A Study On The Mechanism Of The Effect Of Adverse Childhood Experiences On Depression Symptom Among Men Who Have Sex With Men

BackgroundMen who have sex with men(MSM),including young men who have sex with men(YMM),are the high-risk groups of AIDS in China,and sexual behavior is the main way of HIV infection,.While other people's AIDS related risk behaviors are closely related to their psychological and emotional conditions,especially depression,which not only affects their quality of life,but also their AIDS related behaviors.Therefore,the behavior intervention of MSM should pay attention to their psychological and emotional status,and pay attention to the mechanism of depression is a key point of AIDS intervention.In order to effectively intervene the depression of MSM and reduce their AIDS related risk behaviors,we need not only to understand their depression status,but also to analyze their depression mechanism.Some studies have found that adverse childhood experiences(ACE)is a relatively common phenomenon in the population,and ACE also widely exists in MSM population.ACE plays an important role in adult psychological behaviors,such as depression,suicide,sexual behavior,etc.At present,there are few researches on the process and mechanism of ACE's influence on people's psychological behavior.In particular,the mechanism of ACE on depression in MSM population is rarely reported,so it is necessary to study the mechanism of ACE on depression in MSM population.It is a complex process that ACE affects people's psychological behavior.Previous studies have found that ACE affects the behavior of the general population by many factors.In MSM population,whether ace affects the depression of this population is also regulated by a series of factors,such as social support,sexual minority pressure,is it just a direct role,or multiple ways and mechanisms exist at the same time?In particular,does the sexual minority pressure in MSM also play an intermediary role?All these need to be discussed.In addition,from another point of view,people pay more and more attention to the study of behavioral problems from a non-linear perspective.Depression can also be seen as a non-linear and discontinuous psychological and behavioral process.Catastrophe theory is the first mock exam in the theory of nonlinear change.The cusp catastrophe model based on catastrophe theory can well analyze the predictive role of influence factors on psychological behavior.Therefore,we will also use ACE to quantitatively study the factors influencing depression from the perspective of nonlinear.ObjectiveTo understand the status of ACE,sexual minority pressure and depression in MSM population and its related social and psychological factors,to explore the mechanism of ACE effect on depression,as well as its impact on the dynamic change of depression,and to analyze the process of ACE effect on depression in MSM population from the linear and nonlinear Perspective,so as to provide scientific basis for the prevention and intervention of depression in MSM population.Research methodsFrom October 2017 to October 2018,MSM population in Wuhan,Changsha and Nanchang were selected as the target population,and the subjects were recruited by the combination of opportunity sampling and peer promotion.693 MSM who met the inclusion criteria were investigated anonymously.After the first investigation,the subjects were followed up dynamically by mobile wechat,and their behavior changes after 6 months were tracked.The questionnaire was filled out on the spot by electronic questionnaire and tablet computer.The survey contents include sociodemographic characteristics(age,gender,occupation,etc.),sexual behavior characteristics,ACE(ACE scale measurement),sexual minority pressure(including sexual orientation related discrimination,rejected expectation,internalization discrimination and sexual orientation concealment related scale measurement),depression status(depression scale).Spss20.0 software was used for general descriptive analysis,?²test,t test,variance analysis,multiple linear regression and multiple logistic regression,Spss.Amos.24.0 software was used for structural equation model path analysis,R software"cusp"package was used for cusp catastrophe model analysis.ResultsPart 1 Relationship between ACE and depression in MSM and its mechanism1.Basic characteristics of MSM population 693 MSM were investigated in this survey,with an average age of 27.1±8.5 years,and 94.9%of them were the Han;60.6%and 39.4%of them came from urban and rural areas;75.5%of them were college degree or above;84.4%of them were unmarried;27.7%of them were academic students,58.6%were full-time workers,13.7%were part-time workers;49.6%of them had a monthly income of less than 3000 yuan.73.2%of the respondents were homosexual and 26.8%were bisexual.92.2%of MSM agreed with their sexual orientation.2.Ace,sexual minority pressure and social support and related influencing factors Among the respondents,ACE accounted for 55.0%(ACE score of 1 point or above),among which 21.6%,12.6%,24.2%,17.9%,5.3%and 26.8%reported emotional abuse,physical abuse,sexual abuse,emotional neglect,physical neglect and family dysfunction respectively.The average score of ACE was 1.18±1.57.In the pressure of sexual minorities,the score of homosexual discrimination was 15.93±4.36,the score of expected discrimination was 14.81±6.21,the score of sexual orientation concealment was 17.22±6.63,and the score of self discrimination was13.88±5.62.The score of social support was 60.40±12.52.3.Depression and its influencing factors In MSM population,49.9%of them have different degree of depression symptoms,of which 20.6%are severe depression,13.6%are moderate depression,15.7%are mild depression.The total mean score of depression was 17.43±10.40,including 6.92±5.35 points of depression,7.00±3.37points of positive emotion,4.41±3.57 points of physical symptoms and activity retardation,and 1.09±1.50 points of interpersonal relationship.There was no statistical significance in the difference of depression scores among MSM with different characteristics(P>0.05).There was a positive correlation between depression score and stress score of sexual minorities(all P?0.001),including homosexual discrimination(r=0.236),expected discrimination(r=0.259),sexual orientation concealment(r=0.235),self discrimination(r=0.219),and a negative correlation with social support score(r=-0.367,P?0.001).The depression score of MSM with ACE(19.27±11.14)was higher than that of MSM without ACE(15.18±8.92),the difference was statistically significant(P?0.001).All dimensions of ACE,including abuse,neglect and family dysfunction,were related to the depression scores of MSM(P?0.001),and the higher ace score,the higher depression score(P?0.001).The results of multiple linear regression analysis showed that the age of 25-34(?=3.04),living with lovers(?=-2.72),ACE score(?=1.65)had an impact on depression;the higher the stress score of homosexual discrimination(?=0.36),expected discrimination(?=0.25),sexual orientation concealment(?=0.16),self discrimination(?=0.27),the higher the risk of depression;social support The higher the level of social support,the lower the risk of depression(?=-0.20).4.Analysis of the mediating effect of ace on depression Path analysis showed that ACE(?=0.187,P?0.001)had direct effect on depression,homosexual discrimination(?=0.094,P=0.018),expected discrimination(?=0.118,P=0.004),sexual orientation concealment(?=0.131,P=0.002)and self discrimination(?=0.133,P?0.001)could directly enhance depression.Ace can also indirectly affect depression by enhancing homosexual discrimination(?=0.269,P?0.001),and then indirectly enhance expected discrimination(?=0.376,P?0.001),self discrimination(?=0.123,P<0.002)and sexual orientation concealment effect(?=0.143,P?0.001),and further indirectly enhance depression effect,that is,.Homosexual discrimination,expectation discrimination,self discrimination and sexual orientation concealment all play an intermediary role in the influence of ace on depression.There are also more complex pathways for ace to influence depression:first,ACE enhances homosexual discrimination(?=0.269),and then enhances the depression effect(?=0.131)by enhancing sexual orientation concealment(?=0.143);second,ACE enhances homosexual discrimination(?=0.269),and then enhances self discrimination(?=0.332,P?0.0)by enhancing sexual orientation concealment(?=0.143)After 0.01,the depression effect(?=0.133)was enhanced finally;third,ACE enhanced homosexual discrimination(?=0.269),and then enhanced depression effect(?=0.118)by enhancing expected discrimination(?=0.376,P?0.001);or expected discrimination enhanced depression effect(?=0.131)by enhancing sexual orientation concealment(?=0.414,P?0.001);or enhanced sexual orientation concealment by expected discrimination After concealing(?=0.414),self discrimination was enhanced(?=0.332,P?0.001),and finally depression effect was enhanced(?=0.133).5.An analysis of the adjust effect of social support on depression Path analysis showed that social support had direct negative effects on ACE(?=-0.295,P?0.001),depression(?=-0.249,P?0.001),homosexual discrimination(?=-0.215,P?0.001),sexual orientation concealment(?=-0.165,P?0.001)and expected discrimination(?=-0.133,P?0.001).The interaction between social support and homosexual discrimination weakens the expected discrimination effect(?=-0.103,P=0.001).However,the interaction between social support and homosexuality enhanced the concealment effect of sexual orientation(?=0.100,P?0.001).Social support adjusts the effect of ace on depression through homosexual discrimination and sexual orientation concealment.Part 2:the dynamic changes and influencing factors of depression in YMSM1.Basic characteristics of YMSM Population 300 YMSM were investigated in this survey,with an average age of 20.0±1.9 years,and 92.7%of them were the Han;50.7%and 49.3%of them came from urban and rural areas respectively;82.7%of them were college degree or above;99.0%of them were unmarried;60.7%of them were students,29.0%of them were full-time employed,10.3%were part-time employed,and 73.7%had a monthly income of less than 3000 yuan.79.3%of the respondents were homosexual and 20.7%were bisexual.93.0%of YMSM agreed with their sexual orientation.2.Ace,sexual minority pressure and social support and related influencing factors Among the respondents,the average score of ace was 1.33±1.70,58.3%of YMSM experienced ACE,25.7%,15.7%,21.7%,19.7%,6.3%and 26.8%of them experienced emotional abuse,physical abuse,sexual abuse,emotional neglect,physical neglect and family dysfunction respectively.In the family dysfunction,parents divorced and separated(20.3%)and their families imprisoned(9.7%)were the most.In the pressure of sexual minorities,homosexual discrimination score 15.32±3.83,expected discrimination score 14.37±5.54,sexual orientation concealment score15.74±6.04,self discrimination score 12.59±5.10.The score of social support was61.73±12.47.3.The depressive status of YMSM and its influencing factors Baseline survey and6-month follow-up were conducted on the depression of YMSM.In the baseline survey,49.3%had depression,while 47.3%had depression after 6 months of follow-up.Among them,14.3%were newly depressed,33.0%were persistent depressed and 16.3%were depressed.The results of multiple logistic regression model analysis with the change type of depression as the dependent variable show that:(1)with no depression as the reference,people with lower education level are more likely to have new depression,but this effect is meaningless after the introduction of social support variable(model4),indicating that social support reduces the impact of education level on new depression.(2)As for the improvement of depression,the higher the level of homosexual discrimination,the lower the possibility of depression improvement;but the higher the level of expected discrimination,the higher the possibility of depression improvement.The higher the level of social support was,the more likely the depression was to improve(or=0.95,95%CI:0.92,0.98).(3)The risk of persistent depression was higher in ymms with age?20 years;the risk of persistent depression was higher in ymms with low education than in those with high education;the persistent depression was 2.67 times higher in those with ACE than in those without ACE;the higher the level of expected discrimination,the higher the risk of persistent depression.The higher the level of social support,the lower the possibility of persistent depression.Part 3:A nonlinear model study on the relationship between ACE and depression in MSM population.According to AIC,BIC and R²,the fitting effect of cusp mutation model(R²=0.775,AIC=1659,BIC=1687)is better than that of linear regression model(R²=0.145,AIC=2026,BIC=2044)and logistic regression model(R²=0.146,AIC=2027,BIC=2050).There was a significant negative correlation between social support and depression(a₁=-0.029,P<0.001),which was split by ACE(b₁=0.073,P<0.05).There was a significant negative correlation between social support and depression(a₁=-0.029,P?0.001),which was split by ACE(b₁=0.073,P?0.05),that is,the gradual and stable relationship between social support and depression is split by ACE of MSM,which means that the higher the social support is,the less likely MSM is to be depressed when the ace exposure is low;when the ace exposure is high,even when the social support level is very high,MSM may quickly enter into a state of depression.Conclusion1.Among MSM,ace was more common,and the detection rate of depressive symptoms was higher.Ace,sexual minority pressure and social support are related to depression;2.Ace can directly affect the depression of MSM,or indirectly affect depression through sexual minority pressure(homosexual discrimination,expected discrimination,sexual orientation concealment,self discrimination),and social support can regulate the effect of ace on depression through homosexual discrimination.3.There are many patterns of depression in ymms,and they are affected by ACE,social support,sexual minority pressure and other factors.People with ACE are more likely to be depressed continuously,people with high level of homosexual discrimination are less likely to be depressed for the better,and people with high level of social support are more likely to be depressed for the better..4.The cusp mutation model is better than the linear model in predicting depressive symptoms through ace and social support.MSM depression may be a non-linear discontinuous change process.