The Associations Between Perceived Social Support, Depressive Symptoms, and Psychoactive Substance Use Among Men Who Have Sex with Men: A Cross-Sectional Study

Objectives This study aimed to investigate the prevalence of psychoactive substance use (PSU), identify related factors, and examine the associations among perceived social support, depressive symptoms, and PSU among men who have sex with men (MSM) in China.Methods This study recruited MSM from March 17 to May 28, 2023, via Blued, a popular geosocial networking application among MSM in China. Data on sociodemographic characteristics, sexual behaviors, PSU, perceived social support, and mental health were collected through an online survey. Univariable and multivariable logistic regression analyses were conducted to identify factors associated with PSU. Mediation and moderation analyses were performed to assess the potential associations among perceived social support, depressive symptoms, and PSU.Results A total of 686 MSM were included in this study, with 28.9% reporting PSU in the past 6 months and 46.9% exhibiting depressive symptoms. The most frequently used psychoactive substance was poppers (27.6%, n = 189). Students, participants with higher income levels, those with depressive symptoms, HIV-positive individuals, those with multiple sexual partners, and those with a history of PrEP use were more likely to report PSU. Mediation analysis showed that depressive symptoms fully mediated the association between perceived social support and PSU, whereas the moderating effect of perceived social support was not supported.Conclusions PSU remains prevalent among MSM in China, posing significant mental health risks and increasing vulnerability to HIV. Targeted interventions should provide health education, strengthen social support networks, and improve mental health to reduce PSU, promote safer sexual behaviors, and decrease the risk of HIV transmission among MSM.