The Intersectional Influence of Experienced Stigma on Clinically Significant Depressive Symptoms Among Gay, Bisexual, and Other Men Who Have Sex with Men

We sought to determine how intersectional stigma, operationalized by interactions of perceived stigma experiences in adulthood attributed to various social identities/characteristics (age, gender, race, ethnicity/nationality, religion, height/weight, other aspect of appearance [unrelated to the identities/characteristics listed-e.g. height/weight/race/gender], physical disability, sexual orientation, and HIV status), associates with clinically significant depressive symptoms (DS). We used data from the Multicenter AIDS Cohort Study (Baltimore/Washington, DC; Chicago; Pittsburgh/Columbus; and Los Angeles) on 1,385 sexual minority men (SMM), collected April 1, 2008-March 31, 2009. Classification trees predicted DS. An exploratory factor analysis (EFA) identified stigmas that tended to co-occur. We calculated and decomposed the joint disparity in DS risk between stigmas comprising each EFA factor. Thirty-four percent of men were classified with DS. Stigma was most commonly attributed to sexual orientation. Participants with stigma attributed to multiple social identities/characteristics had an increased risk of DS. In classification trees, covariates (especially income) were stronger predictors of DS than stigmas. Intersectional effects were observed between appearance and physical disability stigma (positive effect), and between race and ethnicity/nationality stigma, and sexual orientation and HIV status stigma (negative effects). Interventions to reduce stigmas among SMM, as well as improve the socioeconomic position of SMM in general, are needed.