Abstract
This study explores the presence of mental health challenges and related service utilization among MSM in China. An online cross-sectional survey recruited 520 MSM in Guangdong, China, to evaluate the participants’ psychiatric symptoms, service fulfillment, and challenges. A high proportion of the participants experienced at least one psychiatric symptom in the past year, but less than half of their mental health service needs were fulfilled. The preferred agencies for mental health services were provincial and city-level general hospitals or primary health centers. Lack of knowledge and misconceptions of mental health services were the primary reasons for not receiving necessary services. Mental health service fulfillment was associated with younger age, lower education, higher income, local residency, cohabitation, and disclosure of MSM status. The high rate of mental health issues and gaps in service seeking indicates an urgent need to increase mental health awareness among MSM.
References
Batchelder, A. W., Safren, S., Mitchell, A. D., Ivardic, I., & Ocleirigh, C. (2017). Mental health in 2020 for men who have sex with men in the United States. Sexual Health, 14(1), 59. https://doi.org/10.1071/sh16083.
Berg, M. B., Mimiaga, M. J., & Safren, S. A. (2008). Mental health concerns of gay and bisexual men seeking mental health services. Journal of Homosexuality, 54(3), 293–306. https://doi.org/10.1080/00918360801982215.
Chen, S. (2018). China’s Complicated LGBT Movement. https://thediplomat.com/2018/06/chinas-complicated-lgbt-movement/.
Chong, E. S., Mak, W. W., Tam, T. C., Zhu, C., & Chung, R. W. (2016). Impact of perceived HIV stigma within men who have sex with men community on mental health of seropositive MSM. AIDS Care, 29(1), 118–124. https://doi.org/10.1080/09540121.2016.1201190.
Cochran, S. D., Sullivan, J. G., & Mays, V. M. (2003). Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States. Journal of Consulting and Clinical Psychology, 71(1), 53–61. https://doi.org/10.1037/0022-006x.71.1.53.
Dunbar, M. S., Sontag-Padilla, L., Ramchand, R., Seelam, R., & Stein, B. D. (2017). Mental health service utilization among lesbian, gay, bisexual, and questioning or queer college students. Journal of Adolescent Health, 61(3), 294–301. https://doi.org/10.1016/j.jadohealth.2017.03.008.
Durso, L. E., & Meyer, I. H. (2012). Patterns and predictors of disclosure of sexual orientation to healthcare providers among lesbians, gay men, and bisexuals. Sexuality Research and Social Policy, 10(1), 35–42. https://doi.org/10.1007/s13178-012-0105-2.
El-Gabalawy, R., Mackenzie, C. S., & Sareen, J. (2015). Mental health service use among older Canadians with anxiety and comorbid physical conditions. Aging and Mental Health, 20(6), 627–636. https://doi.org/10.1080/13607863.2015.1033678.
Evans, K. (2018). Treating financial difficulty—The missing link in mental health care? Journal of Mental Health, 27(6), 487–489. https://doi.org/10.1080/09638237.2018.1520972.
Feng, Y., Wu, Z., & Detels, R. (2010). Evolution of MSM community and experienced stigma among MSM in Chengdu, China. Journal of acquired immune deficiency syndromes (1999), 53(Suppl 1), S98. https://doi.org/10.1097/qai.0b013e3181c7df71.
Guo, C., Li, N., Chen, G., & Zheng, X. (2017). Mental health service utilization and its associated social factors among elderly people with a mental disability in China: A national population-based survey. Scandinavian Journal of Public Health, 47(2), 215–220. https://doi.org/10.1177/1403494817722705.
He, H., Lv, F., Zhang, N. N., Wu, Z., Liao, Q., Chang, Z., et al. (2017). Look into the HIV epidemic of gay community with a socio-cultural perspective: A qualitative study in China, 2015–2016. PLoS ONE. https://doi.org/10.1371/journal.pone.0170457.
Health Commission of Guangdong Province. (2018). World AIDS Day theme publicity campaign in Guangdong Province. https://wsjkw.gd.gov.cn/zwyw_gzdt/content/post_2171879.html.
Houston, E., Sandfort, T., Dolezal, C., & Carballo-Diéguez, A. (2012). Depressive symptoms among MSM who engage in bareback sex: Does mood matter? AIDS and Behavior, 16(8), 2209–2215. https://doi.org/10.1007/s10461-012-0156-7.
Human Resources and Social Security Department of Guangdong Province. (2018). Guidance of human resource market price in Guangdong Province in 2017. https://www.gdhrss.gov.cn/u/cms/gdwz/201801/311127341zq3.pdf.
Li, N., Du, W., Chen, G., Song, X., & Zheng, X. (2013). Mental health service use among Chinese adults with mental disabilities: A national survey. Psychiatric Services, 64(7), 638–644. https://doi.org/10.1176/appi.ps.001232012.
Li, L., Liang, L., Lin, C., Wu, Z., & Wen, Y. (2009). Individual attitudes and perceived social norms: Reports on HIV/AIDS-related stigma among service providers in China. International Journal of Psychology, 44(6), 443–450. https://doi.org/10.1080/00207590802644774.
Liang, D., Mays, V. M., & Hwang, W. (2017). Integrated mental health services in China: Challenges and planning for the future. Health Policy and Planning, 33(1), 107–122. https://doi.org/10.1093/heapol/czx137.
Lu, M., & Xia, Y. (2016). Migration in the People’s Republic of China. ADBI Working Paper 593. Tokyo: Asian Development Bank Institute. https://www.adb.org/sites/default/files/publication/191876/adbi-wp593.pdf.
Martin, R. M., Ridley, S. C., & Gillieatt, S. J. (2017). Family inclusion in mental health services: Reality or rhetoric? International Journal of Social Psychiatry, 63(6), 480–487. https://doi.org/10.1177/0020764017716695.
Mi, G., Ma, B., Kleinman, N., Li, Z., Fuller, S., Bulterys, M., et al. (2016). Hidden and mobile: A web-based study of migration patterns of men who have sex with men in China. Clinical Infectious Diseases, 62(11), 1443–1447. https://doi.org/10.1093/cid/ciw167.
Mimiaga, M. J., OʼCleirigh, C., Biello, K. B., Robertson, A. M., Safren, S. A., Coates, T. J., et al. (2015). The effect of psychosocial syndemic production on 4-year HIV incidence and risk behavior in a large cohort of sexually active men who have sex with men. Journal of Acquired Immune Deficiency Syndromes, 68(3), 329–336. https://doi.org/10.1097/qai.0000000000000475.
National Health and Family Planning Commission of the People’s Republic of China. (2015). China AIDS Response Progress Report. https://www.unaids.org/sites/default/files/country/documents/CHN_narrative_report_2015.pdf.
Nugraheni, P., Tobing, H., Kusumadewi, I., & Siste, K. (2018). Is it important to assess mental health problem in MSM? Asian Journal of Psychiatry. https://doi.org/10.1016/j.ajp.2018.12.003.
Qin, Q., Guo, W., Tang, W., Mahapatra, T., Wang, L., Zhang, N., et al. (2017). Spatial analysis of the human immunodeficiency virus epidemic among men who have sex with men in China, 2006–2015. Clinical Infectious Diseases, 64(7), 956–963. https://doi.org/10.1093/cid/cix031.
Safren, S. A., Blashill, A. J., & O’Cleirigh, C. M. (2011). Promoting the sexual health of MSM in the context of comorbid mental health problems. AIDS and Behavior, 15(Suppl. 1), S30–S34. https://doi.org/10.1007/s10461-011-9898-x.
Shao, B., Song, B., Feng, S., Lin, Y., Du, J., Shao, H., et al. (2018). The relationship of social support, mental health, and health-related quality of life in human immunodeficiency virus-positive men who have sex with men. Medicine. https://doi.org/10.1097/md.0000000000011652.
Sikkema, K. J., Watt, M. H., Drabkin, A. S., Meade, C. S., Hansen, N. B., & Pence, B. W. (2009). Mental health treatment to reduce HIV transmission risk behavior: A positive prevention model. AIDS and Behavior, 14(2), 252–262. https://doi.org/10.1007/s10461-009-9650-y.
Song, Y. (2014). What should economists know about the current Chinese hukou system? China Economic Review, 29, 200–212. https://doi.org/10.1016/j.chieco.2014.04.012.
Stahlman, S., Sanchez, T. H., Sullivan, P. S., Ketende, S., Lyons, C., Charurat, M. E., et al. (2016). The prevalence of sexual behavior stigma affecting gay men and other men who have sex with men across Sub-Saharan Africa and in the United States. JMIR Public Health and Surveillance, 2(2), e35. https://doi.org/10.2196/publichealth.5824.
Tang, W., Mao, J., Tang, S., Liu, C., Mollan, K., Cao, B., et al. (2017). Disclosure of sexual orientation to health professionals in China: Results from an online cross-sectional study. Journal of the International AIDS Society, 20(1), 21416. https://doi.org/10.7448/ias.20.1.21416.
Tsuyuki, K., Pitpitan, E. V., Levi-Minzi, M. A., Urada, L. A., Kurtz, S. P., Stockman, J. K., et al. (2017). Substance use disorders, violence, mental health, and HIV: Differentiating a syndemic factor by gender and sexuality. AIDS and Behavior, 21(8), 2270–2282. https://doi.org/10.1007/s10461-017-1841-3.
United Nations Development Programme. (2016). Being LGBTI in China: A National Survey on Social Attitudes towards Sexual Orientation, Gender Identity and Gender Expression. https://www.asia-pacific.undp.org/content/rbap/en/home/library/democratic_governance/hiv_aids/being-lgbti-in-china--a-national-survey-on-social-attitudes-towa.html.
Urbanoski, K. A., Cairney, J., Bassani, D. G., & Rush, B. R. (2008). Perceived unmet need for mental health care for Canadians with co-occurring mental and substance use disorders. Psychiatric Services, 59(3), 283–289. https://doi.org/10.1176/appi.ps.59.3.283.
Voisin, D. R., Hotton, A. L., & Schneider, J. A. (2016). The relationship between life stressors and drug and sexual behaviors among a population-based sample of young Black men who have sex with men in Chicago. AIDS Care, 29(5), 545–551. https://doi.org/10.1080/09540121.2016.1224303.
Wakida, E. K., Akena, D., Okello, E. S., Kinengyere, A., Kamoga, R., Mindra, A., et al. (2017). Barriers and facilitators to the integration of mental health services into primary health care: A systematic review protocol. Systematic Reviews. https://doi.org/10.1186/s13643-017-0561-0.
Wang, X., Jiang, R., Li, J., Chen, J., Burström, B., & Burström, K. (2018). What do patients care most about in China’s public hospitals? Interviews with patients in Jiangsu Province. BMC Health Services Research. https://doi.org/10.1186/s12913-018-2903-6.
Watson, J., Tang, W., Pan, S., Wu, D., Zhao, P., Cao, B., et al. (2018). Out of the closet, into the clinic: Opportunities for expanding men who have sex with men-competent services in China. Sexually Transmitted Diseases, 45(8), 527–533. https://doi.org/10.1097/OLQ.0000000000000808.
White, Y., Sandfort, T., Morgan, K., Carpenter, K., & Pierre, R. (2016). Family relationships and sexual orientation disclosure to family by gay and bisexual men in Jamaica. International Journal of Sexual Health, 28(4), 306–317. https://doi.org/10.1080/19317611.2016.1227015.
Wirtz, A. L., Kamba, D., Jumbe, V., Trapence, G., Gubin, R., Umar, E., et al. (2014). A qualitative assessment of health seeking practices among and provision practices for men who have sex with men in Malawi. BMC International Health and Human Rights. https://doi.org/10.1186/1472-698x-14-20.
World Health Organization. (2013). Comprehensive Mental Health Action Plan 2013–2020. https://apps.who.int/gb/ebwha/pdf_files/WHA66/A66_R8-en.pdf?ua=1.
Wu, F., Zhang, A., Babbitt, A., Ma, Q., Eyal, N., et al. (2017). Overcoming HIV stigma? A qualitative analysis of HIV cure research and stigma among men who have sex with men living with HIV. Archives of Sexual Behavior, 47(7), 2061–2069. https://doi.org/10.1007/s10508-017-1062-x.
Xu, Z., Huang, F., Kösters, M., & Rüsch, N. (2017a). Challenging mental health related stigma in China: Systematic review and meta-analysis. II. Interventions among people with mental illness. Psychiatry Research, 255, 457–464. https://doi.org/10.1016/j.psychres.2017.05.002.
Xu, X., Li, X., Zhang, J., & Wang, W. (2017b). Mental health-related stigma in China. Issues in Mental Health Nursing, 39(2), 126–134. https://doi.org/10.1080/01612840.2017.1368749.
Xu, J., Tian, Y., Wang, S., & Lu, Y. (2018). Effects of income and psychological identification on the mental health of China’s migrated agricultural population. Iranian Journal of Public Health, 47(9), 1317–1326.
Young, S. D. (2014). Social media technologies for HIV prevention study retention among minority men who have sex with men (MSM). AIDS and Behavior, 18(9), 1625–1629. https://doi.org/10.1007/s10461-013-0604-z.
Zhao, J., Chen, L., Chaillon, A., Zheng, C., Cai, W., Yang, Z., et al. (2016). The dynamics of the HIV epidemic among men who have sex with men (MSM) from 2005 to 2012 in Shenzhen, China. Scientific Reports. https://doi.org/10.1038/srep28703.
Zheng, S. (2018). The growing threat of Chinas HIV epidemic. The Lancet Public Health. https://doi.org/10.1016/s2468-2667(18)30098-7.
Zhou, Y., Rosenheck, R. A., & He, H. (2014). Health insurance in China: Variation in co-payments and psychiatric hospital utilization. Journal of Mental Health Policy and Economics, 17(1), 25–32.
Zhu, Y., Liu, J., Chen, Y., Zhang, R., & Qu, B. (2018). The relation between mental health, homosexual stigma, childhood abuse, community engagement, and unprotected anal intercourse among MSM in China. Scientific Reports. https://doi.org/10.1038/s41598-018-22403-9.
Acknowledgements
We thank our colleagues from Guangdong Provincial Center for Disease Control and Prevention and “Guang Tong” Community-Based Organization who provided assistance that greatly contributed to the research. This study was supported by the UCLA Center for HIV Identification, Prevention, and Treatment Services (CHIPTS) 2018–2019 Mentored Pilot Grant. CHIPTS was funded by the National Institute of Mental Health of the National Institutes of Health under Award Number (P30MH058107). We thank our colleagues from Guangdong Provincial Center for Disease Control and Prevention and “Guang Tong” Community-Based Organization who provided assistance that greatly contributed to the research.
Author information
Authors and Affiliations
Contributions
CL conceptualized the study, conducted data analysis, and drafted the manuscript. LL and YL contributed to the study design and result interpretation. Material preparation and data collection were performed by JL and XF. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
No potential conflict of interest was reported by the authors. All authors have no conflict declared.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Lin, C., Li, L., Liu, J. et al. Mental Health Services for Men Who Have Sex with Men in China. Community Ment Health J 57, 380–386 (2021). https://doi.org/10.1007/s10597-020-00660-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10597-020-00660-1