1 Center for HIV/AIDS Educational Studies and Training, Hunter College of the City University of New York (CUNY) , New York, New York.
2 Community Health Sciences Doctoral Program, Community Health Sciences, University of Illinois at Chicago School of Public Health , Chicago, Illinois.
LGBT Health. 2017 Oct;4(5):352-359. doi: 10.1089/lgbt.2017.0002. Epub 2017 Aug 9.
Depression negatively impacts the health and well-being of gay and bisexual men (GBM). However, little is known about the contexts in which rural GBM live relative to those living in urban areas and their overall mental health. The aim of this study was to examine associations between population density and depressive symptoms and the role of internalized homonegativity and social support as potential mediators.
A nationally representative sample of 1071 GBM (mean age = 40.24) was enrolled. Participants provided their zip codes, which were categorized according to population density and rank-normalized.
In a path analysis model adjusted for race/ethnicity, college education, age, and relationship status, higher population density was significantly associated with increased social support (B = 0.11, P = 0.002) and decreased internalized homonegativity (B = -0.06, P < 0.001). In turn, lower social support (B = -2.93, P < 0.001) and greater internalized homonegativity (B = 4.93, P < 0.001) were significantly associated with greater depressive symptoms. The indirect effects of population density on depression through social support (B = -0.33, P < 0.001) and internalized homonegativity (B = -0.31, P < 0.001) were statistically significant, suggesting evidence for mediation of the effects.
These results indicate that living in less inhabited areas acts on depressive symptoms through mechanisms of lower social support and higher internalized homonegativity. These findings suggest that social contexts in which GBM live can affect mental health outcomes and indicate the need for further support and inclusion of GBM, especially in less inhabited areas.
抑郁会对男同性恋和双性恋者（GBM）的健康和幸福产生负面影响。然而，对于农村 GBM 与城市地区 GBM 的生活环境以及他们的整体心理健康状况，人们知之甚少。本研究旨在探讨人口密度与抑郁症状之间的关联，以及内化的同性恋消极态度和社会支持作为潜在中介因素的作用。
对 1071 名 GBM（平均年龄为 40.24 岁）进行了一项全国代表性样本调查。参与者提供了他们的邮政编码，这些邮政编码根据人口密度进行了分类和等级归一化。
在调整了种族/民族、大学教育程度、年龄和关系状况的路径分析模型中，较高的人口密度与社会支持的增加（B=0.11，P=0.002）和内化的同性恋消极态度的减少（B=-0.06，P<0.001）显著相关。反过来，较低的社会支持（B=-2.93，P<0.001）和较高的内化的同性恋消极态度（B=4.93，P<0.001）与抑郁症状的增加显著相关。人口密度通过社会支持（B=-0.33，P<0.001）和内化的同性恋消极态度（B=-0.31，P<0.001）对抑郁的间接影响具有统计学意义，表明存在中介效应。
这些结果表明，生活在人口密度较低的地区会通过社会支持减少和内化的同性恋消极态度增加的机制对抑郁症状产生影响。这些发现表明，GBM 生活的社会环境会影响心理健康结果，并表明需要进一步支持和包容 GBM，特别是在人口密度较低的地区。
