Associations between adolescent adversity and young adult depression symptoms and allostatic load in Mexican-origin individuals.

OBJECTIVES/GOALS: Chronic stress has vast implications for health. Pathophysiological dysregulation, as evidenced by allostatic load, is associated with increased morbidity and mortality. Health disparities exist in both the incidence and outcomes of chronic stress. This study investigates the intersection of identity, allostatic load, and depression. METHODS/STUDY POPULATION: A nationally representative sample of pre-pandemic health data from the 2017-2020 cycle of the National Health and Nutrition Examination Survey (NHANES) was used to assess variation in depression and allostatic load by identity status. Datasets containing biomarker, mental health, and identity data were merged using Stata. An index of allostatic load was created by generating quartiles for nine biomarkers of cardiovascular (cholesterol, triglycerides, systolic and diastolic blood pressure), metabolic (glucose, body mass index, albumin, creatinine), and immune (c-reactive protein) functioning, and summing the total high risk biomarkers per person. Depression scores were averaged across nine items from the patient health questionnaire, and dichotomous identity variables (e.g., race) were generated. RESULTS/ANTICIPATED RESULTS: People identifying as female (t = 8.25, p < .001) or Black (t = 7.18, p < .001) have higher allostatic load scores, whereas people identifying as White (t = -2.64, p < .01) or Asian (t = -3.80, p < .001) have lower allostatic load scores. People identifying as female (t = 10.76, p < .001), White (t = 2.66, p < .01), or Another/Mixed race (t = 6.23, p < .001) have higher levels of depression, whereas people identifying as Asian (t = 9.17, p < .001) have lower levels of depression. Multiple regression analyses indicate a significant effect of depression on allostatic load when controlling for sociodemographic variables (B = 0.33, SE = 0.05, t = 7.02, p < .001). The identity*depression interaction increases allostatic load for females (B = 0.43, SE = 0.10, t = 4.21, p < .001) and racial/ethnic minority males (B = 0.25, SE = 0.10, t = 2.62, p < .01). DISCUSSION/SIGNIFICANCE: This study highlights differences in the experience of allostatic load and depression based on identity. Depression exerts an independent and moderating effect on allostatic load. Findings have implications for health disparity research, and highlight the dynamic intersection of identity, mental, and physical health in the face of chronic stress.

Background:During the COVID-19 pandemic, the Albanian authorities declared mandatory stay-at-home measures, closing businesses, schools, and public places. This study aims to investigate the impact of these immediate changes on the mental well-being of the population.Methodology:Respondents (N = 1678) aged 18–60 years were selected through a convenient sampling method. A questionnaire was administered online for 26 days, where respondents reported the time spent daily in the COVID-19 topic and filled in their generalities, the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7.Results:Findings suggest a significant negative correlation between age and anxiety scoring (r(n = 1678) = −0.121, P ≤ 0.001) and between age and depression scoring (r(n = 1678) = −0.232, P ≤ 0.001), shown also on the ANOVA test for age and anxiety (F = 6.019, P ≤ 0.05), where younger populations had higher anxiety levels, as well as age and depression (F = 20.326, P ≤ 0.05), where older populations had higher levels of depression. Differences on the level of education resulted in a lower score of anxiety and depression (F = 3.524, P ≤ 0.05; F = 7.739, P ≤ 0.05, respectively) on respondents with higher education. Those who found themselves jobless from the pandemic scored higher on anxiety and depression (F = 9.760, P ≤ 0.05; M = 6.21, ds = 4.686 and F = 16.051, P ≤ 0.05; M = 8.18, ds = 5.791, respectively) compared with those who are still working. Significant differences were found on the ANOVA test related to different amounts of time spent daily on the COVID-19 topic for anxiety and depression (F = 25.736, P ≤ 0.001; F = 5.936, P ≤ 0.003, respectively), with people who spend <1 h scoring higher on depression (M = 7.57, ds = 5.849) and those who spent >3 h scoring higher on anxiety (M = 6.76, ds = 5.60). On the t-test, people on a romantic relationship scored lower levels of depression (t = −4.053, P ≤ 0.0001) compared to single individuals, and females scored higher levels of anxiety (t = 12.344, P ≤ 0.001) compared to males.Conclusions:Younger participants score higher levels of anxiety and depression. Higher education individuals show lower levels of anxiety and depression. Having a job translates into lower levels of anxiety and depression. People who spent more time on the COVID-19 topic daily have higher levels of anxiety, whereas those who spent less time have higher levels of depression. Being in a romantic relationship relates to lower levels of depression. Females report higher levels of anxiety compared to males.

The COVID-19 pandemic has negatively affected the physical and mental health of many. It remains unclear whether such impacts differ across diverse races or age groups, or along the course of the pandemic. This study assessed trends in levels of depression and anxiety symptoms among U.S. adults during COVID-19 and whether differences emerged across race and age. Data were drawn from the Understanding America Study (UAS) COVID-19 survey, a longitudinal panel survey of a nationally representative sample of over 6,000 individuals. A mixed effect linear model was conducted to assess the influence of race and age on the level of depression and anxiety over time during the pandemic, controlling for covariates such as marital status, employment status, and household income. Results indicate that greater age was associated with lower levels of depression and anxiety. Additionally, trends in levels of depression and anxiety vary across races (e.g., minority populations generally reported lower or comparable levels of depression and anxiety comparing to the White). Findings further suggest significant interactions between age and race, especially among minoritized adults. Study findings underscore the importance of future research and tailored strategies to improve culturally sensitive and age-appropriate mental health services targeting diverse populations.

Background: Allostatic load, a measure of cumulative stress-related physiologic dysregulation, is associated with major cardiovascular disease (CVD) events. However, despite evidence of familial aggregation of CVD risk factors, the impact of parental allostatic load on the onset and timing of CVD in offspring remains unknown. Hypothesis: We hypothesize that offspring of parents with lower allostatic load will have longer CVD-free survival time. Aim: To examine whether CVD-free survival in offspring is associated with parental allostatic load and potential sex-specific differences. Methods: A secondary data analysis of 6,145 offspring-mother-father trios derived from the Framingham Heart Study Original (exam 10) and Offspring Cohorts (exam 1). Allostatic load was defined as an index (0-16) of 8 variables (systolic and diastolic blood pressure, total cholesterol, HDL, LDL, total cholesterol/ HDL ratio, fasting blood glucose and body mass index). Kaplan-Meier plots, and Irwin’s restricted mean and multivariable-adjusted Cox proportional hazards regression models were used to examine sex-specific differences and the association between parental allostatic load and offspring’s CVD-free survival. Results: Parents mean age (SD) was 60.8 (8.1) and offspring’s 34.8 (10.5). 22.8% of parents (n=458) and 12.1% (n=412) of offspring had high allostatic load (&gt;8). In a total of 118,132 person-years of follow-up among the offspring, 1060 incident CVD events occurred. The overall CVD incidence rate was 8.9 per 1000 person-years (95% confidence interval [CI] 8.4-9.5) and sons had a higher CVD incident rate than daughters (11.0 vs 7.2, p&lt;0.001). Offspring of mothers with low allostatic load lived 4 more years free of CVD compared to offspring of mothers with high allostatic load. Similarly, offspring of fathers with low allostatic load lived 3 more years free of CVD. The hazard rate of having incident CVD among offspring of mothers and fathers with high (compared to low) allostatic load was 1.58 (1.28-1.95) and 1.39 (95% CI: 1.11-1.75), respectively. Conclusion: Parents' allostatic load has a significant impact on the cardiovascular health of their offspring, with those of mothers with high allostatic load being at a higher risk of developing CVD at a younger age.

Objective: To explore the associations between the type and the amount of substances used with depression and anxiety symptoms by high school students. Methods: The study data was collected by the Istanbul Department of Education on 31,604 high school students which was a survey of 66 questions administered in the school setting. The primary questions and sub-questions on anxiety and depression scores were added to generate a scaled score. Specific substances used by the participants were used to explore the relationship between substance use and depression and anxiety scores by using multinomial logistic regression models. Two regression models were analyzed, one for each dependent variable, keeping the significance level at 0.05. Odds ratios were calculated to explore the association between depression and anxiety scores and specific substance use among the youth. Results: The participants with low levels of anxiety were at an increased odds of using heavy amounts of sleep pills (OR=1.6) and alcohol (OR=1.3) as compared to those without anxiety. In addition to sleep pills and alcohol, illicit substances such as LSD and inhalant use were also seen in the participants with higher levels of anxiety. The participants with low levels of depression were found to be at an increased odds of using sleep pills (OR=1.8) and alcohol (OR=1.3). In addition to this pattern of substance use, participants with higher levels of depression were also found to be heavy cocaine users, low inhalant users, heavy steroid users, and low alcohol users. A decrease in the use of homemade brews was seen in the participants with low and high levels of depression as compared to those who didn’t have any depressive symptoms. Conclusion: A unique pattern of drug and alcohol use was found in the participants experiencing varying levels of anxiety and depression.

To identify possible factors affecting the psychological impact of pre-symptomatic testing for spinocerebellar ataxia type 2 (SCA2) and familial amyloid polyneuropathy (FAP ATTRV30M), we studied (1) the effect of previous experience with the disease in the family, (2) kinship with the closest affected relative and (3) gender of affected parent, when adapting to test results; as well as (4) differences in the course of psychological wellbeing in 63 subjects ( 28 at-risk for FAP ATTRV30M, and 35 at risk for SCA2), who pursued predictive testing for these diseases, in Cuba and in Portugal. Our research shows that individuals with little or no experience with the disease in their family exhibited more anxiety; at-risk subjects for SCA2 or FAP ATTRV30M who had a first degree relative with the disease showed lower levels of anxiety and depression during pre-symptomatic testing. Also those with an affected mother had lower levels of depression, either immediately, or one year after receipt of test results. Adaptation to pre-symptomatic testing results differed for subjects at-risk for the two different conditions. Unlike the FAP ATTRV30M families, carriers for SCA2 reported pathological levels of depression immediately after-testing (3 weeks), although those levels had returned to normal levels at 6 months. Subjects at-risk for FAP ATTRV30M tended to have less anxiety than those tested for SCA2, at the one-year follow-up. Overall, depression levels improved over time, while anxiety remained more constant. A longer awareness of the disease in the family, closer kinship, and a transmitting mother all lessened the impact of pre-symptomatic testing, as expressed by the post-test levels of anxiety and depression.

Factors associated with depression, anxiety, and PTSD symptomatology during the COVID-19 pandemic: Clinical implications for U.S. young adult mental health

Aim/Purpose: This descriptive study examines indicators of well-being and sources of emotional connection for social work doctoral students at American institutions during the COVID-19 pandemic, including symptoms of depression, anxiety, work-related burnout, emotional connection to others, and changes in child care among parent respondents. This study also explores if particular groups of doctoral students experience heightened risks to well-being during the pandemic. Background: Social isolation strategies associated with the COVID-19 pandemic present challenges for doctoral student well-being, mental health, professional relationships, and degree persistence. Of particular concern is the potentially disproportionate impact the pandemic may have on the well-being of students who already face additional barriers to degree completion, such as parents and caregivers, as well as those who face obstacles associated with structural oppression, including persons of color, women, and sexual minority (SM) students. Methodology: Baseline data was used from a longitudinal survey study conducted by the authors on social work doctoral student well-being during the COVID-19 pandemic. Participants (N = 297) were recruited through the Group for the Advancement of Doctoral Education in Social Work’s (GADE’s) publicly available list of 89 member institutions in the United States. The majority of respondents identified as women (80.1%), 35% of the sample identified as a person of color and/or non-White race, 30% identified as a sexual minority, and 32% were parents of children under 18 years of age. Contribution: This study contributes to the larger body of literature on factors associated with risk, resilience, and well-being among doctoral students, and it offers a specific exploration of these factors within the context of the COVID-19 pandemic. This study deepens our understanding of social work doctoral students in particular, who have higher rates of doctoral enrollment by women and persons of color than many other academic disciplines. Findings: Emotional connection to loved ones was significantly correlated with lower levels of depressive symptoms, anxiety symptoms, and work-related burnout. Outcomes varied by race, with Black and Asian respondents indicating higher levels of emotional connection to loved ones as compared to White respondents, and Black respondents indicating lower levels of anxiety and depression compared to White respondents. SM respondents indicated significantly lower levels of emotional connection and higher levels of depression and anxiety, as compared to heterosexual respondents. Parents reported receiving substantially less child care assistance than they were before the pandemic, but also reported lower levels of anxiety, depression, and work-related burnout compared to childless respondents. Recommendations for Practitioners: Recommendations for doctoral program directors and chairs include implementing a purposive communication strategy, faculty modeling self-care and boundaries, creating opportunities for connection, scheduling value-added activities driven by student interest and needs, approaching student needs and plans of study with flexibility, and creating virtual affinity groups to help students connect with those facing similar challenges. Recommendation for Researchers: Outcome evaluation studies of doctoral program initiatives and policies to promote student well-being--both during and in the aftermath of the COVID-19 pandemic-- is warranted. Impact on Society: The COVID-19 pandemic presents complex financial, interpersonal, and programmatic challenges for doctoral faculty and program directors, many of which affect the well-being and mental health of their students. Findings and recommendations from this study may be used to address the needs of doctoral students and support their path to doctoral degree completion. Future Research: Future studies should include measures that tap a broader range of indicators of depression, anxiety, and emotional connection, and additional domains of well-being. Multivariate analyses would permit predictive conclusions, and follow-up qualitative analyses would offer deeper insights into doctoral students’ well-being, coping skills, and experiences within the context of the COVID-19 pandemic.

IntroductionMental health is a state of complete wellbeing that includes people’s cognitive, affective, and behavioral aspects. This means that an individual with low levels of depression, anxiety, and stress can function optimally in their daily life, contributing to the community and enjoying and creating meaningful relationships with their peers and environment. The purpose of the study was to determine the levels of stress, anxiety, and depression along with the levels of burnout manifested by Chilean preschool education professionals.MethodA quantitative, non-experimental, correlational design was applied. A purposive sample of 560 preschool teachers and assistants participated. Data were collected using the Depression Anxiety and Stress Scale (DASS-21) and the Maslach Burnout Inventory (MBI). Analyses included descriptive and inferential statistics.ResultsParticipants exhibited low levels of stress, anxiety, and depression. However, emotional exhaustion and depersonalization showed positive correlations with all three mental health indicators. Conversely, personal accomplishment was negatively correlated with them. Structural equation modeling revealed that anxiety mediates the relationship between burnout and depressive symptoms, with emotional exhaustion having the greatest impact.DiscussionThese findings underscore the importance of reinforcing psychological and socio-emotional support for preschool education teams. Strengthening professional wellbeing is critical not only for educators’ health but also for enhancing the quality of early childhood education.

Host physiological factors may influence immune response, treatment tolerance, and survival during immune checkpoint inhibitor (ICI) therapy. Allostatic load (AL) summarizes cumulative physiological dysregulation across multiple biological systems. We evaluated whether pre-treatment AL is associated with immune-related toxicity and clinical outcomes among patients with advanced melanoma receiving ICIs. We analyzed 399 patients with melanoma treated with ICIs at the University of Virginia Cancer Center (2013-2025). AL was derived from routinely collected clinical laboratory biomarkers measured prior to treatment initiation. Multinominal logistic and Cox regression models assessed associations between AL and immune-related adverse events (irAEs), treatment response, disease progression, and overall survival (OS), adjusting for demographic, clinical, and treatment factors. The mean AL score was 4.43. Each 1-unit increase in AL was associated with higher odds of grade ≥ 2 toxicity (adjusted odds ratio [OR] = 1.30; 95% confidence interval [CI]: 1.08-1.57). Among patients who developed irAEs, higher AL was associated with poorer treatment response (adjusted OR = 1.24; 95% CI: 1.01-1.54) and increased risk of disease progression (adjusted hazard ratio [HR] = 1.14; 95% CI: 0.98-1.33). Higher AL was also associated with shorter OS, with a 26% higher mortality risk per 1-unit increase in AL (adjusted HR = 1.26; 95% CI: 1.14-1.39). Higher pre-treatment AL was associated with increased immune-related toxicity and poorer survival in melanoma patients treated with ICIs. AL represents a feasible pre-treatment marker of host physiological vulnerability that may complement existing clinical predictors. Prospective studies are needed to validate these findings and assess clinical utility.

Approximately one-fourth of pregnancies experience adverse pregnancy outcomes, such as hypertensive disorders of pregnancy (HDPs), preterm birth, stillbirth, and small-for-gestational age (SGA) neonates. Although an uncertain pathophysiology leading to these outcomes of pregnancy is understood, a major contributing factor may be cumulative stress. Chronic wear and tear on the adaptive system of the body, as well as chronic stress exposure, can be assessed via allostatic load. Chronic stress hailing from circumstances such as food or housing insecurity, racism, unemployment, or a combination of these may contribute to the racial and ethnic disparities observed in pregnancy outcomes. This study aimed to assess the relationship between the allostatic load and adverse pregnancy outcomes, while hypothesizing that higher odds of adverse pregnancy outcomes are directly associated with higher allostatic loads. Second, the authors hypothesized that a significant portion of racial and ethnic disparities in adverse pregnancy outcomes will be accounted for with high allostatic loads. The primary outcome was a composite adverse pregnancy outcome: HDPs, SGA, preterm birth, and stillbirth. Between October 2010 and September 2013, the nuMoM2b study (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be) enrolled 10,038 nulliparous individuals with singleton pregnancies. Eligible individuals were nulliparous, had a viable single gestation with an estimated gestational age of 60/7 and 136/7 weeks, and intended delivery at a participating clinical site. Exclusionary criteria were as follows: unable to provide informed consent, age younger than 13 years, planned termination of pregnancy, 3 or more prior pregnancy losses, fetal malformations or aneuploidy upon enrollment, or having a donor ovum pregnancy. Included within the study were 3 study visits during pregnancy and a final visit at delivery. Baseline clinical assessments, standardized questionnaires by trained chart abstracts, and medical record abstraction were used to ascertain maternal characteristics. Assessment of urine and serum collected between 6 and 14 weeks granted insight into allostatic load biomarkers. A total of 4266 pregnant individuals were included in the primary analysis, with high allostatic load being identified in 35% of the population (≥4 biomarkers in the worst quartile). Some 1171 individuals (27.5%) were identified to have adverse pregnancy outcomes: 386 preterm births (8.6%), 586 HDPs (14.0%), 12 stillbirths (0.3%), and 449 SGA neonates (11%). Adverse pregnancy outcomes occurred in the following numbers: 1 adverse outcome for 967 individuals, 2 for 165, 3 for 38, and 1 for all 4. High allostatic load held significant association with composite adverse pregnancy outcome, whereas HDPs differed by self-reported race. After adjustment for maternal age, gravidity, smoking, bleeding in the first trimester, and health insurance, high allostatic load was associated with the composite adverse pregnancy outcome (adjusted odds ratio [aOR], 1.5; 95% confidence interval [CI], 1.3–1.7) and hypertensive disorders (aOR, 2.5; 95% CI, 2.0–2.9), but not preterm birth or SGA. High allostatic load only partially mediated the association between self-reported race and adverse pregnancy outcomes. The association between allostatic load and hypertensive disorders differed by self-reported race, but it did not differ for the composite adverse pregnancy outcome, preterm birth, or SGA. Limitations of the study included the small number of stillbirths. Furthermore, the study used the 10-factor allostatic load index and did not assess additional cardiovascular and metabolic indicators in the broader allostatic load index. In addition, the cohort only included nulliparous individuals with tertiary care center access, which is not necessarily generalizable to other populations. Strengths of the study included its use of a large, well-characterized prospective cohort, as well as equal weighing of allostatic load biomarkers and a study population that was racially, ethnically, and geographically diverse. In conclusion, the study indicates that early-pregnancy high allostatic loads are associated with subsequent adverse pregnancy outcomes (HDPs in particular). Allostatic load was also a partial mediator between adverse pregnancy outcomes and race. Further evaluation of components of chronic stress and allostatic load as potentially modifiable risk factors is supported by these findings as a means of improving pregnancy outcomes via these potentially modifiable risk factors.

ConclusionsAt diagnosis, control patients had the lowest depression levels and anxiety scores, followed by those with limited HNSCC disease and these with extended HNSCC disease.Anxiety and depression levels at diagnosis predicted prognosis via an association with extent of disease. Sense of humor, but not anxiety score or depression level, predicted lower QoL and depression levels at follow-up.ObjectiveTo study the association between anxiety score, depression level and sense of humor at diagnosis in head and neck squamous cell carcinoma (HNSCC) patients versus TNM stage, prognosis and depression level/quality of life (QOL) 6 years following diagnosis. A control group of patients with benign HN disease was also included.Material and methodsMale patients with newly diagnosed HNSCC (n=78) or benign HN (n=61) disease completed the following questionnaires: the Beck Depression Inventory, the Spielberger Trait Anxiety Inventory (state) and the Svebak humor questionnaire. Patients with cachexia or those aged >80 years were excluded. In the HNSCC patients, TNM stage, prognosis and QOL/depression level (n=27) were determined following successful therapy.ResultsHNSCC patients reported higher anxiety scores and lower depression levels than control patients, although there was overlap between the groups. N stage was associated with high anxiety scores and depression levels, whereas T stage was only associated with depression levels. Both anxiety scores and depression levels at diagnosis predicted prognosis through an association with TNM stage. Sense of humor, but not depression levels or anxiety scores, at diagnosis predicted QoL and depression level at follow-up.

The current study aims to identify the factors associated with anxiety and depression in patients with acute coronary syndrome (ACS) at hospital discharge from a Peruvian health center. Patients at discharge from the cardiology hospitalization service between November 2019 and December 2020 were evaluated using a cross-sectional study. The median time elapsed from the ACS event to the interview date was 10 months. A total of 34.1% of the population presented mild depression and 78.8% had mild anxiety. All three of our analyses indicated that patients who had attended university had significantly lower levels of both depression and anxiety, and patients with diabetes had significantly higher levels of anxiety. The lower-low socioeconomic group had 1.5 times the frequency of depression (p-value = 0.002) and 3.12 times the frequency of anxiety (p-value = 0.050). Interestingly, while a good quality of life was associated with lower levels of depression, it was also associated with higher levels of moderate/severe anxiety (p-value = 0.035). A multiple regression analysis found that hypertension was also associated with higher levels of anxiety, and patients who have had COVID-19 had 21.05 times the level of moderate/severe anxiety (p-value = 0.000). Cases of ACS are more frequent in patients with an age greater than or equal to 60 years, as well as in males. Isolation was a common feature that may have a negative impact on their quality of life and mental health.

Lifestyle choices significantly influence mental health in later life. In this study we investigated the effects of the Christian Orthodox Church (COC) fasting diet, which includes long-term regular abstinence from animal-based products for half the calendar year, on cognitive function and emotional wellbeing of healthy adults. Two groups of fasting and non-fasting individuals were evaluated regarding their cognitive performance and the presence of anxiety and depression using the Mini Mental Examination Scale, the Hamilton Anxiety Scale, and the Geriatric Depression Scale (GDS), respectively. Data on physical activity, smoking, and vitamin levels were collected and correlated with mental health scoring. Negative binomial regression was performed to examine differences in the GDS scores between the two groups. Significantly lower levels of anxiety (7.48 ± 4.98 vs. 9.71 ± 5.25; p < 0.001) and depression (2.24 ± 1.77 vs. 3.5 ± 2.52; p < 0.001), along with better cognitive function (29.15 ± 0.79 vs. 28.64 ± 1.27; p < 0.001), were noticed in fasting compared to non-fasting individuals. GDS score was 31% lower (Incidence Rate Ratio: 0.69, 95% Confidence Interval: 0.56–0.85) in the fasting group compared to the control, while vitamin and ferrum levels did not differ. The COC fasting diet was found to have an independent positive impact on cognition and mood in middle-aged and elderly individuals.

Depression is one of the biggest health issues among men who have sex with men (MSM) living with HIV, where sexual identity might play an intricate role. Yet, findings of the relationship between sexual identity and depression were mixed and few studies explored its underlying mechanisms. This study aimed to examine the association between sexual identity and depression, and the potential mediating role of HIV-related stigma and moderating role of age. A cross-sectional survey was conducted among 203 MSM living with HIV in Guangxi, China. Participants provided information on sexual identity, depression, HIV-related stigma, and background information. Descriptive statistics, bivariate analysis, and path analysis were applied to examine our hypotheses. Bivariate analysis demonstrated that participants who self-identified as gay reported a lower level of HIV-related stigma and depression. Path analysis revealed an insignificant direct effect of identifying as gay on depression. Yet, the indirect pathway was significant, with identifying as gay being associated with a lower level of HIV stigma and thus a lower level of depression. This indirect effect was moderated by age. The conditional indirect effect was significant in the younger group yet ceased in the older group. The study provided information to better understand the effect of sexual identity on mental health among stigmatized sexual and gender minorities by highlighting the mediating effect of HIV-related stigma and the protective effect of age. Interventions targeting mental health of MSM living with HIV might consider placing greater emphasis on addressing HIV-related stigma among younger MSM.