Washington Blade - September 15, 2006
Ryan Lee

But in recent years, mental health experts have paid more attention to the various gradations of depression, and some gay health advocates say it's time people recognized how even moderate levels of depression can significantly impact behavior.

A new report compiled by the Medius Institute for Gay Men's Health - a small, New York-based organization founded in June 2005 - suggests that because gay men have higher rates of depression than the general population, they also are more likely to engage in high-risk behavior associated with depression, including unsafe sex and drug use.

"It would be an oversimplification to say that depression 'causes' the risky behavior," according to the report, "Living on the Edge: Gay Men, Depression & Risk-Taking," written by Spencer Cox, Medius founder and executive director.

"Instead, it appears that in gay men, multiple epidemics - such as depression, drug abuse, violence, childhood sexual abuse and HIV - interact to increase risk for one another," Cox wrote.

Depression - along with milder mood disorders like dysthymia - should not be viewed as the latest "crisis-of-the-month" for gay men, but rather as "a background risk modulator" that subconsciously influences a range of behaviors, Cox said.

Cox compiled the Medius report by searching medical databases for already-existing studies on depression among gay men and other populations, as well as through interviews with mental health and sex researchers and service providers.

Cox estimated that he reviewed and analyzed about 300 different studies, from sources as varied as the Centers for Disease Control & Prevention and National Institutes of Health, to the Gay Urban Men's Health Study.

Among the previous findings Cox highlighted in his overview was that gay men were more likely than heterosexual men and lesbians to experience depression, and that depression in younger gay men was associated with increases in risk-taking behavior, such as not wearing a condom.

"What makes the gay experience [with depression] unique is the high levels of depression - roughly one-in-five gay men experience depressive symptoms," said Cox, noting that the rate for the general population is less than half of that. "So, it's like everything is louder for us, everything is bigger when we're talking about depression and mental illness in gay men."

The result of that amplification, according to Cox, is a culture where scores of gay men engage in drug use and high-risk sexual behavior to cope with unseen depression, oblivious to the toll their self-destructive habits are taking on their well being.

"The normalization of a lot of those things makes it very hard to see what's happening - everybody you know is doing a bump of cocaine on the dance floor, so go ahead," Cox said. "I do think it's very hard for people to say, 'I'm very confused, and I need help.'

"We need to make it OK to say, 'You need help, get help,'" he added.

'Problems in our community'

Confronting issues like drug use, risky sexual behavior and depression among gay men often involves sensitive topics - judgment, limiting sexual liberation, attempting to appear "normal" to mainstream society - and Cox knows that plenty of gay activists tackling issues like these have been maligned as moralistic assimilationists.

"I'm not anti-partying in the traditional sense," Cox said. "I think the point is not that we don't have a good time. It's that when we see something is not working, we need to stop.

"Well being is about gay men building lives they value so much that they won't want to put them at risk," Cox said.

Robert Weiss, clinical director of the Sexual Recovery Institute in Los Angeles, agreed that calling attention to underlying crises among gay men is at times intimidating.

"I think it's very, very difficult for those of us in the field of mental health and substance abuse to talk about the problems in our community," said Weiss, who is also the author of "Cruise Control: Understanding Sex Addiction in Gay Men."

"It's hard for us because there's a lot of sensitivity to being positive about the community," he said.

Nevertheless, Weiss notes that multiple studies show higher rates of substance abuse among gay men than the general population, and adds, "I have no doubt in my mind that there is more acting out in other addictive ways," such as sexually.

But determining whether depression leads gay men to act out sexually, or whether an abundance of sexual activity creates a depressing set of circumstances, is as difficult as answering whether a chicken or egg comes first, Weiss said.

"If you spend three to four hours a week, five nights a week online looking for sex, then the weekends in a bathhouse, you're not going to feel so good," Weiss said. "The behavior itself is very isolating, alienating and leaves people feeling hopeless.

"I have certainly seen men who appeared quite depressed, but once they stopped acting out and gained some sense of hope that they can live differently, then they're not as depressed."

Depression hampering HIV prevention?

In addition to things like social discrimination, one of the most overlooked factors contributing to depression among gay men is a profound sense of loneliness many of them feel, Cox said.

"There's lots of lonely gay men with a lot of shame about it, they lack friends and they're ashamed about that too," he said. "They're lonely and looking for something to fill that gap, and sex fills the boredom."

With the state of gay relationships evolving rapidly, many gay men have unrealistic expectations of what love, life and friendship is about, said Steven Bereznai, author of "Gay & Single ... Forever?: 10 Things Every Gay Guy Looking For Love (and Not Finding It) Needs to Know."

"I think there's a lot of pressure and status to being in a relationship, and if you're not in one, there's anecdotal evidence that gay men can be down on themselves," Bereznai said.

Gay men who are unknowingly desperate to avoid the loneliness and lack of intimacy often associated with depression may compromise their safer sex practices to achieve "sexual success and acceptance," Bereznai said.

For gay men to protect themselves against the consequences of high-risk behavior, they must have access to quality mental health services and receive HIV-prevention messages that incorporate more than just condom use, experts said.

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