Network analysis of depression-anxiety symptoms and their association with sexualized substance use among Chinese men who have sex with men: A multi-center study.

BACKGROUND

Despite the high comorbidity of depression and anxiety among men who have sex with men (MSM), the dynamic interplay between specific symptoms and their association with high-risk behaviors remains poorly understood. This study employed network analysis to examine symptom interactions and their relationship with Sexualized Substance Use (SSU) among Chinese MSM.

METHODS

We conducted a cross-sectional study of 2403 MSM across six metropolitan regions in China (October 2023-March 2024). Participants completed validated Chinese versions of the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scales, along with substance use assessments. Network structures were estimated using the Extended Bayesian Information Criterion.

RESULTS

The prevalence of any depressive symptoms (PHQ-9 ≥ 5) and anxiety symptoms (GAD-7 ≥ 5) was 50.2 % and 42.0 %, respectively, with 37.2 % (95 % CI: 35.3 %-39.1 %) reporting SSU. Network analysis (stability coefficient = 0.75) identified three central symptoms with highest Expected Influence: psychomotor changes (PHQ8), excessive worry (GAD3), and depressed mood (PHQ2). Bridge symptom analysis revealed psychomotor changes, irritability (GAD6), and fear (GAD7) as key connectors between depression and anxiety clusters. Flow network analysis demonstrated the strongest edge weight between sleep disturbance (PHQ3) and SSU.

LIMITATIONS: The cross-sectional design precludes causal inference, and self-reported measures may introduce recall bias.

CONCLUSIONS

This network analysis reveals complex symptom interactions underlying depression-anxiety comorbidity and their association with SSU among Chinese MSM. The identification of central symptoms, bridge symptoms, and the novel role of sleep disturbance provides potential targets for integrated mental health interventions in this vulnerable population.