目的:在中国男男性行为者(MSM)中,抑郁症的发生率很高,关于MSM病耻感与抑郁关系的研究有限。在心理调解框架的指导下,探讨MSM中污名与抑郁的关系,以及积极的性认同在其中的作用,我们测试了这个模型是否:1)制定了MSM污名,感知到的MSM污名,积极的性认同与抑郁症有关;2)它们对抑郁症的影响是通过弹性应对和社会支持来介导的;3)感知到的MSM污名是制定的MSM污名和积极的性认同对抑郁症的影响的中介。
方法:我们使用结构方程模型(SEM)对2022年12月使用非概率抽样方法招募的1,014名MSM进行的横断面调查数据进行了调解分析。数据通过了一般分析,如正态和相关性,允许建模。最终的SEM拟合度量表明该模型是可接受的。
结果:结构方程模型结果表明,病耻感直接对抑郁症状产生积极影响(β=0.558,95%置信区间=0.457〜0.644,P<0.001)。病耻感对抑郁症状具有积极作用(β=0.114,95CI=0.036〜0.200,P=0.002)。积极身分对抑郁症状具有积极影响(β=0.086,95CI=0.016~0.162,P=0.013)。此外,中介效应分析结果表明,制定的污名对通过社会支持的抑郁效应的间接影响为(β=0.040,95CI=0.003〜0.017,P=0.049);感知的污名对通过弹性应对的抑郁效应的间接影响为(β=-0.015,95CI=-0.034〜-0.002,P=0.056);积极的性认同对通过社会支持的影响的间接影响为(95〜CI=0.0
结论:弹性应对和社会支持介导了病耻感和抑郁之间的关系,两者都受到积极认同的影响。这项研究表明,加强应对和社会支持可能会减少污名对抑郁症状的影响,两者都是MSM干预的潜在目标。引导MSM形成积极的性认同有利于降低MSM中抑郁症状的患病率。
OBJECTIVE: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.