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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Ahaneku, H., Ross, M. W., Nyoni, J. E., Selwyn, B., Troisi, C., Mbwambo, J., … McCurdy, S. (2016). Depression and HIV risk among men who have sex with men in Tanzania. AIDS Care, 28, 140–147.
Beck, A., & Weissman, A. (1974). The measurement of pessimism: The Hopelessness Scale. Journal of Consulting and Clinical Psychology, 42(6), 861–865.
Berg, R. C., Ross, M. W., Weatherburn, P., & Schmidt, A. J. (2013). Structural and environmental factors are associated with internalised homonegativity in men who have sex with men: Findings from the European MSM internet survey (EMIS) in 38 countries. Social Science and Medicine, 78, 61–69.
Blatt, S. J., Luyten, P., & Corveleyn, J. (2005). Toward a dynamic interaction model of depression and its treatment. Psyche-Zeitschrift für Psychoanalyse und Ihre Anwendungen, 59(9–10), 864–891.
Catania, J. A., Kegeles, S. M., & Coates, T. J. (1990). Towards an understanding of risk behavior—an aids risk reduction model (ARRM). Health Education Quarterly, 17(1), 53–72.
Centers for Disease Control and Prevention. (2015). HIV among gay/bisexual men. http://www.cdc.gov/hiv/risk/gender/msm/facts/index.html. Accessed March 24, 2015.
Chen, Y., Bennett, D., Clarke, R., Guo, Y., Yu, C., Bian, Z., … Chen, Z. (2007). Patterns and correlates of major depression in Chinese adults: A cross-sectional study of 0.5 million men and women. Psychological Medicine, 47(5), 958–970.
Choi, K. H., Lui, H., Guo, Y. Q., Han, L., & Mandel, J. S. (2006). Lack of HIV testing and awareness of HIV infection among men who have sex with men, Beijing, China. AIDS Education and Prevention, 18(1), 33–43.
de Jong Giervel, J., & van Tiburg, T. (1999). Living arrangements of older adults in the Netherland and Italy: Coresidence values and behavior and their consequences for loneliness. Journal of Cross-Cultural Gerontology, 14, 1–24.
de Voux, A., Baral, S. D., Bekker, L. G., Beyrer, C., Phaswana-Mafuya, N., Siegler, A. J., … Stephenson, R. (2016). A social network typology and sexual risk-taking among men who have sex with men in Cape Town and Port Elizabeth, South Africa. Culture Health & Sexuality, 18(5), 509–523.
DeLonga, K., Torres, H. L., Kamen, C., Evans, S. N., Lee, S., Koopman, C., & Gore-Felton, C. (2011). Loneliness, internalized homophobia, and compulsive internet use: Factors associated with sexual risk behavior among a sample of adolescent males seeking services at a community LGBT center. Sexual Addiction & Compulsivity, 18(2), 61–74.
DeSalvo, K. B., Bloser, N., Reynolds, K., He, J., & Muntner, P. (2006). Mortality prediction with a single general self-rated health question. Journal of General Internal Medicine, 21(3), 267–275.
Dispenza, F., Dew, B. J., Tatum, A. K., & Wolf, E. C. M. (2015). Sexual health risk behaviors among older men who have sex with men: Implications for interventions. Adultspan Journal, 14(1), 35–48.
Du Bois, S. N., & McKirnan, D. J. (2012). A longitudinal analysis of HIV treatment adherence among men who have sex with men: A cognitive escape perspective. AIDS Care, 24(11), 1425–1431.
Dyer, T. P., Regan, R., Pacek, L. R., Acheampong, A., & Khan, M. R. (2015). Psychosocial vulnerability and HIV-related sexual risk among men who have sex with men and women in the United States. Archives of Sexual Behavior, 44(2), 429–441.
Ferro, E. G., Weikum, D., Vagenas, P., Copenhaver, M. M., Gonzales, P., Peinado, J., … Altice, F. L. (2015). Alcohol use disorders negatively influence antiretroviral medication adherence among men who have sex with men in Peru. AIDS Care, 27(1), 93–104.
Fishbein, M. (2009). An integrative model for behavioral prediction and its application to health promotion. In R. J. DiClemente, R. A. Crosby, & M. C. Kegler (Eds.), Emerging theories in health promotion practice and research (2nd ed., pp. 85–112). San Francisco, CA: Jossey-Bass.
Fisher, J. D., Fisher, W. A., & Shuper, P. A. (2009). The informational-motivational-behavioral skills model of HIV prevention behavior. In R. J. DiClemente, R. A. Crosby, & M. C. Kegler (Eds.), Emerging theories in health promotion practice and research (2nd ed., pp. 40–71). San Francisco, CA: Jossey-Bass.
Hall, H. I., Song, R. G., Rhodes, P., Prejean, J., An, Q., Lee, L. M., … Janssen, R. S. (2008). Estimation of HIV incidence in the United States. Journal of the American Medical Association, 300(5), 520–529.
Herbst, J. H., Beeker, C., Mathew, A., McNally, T., Passin, W. F., Kay, L. S., … Johnson, R. L. (2007). The effectiveness of individual-, group-, and community-level HIV behavioral risk-reduction interventions for adult men who have sex with men a systematic review. American Journal of Preventive Medicine, 32(4), S38–S67.
Herek, G. (2004). Beyond homophobia: Thinking about sexual prejudice and stigma in the twenty-first century. Sexuality Research & Social Policy, 1, 6–24.
Hubach, R. D., Dodge, B., Li, M. J., Schick, V., Herbenick, D., Ramos, W. D., … Reece, M. (2015). Loneliness, HIV-related stigma, and condom use among a predominantly rural sample of HIV-positive men who have sex with men (MSM). AIDS Education and Prevention, 27(1), 72–83.
Hughes, M. E., Waite, L. J., Hawkley, L. C., & Cacioppo, J. T. (2004). A short scale for measuring loneliness in large surveys—Results from two population-based studies. Research on Aging, 26(6), 655–672.
Kohout, F. J., Berkman, L. F., Evans, D. A., & Cornoni-Huntley, J. (1993). Two shorter forms of the CES-D Depression Symptoms Index. Journal of Aging and Health, 5, 179–193.
Kott, A. (2011). Drug use and loneliness are linked to unprotected sex in older adults with HIV. Perspectives on Sexual and Reproductive Health, 43(1), 70. https://doi.org/10.1363/4306911.
Kurtz, S. P. (2005). Post-circuit blues: Motivations and consequences of crystal meth use among gay men in Miami. AIDS and Behavior, 9(1), 63–72.
Kuyper, L., & Fokkema, T. (2010). Loneliness among older lesbian, gay, and bisexual adults: The role of minority stress. Archives of Sexual Behavior, 39(5), 1171–1180.
Li, R., Cai, Y., Wang, Y., Sun, Z., Zhu, C. D., Tian, Y. L., … Gan, F. (2016). Psychosocial syndemic associated with increased suicidal ideation among men who have sex with men in Shanghai, China. Health Psychology, 35(2), 148–156.
Luo, Y., & Waite, L. J. (2014). Loneliness and mortality among older adults in China. Journals of Gerontology Series B-Psychological Sciences and Social Sciences, 69(4), 633–645.
Luria, R. E. (1975). Validity and reliability of Visual Analogue Mood Scale. Journal of Psychiatric Research, 12(1), 51–57.
Martin, J. I., & Knox, J. (1997). Loneliness and sexual risk behavior in gay men. Psychological Reports, 81(3), 815–825.
Mimiaga, M. J., Reisner, S. L., Closson, E. F., Perry, N., Perkovich, B., Nguyen, T., … Colby, D. (2013). Self-perceived HIV risk and the use of risk reduction strategies among men who engage in transactional sex with other men in Ho Chi Minh City, Vietnam. AIDS Care, 25(8), 1039–1044.
Mustanski, B., Garofalo, R., Herrick, A., & Donenberg, G. (2007). Psychosocial health problems increase risk for HIV among urban young men who have sex with men: Preliminary evidence of a syndemic in need of attention. Annals of Behavioral Medicine, 34(1), 37–45.
Neme, S., Goldenberg, T., Stekler, J. D., Sullivan, P. S., & Stephenson, R. (2015). Attitudes towards couples HIV testing and counseling among Latino men who have sex with men in the Seattle area. AIDS Care, 27(10), 1354–1359.
Ophir, Y., Asterhan, C. S. C., & Schwarz, B. B. (2017). Unfolding the notes from the walls: Adolescents’ depression manifestations on Facebook. Computers in Human Behavior, 72, 96–107.
Peplau, L. A., & Perlman, D. (1982). Perspectives on loneliness. In L. A. Peplau & D. Perlman (Eds.), Loneliness: A sourcebook of current theory, research and therapy (pp. 1–8). New York: Wiley.
Pope, M., Wierzalis, E. A., Barrett, B., & Rankins, M. (2007). Sexual and intimacy issues for aging gay men. Adultspan Journal, 6, 68–82.
Pyun, T., Santos, G. M., Arreola, S., Do, T., Hebert, P., Beck, J., … Ayala, G. (2014). Internalized homophobia and reduced HIV testing among men who have sex with men in China. Asia-Pacific Journal of Public Health, 26(2), 118–125.
Russell, D. W. (1996). UCLA Loneliness Scale (Version 3): Reliability, validity, and factor structure. Journal of Personality Assessment, 66(1), 20–40.
Safren, S. A., Reisner, S. L., Herrick, A., Mimiaga, M. I., & Stall, R. D. (2010). Mental health and HIV risk in men who have sex with men. Journal of Acquired Immune Deficiency Syndromes, 55, S74–S77.
Savikko, N., Routasalo, P., Tilvis, R. S., Strandberg, T. E., & Pitkala, K. H. (2005). Predictors and subjective causes of loneliness in an aged population. Archives of Gerontology and Geriatrics, 41(3), 223–233.
Shek, D. T. L. (1993). Measurement of pessimism in Chinese adolescents—The Chinese Hopelessness Scale. Social Behavior and Personality, 21(2), 107–119.
Shernoff, M. (2006). Condomless sex: Gay men, barebacking, and harm reduction. Social Work, 51(2), 106–113.
Stall, R., Mills, T. C., Williamson, J., Hart, T., Greenwood, G., Paul, J., … Catania, J. A. (2003). Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men. American Journal of Public Health, 93(6), 939–942.
Tao, J., Vermund, S. H., Lu, H. Y., Ruan, Y. H., Shepherd, B. E., Kipp, A. M., … Qian, H. Z. (2017). Impact of depression and anxiety on initiation of antiretroviral therapy among men who have sex with men with newly diagnosed HIV infections in China. AIDS Patient Care and STDs, 31(2), 96–104.
Tilvis, R. S., Pitkala, K. H., Jolkkonen, J., & Strandberg, T. E. (2000). Social networks and dementia. Lancet, 356(9223), 77–78.
Tomori, C., McFall, A. M., Srikrishnan, A. K., Mehta, S. H., Solomon, S. S., Anand, S., … Celentano, D. D. (2016). Diverse rates of depression among men who have sex with men (MSM) across India: Insights from a multi-site mixed method study. AIDS and Behavior, 20(2), 304–316.
Torress, H. L., & Gore-Felton, C. (2007). Compulsivity, substance use, and loneliness: The Loneliness and Sexual Risk Model (LSRM). Sexual Addiction & Compulsivity, 14(1), 63–75.
Vanable, P. A., Carey, M. P., Blair, D. C., & Littlewood, R. A. (2006). Impact of HIV-related stigma on health behaviors and psychological adjustment among HIV-positive men and women. AIDS and Behavior, 10(5), 473–482.
Watkins, T. L., Simpson, C., Cofield, S. S., Davies, S., Kohler, C., & Usdan, S. (2016). The relationship of religiosity, spirituality, substance abuse, and depression among black men who have sex with men (MSM). Journal of Religion and Health, 55(1), 255–268.
Wei, C. Y., Cheung, D. H., Yan, H. J., Li, J. J., Shi, L. E., & Raymond, H. F. (2016). The impact of homophobia and HIV stigma on HIV testing uptake among Chinese men who have sex with men: A mediation analysis. Journal of Acquired Immune Deficiency Syndromes, 71(1), 87–93.
Wei, C. Y., Yan, H. J., Yang, C. K., Raymond, H. F., Li, J. J., Yang, H. T., … Stall, R. (2014). Accessing HIV testing and treatment among men who have sex with men in China: A qualitative study. AIDS Care, 26(3), 372–378.
Woodward, J. C., & Kalyanmasih, V. (1990). Loneliness, coping strategies and cognitive styles of the gifted rural adolescent. Adolescence, 25(100), 977–988.
Wu, Y. L., Yang, H. Y., Wang, J., Yao, H., Zhao, X., Chen, J., … Sun, Y. H. (2015). Prevalence of suicidal ideation and associated factors among HIV-positive MSM in Anhui, China. International Journal of STD and AIDS, 26(7), 496–503.
Yan, H. M., Wong, F. Y., Zheng, T., Ning, Z., Ding, Y. Y., Nehl, E. J., … He, N. (2014). Social support and depressive symptoms among ‘money’ boys and general men who have sex with men in Shanghai, China. Sexual Health, 11(3), 285–287.
Yu, S. C., Lin, Y. H., & Hsu, W. H. (2013). Applying structural equation modeling to report psychometric properties of Chinese version 10-item CES-D Depression Scale. Quality & Quantity, 47(3), 1511–1518.
Zhang, H., Lu, H. Y., Pan, S. W., Xia, D. Y., Zhao, Y. J., Xiao, Y., … Shao, Y. M. (2015). Correlates of unprotected anal intercourse: The influence of anal sex position among men who have sex with men in Beijing, China. Archives of Sexual Behavior, 44(2), 375–387.
Zhao, J., Cai, R., Chen, L., Cai, W. D., Yang, Z. R., Richardus, J. H., & de Vlas, S. J. (2015). A comparison between respondent-driven sampling and time-location sampling among men who have sex with men in Shenzhen, China. Archives of Sexual Behavior, 44(7), 2055–2065.
Zhong, B. L., Xu, Y. M., Jin, D., Zou, X. W., & Liu, T. B. (2016). Prevalence and correlates of loneliness among Chinese service industry migrant workers: A cross-sectional survey. Medicine, 95(24), e3903. https://doi.org/10.1097/MD.0000000000003903.
This study was funded by a grant from the U.S. National Institute of Mental Health (Grant Number: R00MH093201).
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The authors declare that they have no conflicts of interest.
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Su, X., Zhou, A.N., Li, J. et al. Depression, Loneliness, and Sexual Risk-Taking Among HIV-Negative/Unknown Men Who Have Sex with Men in China. Arch Sex Behav 47, 1959–1968 (2018). https://doi.org/10.1007/s10508-017-1061-y
- Mental health
- Sexual orientation