on a personal, interpersonal and societal level.
Love and relationship problems are mostly breakups and difficulties establishing stable, long-term relationships. In the preliminary qualitative research before the surveys in 2001, gay men had mentioned love and relationships as the most important aspects for a good quality life all while acknowledging that it was the area where they were least satisfied. – Gay men, and particularly younger ones, who often seek out a partner, live in a gay male culture that reproduces the male canons of society and values sex over a romantic relationship and performance over quality.