Discrimination, Coping, and Depression among Black Men Who Have Sex with Men

112 Discrimination, Coping, and Depression among Black Men Who Have Sex with Men Brown, et al. Journal of Health Disparities Research and Practice Volume 12, Issue 6, Winter 2019, pp. 112-134 © 2011 Center for Health Disparities Research School of Community Health Sciences University of Nevada, Las Vegas Discrimination, Coping, and Depression among Black Men Who Have Sex with Men Andre L. Brown, University of Pittsburgh Jordan Sang, University of Pittsburgh Leigh Bukowski, University of Pittsburgh Steven Meanley, University of Pennsylvania Byron D. Brooks, East Tennessee State University Cristian Chandler, Emory University Corresponding Author: Andre Brown, ABSTRACT Black men who have sex with men (BMSM) have elevated risk for depression compared to the general population. BMSM’s capacity to cope with these experiences is not well understood. Increased understanding of how multiple forms of discrimination contribute to depression and how BMSM cope with discrimination can better inform interventions. Data come from 3,510 BMSM who attended Black Pride events in six U.S. cities from 2015-2017. Participants completed a health survey that ascertained their psychosocial health and resiliency profiles. Using multivariable logistic regression models, we tested the associations between type-specific discrimination (race, sexuality, HIV status) and depression. We then conducted sub-analyses to determine if coping attenuated the association between type-specific discrimination and depression. Our findings indicated that increased odds of depression among BMSM were associated with discrimination based on race (aOR=1.38, 95% CI = 1.08-1.76), sexual orientation (aOR=1.32, 95% CI = 1.011.72), and HIV status (aOR=1.53, 95% CI = 1.08-2.17). Sub-analyses indicated coping had inconsistent moderation effects between type-specific discrimination and depression. Our findings demonstrate that impact of various forms of discrimination on BMSM’s mental health and the mitigating role of coping. Interventions should seek to address depression by reducing experiences of discrimination and building coping resiliency. Keywords: Depression; Discrimination; Coping; Black MSM INTRODUCTION Depression is a common health problem and one of the leading causes of disability among working-age individuals (Gelenberg, 2010). It is estimated that nearly 7% of all U.S. Journal of Health Disparities Research and Practice Volume 12, Issue 6, Winter 2019 http://digitalscholarship.unlv.edu/jhdrp/ Follow on Facebook: Health.Disparities.Journal Follow on Twitter: @jhdrp 113 Discrimination, Coping, and Depression among Black Men Who Have Sex with Men Brown, et al. adults experienced at least one major depression episode in the past year (National Institute of Mental Health, 2017). While few studies have examined depression among Black men who have sex with men (BMSM), previous data suggest that depression may affect this group more than the general U.S. adult population in part because of disproportionate experiences with racism, homophobia, and other forms of discrimination (Alvy et al., 2011; Cochran & Mays, 1994; De Santis & Vasquez, 2011; Friedman et al., 2018; Graham, Aronson, Nichols, Stephens, & Rhodes, 2011; Maulsby et al., 2014; Reisner et al., 2009). Some studies estimate the proportion of BMSM with depression to be as high as 33%; this is a rate nearly five times greater than the national estimate for all adults (Graham et al., 2011; National Institute of Mental Health, 2017; Reisner et al., 2009; Watkins et al., 2016). Mental health disorders like depression also have an especially debilitating impact on BMSM’s health and well-being (Graham et al., 2011). Previous studies have shown that BMSM living with depression have increased HIV risk behaviors (e.g., condomless anal intercourse) and sexually transmitted infections, a higher likelihood of violence exposure and victimization, and elevated smoking, alcohol, and substance use rates (Corliss et al., 2012; Jerome & Halkitis, 2009; Kuhns et al., 2016; McKirnan, Tolou-Shams, Turner, Dyslin, & Hope, 2006; Voisin, Hotton, Schneider, & Team, 2017) when compared to Black and other MSM living without depression. These findings collectively suggest that when compared to the general population, BMSM may have greater rates of, and exposure to risk factors for depression. BMSM’s disproportionate risk for and rates of depression highlight the need to identify the aggravating and mitigating factors influencing this health problem in this vulnerable group. To help meet that need, this study will examine the relationship between various types of discrimination experienced by BMSM and depression outcomes in this group. The study will also examine how self-reported discrimination coping abilities affect the relationship between discrimination and depression for BMSM. Explicating the impact of discrimination and coping on depression can aid in scaling up or developing innovative intervention strategies for BMSM that prevent potential drivers of depression or reduce the negative health and social impact of these drivers on their psychological well-being. Role of Discrimination in Depression Two complementary theoretical frameworks, Intersectionality Theory (Crenshaw, 1989) and Minority Stress Theory (Meyer, 1995), help to understand BMSM’s experiences of discrimination and the relationship between discrimination and depression for this group. Intersectionality Theory asserts that marginalized identities, such as Black race and sexual minority orientation, are not mutually exclusive. These identities often intersect and work in concert to create multifaceted social experiences for marginalized groups that may compound incidents of discrimination and other negative social occurrences (Bowleg, 2013; Crenshaw, 1989). As members of both racial and sexual minority groups, BMSM sit at the intersection of two marginalized identities (Dyer et al., 2012; Ports et al., 2017). BMSM’s positioning at this intersection exposes them to multiple forms of discrimination, including racism and homophobia (Bogart et al., 2011; Bowleg, 2013; Crawford, Allison, Zamboni, & Soto, 2002; Jeffries, Marks, Lauby, Murrill, & Millett, 2013; Loiacano, 1989; Stokes & Peterson, 1998). Minority Stress Theory asserts that existing in a heteronormative and heterosexist society exposes racial and sexual minorities, like BMSM, to chronic stress (Meyer, 1995). BMSM’s Journal of Health Disparities Research and Practice Volume 12, Issue 6, Winter 2019 http://digitalscholarship.unlv.edu/jhdrp/ Follow on Facebook: Health.Disparities.Journal Follow on Twitter: @jhdrp 114 Discrimination, Coping, and Depression among Black Men Who Have Sex with Men Brown, et al. stigmatized social identities as racial and sexual minorities subject them to stressors such as racism, homophobia, and other forms of social discrimination that contribute to chronic stress in this population. This chronic stress facilitates several heal (...truncated)