School of Public Health, Chongqing Medical University, Chongqing 400016, China; Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China.
School of Public Health, Chongqing Medical University, Chongqing 400016, China.
Ann Epidemiol. 2024 Aug;96:32-39. doi: 10.1016/j.annepidem.2024.05.010. Epub 2024 Jun 1.
High levels of depression are common among men who have sex with men (MSM) in China, and there is limited research on the relationship between MSM stigma and depression. Guided by the psychological mediation framework, to explore the relationship between stigma and depression among MSM and how positive sexual identity plays a role in it, we tested this model whether: 1) enacted MSM stigma, perceived MSM stigma, and positive sexual identity are associated with depression; 2) their effects on depression are mediated through resilient coping and social support; and 3) perceived MSM stigma is a mediator of the effects of enacted MSM stigma and positive sexual identity on depression.
We conducted mediation analyses using structural equation modeling (SEM) on data from a cross-sectional survey conducted among 1014 MSM recruited using a non-probability sampling method in December 2022. The data passed general analyses such as normality and correlation, which allowed for modeling. The final SEM fit metrics indicated that the model was acceptable.
Structural equation modeling results showed that enacted stigma directly and positively affected depressive symptoms (β = 0.558, 95 % confidence interval = 0.457 ～ 0.644, P < 0.001). Perceived stigma had a positive effect on depressive symptoms (β = 0.114, 95 %CI = 0.036 ～ 0.200, P = 0.002). Positive identity had a positive effect on depressive symptoms (β = 0.086, 95 %CI = 0.016 ～ 0.162, P = 0.013). In addition, the results of mediation effect analysis showed that the indirect effect of enacted stigma on the effect of depression through social support was (β = 0.040, 95 %CI = 0.003 ∼ 0.017, P = 0.049); The indirect effect of perceived stigma on the effect of depression through resilient coping was (β = -0.015, 95 %CI = -0.034 ∼ -0.002, P = 0.056); The indirect effects of positive sexual identity on the effect of depression through resilient coping and social support were (β = -0.025, 95 %CI = -0.056 ∼ -0.002, P = 0.052) and (β = -0.056, 95 %CI = -0.101 ∼ -0.023, P = 0.005).
Resilient coping and social support mediated the relationship between stigma and depression, and both were influenced by positive identity. This study reveals that enhancing coping and social support may reduce the impact of stigma on depressive symptoms, both of which are potential targets for interventions for MSM. Guiding MSM to develop a positive sexual identity is conducive to reducing the prevalence of depressive symptoms among MSM.
在中国，男男性行为者（MSM）中普遍存在较高水平的抑郁，而关于 MSM 污名与抑郁之间的关系的研究有限。本研究以心理中介框架为指导，探讨了 MSM 污名与抑郁之间的关系，以及积极的性认同在其中的作用，检验了以下模型：1）实施的 MSM 污名、感知的 MSM 污名和积极的性认同与抑郁相关；2）它们对抑郁的影响是否通过弹性应对和社会支持来中介；3）感知的 MSM 污名是否是实施的 MSM 污名和积极的性认同对抑郁影响的中介。
我们使用结构方程模型（SEM）对 2022 年 12 月采用非概率抽样方法招募的 1014 名 MSM 进行的横断面调查数据进行中介分析。数据通过正态性和相关性等一般分析进行检验，从而可以进行建模。最终 SEM 拟合指标表明模型是可接受的。
结构方程模型结果表明，实施的污名直接且积极地影响抑郁症状（β=0.558，95%置信区间=0.457 ～ 0.644，P<0.001）。感知的污名对抑郁症状有积极影响（β=0.114，95%CI=0.036 ～ 0.200，P=0.002）。积极的身份对抑郁症状有积极影响（β=0.086，95%CI=0.016 ～ 0.162，P=0.013）。此外，中介效应分析的结果表明，实施的污名通过社会支持对抑郁的间接效应为（β=0.040，95%CI=0.003 ～ 0.017，P=0.049）；感知的污名通过弹性应对对抑郁的间接效应为（β=-0.015，95%CI=-0.034 ～ -0.002，P=0.056）；积极的性认同通过弹性应对和社会支持对抑郁的间接效应分别为（β=-0.025，95%CI=-0.056 ～ -0.002，P=0.052）和（β=-0.056，95%CI=-0.101 ～ -0.023，P=0.005）。
弹性应对和社会支持中介了污名与抑郁之间的关系，而这两者都受到积极认同的影响。本研究揭示了增强应对和社会支持可能会降低污名对抑郁症状的影响，这两者都是 MSM 干预的潜在目标。指导 MSM 建立积极的性认同有助于降低 MSM 抑郁症状的发生率。
