Kathryn Crandall

A team of researchers at the Yale School of Public Health received a $3.9 million grant on Feb. 16 from the National Institute of Mental Health to develop intervention strategies for young gay and bisexual men struggling with mental health issues.

Previous research has identified that gay and bisexual men are about twice as likely as their heterosexual peers to experience mental health issues, including major depressive and anxiety disorders. Mental health issues also put this population at risk for HIV infection, substance abuse and other health-risk behaviors. According to researchers, the root of the problem is the exposure to stigma-related stress in the daily lives of gay and bisexual men. To combat these mental and sexual health challenges, SPH professor John Pachankis and his team are researching cognitive-behavioral intervention strategies to help young gay and bisexual men cope with stigma-related stress in their mental and sexual health treatments and promote healthy behavior within this population. The recent $3.9 million grant will help Pachankis’ team apply the intervention treatment they developed over the course of a pilot study to larger control groups in New York City and Miami. The ultimate goal, Pachankis said, is to develop an effective treatment plan.

“The treatment aims to target the underlying drivers of these co-occurring health problems, the root of [which] is the stigma-related stress that disproportionately affects gay and bisexual men,” Pachankis told the News. “This grant allows us to continue testing the treatment that we developed in the pilot study. Our hypothesis is that the treatment will improve gay and bisexual mental, sexual and behavioral health.”

Mental health problems do not exist in isolation for this population and are often related to HIV, substance abuse and other health challenges, Pachankis added. For example, gay and bisexual men who have internalized negative attitudes toward themselves may choose to avoid romantic relationships and experience difficulty expressing intimacy in healthy, self-affirmative ways. Others who have encountered frequent rejections or have felt socially isolated may try to escape their stress through alcohol or substance abuse.

An important question to understand, Pachankis said, is why gay and bisexual men are much more likely than heterosexual males to experience mental and sexual health problems. The most viable explanation, he said, is this population’s disproportionate exposure to stigma-related stress, especially among young gay and bisexual men.

Max Goldberg ’17, a peer liaison for the Office of LGBTQ Resources, said many of the gay and bisexual men at Yale face issues shared by other gay and bisexual communities: communal marginalization, rejection at the hands of family and friends and difficulty finding people like them. Goldberg added that he has had many conversations with other gay and bisexual men at Yale, who report feeling “dizzying” levels of stress because of their identity. Gay and bisexual men make up around one-fifth of Yale’s male-identified population, Goldberg said.

“This stress … in turn leads to risky sexual behavior, substance abuse, chronic sleeplessness, anxiety, depression and so on,” Goldberg told the News. “When you mix identity-related stress in with the normal vicissitudes of life and toss it all into the pressure cooker of an Ivy League university, it becomes obvious why so many gay and bisexual men at Yale seek out LGBTQ-oriented mental health services.”

Pachankis and his team are attempting to design population-specific mental health treatment in consultation with community mental health providers as well as at-risk gay and bisexual men. In a multiyear pilot study, the researchers developed a 10-session cognitive-behavioral intervention that helped these men recognize the origins of stigma-related stress, tolerate strong emotions and develop healthier sex and social lifestyles. The treatment has a strong focus on encouraging healthy forms of self-expression and emotion regulation while reducing unhealthy avoidance patterns, he said.

Students and postdocs from Yale’s Center for Interdisciplinary Research on AIDS are among the researchers on Pachankis’ team, as the study targets mental health intervention strategies that can also reduce risks of HIV infection and other sexual health problems. Pachankis himself is affiliated with CIRA, New England’s only AIDS research center funded by the National Institute of Mental Health. Gay and bisexual men are 40 times more likely to become infected with HIV than heterosexual men, according to Pachankis.

Adam Eldahan MPH ’14, a researcher at CIRA and the project coordinator for Pachankis’ study in New York City, said depression and anxiety can increase HIV risk behavior. Combined with substance use, these factors can “further exacerbate” this population’s risk of HIV infection.

Executive Director of CIRA Elaine O’Keefe said one of the biggest public health challenges is the resurgence of HIV infections in young gay and bisexual men. O’Keefe said solving this difficult task has been a primary focus at CIRA for some time now, and she is “thrilled” that Pachankis’ application for the grant was successful. O’Keefe said it is clear that more needs to be done to combat issues of mental health, sexual health and stigma among gay and bisexual men. The risk of HIV infections is even higher for gay and bisexual men of color, she added.

CIRA’s Assistant Director of Community Research and Implementation Core Jim Pettinelli called Pachankis’ study “very timely, innovative and important.”

“[Pachankis] is really using this grant to focus on cutting-edge issues and figure out the connection between mental health and sexual health,” Pettinelli said.

He added that since the younger population is being impacted significantly by HIV, it is important for researchers to seek the input of this constituency to develop new projects.

Pachankis emphasized that mental health clinicians and members of the gay and bisexual community have contributed to the treatment’s development.

Given the manual format of the intervention, Eldahan added, the treatment, if proven cost-effective, could be hopefully used in a variety of settings, including HIV and mental health clinics, private and public health clinics as well as on high school and college campuses across the country.

Eldahan said the most exciting part of the study is that it will give clinicians an effective, evidence-based tool that targets the adverse psychological effects of homophobia as a means of improving mental and sexual health among minorities.

Assistant Dean of Student Affairs and Director of the Office of Gender & Campus Culture Melanie Boyd, who called Pachankis’ study “truly exciting research,” also highlighted the benefits of a positive intervention that will help empower the gay and bisexual community.

“Not only does it focus on the needs of a community at disproportionate risk, the intervention works by actively building empowerment,” Boyd said. “These kinds of positive strategies are especially powerful, reducing harms while also strengthening marginalized communities.”