Morbidities

• Author: Ford Hickson - Axel J. Schmidt - David S. Reid - Peter Weatherburn - Ulrich Marcus - Susanne B. Schink
• Pages: 39-49

TECHNICAL REPORT EMIS-2017 – The European Men-W ho-Have-Sex-With-Men Internet Surv ey

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4. Morbidities

Morbidity includes both p hysical and psychological i ll health. For a health prog ramme, reduction in and preventi on

of morbidities are the u ltimate outcomes sought. EMIS-2017 asked about two areas of sexual health morbidity:

mental ill-health and sexually transmitt ed infections.

This chapter describes a ll the indicators of mor bidity used in EMIS-2017 across the w hole sample, and by c ountry

in the tables at the end o f the chapter. Chapter 8 c onsiders how these mor bidity indicators vary between specific

target groups for sexual h ealth interventions.

4.1 Summary

Mental health problems rem ain common among MSM :

• Anxiety and depression – usin g PHQ-4, a short screenin g tool that measures anx iety and depression, to give

an indication of mental health, 18% of the entire sample reported at least mo derate anxiety/depressio n in the

last two weeks and 8% r eported experiencing sev ere anxiety and depress ion in the same time p eriod.

• Suicidal ideation – 21% had thought of harming themselves in the past two weeks and 6% thought of

harming themselves on at l east half of the day s during that time.

• Sexual unhappiness – 22% indicated sexual unhappin ess on a self-rating scale.

• Alcohol dependency – using th e CAGE4 screening mea sure of alcohol dependenc y, 18% met the criteria for

potential alcohol dependen cy.

Sexually transmitted infection s also remain common amo ng MSM:

• HIV diagnoses – 10% of the e ntire sample self-reported having ever been diagn osed with HIV. Excludin g

participants who were alr eady diagnosed 12 month s ago the percentage that rec eived an initial HIV diagnosis

in the last 12 months wa s 1.1%.

• Unsuppressed diagnosed HI V infection – 0.9% overall repo rted non-suppressed HIV i nfection.

• Diagnoses of bacterial STIs (syphilis, gonorrho ea and chlamydia) – 4% had been diagnosed with syphilis in

the last 12 months, 5% with gonorrhoea and 5% with chlamydia or LGV.

• Diagnosis of anal or genital warts (HPV infection) – 16% had a history of ano-genital w arts.

• Hepatitis – 7% had a history of hepatitis A, 6% of hepatitis B, and 2% of hepatitis C. Just over 1% of the

overall sample reported HIV/ hepatitis co-infection.

4.2 Mental health problems

Poor mental health is a m ajor cause of morbidity and is more common in sexual minorities than in the sexual majori ty. In

addition, the associatio n between poor mental healt h and HIV transmission risk behaviour (that is, sexual risk behaviour

and poor medic ation adherence) is well e stablished [17,18]. This is one mechan ism by which multiple morb idities occur

in the same people, a phenomenon also known as syndemics.

4.2.1 Anxiety/depression (PHQ-4)

We used the Patient Heal th Questionaire-4 [19], a sh ort clinical scr eening tool th at measures combined anxiet y and

depression, to give an in dication of mental well-being. While th e tool is not intended to be diagnostic, and may over-

estimate the prevalence of problem s, it was chosen for its bre vity and ease of interpretat ion. Men were asked ‘Over th e

last 2 weeks, h ow often have you been bothered by the fol lowing proble ms?’ and were o ffered the following four

responses: Feelin g nervous, anxious or on ed ge; Not being able to stop o r control worrying; Littl e interest or pl easure in

doing things; Feeling down, depressed, or hopeless. Responses included not at all (0 points); some days (1 point); more

than half the days (2 points); nearly every day (3 points). The total points give a score from 0 to 12 which can be

grouped into four bands. Table 4.1 gives the percentage of men falling in each band (missing for 4%) and the usual

interpretation for this validated scale.

Table 4.1 Anxiety and depression (PHQ-4) score

PHQ-4 score

(N=125 856; missing n=1 936)

Interpretation % of all

0挑2

Normal

48.0

3挑5

Mild anxiety and depression

33.6

6挑8

Moderate anxiety and depres sion

10.7

9挑12

Severe anxiety and depressi on

7.7

TOTAL

100.0