Loneliness, social support, and depressive symptoms among men who acquired HIV through sexual transmission in China

Loneliness and social support are important psychosocial correlates of depressive symptoms among people living with HIV, but their interrelationships remain insufficiently understood. This cross-sectional study examined associations among loneliness, social support, and depressive symptoms in 436 Chinese men living with HIV who acquired HIV through sexual transmission. Participants completed the Patient Health Questionnaire-9, Social Support Rating Scale, and UCLA Loneliness Scale. Correlation analysis, multivariable logistic regression, and latent-variable mediation analysis were performed. In the fully adjusted logistic regression model, high loneliness was associated with greater odds of moderate-to-severe depressive symptoms (adjusted OR = 4.790, 95% CI: 2.778 ~ 8.259), whereas total social support was not independently associated with the dichotomized depressive symptom outcome (adjusted OR = 0.985, 95% CI: 0.957 ~ 1.013). In the adjusted latent-variable mediation model, loneliness showed a small indirect association with depressive symptom scores through social support (indirect effect = 0.011, 95% bias-corrected bootstrap CI: 0.001 ~ 0.034). These findings highlight a strong association between loneliness and depressive symptoms and suggest a modest statistical indirect pathway involving social support. Longitudinal studies among men living with HIV are needed to clarify the temporal ordering and direction of these associations.