Psychosocial symptom networks and high-risk sexual behaviors among men who have sex with men: a network analysis

Psychosocial problems are prevalent among men who have sex with men (MSM) and are linked to high-risk sexual behaviors. Previous studies have often examined these factors separately, without considering their interconnections. Network analysis offers a way to explore these relationships, but has seldom been applied to MSM in the context of both mental health and sexual risk. This study aimed to: (1) model psychosocial symptom networks among MSM; (2) compare network structures across demographic subgroups; and (3) examine how central symptoms relate to high-risk sexual behaviors. A cross-sectional survey was conducted among 405 MSM in Taizhou, China, using venue-based and online snowball sampling. Psychosocial problems—including depression, anxiety, self-esteem, internalized homonegativity, loneliness, perceived social support, and sociosexual orientation—were assessed using validated self-report scales. High-risk sexual behavior was measured based on condom use and number of sexual partners. Network analysis was used to examine symptom-level associations, and network comparison tests explored differences across demographic subgroups. Associations between central symptoms and high-risk behaviors were examined using correlation and regression analyses. Among 405 MSM, 12.4% reported moderate-to-severe depression and 10.1% moderate-to-severe anxiety. Strongest network connections appeared between depression and anxiety, and between loneliness and sociosexual desire. Central nodes included ‘feeling nervous’, desire for uncommitted sexual relationships, ‘feeling tired’, ‘lacking companionship’, and ‘no good’. Significant structural differences were found between participants < 33 years and those ≥ 33 years (p = 0.017), with older individuals showing generally weaker psychosocial connections. Central symptoms were significantly associated with risky sexual behaviors, especially in younger participants. Emotional distress, low self-esteem, loneliness, and sociosexual desire emerged as central psychosocial problems linked to high-risk sexual behaviors among MSM. Network structures differed by age, with younger MSM showing stronger interconnections. These findings highlight the need for age-specific, targeted interventions to reduce sexual risk and improve mental health among MSM.