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The minority stress model postulates that men who have sex with men (MSM) often encounter multiple stressors because of their sexual minority status, which may lead to psychological problems and maladaptive coping such as addictive behaviors (eg, internet gaming disorder [IGD]). It was hypothesized that hopelessness and loneliness would be associated with IGD via self-control among MSM.
This study investigated the prevalence of IGD and its associations with variables related to minority stress (loneliness and hopelessness) among MSM who were university students. Mediation involving such associations via self-control was also explored.
With informed consent, 305 MSM attending universities in Sichuan, China participated in the study. The validated
The prevalence of IGD was 12.8% (n=39). Logistic regression found that IGD was positively associated with hopelessness and loneliness, and negatively associated with self-control. The structural equation modeling identified three significant paths between hopelessness/loneliness and IGD: (1) hopelessness → lower self-control → higher IGD (full mediation), (2) loneliness → lower self-control → higher IGD (partial mediation: effect size of 28%), and (3) a direct effect from loneliness to IGD.
IGD was prevalent among young MSM and warrants interventions that may try to reduce the level of psychosocial problems such as loneliness and hopelessness and improve self-control. According to the socioecological model, the promotion of social acceptance and reduction in stigma toward MSM are important in reducing loneliness and hopefulness among MSM. Self-control links up the relationships between psychosocial problems and IGD and should be given special attention. Longitudinal studies are warranted to confirm the findings and test new mediations between loneliness/hopelessness and MSM with IGD.
Men who have sex with men (MSM) is a sexual minority group that is vulnerable to addictive behaviors [
IGD has become a growing public health concern, as it is prevalent and was associated with many potential harms including depression and increased violence [
MSM tend to have high levels of loneliness and hopelessness [
The mechanism between loneliness/hopelessness and IGD among MSM would be informative for designing effective interventions but has not been studied. Self-control is a potential mediator between loneliness/hopelessness and IGD. Self-control has special relevance as MSM exhibited weaker self-control than non-MSM [
This study investigated the prevalence and factors (ie, loneliness, hopelessness, and self-control) of IGD among university students who were MSM in mainland China. It also investigated the mediation effect of self-control between loneliness/hopelessness and IGD. It was hypothesized that loneliness and hopelessness would be positively associated with IGD, loneliness and hopelessness would be negatively associated with self-control, and self-control would be negatively associated with IGD. The direct effects from loneliness and hopelessness to IGD were also tested in this study. The study has special relevance to the MSM population, as they tend to have higher levels of addictive behaviors and loneliness/hopelessness, and a lower level of self-control. The information would facilitate tailored IGD interventions targeting MSM.
An anonymous cross-sectional study was conducted among university students who were MSM in Chengdu, China during September and October 2018. Inclusion criteria included those aged ≥18 years, male full-time university students, self-reporting having sex with men in the past 6 months, and provision of informed consent. Convenience sampling was conducted. A local nongovernmental organization, Chengdu Tongle Health Counselling Service Center, trained and briefed 20 paid part-time outreach fieldworkers who were university students and MSM; these workers then recruited participants through their networks and by posting invitations on some online social networking sites frequently used by local MSM who are university students (eg, WeChat group and Blued). Interested prospective participants contacted the coordinators. After confirming the participants’ eligibility to join the study, the coordinators briefed the participants about the study and obtained their verbal informed consent. The coordinator would then send the participants a link to access the self-administered online questionnaire. It took about 20 minutes to complete. An incentive of ¥20 (about US $3) was given to participants who completed the web-based survey as a token of appreciation.
Such information included year of study, study major, whether local residents of Chengdu, and average monthly expenditure.
IGD was assessed by using the 9-item
Loneliness was assessed using the 3-item short version of the UCLA Loneliness Scale [
Hopelessness was assessed by using the 4-item Beck Hopelessness Scale [
Self-control was assessed by using the 11-item Chinese Self-control Scale [
Regarding sample size requirement, structural equation modeling (SEM) was used as the key statistical method; it requires a minimum of 10 cases per item/unobserved variable [
IGD was a binary dependent variable. Univariable logistic regression analysis was conducted to test the associations between background factors and IGD. Multivariable logistic regression analysis was conducted to test the associations between the three psychological factors (loneliness, hopelessness, and self-control) and IGD, adjusting for background factors. Crude odds ratio (ORc), adjusted odds ratio (ORa), and their respective 95% CIs were generated. SEM, using the weighted least squared mean and variance adjusted estimator, was conducted to test the potential mediation mechanisms that self-control would mediate between loneliness/hopelessness and IGD. Three latent variables were created: the two latent variables of loneliness and hopelessness were derived from the three and four original scale items, respectively, while the latent variable of self-control was derived from three randomly grouped parcels from the original 11 items (item parceling is recommended to reduce measurement errors of latent variables that are measured with relatively more items in SEM [
This study was approved by the Survey and Behavioral Research Ethics Committee of the Chinese University of Hong Kong (SBRE-21-0635).
Of 305 participants, the mean age was 21.1 (SD 2.8, range 14-30) years. About 30.5% (n=93) were local residents of Chengdu, majored in arts subjects (n=88, 28.9%), and spent >¥2000 (about US $313) per month on average (n=84, 27.5%). About one-fourth were in their first year (n=69, 22.6%), second year (n=76, 24.9%), and third year (n=75, 24.6%). The prevalence of IGD was 12.8% (39/305; see
Descriptive statistics (N=305).
|
Participants, n (%) | |
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Chengdu | 93 (30.5) |
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Other cities | 208 (68.2) |
|
No answer | 4 (1.3) |
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||
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Arts | 88 (28.9) |
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Business | 40 (13.1) |
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Science | 135 (44.3) |
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Others | 22 (7.2) |
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Not reported | 20 (6.6) |
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Year 1 | 36 (11.8) |
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Year 2 | 69 (22.6) |
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Year 3 | 76 (24.9) |
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Year 4 or final year | 75 (24.6) |
|
Not reported | 49 (16.1) |
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≤2000 (about US $330) | 212 (69.5) |
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>2000 | 84 (27.5) |
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Not reported | 9 (3.0) |
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No | 266 (87.2) |
|
Yes | 39 (12.8) |
Univariable logistic regression analysis showed that the fourth year or final year students (ORc 0.23, 95% CI 0.06-0.86) were less likely than others to have IGD. The associations between sociodemographics (age, place of residence, study major, and average monthly expenditure) and IGD were nonsignificant among university students who were MSM (see
Associations between background factors and internet gaming disorder (N=305).
Independent variables | Internet gaming disorder, ORca (95% CI) | ||
Age | 0.92 (0.81-1.05) | ||
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Chengdu | 1.0 (reference group) | |
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Other cities | 1.07 (0.50-2.26) | |
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Not reported | 7.56 (0.95-58.40) | |
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Arts | 1.0 (reference group) | |
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Business | 1.11 (0.36-3.50) | |
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Science | 1.20 (0.53-2.74) | |
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Others | 1.23 (0.31-4.92) | |
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Not reported | 1.38 (0.34-5.54) | |
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Year 1 | 1.0 (reference group) | |
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Year 2 | 0.70 (0.24-2.03) | |
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Year 3 | 0.78 (0.28-2.18) | |
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Year 4 or final year | 0.23 (0.06-0.86)* | |
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Not reported | 0.58 (0.18-1.90) | |
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|||
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≤2000 (about US $330) | 1.0 (reference group) | |
|
>2000 | 1.03 (0.49-2.19) | |
|
Not reported | 0.86 (0.10-7.12) |
aORc: crude odds ratio.
*
Adjusted for background factors, multivariable logistic regression analysis showed that loneliness (ORa 1.29, 95% CI 1.14-1.47) and hopelessness (ORa 1.27, 95% CI 1.15-1.40) were both positively and significantly associated with IGD, while self-control was negatively associated with IGD (ORa 0.90, 95% CI 0.87-0.94; see
Adjusted associations between the three psychosocial variables and internet gaming disorder (N=305).
Independent variablesa | Adjusted odds ratio (95% CI) |
Loneliness | 1.29 (1.14-1.47)*** |
Hopelessness | 1.27 (1.15-1.40)*** |
Self-control | 0.90 (0.87-0.94)*** |
aThe models were adjusted for background variables including age, place of residence, study major, year of study, and average monthly expenditure.
***
The model fit index of the measurement model of the three latent variables of loneliness, hopelessness, and self-control were satisfactory (χ2 /
Structural equation modeling testing the mediation effect of self-control between loneliness/hopelessness and IGD (standardized coefficients were reported). IGD: internet gaming disorder.
This study observed a 13% (39/305) prevalence of IGD among Chinese MSM who were university students, which is relatively high and requires attention. It is unknown whether the prevalence would be higher than that of non-MSM who are university students as this study did not involve the non-MSM group and hence no comparison can be made. Future confirmation is warranted. Nonetheless, the high prevalence deserves attention and warrants interventions, as IGD was associated with mental problems such as depression [
Year of study was the only background variable significantly associated with IGD. Year 4 students showed lower prevalence of IGD than other students. Previous studies reported similar results that lower grades (eg, first year) were associated with higher risk of addictive behaviors (eg, substance use) [
As expected, loneliness and hopelessness were both positively associated with IGD in this study, which corroborates findings of other studies [
A more acceptable social environment is also warranted to reduce risk factors of IGD such as loneliness and hopelessness. In agreement with the socioecological model of health [
Supporting one of the hypotheses of this study, self-control was negatively associated with IGD. The finding was supported by previous theoretical and empirical studies [
This study has several limitations. First, due to the cross-sectional study design, no causal and temporal inferences can be claimed. Second, reporting bias (eg, recall bias and social desirability bias) may exist and result in underreported prevalence of IGD and an inflated level of self-control. Third, selection bias may exist; the characteristics between MSM participants and nonparticipants might differ but could not be compared. Fourth, the participating universities were conveniently selected in the studied city; generalization of the results to other regions in and outside China should be cautiously made. Fifth, this study did not investigate other potential determinants of IGD that were closely related to the MSM status (eg, sexual orientation, sexual role, and sexual behaviors). Sixth, other potential mediators of the association between hopelessness and IGD may exist but had not been investigated; some of these factors/mediators of IGD may have special relevance to MSM, such as internalized stigma and cognitive bias [
In conclusion, this study observed relatively high prevalence of IGD among MSM who are university students in China, which was significantly associated with loneliness, hopelessness, and self-control. Interventions preventing IGD among MSM who are emerging adults might hence need to simultaneously improve loneliness, hopelessness, and self-control. A novel finding of this study was that self-control significantly (and fully or partially) mediated between loneliness/hopelessness and IGD, respectively. The significant mediation effects highlight the importance of self-control apart from its well-studied direct effect on IGD. It suggests that self-control links up the relationships between commonly found psychological problems (eg, loneliness and hopelessness) and IGD among MSM. Future longitudinal and intervention studies are needed to verify the above findings among MSM and other sexual minority groups.
comparative fit index
Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition)
internet gaming disorder
men who have sex with men
adjusted odds ratio
crude odds ratio
root mean square error of approximation
structural equation modeling
Tucker-Lewis index
We would like to thank the participants for their contribution to this study.
None declared.