The Association of Collective Self-Esteem to Individual Self-Esteem, Depression, and Sexual Health of Indian Men Who Have Sex with Men: A Longitudinal Analysis

Abstract Background Men who have sex with men (MSM) in India face unique psychosocial and HIV-related stressors. Collective self-esteem (CSE) may be a particularly important protective factor for this population given Indian collectivist cultural values. This study examined potential effects of CSE sequentially on individual self-esteem (ISE), depression and, in turn, sexual behavior and health outcomes longitudinally among Indian MSM. Method Three hundred and one Indian MSM were surveyed at baseline, and at 4, 8, and 12 months. Assessments included the CSE scale, Rosenberg ISE, clinically significant depressive symptoms, condomless anal sex (CAS), and sexually transmitted infections (STIs). After confirmatory factor analysis (CFA) of the CSE scale, path models were estimated to examine longitudinal associations of CSE on outcomes via serial mediation. Results One of the three collective self-esteem factors from the CFA, public view of group, significantly predicted outcomes. This factor, a higher public view of group, predicted increased ISE 4 months later, which in turn via mediation, predicted fewer clinically significant depressive symptoms at 8 months (B = −0.685, β = −0.048, 95% BCa CI −1.547, −0.280). When adding CAS as the outcome at 12 months, ISE at 4 months and depression at 8 months were serial mediators of the effects of public view of group ( B = −0.207, β = −0.017, 95% BCa CI −1.086, −0.051). When adding STI to the model instead of CAS, STI incidence was not predicted. Conclusion Of the components of collective self-esteem in Indian MSM, public view of group emerged as a key predictor of mental and sexual health in Indian MSM. Addressing collective self-esteem and/or its contributors (e.g., stigma) may have beneficial effects for Indian MSM.