Exploring the Roles of Socioeconomic Status, Discrimination, Personal Social Capital, and Psychological Distress Among Older Men Who Have Sex with Men in Hong Kong and Mainland China: A Cross-Sectional Study

Abstract Background Older men who have sex with men (OMSM) remain understudied in Asian sexual minority health research. In Hong Kong and Mainland China, psychological distress among OMSM may be shaped by stigma, discrimination, and socioeconomic disadvantage within limited protective policy environments. This study examined the prevalence and determinants of psychological distress among OMSM in these two regions. Methods A cross-sectional online survey was conducted in 2024 among 302 OMSM aged ≥ 60 years, including 151 participants from Hong Kong and 151 from Mainland China. Participants were recruited through LGBT organizations, NGOs, and academic institutions using convenience, snowball, and targeted sampling. Data were analyzed using descriptive statistics, bivariate analyses, and hierarchical logistic regression to assess associations between psychological distress and socioeconomic status, personal social capital, and discrimination. Results Higher monthly income (> HK$18,700) was associated with increased psychological distress (OR = 2.82). Everyday discrimination emerged as the strongest predictor: each unit increase on the Everyday Discrimination Scale was associated with a 17% higher likelihood of distress (OR = 1.17), accounting for 35.9% of the explained variance. After adjusting for discrimination, education and personal social capital were no longer significant. Conclusions Discrimination is the primary determinant of psychological distress among OMSM, outweighing socioeconomic and social factors. Interventions addressing minority stress and discrimination are essential to improving mental health among aging sexual minority populations in diverse sociocultural contexts. Public Significance Statement: This study shows that discrimination is the strongest contributor to psychological distress among older men who have sex with men in Hong Kong and Mainland China, outweighing socioeconomic and social factors. Reducing everyday discrimination and minority stress is essential to improving mental health and well-being among aging sexual minority populations.