Depression and barriers to accessing mental health services treatment among gbMSM persons who use crystal meth in Mexico City: a mixed methods study

• About half of Mexican gbMSM who used crystal meth had current treatment barriers • Depressive symptoms and prior experiences moderated attitudinal/structural barriers • Negative experiences, stigma, and perceived ineffectiveness, hinder treatment-seeking A small proportion of persons who need treatment for substance use disorders engage in timely health services due to several structural and attitudinal barriers. Crystal meth use has been associated with higher risk of depressive symptoms. We aimed to document the barriers for using mental health services and their association with depressive symptoms, and to analyze them based on the lived experiences of Mexican gay and bisexual men who have sex with men (gbMSM) who use crystal meth. Mixed- methods study. Adult gbMSM (n= 165) from the metropolitan area of Mexico City were recruited through snowball sampling and responded to an online survey. We assessed the association of depressive symptoms with current treatment barriers through logistic regression models, stratifying by previous treatment experience. Semi-structured interviews were performed among a purposively selected sub-sample (n= 25). Attitudinal barriers were more prevalent than structural barriers among those who had treatment (67% and 53%, respectively) and those who had not been in treatment (47% and 46%). Moderate and severe depressive symptoms were independently associated with a higher prevalence of attitudinal and structural barriers, especially among those without treatment experience (aPOR= 5.08 and 6.48, p< 0.05, respectively). Mental health affects and is affected by crystal meth use, and treatment barriers may be moderated by negative treatment experiences, stigma, and perceived lack of effectiveness. Participants reported experiencing significant stigma during treatment, along with other negative encounters with mental health services. These experiences, in addition to structural barriers and depressive symptoms, hinder treatment-seeking.