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. 2020 Jun;24(6):1793-1806.
doi: 10.1007/s10461-019-02724-0.

Investigating Conceptual Models for the Relationship Between Depression and Condomless Sex Among Gay, Bisexual, and Other Men Who have Sex with Men: Using Structural Equation Modelling to Assess Mediation

A R Miltz  1 , A J Rodger  2 , A Cozzi Lepri  2 , J Sewell  2 , N C Nwokolo  3 , S Allan  4 , C Scott  5 , D Ivens  6 , M Lascar  7 , A Speakman  2 , A N Phillips  2 , L Sherr  2 , S Collins  8 , J Elford  9 , F C Lampe  2 ; AURAH Study Group
Affiliations

Investigating Conceptual Models for the Relationship Between Depression and Condomless Sex Among Gay, Bisexual, and Other Men Who have Sex with Men: Using Structural Equation Modelling to Assess Mediation

A R Miltz et al. AIDS Behav. 2020 Jun.

Abstract

The aim of this study is to investigate five hypothesized mechanisms of causation between depression and condomless sex with ≥ 2 partners (CLS2+) among gay, bisexual, and other men who have sex with men (GBMSM), involving alternative roles of self-efficacy for sexual safety and recreational drug use. Data were from the AURAH cross-sectional study of 1340 GBMSM attending genitourinary medicine clinics in England (2013-2014). Structural equation modelling (SEM) was used to investigate which conceptual model was more consistent with the data. Twelve percent of men reported depression (PHQ-9 ≥ 10) and 32% reported CLS2+ in the past 3 months. AURAH data were more consistent with the model in which depression was considered to lead to CLS2+ indirectly via low self-efficacy for sexual safety (indirect Beta = 0.158; p < 0.001) as well as indirectly via higher levels of recreational drug use (indirect Beta = 0.158; p < 0.001). SEM assists in understanding the relationship between depression and CLS among GBMSM.

Keywords: Depression; Gay, bisexual and other men who have sex with men (MSM); Sexual behaviour; Structural equation modelling.

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Conflict of interest statement

ANP has received payments for presentations made at meetings sponsored by Gilead in spring 2015. NCN has received support for attendance at conferences, speaker fees and payments for attendance at advisory boards from Gilead Sciences, Viiv Healthcare, Janssen Pharmaceuticals and Bristol Myers Squibb and a research grant from Gilead Sciences.

Figures

Fig. 1
Fig. 1
Overall conceptual model of hypothesized causal connections between socio-economic factors, psychosocial measures, and sexual risk behaviour collected in the AURAH study
Fig. 2
Fig. 2
Specific causal mechanisms investigated in five separate conceptual models (arrows between other factors remain the same as in Fig. 1)
Fig. 3
Fig. 3
SEM of conceptual model (iii) of the link between depression and CLS with ≥ 2 partners in the AURAH study. aThe model is considered to have a satisfactory fit if: CFI and TLI are ≥ 0.90 & RMSEA is ≤ 0.08. The model is considered to have a good fit if: CFI and TLI are ≥ 0.95 & RMSEA is ≤ 0.06 (higher 90% CI ≤ 0.08), p > 0.05 [37, 45]. bThe gender of the partner was not specified. Men who had a female partner may have been less likely to disclose their sexual orientation, explaining the negative coefficient with concealment of sexual identity (a positive coefficient was hypothesized). cThe majority of men attended a clinic in London (75.9%) and may represent a select group of migrants of higher socio-economic status seeking job opportunities, explaining the positive coefficient
See this image and copyright information in PMC

References

    1. Nash S, Desai S, Croxford S, et al. Progress towards ending the HIV epidemic in the United Kingdom: 2018 report. London: Public Health England; 2018.
    1. Delpech V, Desai M. Towards elimination of HIV amongst gay and bisexual men in the United Kingdom. London: Public Health England; 2017.
    1. PHE . Sexually transmitted infections and screening for chlamydia in England, 2018. London: Public Health England (PHE); 2019.
    1. Rana S, Macdonald N, French P, et al. Enhanced surveillance of syphilis cases among men who have sex with men in London, October 2016–January 2017. Int J STD AIDS. 2019;30(5):422–429. - PubMed
    1. Houston E, Sandfort T, Dolezal C, Carballo-Dieguez A. Depressive symptoms among MSM who engage in bareback sex: does mood matter? AIDS Behav. 2012;16(8):2209–2215. - PMC - PubMed