Social Support and the Mental Health of Older Gay Men: Findings From a National Community-Based Survey

Social Determinants of Health Inequities for Older LGBT Adults: A Scoping Review

INTRODUCTION

Despite the research on a health-disparate population, less is known about the social determinants of health (SDOH) inequities among older lesbian, gay, bisexual, and transgender (LGBT) adults. This scoping review aimed to explore and summarize what is known in the literature regarding the SDOH among older LGBT adults.

METHODS

The Joanna Briggs Institute's (JBI) approach guided this scoping review, which examined 31 articles that included quantitative, qualitative, and mixed-method studies. Data were analyzed by three independent reviewers through a predesigned process of data charting, descriptive summary, and thematic analysis.

RESULTS

Older participants were primarily LGBT and LGB. The findings identified four intersecting dimensions of individuals, social, economic, and health care system, contributing to health inequities and poor health outcomes.

CONCLUSION

Given the importance of SDOH for older LGBT adults, stakeholders including health care providers need to better understand the multiple intersecting influences, provide culturally congruent health care, and integrate sources of support into the care of these sexual- and gender-minority older adults.

Examining the Influence of Pre-HAART Experiences on Older, Self-Identifying Gay Men's Contemporary Constructions of Quality of Life (QOL)

Some older gay men (50+) experience diminished quality of life (QOL) due to historical and ongoing discrimination in addition to living through a collective trauma-the pre-HAART era of the HIV/AIDS epidemic-characterized by the absence of treatment and rampant discrimination targeting gay men. A growing body of literature, however, illustrates that older gay men demonstrate remarkable resilience but little is known about how QOL is conceptualized and how these conceptualizations are potentially shaped by pre-HAART experiences. The current study drew on constructivist grounded theory methods to examine how QOL is conceptualized in light of the sociohistorical relevance of pre-HAART. Twenty Canadian based gay men aged 50+ participated in semi-structured interviews via Zoom. Ultimately, QOL is understood as experiencing contentment, which is made possible by the development and implementation of three key processes: (1) developing and cultivating meaningful connections, (2) growing into and embracing identity, and (3) appreciating the capacity to do what brings joy. QOL for this group is greatly informed by a context of disadvantage, and the demonstrated resilience warrants further investigation to meaningfully support the overall well-being of older gay men.

Community-based support to improve mental health and wellbeing in older sexually and gender diverse people: a scoping review

OBJECTIVES

This scoping review seeks to identify what community-based support is used by older sexually and gender diverse (SGD) people, that aims to improve mental health/wellbeing.

METHODS

A scoping review was conducted using the Arksey and O'Malley framework. APA PsycInfo, Embase, MEDLINE, PubMed, and Scopus were searched. Key information was extracted and entered into a structured coding sheet before being summarized.

RESULTS

Seventeen studies were included (41% observational qualitative and 35% observational quantitative). The most commonly used community-based support was lesbian, gay, bisexual and transgender (LGBT) social groups. A range of practices were reported in five studies, including in SGD affirming religious congregations and mind-body practices. Two studies reported the use of formal programmes, with one based on a group initiative. Positive outcomes included feeling connected, improved social support and mental health, and coping with illness. Five studies reported null or negative findings, including a lack of acceptance. Most studies used categories for sex and gender inaccurately, and lacked detail when describing community-based support.

CONCLUSION

The use of community-based support by older SGD people is underexplored. More interventions designed for and by this community are needed, along with experimental research to draw conclusions on effectiveness to improve mental health or wellbeing.

Sexual orientation and cognition in aging populations: Results from the Canadian Longitudinal Study on Aging

The current study utilized the Canadian Longitudinal Study on Aging (CLSA) data to investigate the relationship between sexual orientation and cognitive health of the aging population. Cognitive flexibility and verbal fluency were examined as outcome variables in the study. A total of 45,993 respondents were included in the analyses. Each model had social support or social participation as a mediator. A series of mediation analysis, stratified by gender, revealed that aging gay men performed better in cognitive tasks related to cognitive flexibility when compared to their heterosexual counterparts. The results also indicated that social support is a protective factor for cognitive health in aging lesbian women. This study provides an opportunity to consider how clinical and social services can strategize to build inclusive environments for the aging sexual minority population.

Exploring discrimination, social acceptance, and its impact on the psychological well-being of older men who have sex with men: A cross-sectional study

BACKGROUND

The exploration of discrimination, social acceptance, and their impact on the psychological well-being of older men who have sex with men (MSM) is a critical area of study within the broader field of LGBTQ+ research. This demographic, comprising individuals who identify as both male and homosexual and are aged in the older spectrum of the population, faces unique challenges that intersect age, sexual orientation, and societal attitudes. Objectives This study aimed to explore the relationship between social acceptance and isolation with discrimination and the impact on the psychological well-being of older MSM.

METHODS

A cross-sectional survey was administered among older MSM residing in three distinct regions: the People's Republic of China (PRC), Hong Kong, and Taiwan, with a total sample size of N = 453 participants, evenly distributed with N = 151 individuals from each region. The survey included the General Health Questionnaire-12 (GHQ-12), the Discrimination and Self-Stigma Evaluation Scale (DSSES), and the Perceived Acceptance Scale (PAS) which measures the perceived social acceptance from friends, mother, father, and family. The data were analyzed using descriptive statistics, ANOVA, and regression analysis.

RESULTS

The mean scores of the GHQ-12 indicated that the participants had a moderate level of psychological distress, with a mean score of 6.38 (SD = 2.55). The DSSES mean score was 27.78 (SD = 8.73), indicating that participants experienced discrimination in their everyday lives. The PAS mean score was 3.08 (SD = 0.48), indicating that participants had a moderate level of perceived social acceptance. These results suggest that discrimination and social acceptance differ among older MSM in different areas in PRC, Hong Kong, and Taiwan.

CONCLUSIONS

The study highlights the impact of discrimination and social acceptance on the psychological well-being of older MSM. The findings suggest that interventions aimed at reducing discrimination and promoting social acceptance may improve the psychological well-being of older MSM. These results have important implications for healthcare providers and policymakers in developing strategies to promote social acceptance and reduce discrimination towards older MSM.

Impact of Neighborhood Deprivation on Aging Sexual Minority People's Depression: Results from the CANUE and CLSA data

As the aging population grows across the world, exploring the impact of social environment on minority populations' aging and well-being would be an essential step towards building an inclusive society. Using the Canadian Longitudinal Study on Aging (CLSA) and Canadian Urban Environmental Health Research Consortium (CANUE) data, the study investigated the relationship between deprivation and depression level in aging sexual minority people to examine how neighborhood level social and material deprivation influence mental health. 48,792 survey respondents were included in our analyses and the average age was 62.9. The study had 47,792 heterosexual, 760 gay/lesbian, and 240 bisexual individuals (23,977 men and 24,815 women). Regression analyses were conducted while controlling for age in each model. Results revealed that neighborhood material deprivation has a significant impact on mental health outcomes of aging lesbian women and bisexual men. The study provides an opportunity for intervention considerations for materially deprived neighborhoods to serve the aging sexual minority people residing in such areas.

The role of social support on cognitive function among midlife and older adult MSM

OBJECTIVE

This study examines the association between social support and cognitive function among midlife and older MSM living with or without HIV.

DESIGN

We analyzed longitudinal data from participants enrolled from October 2016 to March 2019 in the Patterns of Healthy Aging Study, a substudy of the Multicenter AIDS Cohort Study.

METHODS

We conducted a cross-sectional analysis to estimate the association between social support and three measures of cognitive function [Trail Making Test (TMT) Part A, TMT Part B to A ratio, and Symbol Digit Modalities Tasks (SDMT)]. We also used linear mixed-effects models to estimate the association between baseline social support and cognitive function across four subsequent time points. We evaluated a multiplicative interaction term between baseline social support and time, in order to determine whether cognitive trajectories over time vary by baseline social support.

RESULTS

Social support was associated with lower TMT Part A scores at baseline and over the subsequent 2 years, indicating better psychomotor ability. Social support was associated with higher SDMT scores at baseline and across 2 years, indicating better information processing. We observed no association between social support and TMT B to A ratio at baseline or across 2 years, indicating no effect on set-shifting ability. Longitudinal cognition outcome trajectories did not vary by the level of baseline social support.

CONCLUSION

Social support and cognitive function were associated in this sample over a short time period. Further research should explore causal relationships over the lifespan.

Conflict with children, psychological depression, and problematic internet use among Chinese older adults: The moderating effect of sociability and living situation

Introduction

Problematic internet use among the elderly is an emerging area as previous studies focused more among the young people. Only a few studies focused on problematic internet use at the level of individual characteristics of older adults or on mitigating factors at the level of the older adult's family, ignoring family-level disruptive factors.

Objective

The purpose of study is to investigate the relationship between conflict with children and problematic internet use among the elderly, as well as the mediating mechanisms and boundary conditions of the relationship.

Methods

The valid sample of study composed of 428 older adults from 39 different villages and communities in central China. Data analyses were conducted by SPSS, MPLUS, and SmartPLS software. To test our hypotheses, we implement several quantitative methods, including confirmatory factor analysis (CFA), correlations analysis, and ordinary least squares (OLS) regression. Also, we employed partial least square structural equation modeling (PLS-SEM) for robustness testing.

Results

The results indicated that conflict with children was positively associated with problematic internet use of old people; psychological depression mediated the relationship between conflict with children and old adults' problematic internet use; sociability moderated the effect of conflict with children on psychological depression; and living situation moderated the effect of psychological depression on problematic internet use among the elderly.

Conclusion

The current research improved the understanding of the mechanisms that produce problematic internet use among the elderly and helped prevent or reduce problematic internet use in older adults in terms of family support systems and individual ability characteristics.

Association between Family Support, Stress, and Sleep Quality among College Students during the COVID-19 Online Learning Period

(1) Background: During the past 3 years, the COVID-19 pandemic has severely affected the normal school schedule of college students, jeopardizing their mental health, sleep quality, and interpersonal relationships. However, previous studies have focused on the dimension of social support received, and few studies have measured in depth the association of support received from family on adolescents’ physical and mental health. Therefore, this study explored the associations between family support received by Chinese college students during COVID-19 pandemic online classes, stress and sleep quality, and the mediating role of stress. (2) Methods: A cross-sectional study conducted at Chongqing Medical University recruited 712 college students through a university-wide incidental random sample using the Questionnaire Star platform. Statistical description and correlation analysis was conducted using SPSS 25.0, and structural equation modeling was constructed using AMOS 22.0 to test for mediating effects; (3) Results: The family support score of college students during the COVID-19 pandemic online course was 19.41 ± 4.62. Correlation analysis showed that sleep quality was negatively correlated with family support (r = −0.224, p < 0.01), positively correlated with stress (r = 0.324, p < 0.01), and family support was negatively correlated with stress (r = −0.159, p < 0.01). The results of structural equation modeling showed that stress partially mediated the relationship between family support and sleep quality among college students (indirect effect = −0.150, p < 0.01, SE = 0.013,95% CI = [−0.208, −0.064]). The model R2 was 36.4%. (4) Conclusions: Schools should consider implementing sleep education, and stress relief curriculum measures to improve the quality of students’ sleep, and should focus on the role that family plays during online classes. This will help students overcome the negative emotional effects of stress in the COVID-19 pandemic and improve their learning efficiency and physical and mental health.

Family support and transport cost: understanding health service among older people from the perspective of social-ecological model

Background

This study is to investigate the interaction of family support, transport cost (ex-post), and disabilities on health service seeking behavior among older people from the perspective of social ecological model.

Method

We conduct a series of regressions including the Poisson model and Multiple logit model. The Heckman two-stage procedure is also conducted to check the robustness.

Results

Given that health care resources are generally concentrated in densely populated urban areas, access to services of higher-class health care facilities is found associated with higher transport cost (ex-post). Family support could also promote the access to higher-class health care facilities. Although disability may impede such access, this effect may be mitigated by paying higher transport cost (ex-post).

Conclusions

Alleviating transport deprivation and promoting family support are critical for access to better healthcare services among older people with disabilities.

The Relationship Between Living Alone and Depressive Symptoms Among Older Gay Men: The Moderating Role of Age

Living alone is a risk factor for depressive symptoms among older gay men. It is likely this relationship strengthens as gay men age, due to social isolation and fewer family supports. This study investigated whether the relationship between living alone and depressive symptoms was moderated by age among older gay men. A community sample of 270 Australian gay men aged 60 to 91 years (M = 68.81, SD = 8.69) completed the Center for Epidemiologic Studies-Depression Scale. Results supported the moderation model. The Johnson-Neyman analysis indicated that living alone was associated with depressive symptoms among gay men aged older than 66.28 years. Results imply that gay men older aged in their mid-sixties and older who live alone are at increased risk of depressive symptoms, and are a group of men that need targeted interventions to reduce depressive symptoms.

Alternative Friendships to Improve Men's Health Status. The Impact of the New Alternative Masculinities' Approach

BACKGROUND

Men who develop behaviors connected with the model of hegemonic masculinity present several health problems. Previous research has shown the types of problems that men commonly suffer in this regard such as chronic diseases, dietary disorders, and traffic accidents. To combat and overcome this situation, several campaigns, policies and recommendations have been undertaken, and consequently, their influence has been analyzed. However, there have been few investigations into the role of men's friendship in the reduction of these physical health problems. The findings presented in this article are focused on this issue, illustrating the impact of male friendship on the shaping of healthy behaviors.

METHODS

Drawing upon a qualitative-based methodology articulated in a case study of the Men in Dialogue association, located in Spain, the study has followed the premises of the communicative approach, a total of 15 structured online open-ended questionnaires have been performed and analyzed. The median age of the participants is 37.5 years.

RESULTS

The findings show how men involved in Men in Dialogue are promoting a kind of masculine friendship that is improving men's emotional well-being and, consequently, their physical health.

Primary and secondary supportive partnerships among HIV-positive and HIV-negative middle-aged and older gay men

This study describes the primary and secondary partnerships of aging gay men participating in the Understanding Patterns of Healthy Aging Among Men Who Have Sex with Men substudy of the Multicenter AIDS Cohort Study and examines differences in the prevalence of these relationship structures by HIV status while adjusting for age, education, and race/ethnicity. Relationships were compared within the following structural categories: “only a primary partnership”, “only a secondary partnership”, “both a primary and secondary relationship”, or “neither a primary nor secondary relationship”. There were 1,054 participants (51.9% HIV negative/48.1% HIV positive) included in the study. Participants had a median age of 62.0 years (interquartile range: 56.0–67.0) and most reported being non-Hispanic white (74.6%) and college educated (88.0%). Of the 1,004 participants with available partnership status data, 384 (38.2%) reported no primary or secondary partnerships, 108 (10.8%) reported secondary-only partnership, 385 (38.3%) reported primary-only partnership, and 127 (12.6%) reported both primary and secondary partnerships. Of participants who reported primary partnerships only, the prevalence rates (PRs) were lower among those 62 years and older, HIV positive, black non-Hispanic and Hispanics. Of participants who reported only having a secondary partnership, the PRs were higher among those 62 years and older and HIV positive. Of participants who did not report having either a primary or secondary partnership, the PRs were higher among those 62 years and older, HIV positive, and black non-Hispanic compared with their respective referent groups. There was no significant difference in PRs of having both primary and secondary partnerships by age category, HIV status, race/ethnicity, and education. This study aimed to fill a knowledge gap in the literature regarding both primary and secondary supportive partnerships among aging HIV-positive and HIV-negative gay men.

Family Support, Multidimensional Health, and Living Satisfaction among the Elderly: A Case from Shaanxi Province, China

The current study investigated the association between three types of family support and living satisfaction of elderly individuals in China, and paid particular attention to the possible mediating role of the elderly population’s multidimensional health. A cross-sectional survey was conducted in 2019, and 938 elderly people from seven counties (districts) of China’s Shaanxi province were enrolled. Multivariable linear regression and mediation effect analysis were employed to examine the integrated relationships among these variables. The results showed that emotional support and decisional support from families were positively related to the living satisfaction of elderly individuals (β = 0.101, p = 0.000; β = 0.263, p = 0.000), while the relationship between daily living support and living satisfaction was not significant (β = 0.017, p > 0.05). The mediation examination further demonstrated that both mental state and social integration mediated the association between emotional support and living satisfaction, as well as the association between decisional support and living satisfaction, but a mediating effect of physical health was not observed. These results indicate the pathways in the relationships of different types of family support to living satisfaction via mental state and social integration, having significant implications for enhancing the living satisfaction the elderly.

Differential Effects of Social Support by Sexual Orientation: A Study of Depression Symptoms Among Older Canadians in the CLSA

This study examined differences in symptoms of mental illness, specifically depression, by sexual orientation and examined the protective role of social support among lesbian, gay, and bisexual (LGB) older Canadians. Data were drawn from the Canadian Longitudinal Study on Aging, a national study of adults aged 45–85 years at baseline ( n = 46,157). We examined whether the effect of sexual orientation on depression symptoms was moderated by four types of social support: emotional/informational support, affectionate support, tangible support, and positive social interaction. LGB identification was associated with increased depression symptoms relative to heterosexual participants. After adjustment for covariates, bisexual identity remained a significant predictor of depression symptoms. Low emotional/informational social support was associated with increased depression symptoms, an effect that was most pronounced for lesbian and gay participants. The findings contribute to the growing body of research on the mental health of older LGB people.

"We Are Powerful People": Health-Promoting Strengths of LGBTQ Communities of Color

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities of color experience intersecting systems of oppression that limit access to health care, safety, and other basic resources. Important research has documented these disparities, their antecedents, and consequences. However, little research has examined the strengths of multiply marginalized LGBTQ communities. Drawing from a health equity framework, this study is based on interviews with 38 LGBTQ-identified people of color in New York City. We used framework analysis to examine participants' perspectives on the role of community in enhancing health and well-being. Community strengths identified by participants included (a) safety, acceptance, and support; (b) interconnectedness and resource sharing; and (c) advocacy, collective action, and community potential. Recommendations for policy, practice, and future research are suggested, including efforts toward community power building.

The Relationship between living alone, sense of belonging, and depressive symptoms among older men: the moderating role of sexual orientation

Objectives: Living alone is a risk factor for depressive symptoms among older men, and is likely to occur due to belongingness needs being unmet. It is proposed the living alone-sense of belonging and living alone-depressive symptoms relations are stronger for gay men than heterosexual men, due to different family circumstances. This research tested a moderated mediation model, specifically whether the relationship between living alone and depressive symptoms is mediated by sense of belonging, and whether the living alone-sense of belonging and living alone-depressive symptoms relationships are moderated by sexual orientation.Method: A community sample of 169 Australian gay men aged 65 to 93 years and 187 Australian heterosexual men aged 65 to 94 years completed the Psychological subscale of the Sense of Belonging Instrument and the Center for Epidemiologic Studies Depression Scale.Results: Results supported the simple mediation model, with living alone being associated directly and indirectly with depressive symptoms via sense of belonging. The conditional indirect effect of living alone on depressive symptoms via sense of belonging was not significant, and therefore the moderated mediation model was not supported.Conclusion: Results imply that older men who live alone are at increased risk of depressive symptoms directly and indirectly via lower levels of sense of belonging.

Psychosocial and Behavioral Correlates of Internalized Homonegativity in Midlife and Older Gay and Bisexual Men

This study investigated psychosocial and demographic variables that might influence internalized homonegativity (IH) in midlife and older gay and bisexual men (GBM). Data were collected from 802 community-dwelling GBM aged 40 to 94 years ( M = 54.8) through an anonymous questionnaire that assessed levels of IH, coping self-efficacy, self-silencing, and other characteristics. Multivariate logistic regression analysis successfully explained 22% of the variance in predicting IH, which was significantly related to coping self-efficacy, self-silencing, gay community volunteering, partnership status, and race, F = 59.74, p < .001. IH scores were highest in participants who were single, had lower education levels, were non-White, were less involved in gay community volunteering, experienced less coping self-efficacy, and reported higher levels of self-silencing behaviors. These data underscore the need for more tailored programming approaches for midlife and older GBM, focusing on underlying factors contributing to IH that include skill-building to increase coping self-efficacy, community involvement, and decrease self-silencing behaviors in this overlooked population.

Intergenerational relationship, family social support, and depression among Chinese elderly: A structural equation modeling analysis

OBJECTIVE

This study aimed to investigate the association among intergenerational relationship, family social support, and elderly's depression symptoms.

METHOD

Data were obtained from China Longitudinal Aging Social Survey (CLASS) 2014, which is a continuous large-scale national social survey project conducted by the National Survey Research Center at Renmin University of China. Stratified multi-stage probability sampling method was used to collect the sample (N = 11,511). Structural equation modeling was adopted to analyze the association among intergenerational relationship, family social support, and elderly's depression.

RESULTS

Intergenerational relationship and family social support were negatively correlated with an elderly's depression level. Elderly who enjoyed positive intergenerational relationships with their children would experience adequate family social support and likely have few depression symptoms.

CONCLUSION

Intergenerational relationship directly affected the elderly's depression level. Family social support played a mediating role between intergenerational relationship and depression. Our findings could contribute to current theories and knowledge and provide implications in social policy, pension service, and social work intervention for the elderly in China.

Understanding the structure, experiences and challenges of social support for older lesbian, gay and bisexual people: a systematic review

The psycho-social contexts of older lesbian, gay and bisexual (LGB) individuals suggest that they may face unique strengths and barriers in accessing social support. The present review aimed to explore what is known about this by providing a synthesis of this area of research and a methodological critique. The Applied Social Sciences Index (ASSIA), Psychinfo and Medline databases were searched and 22 relevant articles were identified. Key findings were extracted and quality was assessed using a standardised rating scale. The findings indicated that although many older LGB people report similar-sized support networks to older heterosexuals, more support came from friends and less from biological family members. Many reported not receiving enough support; it is possible that differences in care-giving between friends and family and anticipated social support difficulties due to previous LGB-stigma experiences partially account for this. Current recruitment strategies may mean that more-connected older LGB people are over-represented in research. There is a lack of research with the ‘old-old’ population, bisexual people, those with significant health needs, those outside the United States of America and those with additional characteristics associated with discrimination. Practical and research implications are discussed and it is suggested that friendship–carer dyads may need support to have more explicit discussions about care-giving roles due to a lack of societal templates for these kinds of relationships.

The association between negative attitudes toward aging and mental health among middle-aged and older gay and heterosexual men in Israel

OBJECTIVES

The association between negative attitudes toward aging and mental health (indicated by depressive symptoms, neuroticism, and happiness) was explored among Israeli middle-aged and older gay and heterosexual men.

METHOD

In a community-dwelling sample, 152 middle-aged and older gay men and 120 middle-aged and older heterosexual men at the age range of 50-87 (M = 59.3, SD = 7.5) completed measures of negative attitudes toward aging, depressive symptoms, neuroticism, and happiness.

RESULTS

After controlling for socio-demographic characteristics, the association between negative attitudes toward aging and mental health was moderated by sexual orientation, demonstrating that negative attitudes toward aging were more strongly associated with adverse mental health concomitants among middle-aged and older gay men compared to middle-aged and older heterosexual men.

CONCLUSIONS

The findings suggest vulnerability of middle-aged and older gay men to risks of aging, as their mental health is markedly linked with their negative attitudes toward aging. This vulnerability should be addressed by clinicians and counselors who work with middle-aged and older gay men.

Prediction of a new body shape index and body adiposity estimator for development of type 2 diabetes mellitus: The Rural Chinese Cohort Study

To compare the ability of a body shape index (ABSI) and body adiposity estimator (BAE) to BMI, waist circumference (WC) and waist:height ratio (WHtR) for predicting development of type 2 diabetes mellitus (T2DM) in rural adult Chinese. The prospective cohort study included 11 687 eligible participants who were free of T2DM at baseline. The risk of new-onset T2DM for ABSI, BAE, BMI, WC and WHtR quintiles was estimated by Cox proportional-hazards regression at follow-up. We also compared the power of ABSI and BAE to BMI, WC and WHtR for predicting the development of T2DM. With increasing ABSI, BAE, BMI, WC and WHtR, T2DM incidence was substantially increased (Ptrend<0·0001). After adjustment for multi-covariates, risk of T2DM was increased from the second to fifth quintile as compared with first quintile for ABSI (1·27; 95 % CI 0·95, 1·69; 1·35; 95 % CI 1·00, 1·82; 1·75; 95 % CI 1·33, 2·32 and 1·87; 95 % CI 1·40, 2·49; Ptrend<0·0001); BAE (1·82; 95 % CI 1·38, 2·41; 1·93; 95 % CI 1·38, 2·68; 2·73; 95 % CI 1·94, 3·84 and 4·18; 95 % CI 2·98, 5·87; Ptrend<0·0001); BMI (1·42; 95 % CI 1·03, 1·97; 1·62; 95 % CI 1·18, 2·23; 2·59; 95 % CI 1·92, 3·50 and 3·90; 95 % CI 2·90, 5·26; Ptrend<0·0001); WC (1·53; 95 % CI 1·08, 2·17; 1·66; 95 % CI 1·18, 2·33; 2·72; 1·97, 3·76 and 4·09; 95 % CI 2·97, 5·62; Ptrend<0·0001); and WHtR (1·40; 95 % CI 0·98, 1·99; 2·06; 95 % CI 1·47, 2·88; 2·90; 95 % CI 2·10, 4·01 and 4·22; 95 % CI 3·05, 5·85; Ptrend<0·0001). ABSI, BAE, BMI, WC and WHR were effective and comparable in discriminating cases from non-cases of T2DM. Risk of T2DM was increased with elevated ABSI and BAE, but the predictive ability for T2DM did not differ than that of BMI, WC and WHtR in a rural Chinese population.

Mastery, Isolation, or Acceptance: Gay and Bisexual Men's Construction of Aging in the Context of Sexual Embodiment After Prostate Cancer

Age is the predominant risk factor for developing prostate cancer, leading to its description as an "older man's disease." Changed sexual embodiment is a concern for men who develop prostate cancer, often compounding experiences of age-related sexual decline. Although research has examined heterosexual men's experiences of aging in the context of sexual embodiment after prostate cancer, gay and bisexual men have received little attention. This qualitative study used a material-discursive analysis, drawing on positioning theory and intersectionality, to explore constructions of aging following prostate cancer in 46 gay or bisexual men. Thematic decomposition of one-to-one interviews identified three subject positions: "mastering youth," involving maintaining an active sex life through biomedical interventions, accessing commercial sex venues, or having sex with younger men; "the lonely old recluse," involving self-positioning as prematurely aged and withdrawal from a gay sexual scene; and "accepting embodied aging," involving the incorporation of changed sexual function into intimate relationships and finding pleasure through nonsexual activities. These subject positions are conceptualized as the product of intersecting masculine and gay identities, interpreted in relation to broader cultural discourses of "new aging" and "sexual health," in which sexual activity is conceptualized as a lifelong goal.

Psychosocial factors associated with flourishing among Australian HIV-positive gay men

Background

Mental health outcomes among HIV-positive gay men are generally poorer than in the broader population. However, not all men in this population experience mental health problems. Although much is known about factors associated with depression and anxiety among HIV-positive gay men, little is known about factors associated with positive mental health. Such knowledge can be useful for optimizing well-being support programs for HIV-positive gay men.

Methods

In this study, we examined flourishing, which broadly covers most aspects of positive mental health. A sample of 357 Australian HIV-positive gay men completed a survey on their mental health and well-being, including the Flourishing Scale. Given the lack of previous research, we explored a wide range of psychosocial factors, including demographics, stigma, discrimination, and social support, to identify key factors linked to flourishing.

Results

The sample showed a similar level of flourishing to those in general population samples. Several independent factors were found to be associated with flourishing outcomes. Those who were most likely to be flourishing tended to have low or no internalized HIV-related stigma, were employed, received higher levels of practical support, had a sense of companionship with others, and felt supported by family.

Conclusions

These and other findings presented in this article may be used to help inform strategies for promoting optimal levels of mental health, and its associated general health benefits, among HIV-positive gay men.