The Depressive Trajectories Among Adolescents Who Have Sex With Men With Different Childhood Adverse Experiences And Their Associations With The Stigma Towards Homosexuality

Objectives:The study aimed to construct longitudinal trajectories of depression in a sample of YMSM and subgroups with different adverse childhood experiences status,explore the association between stigma towards homosexuality and depressive trajectories.The result can provide theoretical basis for personalized psychological interventions for the YMSM population.Methods:From July 2017 to January 2018,with the help of gay organizations in Wuhan,Nanchang and Changsha,the MSM who participated in HIV counseling and testing at MSM community were recruited by using convenient sampling and respondent-driven sampling method.The information about MSM,including demographic characteristics,ACE,stigma towards homosexuality and depressive symptoms,was collected through self-administered electronic questionnaires at baseline and during follow-up.SAS 9.4 software was used for descriptive analysis and univariate analysis,trajectory model was used to analyze the developing trends of depression,and the association between sexual stigma and depression trajectory was explored.Results:（1）Demographic and sociological characteristicsA total of 424 YMSM were included in this study.The average age of all participates was 21.0 years old,most of them were Han nationality（92.7%）,undergraduate/college degree or above（82.9%）,and their parents had high school/secondary school and below（77.9%and 84.5%）,51.9%of the subjects were from urban,and 98.1%were unmarried.58.5%of the respondents were students,31.1%had full-time jobs,and 10.4%were unemployed/others;80.2%were homosexual,followed by bisexuals（14.2%）and uncertain YMSM（5.7%）,and the large majority（92.9%）identified their sexual identity as male.（2）ACE and stigma towards homosexualityAmong 424 YMSM,281（66.3%）reported at least one ACE,and 113（26.7%）reported≥3 ACE,those reported at least one of abuse,neglect or household dysfunction accounted for 48.6%,31.6%and 34.7%,respectively.The score of stigma towards homosexuality at baseline among all MSM,with ACE and without ACE experience MSM were 15.2±3.8,15.7±4.0 and 14.3±3.1,respectively.And the score of sexual stigma with ACE experience were higher than those without ACE experience at baseline and the first three visits（P<0.05）.（3）Depressive symptom and developmental trajectoriesThe prevalence of depressive symptom was 48.6%-54.6%,compared with those without ACE experience,the YMSM population with ACE experience had higher levels of depression at baseline,the first follow-up and the second follow-up（P<0.05）.The results showed that the best group number of depression development trajectories was 4 groups,and the low,medium,increaser and high depression groups accounted for 47.9%,39.4%,6.1%and 6.6%,respectively.The best group number of trajectories of the four dimensions of depression,including depressive mood,positive mood,somatic symptoms and interpersonal status all showed 3 groups.The best grouping of depressive trajectories for those with ACE and those without ACE experience were 3 groups,the proportions of low,medium and high depressive trajectories in those with ACE were 47.5%,44.6%and 7.9%,respectively,and the proportions in those without ACE were 50.0%,40.6%and 9.1%.The best groupings of depression trajectories for those with abuse,neglect and family dysfunction were both low-level and high-level groups,the trajectories of those without abuse and neglect were 4 group of the low,medium,increasing and decreasing groups,while the trajectory of those without family dysfunction showed 3 groups,including low,medium and high groups.（4）Trajectories of depression and sexual stigmaThe sexual stigma among 424 YMSM could increase in the risk of depression in the medium-level（aOR=2.036,95%CI:1.694-2.447）,increaser-group（aOR=1.319,95%CI:1.135-1.753）and high-level（aOR=1.974,95%CI:1.467-2.657）,while perceived stigma and other dimensions had greater effects in the increaser-group（aOR=3.273 and aOR=18.157）than in the medium-level group（aOR=1.710 and aOR=7.125）.Sexual stigma in both subgroups with and without ACE increased the risk of depressive symptoms in the medium-level trajectory group（aOR=2.099 and aOR=2.127）,and the dimension of enacted stigma significantly increased the risk of depression in the medium-level and high-level groups in both subgroups among YMSM,and the effect of enacted stigma on the high-level group（aOR=2.312 and aOR=18.714）was stronger than that in the medium-level group（aOR=1.582 and aOR=3.269）.In the subgroups with experience of abuse,neglect or family dysfunction,the sexual stigma could increase the risk of depression in the high-level trajectory group,and the effect of stigma on depression in the neglect group was most prominent（aOR=2.078,95%CI:1.547-2.791）,followed by family dysfunction group（aOR=2.033,95%CI:1.475-2.803）,while the effect in those with abuse was least strong（aOR=2.023,95%CI:1.613-2.538）.Conclusions:（1）Chinese YMSM have a higher prevalence of ACE,stigma towards homosexuality,and the prevalence of depressive symptoms are higher;（2）Trajectories of depression among 424 YMSM showed that the best group number is 4 groups,including low-level,medium-level,high-level,and increasers groups,among which the depressive level of low,medium and high-level groups remains relatively stable,and stigma towards homosexuality could increase the risk of depression in the medium,increaser and high-level groups;（3）There are differences in the trajectories of depression YMSM subgroups with different ACE,but those with ACE or different types of ACE in the high-level group have higher depression scores and/or proportions than those without corresponding ACE;in the subgroups with abuse,neglect or family dysfunction,the sexual stigma could increase the risk of depression in the high-level trajectory group.