Toronto Metropolitan University, Toronto, Canada.
University of Guelph, Guelph, Canada.
Subst Abuse Treat Prev Policy. 2024 Feb 28;19(1):16. doi: 10.1186/s13011-024-00597-8.
Gay, bisexual, and other men who have sex with men (GBM) report high rates of problematic alcohol use, anxiety, and depression. This may, in part, be due to stressors related to their sexual identity (i.e., minority stressors). However, few studies have examined both distal and proximal stressors, as well as the specific psychological mechanisms by which these stressors may be related to alcohol use outcomes, in a representative sample of GBM. We explored the relationship between distal and proximal stressors and alcohol use outcomes, as well as the role of anxiety and depression as potential mediators of these relationships.
We analyzed the baseline data of 2,449 GBM from Engage, a cohort study of sexually active GBM recruited using respondent-driven sampling (RDS) in Montreal, Toronto, and Vancouver from February 2017 to August 2019. Using structural equation modeling, we examined the associations between distal minority stressors (i.e., experiences of heterosexist harassment, rejection, and discrimination), proximal minority stressors (i.e., internalized homonegativity, concerns about acceptance, concealment, and lack of affirmation), anxiety and depression, and alcohol consumption and alcohol use problems. RDS-adjusted analyses controlled for age, income, sexual orientation, ethnicity, recruitment city, and HIV serostatus.
There were positive direct associations between distal stress and proximal stress, anxiety, and depression, but not alcohol use outcomes. Proximal stress had a positive direct association with anxiety, depression, and alcohol use problems, but not alcohol consumption. Anxiety was positively associated with alcohol consumption and alcohol use problems. Depression was negatively associated with alcohol consumption but not alcohol use problems. Regarding indirect effects, distal stress was associated with alcohol use outcomes via proximal stress and anxiety, but not via depression.
We found support for a minority stress model as it relates to alcohol use outcomes among GBM. Findings suggest that proximal minority stress and anxiety differentially impact the problematic alcohol use among GBM who experience heterosexist discrimination. Clinical providers should consider incorporating the treatment of proximal minority stressors and anxiety into existing alcohol interventions for GBM.
男同性恋、双性恋和其他与男性发生性关系的男性（GBM）报告称，他们有很高的酗酒、焦虑和抑郁问题。这在一定程度上可能是由于与他们的性身份有关的压力源（即少数群体压力源）造成的。然而，很少有研究在代表性的 GBM 样本中同时考察远端和近端压力源，以及这些压力源与酒精使用结果相关的具体心理机制。我们探讨了远端和近端压力源与酒精使用结果之间的关系，以及焦虑和抑郁作为这些关系中介的作用。
我们分析了 2017 年 2 月至 2019 年 8 月期间，通过回应驱动抽样（RDS）在蒙特利尔、多伦多和温哥华招募的活跃 GBM 进行的一项队列研究“参与”（Engage）中 2449 名 GBM 的基线数据。我们使用结构方程模型，考察了远端少数群体压力源（即异性恋骚扰、拒绝和歧视的经历）与近端少数群体压力源（即内化的同性恋消极态度、对接受、隐瞒和缺乏肯定的关注）、焦虑和抑郁，以及酒精消费和酒精使用问题之间的关联。RDS 调整分析控制了年龄、收入、性取向、种族、招募城市和 HIV 血清状况。
远端压力与近端压力、焦虑和抑郁呈正直接关联，但与酒精使用结果无关。近端压力与焦虑、抑郁和酒精使用问题呈正直接关联，但与酒精消费无关。焦虑与酒精消费和酒精使用问题呈正相关。抑郁与酒精消费呈负相关，但与酒精使用问题无关。关于间接效应，远端压力通过近端压力和焦虑与酒精使用结果相关，但与抑郁无关。
我们发现，在 GBM 中，与少数群体相关的压力模型与酒精使用结果之间存在一定的支持。研究结果表明，近端少数群体压力和焦虑会对经历异性恋歧视的 GBM 中出现的问题性饮酒产生不同的影响。临床医生应该考虑将近端少数群体压力源和焦虑的治疗纳入现有的 GBM 酒精干预措施中。
