Disrupting the Path from Depression to Loneliness: Multilevel Resilience among Older Sexual Minority Men with and without HIV

Existing studies examining resilience among sexual minority men (SMM) have been limited by only analyzing 1 level of resilience. We therefore investigated the impact of multiple levels of resilience on the bidirectional relationship between loneliness and depression symptoms among older SMM. Loneliness, depression symptoms, and multilevel resilience scores were collected across 3 time points (October 2016 to March 2017 [T1]; October 2017 to March 2018 [T2]; and October 2018 to March 2019 [T3]) among 1,264 SMM aged 40 years and older living with and without HIV. Longitudinal mediation models were used to test the mediating effect of the multilevel resilience factors at T2 on the bidirectional relationship between loneliness and depression symptoms, adjusting for sociodemographic covariates. The multilevel resilience factors were negatively associated with loneliness and depression symptoms at T1. The individual-level global resilience factor was associated with decreased odds of depression symptoms (odds ratio [OR] = 0.50; 95% CI, 0.32-0.78), while the interpersonal-level relationship confidence (OR = 0.43; 95% CI, 0.24-0.77) and reliability (OR = 0.36; 95% CI, 0.15-0.84) factors were associated with decreased odds of loneliness at T3. The total effect of loneliness at T1 on depressive symptoms at T3 was beta = 0.20 (95% CI, 0.11-0.28) and was reduced to beta = 0.08 (95% CI, -0.04 to 0.20) after the inclusion of the multilevel resilience factors. The total effect of depressive symptoms at T1 on loneliness at T3 was similar (beta = 0.21; 95% CI, 0.13-0.28) with the direct effect of beta = 0.01 (95% CI, -0.08 to 0.11) after the inclusion of the multilevel resilience factors. Regarding specific indirect effects, individual-level global resilience (depression symptoms at T3 only) as well as the interpersonal-level relationship reliability and confidence (loneliness at T3 model only) factors were statistically significant. Multilevel resilience factors mediated the bidirectional relationship between loneliness and depression symptoms. Mental health interventions should consider implementing resilience-informed strategies that mitigate depression symptoms and loneliness among older SMM. Los estudios existentes que examinan la resiliencia entre los hombres de minor & iacute;as sexuales (HSH) se han visto limitados por analizar s & oacute;lo 1 nivel de resiliencia. Por lo tanto, investigamos el impacto de m & uacute;ltiples niveles de resiliencia en la relaci & oacute;n bidireccional entre la soledad y los s & iacute;ntomas de depresi & oacute;n entre los hombres mayores de minor & iacute;as sexuales. Se recopilaron datos sobre soledad, s & iacute;ntomas de depresi & oacute;n y resiliencia multinivel a lo largo de 3 puntos temporales (octubre de 2016 a marzo de 2017 [T1]; octubre de 2017 a marzo de 2018 [T2]; y octubre de 2018 a marzo de 2019 [T3]) entre 1,264 SMM de 40 a & ntilde;os o m & aacute;s que viven con y sin VIH. Se utilizaron modelos de mediaci & oacute;n longitudinal para probar el efecto mediador de los factores de resiliencia multinivel en T2 sobre la relaci & oacute;n bidireccional entre la soledad y los s & iacute;ntomas de depresi & oacute;n, ajustando por covariables sociodemogr & aacute;ficas. Los factores de resiliencia multinivel se asociaron negativamente con la soledad y los s & iacute;ntomas de depresi & oacute;n en T1. El factor de resiliencia global a nivel individual se asoci & oacute; con menores probabilidades de s & iacute;ntomas de depresi & oacute;n (odds ratio [OR] = 0,50; IC 95%, 0,32 - 0,78), mientras que el factor de confianza en las relaciones a nivel interpersonal (OR = 0.43; 95% CI, 0.24-0.77) y los factores de fiabilidad (OR = 0.36; 95% CI, 0.15-0.84) se asociaron con menores probabilidades de soledad en T3. El efecto total de la soledad en T1 sobre los s & iacute;ntomas depresivos en T3 fue beta = 0.20 (95% CI, 0.11-0.28) y se redujo a beta = 0.08 (95% CI, -0.04 to 0.20) tras la inclusi & oacute;n de los factores de resiliencia multinivel. El efecto total de los s & iacute;ntomas depresivos en T1 sobre la soledad en T3 fue similar (beta = 0.21; 95% CI, 0.13-0.28) con el efecto directo de beta = 0.01 (95% CI, -0.08 to 0.11) tras la inclusi & oacute;n de los factores de resiliencia multinivel. En cuanto a los efectos indirectos espec & iacute;ficos, los factores de resiliencia global a nivel individual (s & iacute;ntomas de depresi & oacute;n s & oacute;lo en T3) as & iacute; como la fiabilidad y confianza de las relaciones interpersonales (soledad en el modelo T3 solamente) fueron estad & iacute;sticamente significativos. Los factores de resiliencia multinivel mediaron la relaci & oacute;n bidireccional entre la soledad y los s & iacute;ntomas de depresi & oacute;n. Las intervenciones de salud mental deber & iacute;an considerar la implementaci & oacute;n de estrategias basadas en la resiliencia que mitiguen los s & iacute;ntomas de la depresi & oacute;n y la soledad entre los SMM mayores.