Enacted Stigma and Adverse Mental Health in Chinese Gay and Bisexual Men

Gay and bisexual men face disproportionately higher rates of adverse mental health conditions compared to their heterosexual counterparts. Grounded in the minority stress theory and set within the China's stigmatized cultural context, this study probes deeply into the mediating roles of proximal minority stressors (including rejection sensitivity and internalized homophobia) and individual coping process (i.e., self-efficacy) in the relationship between enacted stigma and adverse mental health among Chinese gay and bisexual men. Furthermore, it examines the moderating roles of outness to the family on the interrelationships among enacted stigma, proximal minority stressors, and adverse mental health. A total of 728 participants, comprising 334 gay men and 394 bisexual men, completed measures of sociodemographics, enacted stigma, rejection sensitivity, internalized homophobia, self-efficacy, outness to the family, and adverse mental health. Results indicated that enacted stigma was positively associated with adverse mental health, with both rejection sensitivity and internalized homophobia acting as partial mediators. Furthermore, the sequential mediation role via proximal minority stressors and self-efficacy was statistically significant. Notably, the degree of outness to the family moderated not only the relationship between enacted stigma and internalized homophobia but also its indirect link on adverse mental health. These findings provide compelling cross-cultural evidence in support of the minority stress theory and spotlight pivotal intervention pathways aimed at addressing adverse mental health prevalent among Chinese gay and bisexual men.