A Syndemic Analysis of Depression Among a Sample of Men Who Have Sex with Men in Shanghai, China Público

Harnisch, Jessica Ann (2014)

Permanent URL: https://etd.library.emory.edu/concern/etds/fx719n17t?locale=pt-BR
Published

Abstract

Background: Chinese men who have sex with men (MSM) and male commercial sex workers (money boys) remain an under-researched population, and are undertreated for depression. Additionally, it has been found that MSM and money boys in Shanghai, China experience a high prevalence of male-on-male intimate partner violence (IPV), drug use, and risky sexual behavior. This study aims to examine the syndemic production of depression due to the synergistic interactions of these psychosocial correlates.

Methods: This is a secondary data analysis of the Shanghai Men's Study, in which three recruitment methods; respondent driven sampling (RDS), community popular opinion leader (CPOL), and venue-based sampling (VBS), were utilized to sample 631 money boys and 721 general MSM (N=1,352). Participants completed a paper survey, and self-reported their demographics, number of sexual partners, held gender role beliefs, experience of abuse from a male sexual partner, drug use, and completed the 12-item CES-D depression screening questionnaire. Analysis was conducted by calculating descriptive statistics for all survey items, and significant differences between money boys, general MSM, and participants from the each three recruitment methods were determined by ANOVAs and Chi-square tests. Multivariate logistics regressions were conducted to assess the association between demographic variables, psychosocial variables, and drug use.

Results: Overall, 392 (29%) of the participants exhibited somewhat elevated to very elevated depressive symptoms. A significantly higher portion of money boys (63.5%) had experience one or two forms of abuse from a male sexual partner than general MSM (29.7%, p<.001). Money boys also had more male sexual partners than general MSM (p<.001), with 43.9% of money boys having more than ten male sexual partners in the last 30 days. Multivariate logistic regressions did not reveal any significant associations between depression and the psychosocial correlates.

Conclusions: We cannot conclude that there is a syndemic production of depression among MSM in Shanghai, China. However, this population is at risk of depression, violent relationships, risky sexual behavior, and substance abuse problems. Because these risks exist, especially among money boys, additional research and interventions are required in order to reduce these risks among the MSM population in Shanghai, China.

Table of Contents

TABLE OF CONTENTS

CHAPTER 1. INTRODUCTION 1
STATEMENT OF THE PROBLEM 5
PURPOSE OF THE STUDY 6
SIGNIFICANCE OF THE STUDY 6
THEORETICAL FRAMEWORK 8
LIMITATIONS 11
HYPOTHESES 11
DEFINITION OF TERMS 12

CHAPTER 2. REVIEW OF RELATED LITERATURE 15
RATE OF DEPRESSION IN CHINA AMONG MSM 16
HEALTH CONSEQUENCES OF DEPRESSION 17
DEPRESSION CORRELATES 18
Gender Role Beliefs 18
Sexual Concurrency 20
Drug Use 21
Male-on-male Intimate Partner Violence 21
GLOBAL PREVALENCE OF INTIMATE PARTNER VIOLENCE 23
HEALTH CONSEQUENCES OF INTIMATE PARTNER VIOLENCE 24
INTIMATE PARTNER VIOLENCE AMONG CHINESE MSM 28
SYNDEMIC PRODUCTIONS AMONG MSM 30
EFFECTS OF RECRUITMENT METHODOLOGY ON DEPRESSION CORRELATES AND PARTICIPANT DEMOGRAPHICS 31
SUMMARY 34
CHAPTER 3. DATA COLLECTION AND PROCEDURES 36
STATEMENT OF THE PROBLEM 36
HUMAN SUBJECTS APPROVAL 37
PARTICIPANT RECRUITMENT METHOD 38
Respondent Driven Sampling 38
Community Popular Opinion Leader Recruitment 42
Venue-Based Recruitment 46
MEASURES 51
Depression 51
Male-on-male Intimate Partner Violence 52
Gender Role Scale 53
Sexual Concurrency 54
Drug Use 55
DATA COLLECTION PROCEDURES 56
TREATMENT OF DATA 56
PRELIMINARY ANALYSES 57
SPECIFIC ANALYSES BY HYPOTHESIS 60
CHAPTER 4. RESULTS 65
SAMPLE CHARACTERISTICS 65
DEMOGRAPHIC DIFFERENCES BASED ON PARTICIPANT TYPE AND RECRUITMENT METHOD 66
DEMOGRAPHIC DIFFERENCES BETWEEN GENERAL MSM AND MONEY BOYS 69
DEMOGRAPHIC DIFFERENCES BASED ON RECRUITMENT METHOD 71
DEMOGRAPHICS OF THE VENUE-BASED SAMPLING PARTICIPANTS 73
DESCRIPTION OF DEPRESSION AMONG THE SAMPLE 76
Rate of Depression among Money Boys and General MSM 77
Rate of Depression among Recruitment Methods 80
Description of Depressive Symptoms among Money Boys and MSM 84
Description of Depressive Symptoms among Recruitment Methods 84
DESCRIPTION OF THE RATE OF IPV IN THE SAMPLE 85
Rate of IPV among Money Boys and General MSM 86
Rate of IPV among Recruitment Methods 87
DESCRIPTION OF GENDER ROLE BELIEFS AMONG THE SAMPLE 88
Gender Role Beliefs among Money Boys and General MSM 90
Gender Role Beliefs among Recruitment Methods 93
DESCRIPTION OF SEXUAL CONCURRENCY AMONG THE SAMPLE 98
Sexual Concurrency among Money Boys and General MSM 98
Sexual Concurrency among Recruitment Methods 101
DESCRIPTION OF DRUG USE AMONG THE SAMPLE 105
Drug Use among Money Boys and General MSM 105
Drug Use among Recruitment Methods 106
DEMOGRAPHIC CORRELATIONS WITH DEPRESSION 107
MAIN ANALYSES BY HYPOTHESIS 109
SUMMARY OF FINDINGS 112
CHAPTER 5. FINDINGS, CONCLUSIONS, IMPLEMENTATIONS AND RECOMMENDATIONS, AND SUMMARY 118
FINDINGS 118
Demographic Characteristics 118
Rate of Depression, Psychosocial Correlates, and Drug Use 118
Moderating Variables 120
Syndemic Production 123
CONCLUSIONS 123
STRENGTHS AND LIMITATIONS 124
IMPLICATIONS AND RECOMMENDATIONS FOR FURTHER STUDY 125


REFERENCES 159
APPENDICES 167
Appendix A 168


List of Tables

1A. SAMPLE DEMOGRAPHICS, STRATIFIED BY RECRUITMENT METHOD AND PARTICIPANT TYPE 127
1B. SAMPLE DEMOGRAPHICS, STRATIFIED BY PARTICIPANT TYPE 128
1C. SAMPLE DEMOGRAPHICS OF SAMPLE, STRATIFIED BY RECRUITMENT METHOD 129
1D. SAMPLE DEMOGRAPHICS OF VENUE-BASED SAMPLING, STRATIFIED BY RECRUITMENT METHOD AND PARTICIPANT TYPE 130
1E. SAMPLE DEMOGRAPHICS OF VENUE-BASED SAMPLING, STRATIFIED BY RECRUITMENT VENUE; INTERNET, BAR, OR BATH HOUSE 131
2.1 RATE OF DEPRESSION AMONGST CHINESE MSM AND MONEY BOYS, STRATIFIED BY RECRUITMENT METHOD 132
2.2 RATE OF DEPRESSION AMONGST THE SAMPLE, STRATIFIED BY PARTICIPANT TYPE 135
2.3 RATE OF DEPRESSION AMONGST THE SAMPLE, STRATIFIED BY RECRUITMENT STRATEGY 137
3.1 DESCRIPTION OF DEPRESSION SYMPTOMS AMONGST MONEY BOYS AND MSM, STRATIFIED BY RECRUITMENT METHOD 140
3.2 DESCRIPTION OF DEPRESSIVE SYMPTOMS AMONGST THE SAMPLE, STRATIFIED BY PARTICIPANT TYPE 140
3.3 DESCRIPTION OF DEPRESSIVE SYMPTOMS AMONGST THE SAMPLE, STRATIFIED BY RECRUITMENT METHOD 140
4.1 PREVALENCE OF MALE-ON-MALE IPV AMONGST CHINESE MSM AND MONEY BOYS, STRATIFIED BY RECRUITMENT METHOD 141
4.2 PREVALENCE OF MALE-ON-MALE IPV AMONGST CHINESE MSM AND MONEY BOYS 142
4.3 PREVALENCE OF MALE-ON-MALE IPV, STRATIFIED BY RECRUITMENT METHOD 143
5.1 GENDER ROLE BELIEFS DISTRIBUTIONS AMONG THE SAMPLE, STRATIFIED BY PARTICIPANT TYPE 144
5.2 GENDER ROLE BELIEFS DISTRIBUTIONS AMONG THE SAMPLE, STRATIFIED BY RECRUITMENT METHOD 146
6.1 SEXUAL CONCURRENCY IN THE LAST 30 DAYS AND LIFETIME, STRATIFIED BY PARTICIPANT TYPE 148
6.2 SEXUAL CONCURRENCY IN THE LAST 30 DAYS AND LIFETIME, STRATIFIED BY RECRUITMENT METHOD 149
7.1 PREVALENCE OF DRUG USE AMONG THE SAMPLE, STRATIFIED BY RECRUITMENT METHOD AND PARTICIPANT TYPE 150
7.2 PREVALENCE OF DRUG USE AMONG THE SAMPLE, STRATIFIED BY PARTICIPANT TYPE 151
7.3 PREVALENCE OF DRUG USE AMONG THE SAMPLE, STRATIFIED BY RECRUITMENT METHOD 152
8.1 CORRELATION OF SAMPLE DEMOGRAPHICS WITH DEPRESSION 153
8.2 CORRELATION OF PSYCHOSOCIAL VARIABLES AND DRUG USE WITH DEPRESSION 154
9 MULTIVARIATE LOGISTIC REGRESSIONS AMONG INTERSECTING HEALTH PROBLEMS AMONG MSM IN THE SHANGHAI MEN'S STUDY 155


List of Figures

1. SYNDEMIC PRODUCTION OF INTIMATE PARTNER VIOLENCE AMONG CHINESE MSM 35
2. BREAKDOWN OF STUDY SAMPLE, STRATIFIED BY RECRUITMENT METHOD 50

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