Skip to main content

Advertisement

Log in

Depression is Associated with Sexual Risk Among Men Who Have Sex with Men, but is Mediated by Cognitive Escape and Self-Efficacy

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Men who have sex with men (MSM) show high rates of HIV infection, and higher rates of depression than non-MSM. We examined the association between depression and sexual risk among “high risk” MSM. Evidence has been mixed regarding the link between depression and risky sex, although researchers have rarely considered the role of psychosocial vulnerabilities such as self-efficacy for sexual safety or “escape” coping styles. In a national sample (N = 1,540) of HIV-positive and HIV-negative MSM who reported unprotected sex and drug use with sex partners, we found evidence that depression is related to HIV transmission risk. Self-efficacy for sexual safety and cognitive escape mediated the link between depression and risk behavior, suggesting that psychosocial vulnerability plays an important role in the association of depression with sexual risk. These findings may help us construct more accurate theories regarding depression and sexual behavior, and may inform the design of sexual safety interventions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. CDC. Cases of HIV infection and AIDS in the United States and dependent areas, 2006. In: U.S. Department of Health and Human Services. editors. Vol 18. USA: U.S. Department of Health and Human Services, CDC; 2008.

  2. Herek GM, Garnets LD. Sexual orientation and mental health. Annu Rev Clin Psychol. 2007;3:353–75.

    Article  PubMed  Google Scholar 

  3. Sandfort TG, de Graaf R, Bijl RV, Schnabel P. Same-sex sexual behavior and psychiatric disorders: findings from the Netherlands mental health survey and incidence study (NEMESIS). Arch Gen Psychiatry. 2001;58(1):85–91.

    Article  PubMed  CAS  Google Scholar 

  4. Mills TC, Paul J, Stall R, Pollack L, Canchola J, Chang YJ, et al. Distress and depression in men who have sex with men: the urban men’s health study. Am J Psychiatry. 2004;161(2):278–85.

    Article  PubMed  Google Scholar 

  5. Cochran SD, Mays VM, Sullivan JG. Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States. J Consult Clin Psychol. 2003;71(1):53–61.

    Article  PubMed  Google Scholar 

  6. Cochran SD, Mays VM. Lifetime prevalence of suicide symptoms and affective disorders among men reporting same-sex sexual partners: results from NHANES III. Am J Public Health. 2000;90(4):573–8.

    Article  PubMed  CAS  Google Scholar 

  7. Lin EH, Katon W, Von Korff M, Rutter C, Simon GE, Oliver M, et al. Relationship of depression and diabetes self-care, medication adherence, and preventive care. Diabetes Care. 2004;27(9):2154–60.

    Article  PubMed  Google Scholar 

  8. Odegard PS, Capoccia K. Medication taking and diabetes: a systematic review of the literature. Diabetes Educ. 2007;33(6):1014–29.

    Article  PubMed  Google Scholar 

  9. Allgower A, Wardle J, Steptoe A. Depressive symptoms, social support, and personal health behaviors in young men and women. Health Psychol. 2001;20(3):223–7.

    Article  PubMed  CAS  Google Scholar 

  10. Folkman S, Lazarus RS. Stress-processes and depressive symptomatology. J Abnorm Psychol. 1986;95(2):107–13.

    Article  PubMed  CAS  Google Scholar 

  11. Dombeck MJ, Siegle GJ, Ingram RE. Cognitive interference and coping strategies in vulnerability to negative affect. Hillsdale, NJ, England: Lawrence Erlbaum Associates, Inc; 1996.

    Google Scholar 

  12. Holahan CJ, Moos RH, Holahan CK, Brennan PL. Social context, coping strategies, and depressive symptoms: an expanded model with cardiac patients. J Pers Soc Psychol. 1997;72(4):918–28.

    Article  PubMed  CAS  Google Scholar 

  13. Semple SJ, Patterson TL, Grant I. Psychosocial predictors of unprotected anal intercourse in a sample of HIV positive gay men who volunteer for a sexual risk reduction intervention. AIDS Educ Prev. 2000;12(5):416–30.

    PubMed  CAS  Google Scholar 

  14. Folkman S, Chesney MA, Pollack L, Phillips C. Stress, coping, and high-risk sexual behavior. Health Psychol. 1992;11(4):218–22.

    Article  PubMed  CAS  Google Scholar 

  15. Heatherton TF, Baumeister RF. Binge eating as escape from self-awareness. Psychol Bull. 1991;110(1):86–108.

    Article  PubMed  CAS  Google Scholar 

  16. McKirnan DJ, Ostrow DG, Hope B. Sex, drugs and escape: a psychological model of HIV-risk sexual behaviours. AIDS Care. 1996;8(6):655–69.

    Article  PubMed  CAS  Google Scholar 

  17. Cooper ML, Frone MR, Russell M, Mudar P. Drinking to regulate positive and negative emotions––a motivational model of alcohol-use. J Pers Soc Psychol. 1995;69(5):990–1005.

    Article  PubMed  CAS  Google Scholar 

  18. McKirnan DJ, Vanable PA, Ostrow DG, Hope B. Expectancies of sexual “escape” and sexual risk among drug and alcohol-involved gay and bisexual men. J Subst Abuse. 2001;13(1–2):137–54.

    Article  PubMed  CAS  Google Scholar 

  19. Wulfert E, Wan CK. Condom use: a self-efficacy model. Health Psychol. 1993;12(5):346–53.

    Article  PubMed  CAS  Google Scholar 

  20. Maciejewski PK, Prigerson HG, Mazure CM. Self-efficacy as a mediator between stressful life events and depressive symptoms. Differences based on history of prior depression. Br J Psychiatry. 2000;176:373–8.

    Article  PubMed  CAS  Google Scholar 

  21. John U, Meyer C, Rumpf HJ, Hapke U. Self-efficacy to refrain from smoking predicted by major depression and nicotine dependence. Addict Behav. 2004;29(5):857–66.

    Article  PubMed  CAS  Google Scholar 

  22. Veluz A, McKirnan DJ, Alvy LM. Qualitative analysis of HIV risk and motivation to change in drug-using men who have sex with men (MSM). American Public Health Association conference. Washington, DC, 2007, November.

  23. Bancroft J, Janssen E, Strong D, Vukadinovic Z. The relation between mood and sexuality in gay men. Arch Sex Behav. 2003;32(3):231–42.

    Article  PubMed  Google Scholar 

  24. Stall R, Mills TC, Williamson J, Hart T, Greenwood G, Paul J, et al. Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men. Am J Public Health. 2003;93(6):939–42.

    Article  PubMed  Google Scholar 

  25. Perdue T, Hagan H, Thiede H, Valleroy L. Depression and HIV risk behavior among Seattle-area injection drug users and young men who have sex with men. AIDS Educ Prev. 2003;15(1):81–92.

    Article  PubMed  Google Scholar 

  26. Koblin BA, Husnik MJ, Colfax G, Huang Y, Madison M, Mayer K, et al. Risk factors for HIV infection among men who have sex with men. Aids. 2006;20(5):731–9.

    Article  PubMed  Google Scholar 

  27. Crepaz N, Marks G. Are negative affective states associated with HIV sexual risk behaviors? A meta-analytic review. Health Psychol. 2001;20(4):291–9.

    Article  PubMed  CAS  Google Scholar 

  28. Strathdee SA, Hogg RS, Martindale SL, Cornelisse PG, Craib KJ, Montaner JS, et al. Determinants of sexual risk-taking among young HIV-negative gay and bisexual men. J Acquir Immune Defic Syndr Hum Retrovirol. 1998;19(1):61–6.

    Article  PubMed  CAS  Google Scholar 

  29. Beck A, McNally I, Petrak J. Psychosocial predictors of HIV/STI risk behaviours in a sample of homosexual men. Sex Transm Infect. 2003;79(2):142–6.

    Article  PubMed  CAS  Google Scholar 

  30. Mansergh G, Flores S, Koblin B, Hudson S, McKirnan D, Colfax GN. Alcohol and drug use in the context of anal sex and other factors associated with sexually transmitted infections: results from a multi-city study of high-risk men who have sex with men in the USA. Sex Transm Infect. 2008;84(6):509–11.

    Article  PubMed  CAS  Google Scholar 

  31. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401.

    Article  Google Scholar 

  32. Santor DA, Coyne JC. Shortening the CES-D to improve its ability to detect cases of depression. Psychol Assess. 1997;9(3):233–43.

    Article  Google Scholar 

  33. Carver CS, Scheier MF, Weintraub JK. Assessing coping strategies: a theoretically based approach. J Pers Soc Psychol. 1989;56(2):267–83.

    Article  PubMed  CAS  Google Scholar 

  34. Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51(6):1173–82.

    Article  PubMed  CAS  Google Scholar 

  35. MacKinnon DP, Fairchild AJ, Fritz MS. Mediation analysis. Annu Rev Psychol. 2007;58:593–614.

    Article  PubMed  Google Scholar 

  36. MacKinnon DP, Lockwood CM, Williams J. Confidence limits for the indirect effect: distribution of the product and resampling methods. Multivar Behav Res. 2004;39(1):99–128.

    Article  Google Scholar 

  37. MacKinnon DP, Fritz MS, Williams J, Lockwood CM. Distribution of the product confidence limits for the indirect effect: program PRODCLIN. Behav Res Methods. 2007;39(3):384–9.

    Article  PubMed  Google Scholar 

  38. Mustanski B. The influence of state and trait affect on HIV risk behaviors: a daily diary study of MSM. Health Psychol. 2007;26(5):618–26.

    Article  PubMed  Google Scholar 

  39. Boily MC, Lowndes C, Alary M. The impact of HIV epidemic phases on the effectiveness of core group interventions: insights from mathematical models. Sex Transm Infect. 2002;78(Suppl 1):i78–90.

    Article  PubMed  Google Scholar 

  40. Coxon APM, McManus TJ. How many account for how much? Concentration of high-risk sexual behaviour among gay men. J Sex Res. 2000;37(1):1–7.

    Article  Google Scholar 

  41. Chesney MA, Koblin BA, Barresi PJ, Husnik MJ, Celum CL, Colfax G, et al. An individually tailored intervention for HIV prevention: baseline data from the EXPLORE study. Am J Public Health. 2003;93(6):933–8.

    Article  PubMed  Google Scholar 

  42. DeRubeis RJ, Hollon SD, Amsterdam JD, Shelton RC, Young PR, Salomon RM, et al. Cognitive therapy vs medications in the treatment of moderate to severe depression. Arch Gen Psychiatry. 2005;62(4):409–16.

    Article  PubMed  Google Scholar 

  43. Kalichman SC, Weinhardt L. Negative affect and sexual risk behavior: comment on Crepaz and Marks (2001). Health Psychol. 2001;20(4):300–1.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

This research was conducted as part of Project MIX: Behavioral Intervention to Reduce Sexual Risk Behavior of Substance-Using (Non-Injection) Men Who Have Sex With Men. It was supported by the Centers for Disease Control and Prevention through cooperative agreements with the University of Illinois at Chicago and Howard Brown Health Center, New York Blood Center and the New York Academy of Medicine, the San Francisco Department of Public Health AIDS Office, the Health Research Association in Los Angeles, and the CDC Division of HIV/AIDS Prevention in Atlanta. The authors wish to recognize the contributions of the Project MIX Study Team. We would also like to thank Lisa Kuhns, Steve Du Bois, Christine Holland, David Fingerhut, and Natalie Richie for their comments on this paper, as well as Brian Mustanski, Linda Skitka, and Jon Kassel for their help on an earlier version of this paper.

Author information

Authors and Affiliations

Authors

Consortia

Corresponding author

Correspondence to Lisa M. Alvy.

Additional information

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the CDC.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Alvy, L.M., McKirnan, D.J., Mansergh, G. et al. Depression is Associated with Sexual Risk Among Men Who Have Sex with Men, but is Mediated by Cognitive Escape and Self-Efficacy. AIDS Behav 15, 1171–1179 (2011). https://doi.org/10.1007/s10461-010-9678-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-010-9678-z

Keywords

Navigation