Disparity in depressive symptoms between heterosexual and sexual minority men in China: The role of social support

Autoři: Jingchu Hu aff001;  Ling Tan aff002;  Gang Huang aff003;  Wenjun Yu aff005
Působiště autorů: Department of Anxiety Disorders, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China aff001;  School of Management, Guangdong University of Technology, Guangzhou, Guangdong, China aff002;  Shenzhen Kangning Hospital, Shenzhen, Guangdong, China aff003;  Normal College, Shenzhen University, Shenzhen, Guangdong, China aff004;  College of Education, JingGangShan University, Ji’An, Jiangxi, China aff005
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0226178


Accumulating evidence suggests that sexual minorities experience elevated levels of depressive symptoms compared to heterosexuals in Western countries. Still, little is known about whether there is any difference in depressive symptoms between sexual minority men and heterosexual men in China. This study investigated the differences in depressive symptoms and social support between 302 Chinese sexual minority men and 249 heterosexual men. The association between depressive symptoms, social support and sexual orientation was also explored. Our results indicated that Chinese sexual minority men have more depressive symptoms and perceived lower social support than heterosexual men. Overall, sexual orientation and social support both predicted depressive symptoms. Different from previous Western studies, in our results, social support fully mediates but does not moderate the relationship between sexual orientation and depressive symptoms in Chinese men. The current findings suggest that social support has a significant impact on depressive symptoms among Chinese sexual minority men, highlighting the unique role of social support in understanding depressive symptoms among Chinese sexual minority men. Providing more social support, as well as promoting accepting and positive environments, may lead to better adjustment in this population in China.

Klíčová slova:

Depression – Educational attainment – Heterosexuals – Human families – Chinese people – Interpersonal relationships – Mental health and psychiatry – Psychological stress


1. Galliher RV, Rostosky SS, Hughes HK. School belonging, self-esteem, and depressive symptoms in adolescents: an examination of sex, sexual attraction status, and urbanicity. J Youth Adolesc. 2004;33: 235–245.

2. Marshal MP, Dietz LJ, Friedman MS, Stall R, Smith HA, McGinley J, et al. Suicidality and depression disparities between sexual minority and heterosexual youth: a meta-analytic review. J Adolesc Health. 2011;49: 115–123. doi: 10.1016/j.jadohealth.2011.02.005 21783042

3. Marshal MP, Dermody SS, Cheong J, Burton CM, Friedman MS, Aranda F, et al. Trajectories of depressive symptoms and suicidality among heterosexual and sexual minority youth. J Youth Adolesc. 2013;42: 1243–1256. doi: 10.1007/s10964-013-9970-0 23784511

4. Lock J, Steiner H. Gay, lesbian, and bisexual youth risks for emotional, physical, and social problems: results from a community-based survey. J Am Acad Child Adolesc Psychiatry. 1999;38: 297–304. doi: 10.1097/00004583-199903000-00017 10087691

5. Prestage G, Hammoud M, Jin F, Degenhardt L, Bourne A, Maher L. Mental health, drug use and sexual risk behavior among gay and bisexual men. Interna J of Drug Policy. 2018;55, 169–179.

6. Russell ST, Joyner K. Adolescent sexual orientation and suicide risk: evidence from a national study. Am J Public Health. 2001;91: 1276–1281. doi: 10.2105/ajph.91.8.1276 11499118

7. Wight RG, LeBlanc AJ, Meyer IH, Harig FA. Internalized gay ageism, mattering, and depressive symptoms among midlife and older gay-identified men. Soc Sci Med. 2015;147: 200–208. doi: 10.1016/j.socscimed.2015.10.066 26588435

8. Liu X, Jiang D, Chen X, Tan A, Hou Y, He M, et al. Mental Health Status and Associated Contributing Factors among Gay Men in China. Int J Environ Res Public Health. 2018;15: 1065.

9. Hu J, Hu J, Huang G, Zheng X. Life satisfaction, self-esteem, and loneliness among LGB adults and heterosexual adults in China. J Homosex. 2016;63: 72–86. doi: 10.1080/00918369.2015.1078651 26244408

10. Gao SY, Jia XM. Researches on homosexuality domestic during recent 15 years. Chin J Health Psychol. 2008;16: 461–463.

11. Lam TH, Stewart SM, Leung GM, Lee PW, Wong JP, Ho LM, et al. Depressive symptoms among Hong Kong adolescents: relation to atypical sexual feelings and behaviors, gender dissatisfaction, pubertal timing, and family and peer relationships. Arch Sex Behav. 2004;33: 487–496. doi: 10.1023/B:ASEB.0000037429.79394.c6 15305119

12. Zhang H, Wong WC, Ip P, Fan S, Yip PS. Health status and risk behaviors of sexual minorities among Chinese adolescents: a school-based survey. J Homosex. 2017;64: 382–396. doi: 10.1080/00918369.2016.1190221 27183532

13. Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129: 674–697. doi: 10.1037/0033-2909.129.5.674 12956539

14. Baams L, Grossman AH, Russell ST. Minority stress and mechanisms of risk for depression and suicidal ideation among lesbian, gay, and bisexual youth. Dev Psychol. 2015;51: 688–696. doi: 10.1037/a0038994 25751098

15. Lehavot K, Simoni JM. The impact of minority stress on mental health and substance use among sexual minority women. J Consult Clin Psychol. 2011;79: 159–70. doi: 10.1037/a0022839 21341888

16. Secor AM, Wahome E, Micheni M, Rao D, Simoni JM, Sanders EJ, Graham SM. Depression, substance abuse and stigma among men who have sex with men in coastal Kenya. AIDS. 2015;29: S251–9. doi: 10.1097/QAD.0000000000000846 26562814

17. Wills TA. Social support and interpersonal relationships. In: Clark MS, editor. Review of personality and social psychology, prosocial behavior. Thousand Oaks, CA, US: Sage Publications, Inc.; 1991. pp. 265–289.

18. De Man AF, Gutiérrez BIB. The relationship between level of self-esteem and suicidal ideation with stability of self-esteem as moderator. Can J Behav Sci. 2002;34: 235–238.

19. Uchino BN, Cacioppo JT, Kiecolt-Glaser JK. The relationship between social support and physiological processes: a review with emphasis on underlying mechanisms and implications for health. Psychol Bull. 1996;119: 488–531. doi: 10.1037/0033-2909.119.3.488 8668748

20. Wong CF, Schrager SM, Holloway IW, Meyer IH, Kipke MD. Minority stress experiences and psychological well-being: the impact of support from and connection to social networks within the Los Angeles house and ball communities. Prev Sci. 2014;15: 44–55. doi: 10.1007/s11121-012-0348-4 23412944

21. Parra LA, Bell TS, Benibgui M, Helm JL, Hastings PD. The buffering effect of peer support on the links between family rejection and psychosocial adjustment in LGB emerging adults. J Soc Pers Relat. 2017;35: 854–871.

22. Williams T, Connolly J, Pepler D, Craig W. Peer victimization, social support, and psychosocial adjustment of sexual minority adolescents. J Youth Adolesc. 2005;34: 471–482.

23. Safren SA, Heimberg RG. Depression, hopelessness, suicidality, and related factors in sexual minority and heterosexual adolescents. J Consult Clin Psychol. 1999;67: 859–866. doi: 10.1037//0022-006x.67.6.859 10596508

24. Vincke J, Bolton R. Social support, depression, and self-acceptance among gay men. Hum Relat. 2016;47: 1049–1062.

25. Wu J. From “Long Yang” and “Dui Shi” to Tongzhi: homosexuality in China. J Gay Lesbian Psychotherapy. 2003;7: 117–143.

26. Liu WN, Ma LJ, Luo JJ. Comparison study of college students' implicit attitude and explicit attitude to homosexuality. Chin J Health Psychol. 2010;18: 1494–1495.

27. Tan L, Chen J, Xia T, Hu J. Predictors of suicidal ideation among children and adolescents: roles of mental health status and meaning in life. Child Youth Care Forum. 2017;47: 219–231.

28. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 2016;1: 385–401.

29. Chen ZY, Yang XD, Li XY. Psychometric features of CES-D in Chinese adolescents. Chin J Clin Psychol. 2009;17: 443–445.

30. Huang QB, Wang XH, Chen G. Reliability and validity of 10-item CES-D among middle aged and older adults in China. Chin J Health Psychol. 2015;7: 1036–1041.

31. Tang XL, Cheng MQ, Hu LK, Wang AZ. Comparison of the results of CES and D—SDS on the evaluation of college students' depressive symptoms. Chin Ment Health J. 1995;1: 19–20.

32. Fang JQ, Yao SQ. Reliability and validity of the Chinese version of the depression experience questionnaire in 640 college students and the comparison of the two scoring systems. Chin Ment Health J. 2008;3: 184–188.

33. Zimet GD, Dahlem NW, Zimet SG, Farley GK. The multidimensional scale of perceived social support: a confirmation study. J Clin Psychol. 1991;47: 756–761. doi: 10.1002/1097-4679(199111)47:6<756::aid-jclp2270470605>3.0.co;2-l 1757578

34. Huang JQJ, Ren WH. The relationship between coping style, social support and psychosomatic symptoms among cancer patients. Chin Ment Health J. 1996;10: 160–161.

35. Chou KL. Assessing Chinese adolescents’ social support: the multidimensional scale of perceived social support. Pers Individ Dif. 2000;28: 299–307.

36. Preacher KJ, Hayes AF. SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behav Res Methods Instrum Comput. 2004;36: 717–731. doi: 10.3758/bf03206553 15641418

37. Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods. 2008;40: 879–891. doi: 10.3758/brm.40.3.879 18697684

38. Balsam KF, Beauchaine TP, Mickey RM, Rothblum ED. Mental health of lesbian, gay, bisexual, and heterosexual siblings: effects of gender, sexual orientation, and family. J Abnorm Psychol. 2005;114: 471–476. doi: 10.1037/0021-843X.114.3.471 16117584

39. Lewis NM. Mental health in sexual minorities: recent indicators, trends, and their relationships to place in North America and Europe. Health Place. 2009;15: 1029–1045. doi: 10.1016/j.healthplace.2009.05.003 19515600

40. la Roi C, Kretschmer T, Dijkstra JK, Veenstra R, Oldehinkel AJ. Disparities in depressive symptoms between heterosexual and lesbian, gay, and bisexual youth in a Dutch cohort: the TRAILS study. J Youth Adolesc. 2016;45: 440–456. doi: 10.1007/s10964-015-0403-0 26748920

41. Doty ND, Willoughby BL, Lindahl KM, Malik NM. Sexuality related social support among lesbian, gay, and bisexual youth. J Youth Adolesc. 2010;39: 1134–1147. doi: 10.1007/s10964-010-9566-x 20593304

42. Puckett JA, Woodward EN, Mereish EH, Pantalone DW. Parental rejection following sexual orientation disclosure: impact on internalized homophobia, social support, and mental health. LGBT Health. 2015;2: 265–269. doi: 10.1089/lgbt.2013.0024 26788675

43. Shilo G, Savaya R. Effects of family and friend support on LGB youths' mental health and sexual orientation milestones. Fam Relat. 2011;60: 318–330.

44. Watson RJ, Grossman AH, Russell ST. Sources of social support and mental health among LGB youth. Youth Soc. 2019;51: 30–48. doi: 10.1177/0044118X16660110 30636819

45. van Beusekom G, Baams L, Bos HM, Overbeek G, Sandfort TG. Gender nonconformity, homophobic peer victimization, and mental health: how same-sex attraction and biological sex matter. J Sex Res. 2016;53: 98–108. doi: 10.1080/00224499.2014.993462 26099017

46. Teasdale B, Bradley-Engen MS. Adolescent same-sex attraction and mental health: the role of stress and support. J Homosex. 2010;57: 287–309. doi: 10.1080/00918360903489127 20390994

47. Chow PK, Cheng ST. Shame, internalized heterosexism, lesbian identity, and coming out to others: a comparative study of lesbians in mainland China and Hong Kong. J Couns Psychol. 2010;57: 92–104. doi: 10.1037/a0017930 21133562

48. Taylor SE, Sherman DK, Kim HS, Jarcho J, Takagi K, Dunagan MS. Culture and social support: who seeks it and why? J Pers Soc Psychol. 2004;87: 354–362. doi: 10.1037/0022-3514.87.3.354 15382985

49. Bishop GD, Kaur D, Tan VL, Chua YL, Liew SM, Mak KH. Effects of a psychosocial skills training workshop on psychophysiological and psychosocial risk in patients undergoing coronary artery bypass grafting. American Heart Journal, 2005;150:602–609. doi: 10.1016/j.ahj.2004.10.015 16169348

50. Li C, Chu F, Wang H, Wang XP. Efficacy of Williams LifeSkills training for improving psychological health: A pilot comparison study of Chinese medical students. Asia-Pacific Psychiatry, 2014, 6:161–169.

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