抑郁与性行为之间的矛盾关联：对男同性恋、双性恋和其他与男性发生性行为者中进行流行病学调查的启示。

Opposing associations of depression with sexual behaviour: implications for epidemiological investigation among gay, bisexual and other men who have sex with men.

机构信息

Institute for Global Health, University College London, London, UK

Institute for Global Health, University College London, London, UK.

出版信息

Sex Transm Infect. 2021 Dec;97(8):613-618. doi: 10.1136/sextrans-2020-054634. Epub 2021 Jan 11.

DOI:10.1136/sextrans-2020-054634

PMID:33431606

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8606445/

Abstract

OBJECTIVE

The aim of this report is to investigate the nature of the relationship between depression and condomless sex (CLS) among gay, bisexual and other men who have sex with men (GBMSM).

METHODS

Data are from the Antiretrovirals, Sexual Transmission Risk and Attitude (ASTRA) study of people living with HIV and attending one of eight HIV outpatient clinics in England (2011-2012) and the Attitudes to and Understanding of Risk of Acquisition of HIV (AURAH) study of HIV-negative/unknown status individuals attending one of 20 genitourinary medicine clinics in England (2013-2014). This analysis included GBMSM only. For each study, the prevalence of depressive symptoms (Patient Health Questionnaire-9 score ≥10) was presented according to three categories of sex in the past 3 months (considering anal/vaginal sex with men/women and anal sex with men in separate definitions): (1) no sex, (2) condom-protected sex only and (3) CLS. Multinomial logistic regression with 'condom-protected sex only' as the reference group was used to adjust for age and (for ASTRA participants) time since HIV diagnosis.

RESULTS

There were opposing associations of depression with recent sexual behaviour: the prevalence of depression was higher among those who reported no sex and those who reported CLS, compared with those who reported condom-protected sex only. Among the 2170 HIV-positive GBMSM in ASTRA, considering anal/vaginal sex with men/women, the prevalence of depressive symptoms was 32%, 20% and 28%, respectively, among men reporting no sex (n=783), condom-protected sex only (n=551) and CLS (n=836) (global p<0.001). Among the 1477 HIV-negative GBMSM in AURAH, the prevalence of depressive symptoms was 12%, 8% and 13%, respectively, for no sex (n=137), condom-protected sex only (n=487) and CLS (n=853) (global p=0.017). Patterns were similar after adjustment and when only considering anal sex between men.

CONCLUSIONS

Depression may be linked both to lack of sexual activity and to sexual risk taking. When investigating associations between depression and CLS, it is important to separate out individuals reporting condom-protected sex only from those reporting no sex.

摘要

目的

本报告旨在探讨男同性恋、双性恋和其他与男性发生性行为者（GBMSM）中抑郁与无保护性行为（CLS）之间关系的本质。

方法

数据来自于英格兰 8 家艾滋病毒门诊中的 HIV 感染者参与的抗逆转录病毒、性传播风险和态度（ASTRA）研究（2011-2012 年）和英格兰 20 家泌尿科诊所中 HIV 阴性/未知状态个体参与的艾滋病毒感染风险的态度和理解（AURAH）研究（2013-2014 年）。本分析仅包括 GBMSM。对于每项研究，根据过去 3 个月内的三种性行为类别（考虑与男性/女性的肛交/阴道交和与男性的肛交），呈现出抑郁症状（患者健康问卷-9 得分≥10）的流行率：（1）无性行为，（2）仅使用避孕套的性行为和（3）CLS。采用多项逻辑回归，以“仅使用避孕套的性行为”为参照组，调整年龄因素（对于 ASTRA 参与者，还调整了 HIV 诊断后的时间）。

结果

抑郁与近期性行为呈相反关联：与仅报告使用避孕套的性行为和报告无性行为的人相比，报告 CLS 的人抑郁的患病率更高。在 ASTRA 中 2170 名 HIV 阳性的 GBMSM 中，考虑与男性/女性的肛交/阴道交，分别报告无性行为（n=783）、仅使用避孕套的性行为（n=551）和 CLS（n=836）的男性中抑郁症状的流行率分别为 32%、20%和 28%（全球 p<0.001）。在 AURAH 中 1477 名 HIV 阴性的 GBMSM 中，无性行为（n=137）、仅使用避孕套的性行为（n=487）和 CLS（n=853）的抑郁症状的流行率分别为 12%、8%和 13%（全球 p=0.017）。调整后和仅考虑男性之间的肛交时，结果相似。