Evaluating mental health services and primary health care use among sexual minority men in Canada

Research on sexual minority men in Canada has consistently highlighted that they are disproportionately affected by several mental and physical health conditions compared with heterosexual men. However, relatively less is known about their use of health services. The overarching aim of this thesis is to better understand the use of mental health and primary health care services among sexual minority men, which may inform more equitable health care practices. This aim is consistent with Objective 5 of Canada’s First 2SLGBTQI+ (Two-Spirit, Lesbian, Gay, Bisexual, Transgender, Queer, Intersex +) Federal Plan, passed in 2022; it seeks to strengthen data to guide evidence-based policy making for sexual minority men. In the first manuscript, we used data on 20,874 heterosexual men and 509 gay and bisexual men (GBM) from the 2015-2016 cycles of the Canadian Community Health Survey (CCHS). Using linear regression, we evaluated the association between the number of mental health consultations and depressive symptom scores. Despite GBM using mental health services more frequently than heterosexual men, we found associations to be comparable between heterosexual men and GBM. We discuss the potential role of the deficiency of 2SLGBTQI+ curricula in professional training on our findings and highlight the need for more research. In the second manuscript, we used data from the Engage Cohort study on 2,371 GBM living in Montreal, Toronto, and Vancouver. We evaluated the mediating role of perceived discrimination secondary to intersections of race and HIV status on use of mental health services. We fit a three-way decomposition of causal mediation effects using the imputation method for natural effect models. Relative to white HIV-negative GBM, we found that white GBM living with HIV had higher mental health services use odds not mediated by perceived discrimination. Among racialized HIV-negative GBM, we found comparable mental health services use odds relative to white HIV-negative GBM, but the odds of use to be significantly mediated by perceived discrimination. Finally, among racialized GBM living with HIV, we found comparable MHS use relative to white HIV-negative GBM with perceived discrimination not significantly mediating the odds of use. Our findings highlight the potential need to address intersecting forms of discrimination in mental health services for multiply marginalized GBM. In the third manuscript, we used data from the 2015-2016 cycles of the CCHS on 41,733 heterosexual men and 1,157 GBM. We evaluated primary care physician consultation frequencies between heterosexual men and GBM. We compared estimates from a traditional Poisson model with those from a data-driven approach (double-selection lasso). We grounded both models on Andersen’s Behavioural Model of Health Services Use. We found that compared with heterosexual men, GBM had a significantly higher number of primary care physician consultations. We contextualise these findings to the current shortage of primary care physicians, discuss what our findings mean for health resource allocation and question the lack of timelier data on primary health care use for GBM

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