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Lin H, Zhou W, Tian X, Wang F. Detection Rates of Mental Health Problems Among Sexual Minorities in Mainland China: A Meta-Analysis. JOURNAL OF HOMOSEXUALITY 2024; 71:1991-2009. [PMID: 37256336 DOI: 10.1080/00918369.2023.2217678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Previous studies that have addressed the growing mental health problems among sexual minorities in mainland China, but failed to inform mental health programs and public health policies with consistent detection results. To obtain robust results on aggregate detection rates and moderators of these problems, we performed a meta-analysis of the related Chinese and English literature published before 2022. Ultimately, 305 eligible studies (ndepression = 127, nanxiety = 71, nsuicide ideation = 55, nsuicide plan = 13, nsuicide attempt = 39) were pooled in the analysis. The results revealed "Money boys" and people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) had higher detection rates than general men who have sex with men. Depression was more prevalent in gays than lesbians, and the latter had a higher detection rate of suicide. Detection rates of anxiety and depression among sexual minorities in China were moderated by detection time, measurement tools, and their detection thresholds. Suggested future priorities include developing more targeted measurement tools that consider the living conditions and psychological characteristics of local sexual minorities, enhancing mental health programs for sexual minorities, and devising more practical and effective interventions to prevent and reduce their mental health problems.
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Affiliation(s)
- Hongyi Lin
- School of Psychology, Nanjing Normal University, Nanjing, China
| | - Wenqin Zhou
- School of Psychology, Nanjing Normal University, Nanjing, China
| | - Xuan Tian
- School of Psychology, Nanjing Normal University, Nanjing, China
| | - Fengyan Wang
- School of Psychology, Nanjing Normal University, Nanjing, China
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Xie L, Mo PKH, Wang Z, Tian X, Lau JTF. Men who have sex with men were more depressed than their counterparts because of lower social support and higher loneliness: A comparative survey among Chinese university students. J Affect Disord 2024; 353:11-18. [PMID: 38373515 DOI: 10.1016/j.jad.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 01/23/2024] [Accepted: 02/06/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Poor mental health is prevalent among men who have sex with men (MSM), including MSM university students (MSMUS), causing a significant burden on their health and society. The study aimed to compare the difference in levels of depressive symptoms between Chinese MSMUS and non-MSMUS and test the mediating roles of social support and loneliness in the relationship between MSM status and depressive symptoms among male university students. METHODS From June to October 2018, a total of 305 MSMUS and 2447 non-MSMUS from two cities in Sichuan province (China) were investigated using questionnaires. RESULTS The proportion of depression in the MSMUS and non-MSMUS groups was 54.1 % and 36.4 %, respectively. MSM status, social support, and loneliness were all significantly associated with depressive symptoms among Chinese university students. Structural equation modelling showed that the association between MSM status and depressive symptoms was partially mediated by three indirect paths, including 1) via social support (mediated proportion = 19.4 %), 2) via loneliness (mediated proportion = 19.3 %), and 3) via social support and then loneliness (mediated proportion = 16.1 %). CONCLUSIONS Depression was prevalent among university students in China, especially MSMUS. The findings increased our understanding of the mediating roles of social support and loneliness in the link between MSM status and depressive symptoms among Chinese male university students, which have great implications for designing interventions to improve their mental health. LIMITATION The cross-sectional study design limited causal inferences.
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Affiliation(s)
- Luyao Xie
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
| | - Phoenix K H Mo
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
| | - Zixin Wang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
| | - Xiaobing Tian
- Department of Epidemiology and Biostatistics, School of Public Health, North Sichuan Medical University, Nanchong, China
| | - Joseph T F Lau
- Public Mental Health Center, School of Mental Health, Wenzhou Medical University, Wenzhou, China; Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Wenzhou Kangning Hospital, Wenzhou Medical University, Wenzhou, China.
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Wang L, Harris R, Simoni JM, Yue Q, Fu J, Zheng H, Ning Z, Xavier Hall CD, Burns PA, Wong FY. Health Service Utilization and Its Associations with Depression and Sexual Risk Behaviors Among Transgender Women in Shanghai, China. Transgend Health 2023; 8:516-525. [PMID: 38130986 PMCID: PMC10732171 DOI: 10.1089/trgh.2021.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose Given the limited research on health care utilization among transgender women in China, we described the use of primary health care and gender-affirming health care, and the associations between utilization of gender-affirming health care and depression and sexual risk behaviors. Methods We conducted a cross-sectional survey in 2017 among a purposive sample of transgender women in Shanghai, China (N=199). We examined correlates of health care utilization and its association with depression and sexual risk behaviors with Chi-square (χ2), Fisher's exact tests, and analysis of variance. Results The majority of the sample (78.5%) only had physician appointments when having an illness, while about one-fifth of the sample had physician appointments for yearly checkups. Nineteen out of 199 participants (9.5%) received gender-affirming surgery, among which only five used hormone therapy prescribed by a doctor (26.3%). Receiving some form of gender-affirming surgery was associated with higher depression scores [Welch's F(2, 12.22)=4.16, p=0.04], engagement in sex work (p=0.001), having 7 or more male sexual partners in the last 30 days (p=0.003), lifetime unprotected sex with a man (p=0.050), and unprotected sex with a main partner (p=0.043). Compared with transgender women who received both breast augmentation and vulvo-vaginoplasty (mean=5.86), those who received breast augmentation only (mean=12.33) scored higher on depression (p=0.04). Conclusions Access to gender-affirming health care is low among transgender women in this study. The utilization of gender-affirming surgery is associated with depression and sexual risk behaviors. Findings suggest China should establish national guidelines on transgender-related health care and set up more clinics to provide consultation and services for the transgender population in China.
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Affiliation(s)
- Liying Wang
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Rachel Harris
- Center for Population Sciences and Health Equity, Florida State University, Tallahassee, Florida, USA
- College of Social Work, Florida State University, Tallahassee, Florida, USA
| | - Jane M. Simoni
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Qing Yue
- Department of HIV/STD Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Jie Fu
- Department of HIV/STD Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Huang Zheng
- Shanghai Piaoxue Multicultural Media Ltd., Shanghai, China
| | - Zhen Ning
- Department of HIV/STD Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Casey D. Xavier Hall
- Institute for Sexual and Gender Minority Health and Wellbeing (ISGMH), Northwestern University, Evanston, Illinois, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA
| | - Paul A. Burns
- Department of Population Health Science, John D. Bower School of Population Health, University Mississippi Medical Center, Jackson, Mississippi, USA
| | - Frank Y. Wong
- Center for Population Sciences and Health Equity, Florida State University, Tallahassee, Florida, USA
- Department of Population Health Science, John D. Bower School of Population Health, University Mississippi Medical Center, Jackson, Mississippi, USA
- Department of Psychology, University of Hawaiʽi at Mānoa, Honolulu, Hawaiʽi, USA
- School of Public Health, Fudan University, Shanghai, China
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Plant K, Connell A, Hosking W, Lyons A. Internalized Homonegativity and Mental Health Among Chinese Gay and Bisexual Cisgender Men: Exploring the Moderating Influences of Psychosocial and Sexual Identity Factors. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:3541-3556. [PMID: 35999423 DOI: 10.1007/s10508-022-02314-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 06/15/2023]
Abstract
Much research on Chinese gay and bisexual men has focused on sexual health and, in particular, HIV-related issues. However, relatively little research has considered psychosocial aspects of being a gay or bisexual man in China. The present study was designed to address this gap by examining psychosocial predictors of mental health from a minority stress perspective. Results from an online survey of 1,786 Chinese gay and bisexual cisgender men revealed that higher levels of internalized homonegativity predicted greater psychological distress and a lower sense of positive well-being. Higher self-esteem, social support, and resilience were strong predictors of lower psychological distress and higher well-being, but these psychosocial factors mostly did not moderate associations between internalized homonegativity and mental health. A stronger sense of sexual identity superiority weakened the associations between internalized homonegativity and both mental health measures, but sexual identity centrality only moderated the association between internalized homonegativity and positive well-being. This study is among the first to examine minority stressors and psychosocial factors, distinct from the HIV-focussed literature, in a Chinese context. These findings may inform interventions targeting increased self-esteem, social support, and resilience, which could be beneficial for the mental health of Chinese gay and bisexual cisgender men.
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Affiliation(s)
- Kylie Plant
- Institute for Health and Sport, Victoria University, P.O. Box 14428, Melbourne, VIC, 8001, Australia
| | - Aneira Connell
- Institute for Health and Sport, Victoria University, P.O. Box 14428, Melbourne, VIC, 8001, Australia
| | - Warwick Hosking
- Institute for Health and Sport, Victoria University, P.O. Box 14428, Melbourne, VIC, 8001, Australia.
| | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
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Nouri E, Moradi Y, Moradi G. What is the global prevalence of depression among men who have sex with men? A systematic review and meta-analysis. Ann Gen Psychiatry 2022; 21:38. [PMID: 36096814 PMCID: PMC9465955 DOI: 10.1186/s12991-022-00414-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 09/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression due to stigma resulting from their sexual identity, isolation, social exclusion, and insufficient access to care and counseling services has become a health problem among men who have sex with men (MSM). OBJECTIVES This study aimed to determine the global prevalence of depression among MSM as a systematic review and meta-analysis. METHODS This study was a systematic review and meta-analysis performed in five steps of search strategy, screening and selecting articles, data extraction, evaluation of the risk of bias, and meta-analysis. In this study, the determined keywords were searched in the databases of PubMed, Scopus, Embase, and Web of Science from January 1913 to July 2021 to find the initial articles, from which data were extracted according to the set checklist in the data extraction stage. Finally, the studies were included in the present meta-analysis according to the inclusion and exclusion criteria, to be evaluated using the Newcastle Ottawa scale checklist. I Square and Q Cochrane were also used to assess the degree of heterogeneity. The analyses were performed using the random-effects model in STATA 16. RESULTS The results showed the quality score of the majority of cross-sectional studies included in the meta-analysis (62 studies) was equal to six or seven (moderate), and five ones had a high-quality score. After combining these studies, the pooled prevalence of depression among MSM in the world was 35% (95% CI 31%-39%, I square; 98.95%, P-value < 0.001). Population subgroup analysis showed the pooled prevalence of depression among MSM living with HIV was 47% (95% CI 39%-55%, I square; 95.76%, P-value < 0.001). Continent subgroup analysis showed the highest pooled prevalence of depression among Asian MSM at 37% (95% CI 31%-43%, I square; 99.07%, P-value < 0.001). Also, in the subgroup analysis of the sampling method, the pooled prevalence in the studies which used the respondent-driven sampling method was equal to 34% (95% CI 25%-43%, I square; 99.32%, P-value < 0.001). Sensitivity analysis revealed the pooled prevalence of depression in studies included in the meta-analysis was near or around the pooled estimate. CONCLUSION The pooled prevalence of depression among MSM was almost three times higher than the general male population. Therefore, particular and therapeutic interventions such as screening, and harm reduction programs for mental disorders, especially depression, are suggested to be considered in service packages.
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Affiliation(s)
- Elham Nouri
- Social Determinant of the Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.,Department of Epidemiology and Biostatistics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Yousef Moradi
- Social Determinant of the Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.,Department of Epidemiology and Biostatistics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ghobad Moradi
- Social Determinant of the Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran. .,Department of Epidemiology and Biostatistics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran.
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Mohamad Fisal ZA, Minhat HS, Mohd Zulkefli NA, Ahmad N. Biopsychosocial approach to understanding determinants of depression among men who have sex with men living with HIV: A systematic review. PLoS One 2022; 17:e0264636. [PMID: 35286312 PMCID: PMC8920233 DOI: 10.1371/journal.pone.0264636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 02/14/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Men who have sex with men (MSM) living with HIV are more likely to be depressed than MSM without HIV. The AIDS epidemic will not end if the needs of people living with HIV and the determinants of health are not being addressed. Compared to HIV individuals without depression, depressed HIV individuals have worse clinical outcomes and higher mortality risk. Depression is caused by a complex combination of social, psychological, and biological variables. This systematic review, thereby motivated by the need to address this gap in the literature, aims to articulate determinants of depression among MSM living with HIV according to the biopsychosocial approach. METHODOLOGY We systematically searched four databases from 2011 to 2021. We searched for observational studies on determinants of depression among MSM living with HIV. The outcome is depression based on the categorical or numerical outcome. Two reviewers independently extracted data and assessed study risks of bias. Any disagreements are consulted with the third reviewer. RESULTS We identified 533 articles, of which only eight studies are included. A total of 3,172 MSMs are included in the studies. We found the determinants of depression and categorized them according to biological, psychological, and social approaches. CONCLUSION The determinants of depression with the strongest evidence across studies were enacted HIV-related stigma, unemployment, sleep disturbance, current smoker, black ethnicity, born overseas, ART initiation, and access to mental health care. Despite weaker evidence, the other relevant determinants to be included were older age, internalized stigma, self-efficacy, and social support. Efforts to improve or prevent depression among MSM living with HIV could benefit from addressing the determinants of depression based on the biopsychosocial approach immediately after HIV diagnosis. Integrating mental health screening and care into HIV treatment settings would strengthen HIV prevention and care outcomes and improve access to mental healthcare.
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Affiliation(s)
- Zul Aizat Mohamad Fisal
- Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- * E-mail:
| | - Halimatus Sakdiah Minhat
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Nor Afiah Mohd Zulkefli
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Norliza Ahmad
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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Wang L, Hong C, Simoni JM, He N, Li C, Chen L, Wong F. Correlates of antiretroviral therapy (ART) initiation among HIV-positive men who have sex with men (MSM) in China. JOURNAL OF GLOBAL HEALTH REPORTS 2022. [DOI: 10.29392/001c.33816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Liying Wang
- University of Washington, Seattle, Washington, United States
| | - Chenglin Hong
- University of California, Los Angeles, California, United States
| | - Jane M. Simoni
- Department of Psychology, University of Washington, Seattle, Washington, United States; Department of Global Health, University of Washington, Seattle, Washington, United States; Department of Gender, Women & Sexuality Studies, University of Washington, Seattle, Washington, United States
| | - Na He
- Fudan University, Shanghai, China
| | - Chenxing Li
- Georgia Institute of Technology, Atlanta, United States
| | - Lingxiao Chen
- University of Washington, Seattle, Washington, United States
| | - Frank Wong
- School of Public Health, Fudan University, Shanghai, China; Center for Population Sciences and Health Equity, Florida State University, Tallahassee, Florida, United States; Department of Psychology, University of Hawaiʽi at Mānoa, Honolulu, Hawaiʽi, United States; John D. Bower School of Population Health, Department of Population Health Science, University Mississippi Medical Center, Jackson, Mississippi, United States
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Mi T, Lan G, Yang X, Li X, Qiao S, Shen Z, Zhou Y. HIV-Related Stigma, Sexual Identity, and Depressive Symptoms Among MSM Living With HIV in China: A Moderated Mediation Modeling Analysis. Am J Mens Health 2022; 16:15579883221087531. [PMID: 35343811 PMCID: PMC8966094 DOI: 10.1177/15579883221087531] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Depression is one of the biggest health issues among men who have sex with men (MSM) living with HIV, where sexual identity might play an intricate role. Yet, findings of the relationship between sexual identity and depression were mixed and few studies explored its underlying mechanisms. This study aimed to examine the association between sexual identity and depression, and the potential mediating role of HIV-related stigma and moderating role of age. A cross-sectional survey was conducted among 203 MSM living with HIV in Guangxi, China. Participants provided information on sexual identity, depression, HIV-related stigma, and background information. Descriptive statistics, bivariate analysis, and path analysis were applied to examine our hypotheses. Bivariate analysis demonstrated that participants who self-identified as gay reported a lower level of HIV-related stigma and depression. Path analysis revealed an insignificant direct effect of identifying as gay on depression. Yet, the indirect pathway was significant, with identifying as gay being associated with a lower level of HIV stigma and thus a lower level of depression. This indirect effect was moderated by age. The conditional indirect effect was significant in the younger group yet ceased in the older group. The study provided information to better understand the effect of sexual identity on mental health among stigmatized sexual and gender minorities by highlighting the mediating effect of HIV-related stigma and the protective effect of age. Interventions targeting mental health of MSM living with HIV might consider placing greater emphasis on addressing HIV-related stigma among younger MSM.
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Affiliation(s)
- Tianyue Mi
- Department of Health Promotion, Education, and Behavior & South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Guanghua Lan
- Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Xueying Yang
- Department of Health Promotion, Education, and Behavior & South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior & South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Shan Qiao
- Department of Health Promotion, Education, and Behavior & South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Zhiyong Shen
- Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Yuejiao Zhou
- Guangxi Center for Disease Control and Prevention, Nanning, China
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Assessing the Determinants of Quality of Life and the Impact on HIV Prevention Measures among HIV-Negative and Status-Unknown Young Men Who Have Sex with Men: A Study in Two U.S. Metropolitan Areas. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020726. [PMID: 35055548 PMCID: PMC8776199 DOI: 10.3390/ijerph19020726] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/02/2022] [Accepted: 01/04/2022] [Indexed: 12/17/2022]
Abstract
Young men who have sex with men (YMSM) in the United States (U.S.) are disproportionally burdened by HIV and experience adverse social determinants of health. Minimal research has examined quality of life (QoL) and psychosocial/behavioral determinants among HIV-negative or status-unknown YMSM. We conducted a study with YMSM from two U.S. cities to assess their QoL scores, and whether specific QoL domains (e.g., physical, psychological, social, and environment) were associated with their demographics, psychosocial determinants, behavioral risk factors, and HIV prevention measures. Black YMSM, YMSM of low socioeconomic status (below high school education, income < $20,000, and lack of health insurance), and YMSM who did not disclose their sexual orientation had the lowest QoL scores across all domains. Substance use and unprotected anal intercourse were negatively associated with men’s physical/psychosocial health. Housing/food instability and perceived stress were among the strongest predictors of lower QoL in all domains. Higher physical/psychological and environment QoL scores were associated with a higher likelihood of HIV testing and PrEP use. The identification of YMSM within these demographic, behavioral, and psychosocial sub-groups is important for targeted intervention to enhance their well-being and engagement with HIV prevention.
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Yan F, Tang S, Goldsamt L, Wang H, Chen J, Li X. Interrelationships Between Intimate Partner Violence, Coping Style, Depression, and Quality of Life Among the Regular Female Sexual Partners of Men Who Have Sex With Men. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP651-NP670. [PMID: 32390497 DOI: 10.1177/0886260520917519] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The regular female sexual partners of men who have sex with men (MSM), namely, "Tongqi" in China, increasingly attract attention in the field of public health due to their high levels of depression and intimate partner violence (IPV), and their potential risk of HIV infection. Few studies have explored the relationships among IPV, coping style, depression, and quality of life (QOL) in this population. To examine these relationships, a cross-sectional online survey was conducted in China from February 2016 to March 2017. A questionnaire, including the Revised Conflict Tactics Scales, the Simplified Coping Style Questionnaire, the Center for Epidemiologic Studies Depression Scale, and the World Health Organization Quality of Life Scale, was completed by a total of 194 Chinese Tongqi. Structural equation modeling (SEM) was used to test the relationships among IPV, coping style, depression, and QOL. IPV (β = -0.12, p = .002), depression (β = -0.79, p < .001), and active coping style directly (β = 0.17, p < .001) affected the QOL of this group of women; IPV also indirectly affected QOL through the mediating effect of passive coping style and depression, and the positive coping style indirectly affected QOL through the mediating effect of depression. The proposed model showed good fit of indices, χ2/d = 43.72/34 = 1.286 < 3, p = .123, root mean square error of approximation (RMSEA) = 0.038. Chinese Tongqi experienced high levels of IPV, which led to a poor QOL, partially through the mediating role of passive coping strategy and depression. Future studies or interventions should emphasize the IPV experienced by Chinese Tongqi and provide psychological support so as to improve the overall well-being of this vulnerable female population.
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Affiliation(s)
- Fang Yan
- Central South University, Changsha, China
| | | | | | | | - Jia Chen
- Central South University, Changsha, China
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11
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Fu H, Feng T, Wang T, Wu X, Cai Y, Yang T. Reported prevalence of depression or depressive symptoms among men who have sex with men in China, 2004-2018: A systematic review and meta-analysis. J Affect Disord 2020; 277:192-203. [PMID: 32829195 DOI: 10.1016/j.jad.2020.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Depression is a major mental disorder that imposes a considerable burden on health. Men who have sex with men (MSM) are at high risk for depression. Numerous studies have reported the prevalence of depression or depressive symptoms among MSM in China. However, the estimates have varied substantially between studies. This meta-analysis aimed to establish the pooled prevalence of depression or depressive symptoms among Chinese MSM to attract public attention. METHOD A systematic search of several electronic databases and a subsequent manual search was performed to identify relevant studies. A random effects model was adopted to calculate the pooled prevalence of depression or depressive symptoms. Heterogeneity between studies and publication bias was also assessed. RESULTS A total of 54 articles with a sample size of 21,950 MSM were analysed. The pooled prevalence of depression or depressive symptoms among MSM was 40.0% (95% CI: 37.9%-45.0%). Substantial heterogeneity was observed across individual studies. The pooled summary estimate stratified by screening instruments and cutoff scores ranged from 19.0% to 60.2%. Subgroup analysis indicated that survey dates, sampling method, HIV infection status and occupation can partially contribute to the between-study heterogeneity. LIMITATIONS The findings should be interpreted with caution because of several limitations related to the heterogeneity across studies, sampling method and quality assessment. CONCLUSIONS Overall, the reported prevalence of depression or depressive symptoms among Chinese MSM was fairly high. The study suggested that more attention and effective intervention programmes are urgently provided to prevent and improve mental health issues among Chinese MSM.
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Affiliation(s)
- Hanlin Fu
- Department of Epidemiology and Health Statistics, XiangYa School of Public Health, Central South University, Changsha, Hunan Province 410078, China; HIV/AIDS Prevention and Control Division, Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong Province 518000, China
| | - Tiejian Feng
- HIV/AIDS Prevention and Control Division, Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong Province 518000, China
| | - Tingting Wang
- Department of Epidemiology and Health Statistics, XiangYa School of Public Health, Central South University, Changsha, Hunan Province 410078, China
| | - Xiaobing Wu
- Department of STD control and prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong Province 518020, China
| | - Yumao Cai
- Department of STD control and prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong Province 518020, China
| | - Tubao Yang
- Department of Epidemiology and Health Statistics, XiangYa School of Public Health, Central South University, Changsha, Hunan Province 410078, China.
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Prevalence of depression, anxiety and suicide among men who have sex with men in China: a systematic review and meta-analysis. Epidemiol Psychiatr Sci 2020; 29:e136. [PMID: 32536353 PMCID: PMC7303796 DOI: 10.1017/s2045796020000487] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Chinese men who have sex with men (MSM) are at high risk for depression, anxiety and suicide. The estimated prevalence of these problems is essential to guide public health policy, but published results vary. This meta-analysis aimed to estimate the prevalence of depressive symptoms, anxiety symptoms and suicide among Chinese MSM. METHODS Systematic searches of EMBASE, MEDLINE, PsycINFO, PubMed, CNKI and Wanfang databases with languages restricted to Chinese and English for studies published before 10 September 2019 on the prevalence of depressive symptoms, anxiety symptoms, suicidal ideation, suicide plans and suicide attempts among Chinese MSM. Studies that were published in the peer-reviewed journals and used validated instruments to assess depression and anxiety were included. The characteristics of studies and the prevalence of depression and anxiety symptoms, suicidal ideation, suicide plans and suicide attempts were independently extracted by authors. Random-effects modelling was used to estimate the pooled rates. Subgroup analysis and univariate meta-regression were conducted to explore potential sources of heterogeneity. This study followed the PRISMA and MOOSE. RESULTS Sixty-seven studies were included. Fifty-two studies reported the prevalence of depressive symptoms, with a combined sample of 37 376 people, of whom 12 887 [43.2%; 95% confidence interval (CI), 38.9-47.5] reported depressive symptoms. Twenty-seven studies reported the prevalence of anxiety symptoms, with a combined sample of 10 531 people, of whom 3187 (32.2%; 95% CI, 28.3-36.6) reported anxiety symptoms. Twenty-three studies reported the prevalence of suicidal ideation, with a combined sample of 15 034 people, of whom 3416 (21.2%; 95% CI, 18.3-24.5) had suicidal ideation. Nine studies reported the prevalence of suicide plans, with a combined sample of 5271 people, of whom 401 (6.2%; 95% CI, 3.9-8.6) had suicide plans. Finally, 19 studies reported the prevalence of suicide attempts, with a combined sample of 27 936 people, of whom 1829 (7.3%; 95% CI, 5.6-9.0) had attempted suicide. CONCLUSIONS The mental health of Chinese MSM is poor compared with the general population. Efforts are warranted to develop interventions to prevent and alleviate mental health problems among this vulnerable population.
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Sun S, Pachankis JE, Li X, Operario D. Addressing Minority Stress and Mental Health among Men Who Have Sex with Men (MSM) in China. Curr HIV/AIDS Rep 2020; 17:35-62. [PMID: 31950336 PMCID: PMC7050812 DOI: 10.1007/s11904-019-00479-w] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Men who have sex with men (MSM) in China experience elevated risks of mental health issues in comparison to the general population in China, which contribute to vulnerability to HIV/STI risks and can comprise the effectiveness of HIV prevention efforts. A conceptual framework for understanding this mental health disparity is minority stress theory, which posits that experiences of external prejudice events (i.e., distal stressors) and internal stress processes such as internalized homophobia and concealment (i.e., proximal stressors) contribute to sexual minorities' elevated risk of psychological distress. To deepen the understanding of mental health among Chinese MSM and explore the potential utility of minority stress theory in this population, this paper synthesizes research evidence regarding prevalent mental health issues as well as how minority stress may be linked to psychological health in Chinese MSM. RECENT FINDINGS Results indicate that Chinese MSM experience a high prevalence of several mental health issues including depression, anxiety, suicidal behaviors, and alcohol dependence. This review further reveals minority stress to be an important determinant of psychological distress among Chinese MSM, though evidence is mixed regarding the relationship between proximal minority stress and psychological health. Nonetheless, there is a lack of mental health services and interventions focusing on MSM in China. Culturally relevant, competent, and LGBT-affirmative mental health interventions are needed for Chinese MSM. To guide future intervention research, we provide considerations for reducing minority stress and promoting psychological health among Chinese MSM.
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Affiliation(s)
- Shufang Sun
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, 167 Point St, Providence, RI, 02906, USA.
| | - John E Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, University of South Carolina Arnold School of Public Health, Columbia, SC, 29208, USA
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI, USA
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Aunon FM, Simoni JM, Yang JP, Shiu C, Chen WT, Edmunds SR, Ramaiya M, Cheng J, Zhao H. Depression and anxiety among HIV-positive men who have sex with men and men who have sex with women in China. AIDS Care 2019; 32:362-369. [PMID: 31672027 DOI: 10.1080/09540121.2019.1683803] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
China is experiencing an emerging HIV epidemic among men who have sex with men (MSM). Minority stress theory posits that marginalized populations experience additional stress, which influences experiences of psychological distress and health outcomes. This study aimed to understand psychological distress of MSM relative to men who have sex with women (MSW) in an urban Chinese setting. Cross-sectional survey data were collected from 162 HIV-positive Chinese men receiving HIV treatment at Beijing's Ditan Hospital. Multiple linear regression with imputation was used to identify correlates of psychological distress. Relative to MSW, MSM were younger, more educated, and less likely to be in a relationship or have children. While both groups reported clinically elevated levels of depression and anxiety, sexual behavior was not associated with either outcome. Higher endorsement of depression symptomology was associated with worse reported physical health (β = -1.37, p < .05) and greater endorsement of maladaptive coping (β = 2.39, p < .05), whereas higher endorsement of anxiety symptomology was associated with greater endorsement of adaptive coping (β = 0.78, p < .05), diminished physical health (β = -0.86, p < .05), and a high school or greater level of education (β = 4.13, p < .05). These findings suggest that interventions targeting coping strategies may address psychological distress among HIV-positive Chinese men.
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Affiliation(s)
- Frances M Aunon
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Jane M Simoni
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Joyce P Yang
- Department of Psychology, University of San Francisco, San Francisco, CA, USA
| | - Chengshi Shiu
- School of Nursing, University of California, Los Angeles, Los Angeles, USA
| | - Wei-Ti Chen
- School of Nursing, University of California, Los Angeles, Los Angeles, USA
| | - Sarah R Edmunds
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Megan Ramaiya
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Joy Cheng
- Kaiser Permanente San Leandro Medical Center, San Leandro, California, USA
| | - Hongxing Zhao
- Beijing Ditan Hospital, Capital Medical University, Beijing, People's Republic of China
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Su X, Zhou AN, Li J, Shi LE, Huan X, Yan H, Wei C. Depression, Loneliness, and Sexual Risk-Taking Among HIV-Negative/Unknown Men Who Have Sex with Men in China. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:1959-1968. [PMID: 29147806 PMCID: PMC5955768 DOI: 10.1007/s10508-017-1061-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 06/20/2017] [Accepted: 08/11/2017] [Indexed: 05/09/2023]
Abstract
Research conducted among men who have sex with men (MSM) in high-income countries has demonstrated that negative mental health is one of the significant drivers of HIV infection, and few studies have examined the status of mental health among MSM in China. We sought to describe depression and loneliness and identify their correlates among Chinese MSM. A cross-sectional study was conducted among HIV-negative or unknown status MSM in 2014. Time-location sampling and online convenience sampling methods were employed. Depression was measured via a short version of CES-D (CES-D 10). Loneliness was measured from a single item in CES-D 10. Multivariable logistic regressions were conducted to identify independent correlates of depression and loneliness. A total of 507 individuals participated in the study. Of them, 26.8 and 35.5% reported moderate-to-severe symptoms of depression and feeling lonely, respectively. Depressed participants were more likely to have a sense of hopelessness for the future (AOR 3.20, 95% CI 1.90, 5.20) and report higher levels of internalized homophobia (AOR 2.32, 95% CI 1.47, 3.67). Participants who reported feeling lonely were more likely to have had condomless receptive anal intercourse in the past 6 months (AOR 1.67, 95% CI 1.08, 2.58) and feel hopeless for the future (AOR 2.40, 95% CI 1.60, 3.70). MSM in China have significant rates of depression and loneliness. HIV prevention efforts should address the mental health needs of Chinese MSM such as providing safe environments for social support and role models.
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Affiliation(s)
- Xiaoyou Su
- School of Public Health, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - A Ning Zhou
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Jianjun Li
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Ling-En Shi
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Xiping Huan
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Hongjing Yan
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Chongyi Wei
- Department of Epidemiology and Biostatistics & Global Health Sciences, University of California, 50 Beale St., Suite 1300, San Francisco, CA, 94105, USA.
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Liu Y, Jiang C, Li S, Gu Y, Zhou Y, An X, Zhao L, Pan G. Association of recent gay-related stressful events with depressive symptoms in Chinese men who have sex with men. BMC Psychiatry 2018; 18:217. [PMID: 29973174 PMCID: PMC6030786 DOI: 10.1186/s12888-018-1787-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 06/12/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND To assess the association of different gay-related stressful events (GRSEs) with depressive symptoms in Chinese men who have sex with men (MSM). METHOD A total of 807 MSM were recruited using respondent-driven sampling from four cities in northeastern China. GRSEs were measured using the Gay Related Stressful Life Events Scale, and depressive symptoms were assessed using the Self-Rating Depression Scale (SDS). RESULTS A total of 26.0% of study participants experienced GRSEs in the past three months, and the average SDS score was lower than the previously reported national average for China. The study participants had significantly elevated risks of depression (SDS score ≥ 53) due to recent troubles with a boss (OR = 4.92, 95% CI = 1.87-12.97) or a workmate (OR = 3.68, 95% CI = 1.52-8.88), loss of a close friend (OR = 2.41, 95% CI = 1.39-4.18), argument with a close friend (OR = 2.07, 95% CI = 1.33-3.22), and being physically assaulted (OR = 2.08, 95% CI = 0.98-4.43). Arguments with family members or classmates had no significant effect on depression. Multiple logistic regression analysis showed that the number of GRSEs, a lower level of education, more advanced age, and HIV infection significantly increased the risk of depression. CONCLUSIONS There are large differences in the associations of different types of GRSEs with depressive symptoms. Reducing the stigmatization and discrimination toward MSM in all social environments and improving the capability of MSM to cope with different types of GRSEs may improve their emotional wellbeing.
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Affiliation(s)
- Yunyong Liu
- Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Xiaoheyan Road 44, Dadong District, Shenyang, 110042, People's Republic of China.
| | - Chao Jiang
- 0000 0000 9558 1426grid.411971.bDepartment of Psychiatry, Dalian Medical University, Dalian, People’s Republic of China
| | - Siyao Li
- 0000 0004 1757 9522grid.452816.cDepartment of Psychiatry, Liaoning Provincial People’s Hospital, Shenyang, People’s Republic of China
| | - Yuan Gu
- Shenyang Municipal Center for Disease Control and Prevention, Shenyang, People’s Republic of China
| | - Yan Zhou
- Dandong Municipal Center for Disease Control and Prevention, Dandong, People’s Republic of China
| | - Xiaoxia An
- Benxi Municipal Center for Disease Control and Prevention, Benxi, People’s Republic of China
| | - Li Zhao
- Anshan Municipal Center for Disease Control and Prevention, Anshan, People’s Republic of China
| | - Guowei Pan
- Liaoning Provincial Center for Disease Control and Prevention, Shenyang, People’s Republic of China
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Liu J, Yi Z, Zhao Y, Qu B, Zhu Y. The psychological health and associated factors of men who have sex with men in China: A cross-sectional survey. PLoS One 2018; 13:e0197481. [PMID: 29813076 PMCID: PMC5973584 DOI: 10.1371/journal.pone.0197481] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 05/03/2018] [Indexed: 11/18/2022] Open
Abstract
Objectives The psychological health of men who have sex with men (MSM) has received increased attention in recent years. We thus investigated the psychological status and associated factors among MSM in China. Methods A cross-sectional survey of 248 MSM was conducted from April to September 2015 using Symptom Checklist 90 (SCL-90) in Huludao and Zhengzhou, China. Statistical analyses utilized SPSS version 19.0 for Windows. Results All Cronbach’s α coefficients of the SCL-90 subscales exceeded 0.7, suggesting acceptable reliability. The coefficient range of the collective validity for all the subscales was >0.4. For the divisional validity, each item correlated better with the hypothetical subscale than with other subscales. Collective validity and divisional validity were both acceptable. The four most frequent types of psychological distress among MSM were depression, obsessive-compulsive behavior, interpersonal sensitivity, and anxiety. Results of the univariate analysis revealed that the following groups had significantly higher SCL-90 scores (P < 0.05): peasantry, married MSM, respondents who reported condomless anal intercourse and a greater number of male partners, and respondents who had not undergone psychosocial counseling and whose family or friends did not know about their sexual identity. In a multivariate logistic regression model, the following parameters were independently associated with higher SCL-90 scores: being married (AOR [adjusted odds ratio] = 3.19; 95% CI [confidence interval]: 1.96 to 5.93), condomless anal intercourse (AOR = 1.16; 95% CI: 1.02 to 1.31), number of male partners (AOR = 1.66 and 1.81; 95% CI: 1.08 to 2.34 and 1.32 to 2.69), family or friends not knowing about sexual identity (AOR = 2.13; 95% CI: 1.17 to 4.92), and lack of psychosocial counseling (AOR = 2.09; 95% CI: 1.06 to 4.09). Conclusions Our results indicate that psychological health problems among MSM in China are of concern. It is thus necessary to strengthen intervention efforts, with more emphasis on intervention programs to improve psychological health among Chinese MSM.
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Affiliation(s)
- Jie Liu
- Department of Health Statistics, School of public health, China Medical University, Shenyang, Liaoning Province, P.R. China
| | - Zhe Yi
- Department of Prothodontics, School of Stomatology, China Medical University, Shenyang, Liaoning Province, People’s Republic of China
| | - Yang Zhao
- Department of Health Statistics, School of public health, China Medical University, Shenyang, Liaoning Province, P.R. China
| | - Bo Qu
- Department of Health Statistics, School of public health, China Medical University, Shenyang, Liaoning Province, P.R. China
- * E-mail:
| | - Yaxin Zhu
- Department of Health Statistics, School of public health, China Medical University, Shenyang, Liaoning Province, P.R. China
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Vu NTT, Holt M, Phan HTT, La LT, Tran GM, Doan TT, Nguyen TNN, de Wit J. Amphetamine-Type-Stimulants (ATS) Use and Homosexuality-Related Enacted Stigma Are Associated With Depression Among Men Who Have Sex With Men (MSM) in Two Major Cities in Vietnam in 2014. Subst Use Misuse 2017; 52:1411-1419. [PMID: 28436758 DOI: 10.1080/10826084.2017.1284233] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Men who have sex with men (MSM) are disproportionately affected by mental health concerns, including depression. Amphetamine-type-stimulants (ATS) use and homosexuality-related stigma and discrimination have been found associated with depression among MSM. OBJECTIVES To assess the prevalence of depression and its associations with ATS use and homosexuality-related stigma and discrimination among MSM in Vietnam. METHODS 622 MSM were conveniently recruited in Hanoi and Ho Chi Minh city, Vietnam, from September to December 2014. We collected information on demographic characteristics, ATS, alcohol and other drug use, sexual behaviors, homosexuality-related and discrimination stigma, and sexual sensation-seeking. Depression and suicidal thoughts were assessed by the Patient Health Questionnaire (PHQ-9). We assessed associations of depression with ATS use and homosexuality-related stigma and discrimination using logistic regression. RESULTS Of 622 sampled MSM, 11.3% were classified as having major depression, 9.8% reported any suicidal thoughts in the last two weeks, 30.4% ever had used any ATS, 88.8% ever ad drank alcohol and 21.5% had ever used any other drugs. In multivariate analysis, depression was significantly associated with ATS use (Adjusted Odds Ratio [AOR: 2.20; (95% Confidence Interval (CI): 1.32-3.67], younger age of sexual debut with another man (AOR: 0.09; 95% CI: 0.02-0.50), and greater enacted homosexuality-related stigma (AOR: 1.97; 95% CI: 1.19-3.26). CONCLUSIONS We found a moderate prevalence of depression among sampled MSM, which was associated with ATS use and enacted homosexuality-related stigma. We recommend integrating assessment and interventions regarding depression and methamphetamine use into gay-friendly, culturally adapted holistic HIV prevention for MSM in Vietnam.
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Affiliation(s)
- Nga Thi Thu Vu
- a Centre for Social Research in Health, University of New South Wales , Sydney , Australia.,b Institute of Preventive Medicine and Public Health, Hanoi Medical University , Hanoi , Vietnam
| | - Martin Holt
- a Centre for Social Research in Health, University of New South Wales , Sydney , Australia
| | - Huong Thi Thu Phan
- c Vietnam Administration for HIV/AIDS Prevention and Control, Ministry of Health , Hanoi , Vietnam
| | - Lan Thi La
- d Hanoi Centre of HIV/AIDS Prevention and Control , Hanoi , Vietnam
| | - Gioi Minh Tran
- e Center for Community Health Promotion , Hanoi , Vietnam
| | | | | | - John de Wit
- a Centre for Social Research in Health, University of New South Wales , Sydney , Australia
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He H, Lv F, Zhang NN, Wu Z, Liao Q, Chang Z, Li Y, Xu H, OuYang L, Huan X, Yang J. Look into the HIV Epidemic of Gay Community with a Socio-Cultural Perspective: A Qualitative Study in China, 2015-2016. PLoS One 2017; 12:e0170457. [PMID: 28107523 PMCID: PMC5249147 DOI: 10.1371/journal.pone.0170457] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 01/05/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Current Chinese studies continue to view male homosexuality through a disease focused lens which pays limited attention to socio-cultural aspects of sexual behavior and HIV transmission. This qualitative study aimed to investigate how socio-cultural factors influence gay men's sexual beliefs and behaviors in contemporary China, and their implications for HIV epidemic. METHODS AND FINDINGS Qualitative methodology was used in this study. During 2015-2016, in-depth interviews were conducted with 61 self identified gay men in Jiangxi, Henan, Heilongjiang, Guangdong, Jiangsu provinces and Chongqing municipality of China. Our study revealed that: 1) influenced by Chinese traditional culture, gay men have conflicts on self-identity, which led to low self-acceptance and negative attitude on sex, and huge socio-psychological stress; 2) a generational differences within gay community was observed, reflected in varied sexual attitudes and practices as well as way for approaching new friends, both of which have implications and challenges on HIV control and prevention; 3) socio-cultural barriers, including open minds towards casual sex and nonmonogamous relationship, and low priority of health demands were widely observed and led to negative coping with AIDS among gay community. CONCLUSIONS It is essential to take a holistic view into gay men's HIV epidemic in China. Socio-cultural barriers for HIV control and prevention found in this study call for serious and imperative consideration on integrated measures, including targeted efforts towards effective sex education and further inclusion of socio-cultural perspectives in HIV/AIDS interventions for gay men.
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Affiliation(s)
- Huijing He
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fan Lv
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail:
| | - Nanci Nanyi Zhang
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zunyou Wu
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qinghua Liao
- Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, Jiangxi Province, China
| | - Zhanjun Chang
- Zhengzhou Center for Disease Control and Prevention, Zhengzhou, Henan Province, China
| | - Yi Li
- Heilongjiang Provincial Center for Disease Control and Prevention, Harbin, Heilongjiang Province, China
| | - Huifang Xu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong Province, China
| | - Lin OuYang
- Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Xiping Huan
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu Province, China
| | - Juan Yang
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Ibragimov U, Harnisch JA, Nehl EJ, He N, Zheng T, Ding Y, Wong FY. Estimating self-reported sex practices, drug use, depression, and intimate partner violence among MSM in China: a comparison of three recruitment methods. AIDS Care 2016; 29:125-131. [PMID: 27367038 DOI: 10.1080/09540121.2016.1201191] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Men who have sex with men (MSM) are the group at highest risk for HIV in China. Researchers have used various recruitment methods to reach this population hidden from the hetero-normative culture. To inform future recruitment strategies, we compared estimates of socio-demographic characteristics, HIV risk behaviors, depression, and intimate partner violence (IPV) across three samples of MSM and money boys in Shanghai, China. Data were collected from three community-based samples of MSM and money boys (n = 1352) recruited via respondent-driven sampling (RDS) (n = 404), community popular opinion leaders (CPOL) (n = 385), and Internet and venue-based sampling (VBS) (n = 546). Different recruitment methods generated samples with statistically significant differences among a number of socio-demographic characteristics, sexual behaviors, drug use, depression scores, and exposure to IPV. Specifically, RDS participants had lower education (p = .002), income levels (p < .001), and were more likely to report condomless sex with a woman (p < .001). CPOL participants were younger (p < .001), more likely to report lifetime condomless anal sex (p = .009), more than 10 male partners in the past 30 days (p < .001), and were less likely to experience violence by a male intimate partner (p = .001). VBS participants had lowest depression score (p = .005) and were more likely to report lifetime drug use (p = .003). Our findings reinforce that each recruitment method may reach a sub-group of MSM with a specific risk profile, so multiple methods may be needed to obtain a representative sample of MSM. Interventions may use specific recruitment methods to target certain segments of the MSM population.
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Affiliation(s)
- Umedjon Ibragimov
- a Department of Behavioral Sciences & Health Education , Emory University Rollins School of Public Health, Emory University , Atlanta , GA , USA
| | - Jessica A Harnisch
- a Department of Behavioral Sciences & Health Education , Emory University Rollins School of Public Health, Emory University , Atlanta , GA , USA
| | - Eric J Nehl
- a Department of Behavioral Sciences & Health Education , Emory University Rollins School of Public Health, Emory University , Atlanta , GA , USA
| | - Na He
- a Department of Behavioral Sciences & Health Education , Emory University Rollins School of Public Health, Emory University , Atlanta , GA , USA.,b Department of Epidemiology , Fudan University School of Public Health , Shanghai , China
| | - Tony Zheng
- c Shanghai Piaoxue Cultural Media, Ltd ., Shanghai , China
| | - Yingying Ding
- b Department of Epidemiology , Fudan University School of Public Health , Shanghai , China
| | - Frank Y Wong
- a Department of Behavioral Sciences & Health Education , Emory University Rollins School of Public Health, Emory University , Atlanta , GA , USA.,d Hubert Department of Global Health , Emory University Rollins School of Public Health , Atlanta , GA , USA.,e Department of Epidemiology , Emory University Rollins School of Public Health , Atlanta , GA , USA.,f Department of Sociology , Emory College, Emory University , Atlanta , GA , USA
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Fan W, Lu R, Wu G, Yousuf MA, Feng L, Li X, Xiao Y, Shao Y, Ruan Y. Alcohol drinking and HIV-related risk among men who have sex with men in Chongqing, China. Alcohol 2016; 50:1-7. [PMID: 26632032 DOI: 10.1016/j.alcohol.2015.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 09/23/2015] [Accepted: 09/23/2015] [Indexed: 12/28/2022]
Abstract
To estimate the prevalence of any alcohol use and heavy alcohol drinking using the Alcohol Use Disorders Identification Test (AUDIT) and its correlates among men who have sex with men (MSM), a cross-sectional study was conducted among 391 MSM in Chongqing, China to collect data about sociodemographic characteristics, alcohol use, sexual behaviors, and other related factors through a computer-assisted self-administered questionnaire. Heavy alcohol drinking in the past 12 months was defined as an AUDIT-C score ≥ 4. Blood was collected from each potential participant to test for HIV and syphilis status. Twenty three percent of MSM had consumed a drink containing alcohol in the previous year. 7.2% had an AUDIT-C score ≥ 4, defined as heavy alcohol drinkers. 23.5% were unmarried, but planning to marry, who were more likely to report any alcohol drinking (adjusted odds ratio [AOR], 2.38; 95% confidence interval [CI], 1.40-4.06) and to have AUDIT-C scores ≥ 4 (AOR, 3.58; 95% CI, 1.60-8.00). MSM who had used any alcohol in the previous year, and MSM who were heavy alcohol drinkers, were more likely to have had anal sex with male casual partners in the previous 6 months, to have been tested for HIV, and to have decreased scores on the scales of general self-efficacy, increased scores on the scales of stigma and discrimination. Our findings provided further evidence of the associations of any alcohol use and heavy alcohol consumption with HIV-risky behaviors, lowered sense of general self-efficacy, and higher sense of HIV/AIDS-related stigma and discrimination among MSM in the city with the highest HIV epidemic among MSM in China.
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Affiliation(s)
- Wensheng Fan
- Department of Public Health, Western Kentucky University, Bowling Green, KY 42101, USA
| | - Rongrong Lu
- Chongqing Center for Disease Control and Prevention, Chongqing, PR China
| | - Guohui Wu
- Chongqing Center for Disease Control and Prevention, Chongqing, PR China
| | - Mohammed Adnan Yousuf
- Department of Public Health, Western Kentucky University, Bowling Green, KY 42101, USA
| | - Liangui Feng
- Chongqing Center for Disease Control and Prevention, Chongqing, PR China
| | - Xuefeng Li
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, PR China; Karamay Center for Disease Control and Prevention, Karamay, PR China
| | - Yan Xiao
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, PR China
| | - Yiming Shao
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, PR China
| | - Yuhua Ruan
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, PR China.
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Stahlman S, Grosso A, Ketende S, Sweitzer S, Mothopeng T, Taruberekera N, Nkonyana J, Baral S. Depression and Social Stigma Among MSM in Lesotho: Implications for HIV and Sexually Transmitted Infection Prevention. AIDS Behav 2015; 19:1460-9. [PMID: 25969182 PMCID: PMC4858167 DOI: 10.1007/s10461-015-1094-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Social stigma is common among men who have sex with men (MSM) across Sub-Saharan Africa, and may influence risks for HIV and sexually transmitted infections (STIs) via its association with depression. We conducted a cross-sectional study of 530 MSM in Lesotho accrued via respondent-driven sampling. Using generalized structural equation models we examined associations between stigma, social capital, and depression with condom use and testing positive for HIV/STIs. Depression was positively associated with social stigma experienced or perceived as a result of being MSM. In contrast, increasing levels of social cohesion were negatively associated with depression. Social stigma was associated with testing positive for HIV; however, this association did not appear to be mediated by depression or condom use. These data suggest a need for integrated HIV and mental health care that addresses stigma and discrimination and facilitates positive social support for MSM.
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Affiliation(s)
- Shauna Stahlman
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, E7133, 615 N. Washington St., Baltimore, MD, 21205, USA,
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23
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Goldsamt LA, Clatts MC, Giang LM, Yu G. Prevalence and Behavioral Correlates of Depression and Anxiety Among Male Sex Workers in Vietnam. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2015; 27:145-155. [PMID: 25984252 PMCID: PMC4431688 DOI: 10.1080/19317611.2014.947055] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVES This study assessed depression and anxiety symptoms, and their association with high-risk sexual and drug behaviors, among male sex workers in three Vietnamese cities. METHODS Male sex workers ages 16 to 35 completed an interview that included the CES-D to assess depressive symptoms and the BAI to assess anxiety symptoms, as well as questions assessing drug and sexual risk practices. RESULTS A majority of participants reported depressive symptomatology although fewer report symptoms of anxiety. Risky sexual and drug use practices predicted both types of symptoms. CONCLUSIONS Mental distress is associated with drug and sexual risk among male sex workers.
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Affiliation(s)
| | | | | | - Gary Yu
- New York University College of Nursing, New York, NY
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24
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Patel SK, Prabhakar P, Saggurti N. Factors Associated with Mental Depression among Men Who Have Sex with Men in Southern India. Health (London) 2015. [DOI: 10.4236/health.2015.79127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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