Study Finds Link Between Sexual Risk-Taking and Depression
Research on the intersection between mental and sexual health is crucial to reducing the disproportionate burden of depression and HIV infection among gay and bisexual men. New data compiled from a nationwide survey of gay and bisexual men demonstrates a significant correlation between sexual risk-taking, such as condomless anal sex (CAS), and depression.
The study, published in AIDS and Behavior, surveyed 1,033 HIV-negative gay and bisexual men not using PrEP about their recent casual sexual activity and depressive symptoms in the past 90 days. Using these data, researchers calculated a depression score and count of total instances of CAS for each survey respondent.
Being young and single and having a low level of education were all significantly correlated with higher rates of depressive symptoms. Out of the entire sample, only 331 men reported one or more instance of CAS with a casual male partner in the past 90 days. Total instances of CAS for each of these respondents ranged from one to 60.
After controlling for age, relationship status and education, depression was found to be positively associated with a total count of CAS events (both receptive and insertive). In other words, being more depressed was statistically associated with having had more instances of condomless anal sex.
These findings are consistent with several prior studies conducted in the field of sexual health. According to one study published in the Archives of Sexual Behavior in 2003, one-on-one interviews with study participants revealed that some gay and bisexual men “use sex as a mood regulator.” Three years earlier, the same researchers proposed a theory that depression reduces sexual inhibition. In light of the current study’s results, it is possible that gay and bisexual men may feel less inhibited from performing CAS when they are depressed.
Brett M. Millar, the first author of the paper, is a doctoral student at the CUNY Graduate Center and Hunter College’s Center for HIV Educational Studies and Training (CHEST). Millar wrote, “Our findings have several potential implications for interventions and programs. Firstly, the results really highlight the need for effective, evidence-based, culturally-sensitive delivery of mental health services for gay and bisexual men. These programs should also be encouraged to address sexual concerns and sexual decision-making for the men they’re aiming to help.”
“This [study],” Millar explained, “speaks to the need for mental health professionals to be aware of, and comfortable with, talking openly about sex with their gay and bisexual male clients. The findings also show that preventing depression among gay and bisexual men, or treating it as effectively as possible, seems instrumental in helping with the prevention of HIV.”
He suggested that although the men in this study may not have been in the midst of a major depressive episode while they were having sex, the study’s findings still underscore the importance of addressing mental and sexual health in tandem.
When interpreting the results of this study, one must remember that correlation does not imply causation. As such, the finding that depression and CAS are correlated does not mean that depression causes CAS any more than the reverse. Even so, statistical correlations like these point to future avenues for research to more accurately characterize the relationship between mental health and sexuality.
Since this study was conducted among HIV-negative men, Millar emphasized, the results may not generalize to women or HIV-positive persons. Future research among these populations would be required to determine whether they also exhibit an association between CAS and depressive symptomology.