School of Health Sciences, Wuhan University, Wuhan, PR China.
School of Health Sciences, Wuhan University, Wuhan, PR China.
Ann Epidemiol. 2021 Apr;56:1-8. doi: 10.1016/j.annepidem.2021.01.001. Epub 2021 Jan 7.
Young men who have sex with men (YMSM) are likely to experience depression due to enacted and internalized stigma. Whether enacted stigma impacts depression through internalized stigma and whether resilience moderates the negative effect are unclear. This study aims to examine a moderated mediation model to explore the role of internalized stigma in mediating the relationship between enacted stigma and depressive symptoms and whether this relationship is modified by resilience among Chinese YMSM.
Between September 2017 and January 2018, we conducted a baseline survey of a four-year cohort study among men who have sex with men in China. An anonymous computer-assisted ("Questionnaire Star") self-interview questionnaire survey was conducted, and 346 YMSM were included for analysis. Sociodemographic characteristics, enacted stigma, internalized stigma, resilience, and depressive symptoms were measured. Mediation and moderated mediation model analysis were used to examine the relationships among these variables.
Overall, 38.7% (137) participants reported depressive symptoms. Internalized stigma partly mediated the relationship between enacted stigma and depressive symptoms (β = 0.091, P < .01). Moderation mediation analysis found positive moderating role of resilience in the relationship between enacted stigma and internalized stigma (β = -0.026, P = .019), as well as between enacted stigma and depressive symptoms (β = -0.053, P = .008). The indirect effects of enacted stigma on depressive symptom through internalized stigma were significant only when resilience was at low (β = 0.191, 95% CI = 0.072，0.366) and moderate (β = 0.104, 95% CI = 0.035，0.220) levels but not significant when resilience was high (β = 0.017, 95% CI = -0.083, 0.140).
Enacted stigma could directly impact depressive symptoms, and internalized stigma partly mediated the relationship between enacted stigma and depressive symptoms. Resilience significantly moderated the association between enacted stigma and depressive symptoms as well as the association between enacted stigma and internalized stigma. Promoting resilience while reducing enacted stigma and internalized stigma may be useful in relieving depressive symptoms among Chinese YMSM.
男男性行为者（MSM）由于遭受和内化的污名而可能经历抑郁。实施性污名是否通过内化的污名影响抑郁，以及韧性是否调节这种负面影响尚不清楚。本研究旨在检验一个调节中介模型，以探讨内化污名在介导实施性污名与抑郁症状之间关系中的作用，以及这种关系是否被中国 MSM 的韧性所改变。
2017 年 9 月至 2018 年 1 月，我们对中国男男性行为者进行了一项为期四年的队列研究的基线调查。采用匿名计算机辅助（“问卷之星”）自访谈问卷调查，共纳入 346 名 MSM 进行分析。测量了社会人口统计学特征、实施性污名、内化污名、韧性和抑郁症状。采用中介和调节中介模型分析来检验这些变量之间的关系。
总体而言，38.7%（137）的参与者报告有抑郁症状。内化污名部分中介了实施性污名与抑郁症状之间的关系（β=0.091，P<0.01）。调节中介分析发现，韧性对实施性污名与内化污名之间的关系（β=-0.026，P=0.019）以及实施性污名与抑郁症状之间的关系（β=-0.053，P=0.008）具有积极的调节作用。只有当韧性处于低（β=0.191，95%置信区间（CI）=0.072，0.366）和中（β=0.104，95%CI=0.035，0.220）水平时，实施性污名通过内化污名对抑郁症状的间接影响才具有统计学意义，而当韧性较高（β=0.017，95%CI=-0.083，0.140）时则不具有统计学意义。
实施性污名可直接影响抑郁症状，内化污名部分中介了实施性污名与抑郁症状之间的关系。韧性显著调节了实施性污名与抑郁症状之间的关系以及实施性污名与内化污名之间的关系。在缓解中国 MSM 的抑郁症状时，促进韧性同时减少实施性污名和内化污名可能是有用的。
