(WITHDRAWN) A Minority Stress Response Model of Health Behaviors in Gay and Bisexual Men

Background and Purpose: Health disparities among sexual minority men remain pervasive and continue to demand evidence-informed interventions. Moving beyond risk reduction, a promising approach is to identify and modify pathways to healthy behaviors such as regular physical activities, nutritious dietary behavior, being socially connected, and avoiding substance use. Integrating self-determination, minority stress, and rejection-identification theories, we formulated an interactive process model that encompasses multiple mediators to examine the effect of minority stress on health-promoting behaviors. Three stress response mechanisms were proposed to elucidate the intricate paths from stigma-related stress to the health behaviors. The first path involves depressive symptoms as a pivotal mediator between the perception of minority stress and healthy behavior. The second and third path defined internalized homophobia and community connectedness as mediators respectively between minority stress and health-promoting behavior; additional paths through depressive symptoms to health-promoting behavior were included to further delineate the role of depressed mood.

Methods: Data for this study came from a cross-sectional online survey conducted in Taiwan during May 11 – 27, 2019. A purposive sample of self-identified gay and bisexual adult men was recruited through a social media advertisement to complete an online survey. Validated scales were used to measure the variables of interest. While 1,422 respondents consented to participate and proceeded to fill out the survey, forty-one were excluded for the issues of eligibility and data quality. The final sample for analysis comprises 1,381 gay (81.5%) and bisexual (18.5%) men aged 18-49 years (Mean = 26.56, SD = 6). Structural equation modeling was performed using Mplus to simultaneously examine multiple hypothesized paths. We also conducted subgroup analyses to examine differences between the minority stress response mechanisms of gay and bisexual men.

Results: The hypothesized paths were largely supported although subgroup differences were noted. For gay men, minority stress was associated with greater depressive symptoms (β = .18, p < .001), internalized homophobia (β = .18, p < .001), and sense of community connectedness (β = .09, p = .01), which in turn yielded direct or indirect associations with health-promoting behavior. The model explained 43.9% variance of health-promoting behaviors in gay men. For bisexual men, depressive symptoms remain an important mechanism linking minority stress (β = .34, p < .001) and health-promoting behavior (β = -.45, p < .001); however, the roles of internalized homophobia and the sense of community connectedness appeared less straightforward.

Conclusions and Implications: These findings cast new light on the behavioral implications of minority stress and elucidate the possible underlying mechanisms. Minority stress was found to hinder gay men’s health-promoting behavior by undermining their emotion and self-acceptance. In reaction to minority stress, a stronger sense of community connectedness otherwise contributes to gay men’s health-promoting behavior. Given that these paths were not explicitly observed in bisexual men, further attention should be paid to their distinctive identity profile and psychosocial experience. The results of this study suggest that research and interventions should be invested to understand and promote the drivers for health-promoting behavior to mitigate health disparities in this population.