Sexual Minority Stigma and Depressive Symptoms among MSM in China: Mediating Roles of Internalized Homophobia and Social Avoidance

Background Sexual minority stigma remains pervasive among gay, bisexual, and other men who have sex with men (GBMSM) in China and is consistently associated with increased risks of depression. This study aimed to examine the mediating roles of internalized homophobia and social avoidance in the association between sexual minority stigma and depressive symptoms among GBMSM.Methods A total of 524 GBMSM (Mean[age] = 29.65, SD = 9.47) were recruited through purposive sampling through the Blued platform in China. A self-administered web-based structured questionnaire was used to collect data on sociodemographic information, high-risk sexual behaviors, psychosocial conditions (e.g., stigma, internalized homophobia, social avoidance). Path analyses were conducted to assess the mediation effect.Results Enacted stigma was associated with depressive symptoms both directly and indirectly via internalized homophobia. In contrast, perceived stigma was directly associated with depressive symptoms but not mediated by internalized homophobia. Both forms of stigma - perceived and enacted - were indirectly associated with depressive symptoms via social avoidance.Conclusion Social avoidance mediated both relationships between perceived stigma, enacted stigma and depressive symptoms, whereas internalized homophobia mediated only the effect of enacted stigma. These findings underscore the need for interventions that promote healthy coping strategies and reduce stigma-related stressors among GBMSM in China.