Exploring Sexual Minority Men's Explanatory Model of Depression: A Comprehensive Meta-Synthesis

Background and Purpose:

Depression affects approximately 350 million people worldwide, is the leading cause of disability and disproportionately affects sexual minority men. Few evidenced based mental health interventions exist for these populations.  In order to inform the development of future clinical interventions, the authors conducted a comprehensive meta-synthesis of sexual minority men’s depression to:  1) summarize current qualitative studies aims and findings; 2) develop a working theoretical framework to understand clinical depression among sexual minority men; and 3) identify important gaps and limitations in this literature.

Methods:

We used a meta-synthesis method (Sandelowski, 2007) guided by the Explanatory Model Interview Catalogue (EMIC) framework (Weiss, 1997) to produce an interpretive synthesis exploring sexual minority men’s narratives of clinical depression. A systematic comprehensive search using three databases (Psycinfo, PubMed and Web of Science) and manual searches were completed to identify English peer-reviewed articles published between 1990 and 2017. Search terms for depression, sexual minority men and illness narratives were used.  Articles were included if they: 1) reported findings from a qualitative study; and 2) explored clinical depression (i.e., participants diagnosed by a medical/mental health professional or based on a validated depression screening tool); and 3) included a sample composed of at least 50% sexual minority men.

Results: The comprehensive search produced a total of 814 articles. Authors (DC) reviewed titles and abstracts and identified 34 potentially relevant articles. All authors reviewed these 34 articles and subsequently identified eight articles eligible for our meta-synthesis. The studies were conducted in Australia, United Kingdom, United States and Scotland. Primarily public health and humanities (none in social work) trained scholars used in-depth interview to explore the roles of gender, drug use, and relationships on depression among white gay clinical service users. Samples sizes ranged from five to 40. Only one study included ethnic minorities; another included gay Transgender (FTM) men.

Among these studies of sexual minority men with clinical depression, a) Perceived Causes of depression included: discrimination, marginalization, strict gender roles etc.; b) Patterns of Distress followed a biomedical; c) Coping Mechanisms included:  keeping depression secret, suicide, illicit drugs, etc.; d) Help Seeking: men preferred to seek help from General Practitioners who were perceived as empathic, honest, humorous and provided a safe environment;  and d) General Illness Beliefs: depression was perceived as feminine and related to illicit drug use.

Implications:

Findings from this meta-synthesis highlight the dearth of qualitative literature that explores the narratives of sexual minority men with clinical depression.  Nevertheless, results from this study provide a working clinically relevant conceptual framework for practitioners and researchers ‘to listen’ to sexual minority men’s experiences regarding depression. The literature on sexual minority men is in its nascent stage; social workers and other scholars should explore diverse groups of sexual minority men including those with intersecting minority statues including ethnic minority groups, older adults and non-English speakers. Implications for social work research and practice will be discussed.