The Prevalence Of Anxiety And Depression Symptoms And Their Related Factors Among Men Who Have Sex With Men(MSM) In Shanghai

Objective:We aimed to understand the prevalence of anxiety and depression symptoms among men who have sex with men(MSM)in Shanghai and analyze its influencing factors.Based on the theory of sexual minority pressure,we explored the causes of anxiety and depression among MSM from three aspects:general stressors,distal stressors and proximal stressors,and provide evidence on the development of targeted intervention strategy.Methods:From December 2018 to June 2019,A cross-sectional questionnaire survey was conducted among MSM in the Changning,Jingan and Pudong New Districts of Shanghai using snowball sampling method.Content of questionnaire included general social-demographic characteristics,high-risk sexual behavior,and sexual minority pressure(social support,abandonment,isolation,self-esteem,involuntary subordination)and mental health(anxiety,depression).Logistic regression model was used to analyze the influencing factors of anxiety and depression symptoms;the structural equation model was used to establish and verify the sexual minority stress model.Results:A total of 539 Shanghai MSM completed the questionnaire effectively.The prevalence rate of anxiety was 11.9%,and depression was 30.6%.23.9%of MSM had low social support,17.6%had occasional or frequent be abandoned and 20.0%felt be isolated,6.5%were detected with low self-esteem,and 26.5%with high involuntary subordination.54.5%of MSM had condomless anal sex and 54.7%had multiple sexual partners in the past 6 months.Univariate analysis showed that low social support,abandonment,isolation,low self-esteem,high involuntary obedience,condomless anal sex,and having multiple sexual partner were associated with anxiety and depression.Multivariate analysis showed that isolation(ORm=1.75,95%CI=1.23-2.50)and high sense of entrapment(ORm=1.24,95%CI=1.16-1.32)were the influencing factors of anxiety;low social support(ORm=0.97,95%CI=0.95-0.99),isolation(ORm=2.66,95%CI=1.89-3.74),sense of defeat(ORm=1.17,95%CI=1.06-1.28),submissive behavior(ORm=0.88,95%CI=0.80-0.97)and social comparison(ORm=1.19,95%CI=1.09-1.29)are the influencing factors of depression.The structural equation model fits the pathway of factors influencing anxiety and depression symptoms among MSM.The model fit index is good.General stressors,distal stressors,and proximal stressors all have effects on MSM anxiety and depression.Three aspects of stressors affect depression symptoms more than anxiety symptoms.Comparing the three types of stressors,distal stressors has the greatest impact on anxiety and depression.Distal stressors(0.465,95%CI=0.379-0.572)and proximal stressors(0.442,95%CI=0.341-0.520)have a direct effect on anxiety and depression of MSM.General stressors(-0.394,95%CI=-0.479～-0.311)and distal stressors(0.245,95%CI=0.197-0.300)have indirect effects on mental health.The coefficient of determination for mental health in the model was 71%.Conclusion:As sexual minority,MSM suffers from general pressure,distal pressure and proximal pressure,which will directly or indirectly affect mental health.Of which distal stressors have the greatest impact.It is recommended that the intervention of MSM should focus on the mental health of the population and reduce the psychological pressure caused by social environment prejudice,discrimination and violence.Targeted MSM health education and psychological counseling is of great significance to reduce the occurrence of anxiety and depression symptoms and HIV infection in this population.