Help-seeking preferences in Australian mental health website visitors: A latent profile analysis.

OBJECTIVE: Psychological distress and suicide rates are climbing in Australia despite substantial mental health programme investment in recent decades. Understanding where individuals prefer to seek support in the event of a personal or emotional crisis may help target mental health resources to where they are most needed. This study aimed to explore individual differences in help-seeking preferences that may be leveraged for early intervention and mental health service design. METHOD: Latent profile analysis was used to explore the help-seeking preferences of 1561 Australian online help-seekers who elected to complete a psychological distress screening on a popular mental health website, Beyond Blue. RESULTS: Four latent profiles of help-seeker emerged that illustrate distinct preference channels for support: help-negaters, professional help-seekers, family help-seekers and help-affirmatives. Help-negaters were the least likely to consider seeking help from any source, recorded the highest levels of psychological distress and suicidal ideation, and were more likely to be younger. Help-affirmatives were the most likely to seek help from any source, particularly from religious leaders, and were more likely to speak a language other than English at home. CONCLUSION: Many individuals experiencing mental health concerns will prefer to seek support from family or community contacts rather than professionals, and some will not seek help at all. Diversity in help-seeking preferences should be considered when designing mental health services, outreach and psychoeducation materials.

Internalized Homonegativity and Mental Health Among Chinese Gay and Bisexual Cisgender Men: Exploring the Moderating Influences of Psychosocial and Sexual Identity Factors.

Much research on Chinese gay and bisexual men has focused on sexual health and, in particular, HIV-related issues. However, relatively little research has considered psychosocial aspects of being a gay or bisexual man in China. The present study was designed to address this gap by examining psychosocial predictors of mental health from a minority stress perspective. Results from an online survey of 1,786 Chinese gay and bisexual cisgender men revealed that higher levels of internalized homonegativity predicted greater psychological distress and a lower sense of positive well-being. Higher self-esteem, social support, and resilience were strong predictors of lower psychological distress and higher well-being, but these psychosocial factors mostly did not moderate associations between internalized homonegativity and mental health. A stronger sense of sexual identity superiority weakened the associations between internalized homonegativity and both mental health measures, but sexual identity centrality only moderated the association between internalized homonegativity and positive well-being. This study is among the first to examine minority stressors and psychosocial factors, distinct from the HIV-focussed literature, in a Chinese context. These findings may inform interventions targeting increased self-esteem, social support, and resilience, which could be beneficial for the mental health of Chinese gay and bisexual cisgender men.

Body Image Disturbances as Predictors of Reduced Mental Health Among Australian Gay Men: Being in a Relationship Does Not Serve as a Protective Factor.

Past studies have demonstrated associations between gay men's body image disturbances and poorer mental health. However, little research has considered whether relationship status, or sexual agreements within relationships, moderates these associations. The present study was designed to address this gap. Results from a survey involving 796 Australian gay men between the ages of 18-39 showed that various measures of body image disturbance significantly and independently predicted satisfaction with life, self-esteem, positive well-being, and psychological distress. However, neither relationship status nor sexual agreement type (monogamous vs. non-monogamous) moderated these associations. These findings suggest that, although gay men may experience appearance-related pressure in order to attract sexual or relationship partners, simply being in a relationship does not reduce the detrimental associations of body image disturbance with mental health. Future research could examine specific aspects of relationship quality and dynamics that may serve as risk or protective factors in this context.

The Mental Health Impact of Physical Appearance Concerns in the Context of Other Life Domains Among Australian Gay Men.

Previous studies have identified gay men as a high-risk population for body image disturbances. However, little research has examined the mental health impact of gay men's physical appearance concerns in the context of other major life domains. The present study addressed this gap by investigating how mental health outcomes (satisfaction with life, self-esteem, positive well-being, and psychological distress) were associated with satisfaction with and importance of physical appearance, work, family relationships, friendships, health and fitness, and sex life among Australian gay men aged 18-39. The possible moderating role of intimate relationship status was also examined. Results from an online survey revealed that greater satisfaction with physical appearance, work, family, and friendships all had similar positive associations with mental health. However, more importance placed on physical appearance was more consistently associated with poorer mental health compared with the subjective importance of other domains. Findings also indicated the associations between physical appearance satisfaction and life satisfaction, and between physical appearance importance and positive well-being, were weaker for those in relationships. Thus, physical appearance matters in gay men's lives, but was only one factor when considered in the broader context of other life areas that contributed to overall well-being. These findings suggest the need for a nuanced and contextualized understanding of how physical appearance concerns fit into gay men's lives.

Prevalence and correlates of sexual partner concurrency among Australian gay men aged 18-39 years.

Mathematical models predict higher rates of HIV and sexually transmitted infections (STIs) in populations with higher rates of concurrent sexual partnerships. Although gay men and other men who have sex with men (MSM) have disproportionately high rates of HIV/STIs, little is known about the prevalence and correlates of sexual concurrency in these populations. This paper reports findings from a national community-based survey of 1,034 Australian gay-identified men aged 18-39 years, who gave detailed information about their sexual partners over the past 12 months. In all, 237 (23 %) reported two or more concurrent sexual partners. For their most recent period of concurrency, 44 % reported three or more partners and 66 % reported unprotected sex with one or more of their partners. A multivariate logistic regression found sexual concurrency was significantly more likely among men on higher incomes (P = 0.02), who first had anal sex at a relatively young age (P = 0.03), and who reported a large number of partners in the past 12 months (P < 0.001). Age, education, HIV status, and other sociodemographic and sexual behavior variables were not significant correlates. However, men who reported sexual concurrency were significantly more likely to have been diagnosed with an STI in the past 12 months (P = 0.04). Findings from this study suggest sexual concurrency is common among younger Australian gay men. With many of these men not always using condoms, health agencies should consider the potential impact of concurrency on HIV/STI epidemics among gay men and other MSM.

Australian gay men's satisfaction with sexual agreements: the roles of relationship quality, jealousy, and monogamy attitudes.

This study examined whether relationship quality, dispositional jealousy, and attitudes towards monogamy were associated with gay men's satisfaction with the agreements they have in their relationships about extra-dyadic sex. Three types of sexual agreement were examined: closed (no extra-dyadic sex is allowed), monogamish (extra-dyadic sex is allowed only when both members of the couple are present), and open (extra-dyadic sex is allowed). Results from a 2010 survey of 772 gay men in relationships indicated that sexual agreement satisfaction was positively associated with levels of intimacy and commitment for all three types of sexual agreement, but was differentially associated with sexual satisfaction within the relationship, jealousy, and monogamy attitudes as a function of sexual agreement type. Mean levels of sexual satisfaction, jealousy, and monogamy attitudes also differed between types of agreement. These findings provided preliminary evidence that sexual agreement satisfaction may be influenced by different factors depending on the type of agreement, which has useful implications for professionals with gay male clients experiencing dissatisfaction with their agreement or with their relationship more generally.

Health disparities among common subcultural identities of young gay men: physical, mental, and sexual health.

Researchers, policymakers, and health agencies have tended to treat gay men as a relatively homogeneous population, with little attention given to its many subcultural identities. In this study, we focused on young gay men and investigated a range of health-related differences according to common subcultural identities, such as Bear, Cub, and Twink. In a nationwide cross-sectional online survey of 1,034 Australian gay men aged 18-39 years, 44% reported a subcultural identity, the two most common being Cub (9%) and Twink (20%). Logistic and linear regression analyses compared Cub- and Twink-identified men and those without a subcultural identity (Non-identified) on a range of health-related outcomes. After adjusting for differences in age and body mass index (BMI), Twink-identified men had the highest risk profile overall, including significantly higher rates of smoking tobacco and alcohol consumption. They were also significantly more likely to report engaging in receptive anal sex. In addition, Cub-identified men were significantly more likely to report being in an ongoing relationship while Non-identified men were significantly less likely to report experiences of discrimination in the past 12 months. Differences on measures of mental health between the three groups were no longer significant after adjusting for age and BMI. In summary, we found numerous health-related differences according to subcultural identity that warrant further investigation by researchers, health agencies, and others concerned with further understanding and addressing health-related challenges of gay men.

Satisfaction with open sexual agreements in Australian gay men's relationships: the role of perceived discrepancies in benefit.

This study investigated whether satisfaction with open sexual agreements in gay men's relationships was associated with perceptions of discrepancies in the benefit experienced from those agreements. Three types of perceived discrepancy between the self and the relationship partner were examined: frequency of casual sex, attractiveness of casual partners, and "overall" benefit. Results from a survey conducted in 2010 of 685 Australian gay men in relationships with open agreements showed that men perceiving discrepancies in benefit, particularly those representing "under-benefit", were less satisfied with their agreement than were men perceiving equal benefit. These results supported hypotheses derived from equity theory and provide insight into factors associated with gay men's satisfaction with open agreements. These findings also have important practical implications. Professionals counselling gay men or couples experiencing low satisfaction with open agreements may consider raising issues of unequal benefit and work with their clients towards achieving equality.

Psychological Distress and Suicidal Ideation in Australian Online Help-Seekers: The Mediating Role of Perceived Burdensomeness.

BACKGROUND: Psychological distress, an umbrella term encompassing emotional anguish and cognitive-behavioral symptoms of anxiety and depression, is closely linked to suicidal ideation. However, the mechanism of this relationship is unclear, dampening the utility of distress screening in suicide prevention. PURPOSE: This study aimed to identify potential mediators of this relationship, and whether effects are sex-specific. METHOD AND PARTICIPANTS: A sample of online help-seekers who had just completed the K10 psychological distress checklist on the Beyond Blue website [N = 1,528] consented to complete measures of help-seeking intentions, financial wellbeing, alcohol use, social connection (belongingness), sense of being a burden on others (burdensomeness); and suicidal ideation. Moderated mediation analysis examined the indirect effects of psychological distress on suicidal ideation through these risk factors, and whether effects were moderated by sex. RESULTS: The model accounted for 44% of the variance in suicidal ideation. The majority of participants had experienced very high psychological distress (77.3%) and at least some suicidal ideation (74.7%) in the past four weeks. A significant indirect effect of burdensomeness was found for both men and women. No other risk factors produced significant indirect effects. CONCLUSIONS: Perceived burdensomeness appears to be central in determining how psychological distress might progress to suicidal thinking. The experience of distress may lead a person to believe that loved ones would be better off without them, prompting suicidal thinking.HighlightsPsychological distress screening is an early intervention opportunity for suicide.Intervention plans could be improved by including perceived burdensome measures.Online screening for distress is a potential bridge to offline-help seeking.

Social connectedness and suicidal ideation: the roles of perceived burdensomeness and thwarted belongingness in the distress to suicidal ideation pathway.

BACKGROUND: Suicide is a serious public health issue. Distress has been identified as a common risk factor, with research also suggesting that a lack of social connectedness is involved. METHODS: This quantitative, cross-sectional study investigated the role of perceived burdensomeness and thwarted belongingness in the psychological distress/suicidal ideation pathway in a community sample of 480 Australian adults. RESULTS: As expected, distress was found to be a strong predictor of suicidal ideation. Perceived burdensomeness and thwarted belongingness both moderated and mediated the relationship between distress and suicidal ideation. Specifically, distress was more strongly linked to suicide ideation when burdensomeness or thwarted belongingness were also high. This moderating effect was stronger for thwarted belongingness than it was for burdensomeness. These variables also mediated the pathway, in that higher distress related to higher burdensomeness and thwarted belonging, which in turn related to higher suicide ideation. This mediating effect was stronger for burdensomeness than for thwarted belonging. CONCLUSIONS: Overall, the findings confirm the importance of our social relatedness in suicide. Increasing belongingness and reducing the perception of being a burden on others may be an important intervention strategy for weakening the link between distress and suicide ideation.

The Gender Paradox: Understanding the Role of Masculinity in Suicidal Ideation.

It is important to understand the role of social determinants, such as gender, in suicidal ideation. This study examined whether conformity to specific masculine norms, particularly high self-reliance and emotional self-control, moderated the relationship between psychological distress and suicidal ideation for men. The other norms explored were those pertaining to behavioral-emotional or social hierarchy status aspects of masculinity, and whether they moderated the psychological distress-suicidal ideation relationship for men and women. The Conformity to Masculine Norms Inventory, the Kessler Psychological Distress Scale, and the Suicidal Ideation Attributes Scale were administered to an Australian community sample in an online survey (n = 486). As predicted, higher psychological distress was associated with higher suicidal ideation. Self-reliance enhanced the relationship and was the only moderator among men. High self-reliance levels might be an important indicator of risk, which can be used when assessing and working with men who are hesitant to openly discuss suicidal ideation with clinicians. For female participants, higher endorsement of behavioral-emotional norms and lower conformity to social hierarchy status norms appear to increase suicide risk in the presence of psychological distress. Our findings suggest that high self-reliance is of particular concern for men experiencing psychological distress. It is also important to consider the roles of masculine norm endorsement in the psychological distress-suicidal ideation relationship among women.

A Brief, Daily, Online Mental Health and Well-being Intervention for University Staff During the COVID-19 Pandemic: Program Description and Outcomes Using a Mixed Methods Design.

BACKGROUND: The unprecedented changes and isolation measures to contain COVID-19 have had multiple psychological and social impacts, with implications for professional and personal functioning. Evidence-informed interventions that can be rapidly implemented under pandemic conditions to support mental health during such times are urgently needed. OBJECTIVE: The aim of this study was to determine the acceptability and preliminary outcomes of a daily online mental health promotion program for tertiary education staff during the COVID-19 pandemic. METHODS: The "Victoria University (VU) Elevenses" program was delivered as an uncontrolled intervention at Victoria University (VU) in the western metropolitan region of Melbourne, Australia. In April 2020, an email invitation was sent to all academic and professional staff inviting them to: (1) participate in the program and (2) opt-in to the research component. The "VU Elevenses" program provided 10-15-minute microinterventions comprising lifestyle and well-being strategies to promote mental health via an online meeting platform at 11 AM each weekday. A mixed methods approach was used to evaluate the program, combining structured questionnaires with semistructured interviews to investigate the experiences of staff who participated in the program. RESULTS: Between 16 and 90 participants provided weekly program feedback. A total of 106 university staff opted into the longitudinal research component and 10 staff participated in the interviews. Participants reported high levels of satisfaction with sessions and perceived benefits for mental health. Approximately one quarter of participants reported moderate to severe symptoms of depression, anxiety, and stress at baseline, with significant reductions in these symptoms in the first 7 weeks of the program, corresponding with easing in mandatory isolation ("lockdown") restrictions. Symptoms of depression, anxiety, and stress all increased when lockdown measures were reintroduced, but not to the same levels as found during the initial lockdown period. Overall changes in depression and anxiety from baseline to the end of the program were explained by changes in COVID-19-related distress, whereas changes in self-compassion explained changes in stress. CONCLUSIONS: We show that it is feasible and acceptable to develop and deliver a program of brief interventions in a timely manner, using a simple and accessible online platform. Although participation in the program was initially associated with reduced symptoms of depression, anxiety, and stress, participants' mental health worsened with the reintroduction of a "lockdown" period. However, as symptoms of depression, anxiety, and stress did not return to levels observed at the start of the VU Elevenses program, participation in the uncontrolled intervention may have offered a protective benefit against the impact of the second significant lockdown period.

Body Appreciation Scale (BAS-2): measurement invariance across genders and item response theory examination.

BACKGROUND: The present study considers a measure of positive body image, the Body Appreciation Scale-2, which assesses acceptance and/or favourable opinions towards the body (BAS-2). Potential variations of the psychometric properties of the scale across males and females, as well as across its different items invite for further investigation. The present study contributes to this area of knowledge via the employment of gender Measurement Invariance (MI) and Item Response Theory (IRT) analyses. METHODS: A group of 386 adults from Australia, Canada, New Zealand, Ireland, the United Kingdom, and the United States of America (USA) were assessed online (N = 394, 54.8% men, 43.1% women, Mage = 27.48; SD = 5.57). RESULTS: MI analyses observed invariance across males and females at the configural level, and non-invariance at the metric level. Further, the graded response model employed to observe IRT properties indicated that all items demonstrated, although variable, strong discrimination capacity. CONCLUSIONS: The items showed increased reliability for latent levels of ∓ 2 SD from the mean level of Body Appreciation (BA). Gender comparisons based on BAS-2 should be cautiously interpreted for selected items, due to demonstrating different metric scales and same scores indicating different severity. The BAS-2 may also not perform well for clinically low and high BA levels. Thus, it should optimally be accompanied by clinical interviews for formal assessment in such cases.

Rural-urban differences in mental health, resilience, stigma, and social support among young Australian gay men.

PURPOSE: Depression and anxiety are common among young gay men, particularly in comparison with their heterosexual counterparts. Little is known about the mental health and well-being of those living in rural areas, where access to support and opportunities for connecting with other gay men may be relatively limited. We examined differences in the well-being of young rural and urban Australian gay men, including mental health, resilience, stigma-related challenges, and social support. METHODS: A national online survey was conducted involving 1,034 Australian gay-identified men aged 18-39 years. FINDINGS: All analyses adjusted for sociodemographic differences between the rural and urban samples. On average, rural men had significantly lower self-esteem, lower life satisfaction, lower social support, and were significantly more likely to be psychologically distressed, concerned about acceptance from others, and to conceal their sexual orientation compared to urban gay men. While resilience among the rural group was lower, this was no longer significant following sociodemographic adjustment. An examination of psychosocial predictors of psychological distress in the rural sample revealed that lower education and lower tangible support independently predicted greater distress. CONCLUSIONS: Young rural Australian gay men appear to be at a considerable disadvantage with regard to mental health and well-being compared with their urban counterparts, and they may need particular attention in mental health prevention and treatment programs.

Agreements about extra-dyadic sex in gay men's relationships: exploring differences in relationship quality by agreement type and rule-breaking behavior.

Research comparing the quality of monogamous and non-monogamous ("open") relationships among gay men has produced mixed findings. In addition, little is known about the consequences of breaking the rules of relationship agreements about extra-dyadic sex. Results from a survey of 229 gay men in romantic relationships showed that open relationships were less passionate, but no less intimate or committed, than monogamous or "threesome-only" relationships. However, men who broke rules reported lower relationship quality overall, regardless of the relationship agreement. Thus, it is less the nature of the agreement itself than adhering to the conditions of it that influences relationship quality.

Using Cognitive Interviewing and Behavioral Coding to Determine Measurement Equivalence across Linguistic and Cultural Groups: An Example from the International Tobacco Control Policy Evaluation Project.

The present study aimed to examine and compare results from two questionnaire pretesting methods (i.e., behavioral coding and cognitive interviewing) in order to assess systematic measurement bias in survey questions for adult smokers across six countries (USA, Australia, Uruguay, Mexico, Malaysia and Thailand). Protocol development and translation involved multiple bilingual partners in each linguistic/cultural group. The study was conducted with convenience samples of 20 adult smokers in each country. Behavioral coding and cognitive interviewing methods produced similar conclusions regarding measurement bias for some questions; however, cognitive interviewing was more likely to identify potential response errors than behavioral coding. Coordinated survey qualitative pretesting (or post-survey evaluation) is feasible across cultural groups, and can provide important information on comprehension and comparability. Cognitive interviewing appears a more robust technique than behavioral coding, although combinations of the two might be even better.

How reactions to cigarette packet health warnings influence quitting: findings from the ITC Four-Country survey.

OBJECTIVES: To examine prospectively the impact of health warnings on quitting activity. DESIGN: Five waves (2002-06) of a cohort survey where reactions to health warnings at one survey wave are used to predict cessation activity at the next wave, controlling for country (proxy for warning differences) and other factors. These analyses were replicated on four wave-to-wave transitions. SETTING AND PARTICIPANTS: Smokers from Australia, Canada, the United Kingdom and the United States. Samples were waves 1-2: n = 6525; waves 2-3: n = 5257; waves 3-4: n = 4439; and waves 4-5: n = 3993. MEASURES: Warning salience, cognitive responses (thoughts of harm and of quitting), forgoing of cigarettes and avoidance of warnings were examined as predictors of quit attempts, and of quitting success among those who tried (1 month sustained abstinence), replicated across four wave-to-wave transitions. RESULTS: All four responses to warnings were independently predictive of quitting activity in bivariate analyses. In multivariate analyses, both forgoing cigarettes and cognitive responses to the warnings predicted prospectively making quit attempts in all replications. However, avoiding warnings did not add predictive value consistently, and there was no consistent pattern for warning salience. There were no interactions by country. Some, but not all, the effects were mediated by quitting intentions. There were no consistent effects on quit success. CONCLUSIONS: This study adds to the evidence that forgoing cigarettes as a result of noticing warnings and quit-related cognitive reactions to warnings are consistent prospective predictors of making quit attempts. This work strengthens the evidence base for governments to go beyond the Framework Convention on Tobacco Control to mandate health warnings on tobacco products that stimulate the highest possible levels of these reactions.

The effects of smoking norms and attitudes on quitting intentions in Malaysia, Thailand and four Western nations: a cross-cultural comparison.

This research investigated the influence of smoking attitudes and norms on quitting intentions in two predominantly collectivistic countries (Malaysia and Thailand) and four predominantly individualistic Western countries (Canada, USA, UK and Australia). Data from the International Tobacco Control Project (N = 13,062) revealed that higher odds of intending to quit were associated with negative personal attitudes in Thailand and the Western countries, but not in Malaysia; with norms against smoking from significant others in Malaysia and the Western countries, but not in Thailand; and with societal norms against smoking in all countries. Our findings indicate that normative factors are important determinants of intentions, but they play a different role in different cultural and/or tobacco control contexts. Interventions may be more effective if they are designed with these different patterns of social influence in mind.