Population-based measures and public health response to stem the spread of the coronavirus may have caused unintended isolation and increased the risk of psychiatric illnesses. Fear, social isolation, and loneliness during this unprecedented time also contribute to worsening mental health outcomes among more vulnerable populations, such as sexual and gender minorities, including gay, bisexual, and other men who have sex with men (MSM), a population that is already disproportionately impacted by adverse mental health conditions due to discriminations, homophobia, sexism, and other minority stressors in China. One potential factor that could exacerbate the underlying mental health issues face by MSM is HIV infection. this study aimed to examine the prevalence of depression and anxiety among MSM during the COVID-19 pandemic and their associated factors. We also sought to understand whether mental health outcomes differ by HIV status among Chinese MSM recruited online.
We conducted a cross-sectional survey in July 2021 on Blued, a geo-social networking (GSN) app for MSM in China with more than 40 million users worldwide. Blued users were invited to participate in a 58-question online survey regarding the impact of COVID-19 on a variety of health and mental health outcomes. Recruitment occurred through the build-in advertising function within the app, including advertising banners, pop-up messages, clickable links, etc. Depression and anxiety symptoms were assessed using the brief PHQ-4 scale. We used a multivariable logistic regression model to examine the association between anxiety and depression with self-reported HIV status, adjusting for sociodemographic characteristics and other significant variables at p<0.05 in bivariate analyses.
A total of 1,308 MSM completed the survey, of whom 1205 participants were eligible for this analysis. Among those, 4.7% (n=59) self-reported being HIV positive. The average age of participants was 31.40 (SD=8.73, range:18-70). PHQ-4 scores indicated that over half (53.2%) of the participants screened mild to severe psychological distress: 34.9% screened mild, 11.6% screened moderate, and 6.6% screened severe psychological distress. Of all participants, 20.9% met the criteria for anxiety and 19.6% for depression. Being screened for anxiety and depression was associated with younger age, being gay (vs. bisexual), being transgender, having a degree below college, being unemployed (vs. employed), and lower income (<3000 RMB vs. >10,000 RMB). In addition, MSM living with HIV reported significantly higher rates of psychological distress (63.7% vs. 52.7%, p<0.05).
Conclusions and Implications:
Our finding highlighted the ways that the COVID-19 pandemic may exacerbate underlying mental health issues experienced by Chinese MSM. This is particularly concerning given that MSM living in China already had very limited access to mental health support and recourses due to various barriers before the pandemic. Besides, our study adds to the literature substantially by indicating the critical role of socioeconomic status on psychological health among sexual and gender minorities. Lastly, there is an urgent need to provide innovative strategies to guarantee ongoing HIV treatment and integrate mental health screening and treatment services at HIV clinics to intervene and provide support as the pandemic continues to evolve in China.