Understanding the role of intersectional identity constructs on psychological well-being of Latino men who have sex with men (LMSM) in San Diego, California: A cross-sectional analysis of the NEXUS study

Background: Latino men who have sex with men (LMSM) experience substantial mental health inequities, partly due to intersectional stigma related to their Latino, masculine (i.e., conceptualized as a spectrum of gendered expectations, where both endorsement and non-endorsement of traditional masculine norms shape experience), and sexual identities. While prior research has examined identity valence (e.g., internalized stigma, pride) and magnitude (e.g., centrality, salience), little is known about how these constructs jointly influence mental health from an intersectional lens. This study explores the impact of intersectional identity constructs on psychological well-being among LMSM in San Diego, California. Methods: We analyzed baseline data from 503 participants enrolled in the NEXUS study, a longitudinal cohort investigating intersectional stigma and HIV prevention using social network methods. Participants reported on identity centrality, salience, internalized stigma, and pride across Latino, masculine, and sexual identities. Mental health outcomes included depression (CESD-10), anxiety (GAD-7), and resilience (CD-RISC-10). Structural equation modeling assessed a measurement model of latent intersectional identity constructs and their associations with psychological well-being. Results: Higher intersectional internalized stigma and identity salience were associated with greater depression (β = 0.33, p < 0.001; β = 0.25, p < 0.001) and anxiety (β = 0.33, p < 0.001; β = 0.22, p < 0.001). Identity centrality was negatively associated with depression (β = -0.14, p = 0.037). Pride was positively associated with resilience (β = 0.16, p = 0.038), while internalized stigma was negatively associated (β = -0.25, p = 0.001). Conclusions: Intersectional internalized stigma and identity salience may harm mental health, while centrality and pride show protective effects. Findings highlight the importance of intersectional frameworks in mental health care for LMSM.