Association of Enacted Stigma with Depressive Symptoms among Gay and Bisexual Men Who Have Sex with Men: Baltimore, 2011 and 2014

Marc Marti-Pastor, Montse Ferrer, Jordi Alonso, Olatz Garin, Angels Pont, Colin Flynn, Danielle German

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Purpose: We assessed differences between gay and bisexual men in enacted stigma, and how the association between stigma and depressive symptoms may vary according to sexual orientation identity. Methods: Participants (671 gay and 331 bisexual men who have sex with men) in Baltimore's 2011 and 2014 National HIV Behavioral Surveillance completed an anonymous survey, including 3 enacted stigma dimensions and the Center for Epidemiologic Studies Depression Scale. Adjusted prevalence ratios were calculated through Generalized Estimating Equation models adjusting for theorized confounders (demographic, socioeconomic, and relational factors). Results: Bisexual men reported stigma experiences less frequently than did gay men (verbal harassment 22.7% vs. 32.3%, and discrimination 15.7% vs. 23.0%). Relevant depressive symptoms were reported by 43.1% of bisexual men and 34.2% of gay men (p < 0.001). Statistically significant differences in depressive symptoms between bisexual and gay men disappeared after adjusting for socioeconomic factors. The three enacted stigma dimensions were significantly associated with depressive symptoms, but their interaction with sexual orientation identity was not. Conclusion: This study confirms the association between enacted stigma and depressive symptoms among gay and bisexual men. However, sexual orientation identity did not modify this association as hypothesized. The bisexual men presented other psychosocial stressors that may explain their higher prevalence of depressive symptoms. The high levels of verbal harassment, discrimination, and physical assault reported by gay and bisexual men and their negative effect on mental health indicate the need to develop new effective public health strategies to avoid these consequences of homophobic and biphobic culture.

Original languageEnglish (US)
Pages (from-to)47-59
Number of pages13
JournalLGBT health
Issue number1
StatePublished - Jan 2020


  • bisexual men
  • discrimination
  • gay men
  • mental health
  • stigma

ASJC Scopus subject areas

  • Dermatology
  • Obstetrics and Gynecology
  • Public Health, Environmental and Occupational Health
  • Psychiatry and Mental health
  • Urology


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