| Objectives:The purpose of this research is to explore and compare the relationship between sexuality minority stress and depressive symptoms among Chinese younger and older MSM(Men who have sex with Men): to explore which kind of the four sexuality minorities stress(sexual orientation-related stigma,rejection expectation,internalized homophobia and identity concealment)has an impact on depressive symptoms,and to explore the mediating mechanisms of sexuality minority stress on depressive symptoms,and to compare their differences between different age groups(adolescents and nonadolescent MSM).The result can provide individualized and specific interventions,,and thus reduce the incidence of depressive symptoms.Methods:Using convenient sampling and respondent-driven sampling method,we carried out a questionnaire survey from September 2017 to January 2018 at MSM community where MSM participate in HIV counselling and testing or recreational activities in three provincial capital cities including Wuhan,Nanchang and Changsha in China.Among 750 recalled questionnaires,715 questionnaires were effective(effective rate: 95.4%).Measures included socio-demographics,sexuality minority stress(sexual orientationrelated stigma,rejection expectation,internalized homophobia and identity concealment)and CES-D depressive symptoms questionnaire.SPSS22.0 software was used for descriptive analysis,univariate and multiple regression analysis,correlation analysis and mediator effect analysis,and Mplus8.0 software was used for path analysis.Results:(1)Demographic and sociological characteristics: Among 715 participates,346 were adolescents MSM(aged 16-24 years old)and 369 were non-adolescent MSM(aged 24 years old above).Among all MSM,more than half of the sample were from urban(60.4%),educated for university or college(66.2%),unmarried(84.4%),and in work(61.8%).Most of MSM(71.5%)reported homosexual orientation,and the large majority(91.3%)identified their sexual identity as male.Adolescents MSM were mostly college educated(73.1%),unmarried(98.8%),and students(54.0%).A larger proportion of the non-adolescent MSM were from urban(69.6%),unmarried(70.5%),and in work(85.4%).Most of MSM(adolescent MSM vs.non-adolescent MSM: 79.2 % vs.66.9%)reported homosexual orientation,and the large majority(91.0% vs.91.6%)identified their sexual identity as male.Whether identified their sexual identity as male is not statistically significant in the two different age subgroups of adolescents and nonadolescents MSM,but the other items are statistically significant in two different age subgroups of adolescents and non-adolescents MSM.(2)Sexuality minority stress and depressive symptoms status: The mean score ± standard error of sexual stigma among all MSM,adolescent MSM and non-adolescent MSM were 15.97 ±4.50,15.39±3.91 and 16.52±4.93,respectively.The mean score ± standard error of rejection expectation among all MSM,adolescent MSM and nonadolescent MSM were 14.73±6.24,14.45±5.74 和 14.99±6.68,respectively.The mean score ± standard error of internalized homophobia among all MSM,adolescent MSM and non-adolescent MSM were 13.94±5.70,13.26±5.30 和 14.57±5.98,respectively.The mean score ± standard error of identity concealment among all MSM,adolescent MSM and non-adolescent MSM were 17.11±6.66,16.01 ±6.24 和 18.14±6.89,respectively.The mean score ± standard error of depressive symptoms among all MSM,adolescent MSM and non-adolescent MSM were 17.63±10.49,17.99±10.79,17.30±10.21,respectively.The prevalence of depressive symptoms was 38.9%(278/715)among all the samples.The prevalence of depressive symptoms among adolescent MSM and non-adolescent MSM was 38.7%(134/346)and 39.0%(144/369),respectively.All scales have good reliability.(3)The difference of sexuality minority stress and depressive symptoms among adolescent MSM and non-adolescent MSM: Compared with adolescent MSM,nonadolescent MSM experienced high levels of sexual stigma(P<0.001),rejection expectation(P = 0.033),internalized homophobia(P = 0.003),and identity concealment(P<0.001).However,there was no significant difference in depressive symptoms between adolescent MSM and non-adolescent MSM(P = 0.935).(4)Multiple linear regression analysis of sexuality minority stress on depressive symptoms among adolescent MSM and non-adolescent MSM: After controlled socialdemographic characteristics,multiple linear regression analysis shows that sexual stigma(P = 0.011)and rejection expectation(P = 0.010)were influencing factors of depressive symptoms among adolescent MSM;sexual orientation-related stigma(P <0.001)and rejection expectation(P = 0.036)and internalized homophobia(P = 0.005)were the influencing factors of depressive symptoms among non-adolescent MSM.(5)Mediating analysis of influencing factors for depressive symptoms among adolescents MSM and non-adolescents MSM: In adolescents with MSM,sexual orientation-related stigma has a significant effect on rejection expectation(β = 0.566,P <0.001)and depressive symptoms(β = 0.443,P = 0.001)The impact of rejection expectation on depressive symptoms is also significant(β = 0.385,P <0.001);rejection expectation plays part mediation effect in the process of sexual orientation-related stigma affecting depressive symptoms.Sexual orientation-related stigma significantly affects rejection expectation(β = 0.468,P = 0.001),internalized homophobia(β = 0.136,P = 0.008),and depressive symptoms(β = 0.365,P = 0.001)among non-adolescent MSM.Rejection expectation(β = 0.182,P = 0.028)and internalized homophobia(β = 0.347,P <0.001)also has significant effects on depressive symptoms;rejection expectation and internalized homophobia both play a part mediation effect in the process of sexual orientation-related discrimination affecting depressive symptoms.(6)Path analysis of from sexual orientation-related stigma to depressive symptoms among adolescent MSM and non-adolescent MSM: Among adolescent MSM,sexual orientation-related stigma can directly affect depressive symptoms(β = 0.160,95% CI: 0.045 ～ 0.252),and it can also indirectly affecting depressive symptoms through rejection expectation(β = 0.079,95% CI: 0.035 ～ 0.140).The total effect size of sexual orientation-related stigma influencing on depressive symptoms is 0.239(95% CI: 0.155 ～ 0.345);the direct effect size of rejection expectation affecting depressive symptoms is 0.205(95% CI: 0.103 ～ 0.333).Among non-adolescent MSM,sexual orientation-related stigma can directly affect depressive symptoms(β = 0.177,95% CI: 0.046 ～ 0.268),and it can also indirectly affect depressive symptoms through rejection expectation and internalized homophobia(β = 0.078,95% CI: 0.032 ～ 0.133).The total effect size of sexual orientation-related stigma affecting depressive symptoms is 0.255(95% CI: 0.136 ～ 0.337);the direct effect size of rejection expectation influencing on depressive symptoms is 0.120(95% CI: 0.016 ～ 0.234),and the direct effect size of internalized homophobia affecting depressive symptoms is 0.204(95% CI: 0.111 ～ 0.322).Conclusion:This paper draws the following conclusions:(1)The incidences of depressive symptoms are higher in all MSM,adolescent MSM and non-adolescent MSM;(2)Compared with adolescent MSM,non-adolescent MSM experience higher levels of sexuality minority stress in four aspects: sexual orientation-related stigma,rejection expectation,internalized homophobia and identity concealment;(3)Among adolescent MSM,sexual orientation-related stigma directly and indirectly affects depressive symptoms through rejection expectation,rejection expectation plays part mediation effect in the process of sexual orientation-related stigma affecting depressive symptoms;(4)Among non-adolescent MSM,sexual orientation-related stigma directly affects depressive symptoms,and indirectly affects depressive symptoms through rejected expectation and internalized homophobia,rejection expectation and internalized homophobia both play a part mediation effect in the process of sexual orientation-related discrimination affecting depressive symptoms. |
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