Understanding the Longitudinal Association of Depression with Unprotected Anal Intercourse in a Cohort of White and Black Non-Hispanic Men Who Have Sex With Men. A Case-Crossover Approach. Open Access

Downs, Jonathan David (2015)

Permanent URL: https://etd.library.emory.edu/concern/etds/2b88qc57q?locale=en


Depression is a common mental disorder, impacting 6% of the population each year. Men who have sex with men (MSM) experience a higher prevalence of depression than others, due to minority stress. This stress may lead to risky sex such as unprotected anal intercourse (UAI). Black MSM report higher levels of depression yet lower levels of UAI than their white counterparts. Using 554 subjects from the InvolveMENt study in Atlanta, white and black, non-hispanic MSM were administered 1.5 hour questionnaires every six months for two years, evaluating depression, unprotected anal intercourse, and other behaviors. A case-control design was used to estimate the effect of depression on UAI. Potential covariates were analyzed in aggregate and at each study period for bivariate associations between exposure and outcome. A full model with 3 total variables, including depression, was generated. Other variables were dropped individually then collectively to assess for possible increases in model precision. None of the 3 reduced models significantly increased precision over the full model. While the unadjusted odds ratio between depression and UAI was significant, the adjusted odds ratio was slightly, non-significantly positive. This may be due to a more distal effect of depression on sexual behavior, sample size limitations due to the study design, or a non-linear trend between depression and UAI. Future studies should incorporate a larger sample size or test for non-linear associations between depression and UAI.

Table of Contents






Tables & Figures...19

Appendix A: Bivariate Associations Between Variables of Interest and Depression...24


Six Months...25

Twelve Months...26

Eighteen Months...27

Twenty-Four Months...28

Appendix B: Bivariate Associations: Unprotected Anal Intercourse...29


Six Months...30

Twelve Months...31

Eighteen Months...32

Twenty-Four Months...33

Appendix C: SAS Code...34

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