Sexual minority men are at greater risk of depression and suicidality than heterosexuals. Stigma, the most frequently hypothesized risk factor for this disparity, operates across socioecological levels-structural (e.g., laws), interpersonal (e.g., discrimination), and individual (e.g., self-stigma). Although the literature on stigma and mental health has focused on interpersonal and individual forms of stigma, emerging research has shown that structural stigma is also associated with adverse mental health outcomes. However, there is limited data on whether changes in structural stigma, such as when a stigmatized person moves to a lower stigma context, affect mental health, and on the mechanisms underlying this association. To address these questions, we use data from the 2017/18 European Men-who-have-sex-with-men Internet Survey (n = 123,428), which assessed mental health (i.e., Patient Health Questionnaire) and psychosocial mediators (i.e., sexual orientation concealment, internalized homonegativity, and social isolation). We linked these data to an objective indicator of structural stigma related to sexual orientation-including 15 laws and policies as well as aggregated social attitudes-in respondents' countries of origin (N = 178) and receiving countries (N = 48). Among respondents who still live in their country of birth (N = 106,883), structural stigma was related to depression and suicidality via internalized homonegativity and social isolation. Among respondents who moved from higher-to-lower structural stigma countries (n = 11,831), longer exposure to the lower structural stigma environments of their receiving countries was associated with a significantly: 1) lower risk of depression and suicidality; 2) lower odds of concealment, internalized homonegativity, and social isolation; and 3) smaller indirect effect of structural stigma on mental health through these mediators. This study provides additional evidence that stigma is a sociocultural determinant of mental health. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

中文翻译：

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结构性污名和性少数男性的抑郁和自杀：对 48 个国家的机制和流动性的多层次检查。

性少数男性比异性恋者更容易患抑郁症和自杀。污名是造成这种差异的最常见的假设风险因素，它在社会生态层面上发挥作用——结构（例如，法律）、人际（例如，歧视）和个人（例如，自我污名）。尽管关于污名和心理健康的文献主要关注人际和个人形式的污名，但新兴研究表明，结构性污名也与不良的心理健康结果有关。然而，关于结构性污名的变化（例如当受污名的人转移到较低的污名环境时）是否会影响心理健康以及这种关联的潜在机制的数据有限。为了解决这些问题，我们使用了 2017/18 年欧洲与男性发生性关系的男性互联网调查（n = 123,428）的数据，其中评估了心理健康（即患者健康问卷）和心理社会中介因素（即性取向隐瞒、内化的同质性和社会孤立）。我们将这些数据与受访者原籍国（N = 178）和接收国（N = 48）中与性取向相关的结构性污名的客观指标联系起来，包括 15 项法律和政策以及社会态度的汇总。在仍居住在出生国的受访者中（N = 106,883），结构性污名与抑郁和自杀通过内化的同质性和社会孤立有关。在从结构性污名程度较高的国家迁移到较低结构性污名国家的受访者中（n = 11,831），长期暴露于接收国较低结构性污名环境与以下显着相关：1) 降低抑郁和自杀的风险；2）隐瞒、内化同质性和社会孤立的可能性较低；3) 结构性污名通过这些中介对心理健康的间接影响较小。这项研究提供了额外的证据，表明污名是心理健康的社会文化决定因素。（PsycInfo 数据库记录 (c) 2021 APA，保留所有权利）。