Chemsex and Psychosis: A Systematic Review

Round 1

Reviewer 1 Report

Thank you very much for the opportunity to review this interesting systematic review. While this is a niche research area, it has the potential to inform the work undertaken in the sexual wellbeing space for gay and bisexual men. 

Chemsex is framed exclusively negatively in the introduction, which is consistent with the overall message of the manuscript itself; however, there are benefits from engaging in chemsex related to sexual pleasure and being able to enjoy sex in the first place. Indeed, plenty of studies have demonstrated that the majority of men engaged in chemsex are not only functioning but do not have any meaningful negative consequences as a result of engaging in chemsex. This should be mentioned since other non-psychosis-related health outcomes of chemsex are also discussed in the introduction. 

The use of the term psychosis within the paper is another important point I would like to raise. The authors need to provide a working definition of psychosis they have used and how they applied this in the selection process. At the moment, the title, introduction and results are inconsistent as it also looks at symptoms of psychosis that could also not present a psychosis in the first place.

Considering the relationship between chemsex and psychosis, there is clearly a difference between chemsex and other types of substance use. This needs to be discussed in regard to the outcome of psychosis. I.e., are psychoses more likely to occur during chemsex compared to non-chemsex-related use of the same substance? This would allow the authors to more clearly contextualise the relationship between chemsex and psychosis. In this aspect, it should also be clearly noted that it is very difficult to establish a causal relationship between the two concepts in a marginalised community like gay and bisexual men, especially when we consider that some previous research demonstrated that men with low sexual wellbeing are more likely to subsequently engage in chemsex, while low sexual wellbeing is generally related to lower mental health etc.... 

Related to my previous comment, the authors should reconsider how they discuss or frame the 'risk factors' they identified. Is being from an 'ethnic minority' really a risk factor for psychosis or chemsex or rather the combined effect of homonegativity and racism? There are a few interesting papers on the effect of intersecting identities on substance use, mental health and psychological wellbeing, that might be able to assist the author with a more robust discussion. 

 

Minor points: 

- Justify why you have chosen these databases above all others.

- What does 'active at work' refer to? (Just being employed?)

- How is a stable relationship defined?

- The authors might want to define 'booty bumping as I'm sure 95% of people will not know what this refers to.

 

 

 

Author Response

Please see the attachment

Author Response File: Author Response.docx

Reviewer 2 Report

This is a very interesting paper focusing on the relationship between Chemsex and Psychosis and their mental and physical health consequences. The paper is well-written and of interest for the journal and the readers. However, prior to its consideration for publication, I recommend several minor changes.

Abstract.

1-What does "a mixed systematic review model" mean? Please, describe it with more details.

2-A total of 10 articles were included, from how many retrieved records?

3-What about early interventions and public health management?

Introduction

1-I recommend to divide the introduction according the following points: social consequences, mental health consequences, and physical health consequences. It would be easier to understand.

2-The main aims/objectives of the paper should be explained with more details. I recommend to build a subsection "1.1.Aims" to describe them.

Materials and Methods.

1- I recomend to describe the screening and selection process first, and afterwards the elegibility criteria. 

2-Please, provide more details about the risk of bias assessment. The authors can describe the CASP checklist.

Results

1-The flowchart should appear in the methods section and not in the middle of the results section.

The discussion and results are well-described. The authors have also proposed future lines of research.

 

Author Response

Please see the attachment

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

The authors have addressed all comments sufficiently.