The impact of stress experienced by sexual minorities on depression among chinese men who have sex with men: an analysis of the mediating effects of social support and intimate partner violence

Men who have sex with men (MSM) are at high risk for depressive symptoms, partly due to stigma related to both sexual minority status and HIV. In the Chinese sociocultural context, sexual minority stigma is deeply intertwined with HIV-related stigma, shaping access to social support, intimate relationships, and mental health outcomes. In China, minority stress is also shaped by structural pressures such as strong family expectations regarding heterosexual marriage and limited institutional protections, which may constrain social support and strain intimate relationships. Although the sexual minority stress model provides a useful framework for understanding mental health disparities, empirical evidence on the mechanisms linking stigma-related stress to depressive symptoms among MSM remains limited. This study aimed to examine the impact of sexual minority stress on depressive symptoms among Chinese MSM and to further clarify the mediating roles of social support and intimate partner violence (IPV), with implications for stigma-informed public health interventions. A total of 1,024 Chinese MSM were recruited through online platforms, of whom 916 provided valid responses. Sociodemographic characteristics were summarized using descriptive statistics. The participants in this study were all male, with a mean age of 30 years. Chi-square tests were conducted to examine differences in depressive symptoms across demographic groups. Structural equation modeling (SEM) was used to assess the pathways linking enacted stigma, internalized stigma, identity concealment, social support, IPV, and depressive symptoms. Sensitivity analyses were conducted to test the robustness of the findings. Overall, 64.96% of participants exhibited depressive symptoms. SEM results indicated that sexual minority stress was directly associated with higher levels of depressive symptoms and indirectly associated through two parallel pathways: reduced social support and increased IPV. The model demonstrated good fit, and sensitivity analyses confirmed the stability of the results. Sexual minority stress contributes to depressive symptoms among MSM through interconnected psychosocial and relational mechanisms. Addressing stigma-related stressors, strengthening social support, and preventing intimate partner violence may not only improve mental health but also support broader HIV-related public health goals by reducing barriers to care, well-being, and social inclusion among MSM.