Background: This cross-sectional study investigated psychological distress among older men who have sex with men (OMSM) in Hong Kong and Mainland China (N = 302; 151 participants per region).
Objectives: This study aimed to investigate the prevalence and determinants of psychological distress among OMSM in Hong Kong and Mainland China. Specifically, it examined how socioeconomic status, social capital, and experiences of discrimination contribute to mental health outcomes within this population.
Methods: This cross-sectional study was conducted in 2022 using an anonymous online survey of 302 OMSM, with 151 participants recruited from Hong Kong and 151 from Mainland China. Eligible participants were aged ≥60 years, had a history of male-to-male sexual intercourse, resided in one of the study regions, and demonstrated Chinese language literacy. Recruitment was carried out through partnerships with LGBT organizations, NGOs, and academic institutions using convenience, snowball, and targeted sampling. Data were analyzed using descriptive statistics, chi-square tests, t-tests/ANOVA, and hierarchical logistic regression to assess associations between psychological distress and socioeconomic status, social capital, and discrimination.
Results: Two predictors emerged as particularly robust. Higher monthly income (>HK$18,700) was consistently associated with elevated psychological distress (OR = 2.82). Most notably, everyday discrimination showed the strongest effect: each unit increase on the Everyday Discrimination Scale (EDS) corresponded to a 17% increase in the likelihood of distress (OR = 1.17), accounting for 35.9% of variance explained. Once discrimination was included, previously significant predictors such as education and social capital lost significance, underscoring its central role in OMSM mental health outcomes.
Conclusions: Discrimination was identified as the principal determinant of psychological distress among OMSM, outweighing traditional socioeconomic and social factors. These findings emphasize the need for targeted interventions to mitigate minority stress in aging sexual minority populations, with sensitivity to regional sociocultural contexts.