Young gay and bisexual men are at significantly greater risk of poor mental health than older men in that group, according to new research published in the Journal of Public Health.
Conducted by the London School of Hygiene & Tropical Medicine and funded by Stonewall, the study found gay and bisexual men under the age of 26 were six times more likely to attempt suicide or self-harm compared to men in that group aged over 45. They were also twice as likely to be depressed or anxious. The researchers say the results reinforce the importance of mental health interventions reaching those who need them most, as well as people who actively seek help.
The study is the first to examine the mental health differences within gay and bisexual men in the UK. Using data from the Stonewall Gay and Bisexual Men's Health Survey, the researchers analysed responses of 5,799 gay and bisexual men aged 16 and over living in the UK. Depression, anxiety, attempted suicide and self-harm were examined against a range of life factors. Age, ethnicity, income and education were all found to have a large impact on mental health.
Black gay and bisexual men were twice as likely to be depressed and five times more likely to have attempted suicide than the white majority. Men in the lower wage bracket were more likely to be depressed, anxious, attempt suicide or self-harm. Those with lower levels of education were twice as likely to experience one of those issues compared to those with degree level education, only in part due to earning a lower wage.
Although more research is needed, the authors suggest older men are able to cope better with homophobia and that homophobia is more prevalent in the lives of younger men. The study also indicates that gay and bisexual men may experience discrimination or marginalisation unrelated to their sexuality.
Lead author Dr Ford Hickson from the London School of Hygiene & Tropical Medicine said: "Mental illness is one of the biggest health challenges facing the world today and can affect people from all walks of life. We know minority groups are at higher risk of poor mental health than the heterosexual majority, however the mental health differences within sexual minorities is unclear.
"Our study showed that among gay and bisexual men, age and ethnicity had a significant impact on mental health, as did income and education. This is possibly because men are better able to cope with homophobia the older they are, or if they are relatively privileged in other areas of their lives."
The researchers also discovered cohabitation is key for positive mental health, with men who are living with a male partner 50% less likely to suffer from depression compared to gay and bisexual men living alone. Living in London was also shown to be advantageous, perhaps because London has the largest population of gay men in the world and isolation and discrimination are less common there.
Dr Hickson said: "Minority groups are usually thought to be more homogenous than they actually are, when in fact there is great variation in health and life situations among this group. What's clear is that health inequalities among gay and bisexual men mirror those in the broader society.
"Poor mental health is not evenly distributed across race, income or education. We must ensure that access to life-changing support services are targeted to where they are needed most. Everyone has the right to good mental health."
April Guasp, Head of Research at Stonewall, said: "We're really pleased to see this further in-depth analysis of mental health issues faced by gay and bisexual men. It's known that a range of factors can increase risk of poor mental health among the population in general and the same holds true for gay and bisexual men. This study contributes to better understanding of the specific risks within LGBT communities and will hopefully lead to more targeted health interventions."
The authors note that their findings may be limited because survey participants were not a random sample of the population and were therefore unlikely to be representative of all UK gay and bisexual men.
Ford Hickson, Calum Davey, David Reid, PeterWeatherburn, Adam Bourne. Mental health inequalities among gay and bisexual men in England, Scotland and Wales: a large community-based cross-sectional survey. Journal of Public Health. Doi:10.1093/pubmed/fdw021
 Suicide attempt was reported by 90/1,521 (5.9%) men under 26 years old, and by 12/1,244 (1%) men over 45 years old. This gives odds ratio of 6.66 (rounded down to take in margin of error)
Self-harm was reported by 210/1524 (13.8%) men under 26 years old, and by 31/1251 (1.7%) over 45s. This gives an odds ratio of 6.25. Depression was reported by 422/1445 (29.2%) men under 26 years old, and by 168/1158 (14.5%). This gives an odds ratio of 2.4.
 15/48 (31.3%) black men were classified as depressed compared with 1071/5128 (20.9%) of white men. This gives an odds ratio of 4.97. Similarly, 5/52 (9.6%) of black men had attempted suicide in the last year compared with 153/5419 (2.8%) of white men. This gives an adjusted odds ratio of 2.00.
 Of men who left school at 16 years, 258/877 (29.4%) suffered depression, 205/904 (22.7%) suffered anxiety, 54/930 (5.8%) had attempted suicide in the last year and 98/938 (1.4%) had self-harmed. The comparable figures for men with university education were 541/3160 (17.1%), 465/3236 (14.4%), 55/3348 (1.6%) and 135/3352 (4.0%) respectively.
About the London School of Hygiene & Tropical Medicine
The London School of Hygiene & Tropical Medicine is a world-leading centre for research and postgraduate education in public and global health, with more than 4,000 students and 1,000 staff working in over 100 countries. The School is one of the highest-rated research institutions in the UK, and among the world's leading schools in public and global health. Our mission is to improve health and health equity in the UK and worldwide; working in partnership to achieve excellence in public and global health research, education and translation of knowledge into policy and practice. http://www.