Loneliness, social support, and depressive symptoms among men who acquired HIV through sexual transmission in China

Loneliness and social support are important psychosocial correlates of depressive symptoms among people living with HIV, but their interrelationships remain insufficiently understood. This cross-sectional study examined associations among loneliness, social support, and depressive symptoms in 436 Chinese men living with HIV who acquired HIV through sexual transmission. Participants completed the Patient Health Questionnaire-9, Social Support Rating Scale, and UCLA Loneliness Scale.

Correlation analysis, multivariable logistic regression, and latent-variable mediation analysis were performed. In the fully adjusted logistic regression model, high loneliness was associated with greater odds of moderate-to-severe depressive symptoms (adjusted OR = 4.790, 95% CI: 2.778 ~ 8.259), whereas total social support was not independently associated with the dichotomized depressive symptom outcome (adjusted OR = 0.985, 95% CI: 0.957 ~ 1.013). In the adjusted latent-variable mediation model, loneliness showed a small indirect association with depressive symptom scores through social support (indirect effect = 0.011, 95% bias-corrected bootstrap CI: 0.001 ~ 0.034).

These findings highlight a strong association between loneliness and depressive symptoms and suggest a modest statistical indirect pathway involving social support. Longitudinal studies among men living with HIV are needed to clarify the temporal ordering and direction of these associations. The authors would like to thank all study participants for their time and contribution to this research, as well as the staff of the Department of Infectious Diseases and the Treatment and Follow-up Clinic of the First Affiliated Hospital of Xiamen University for their assistance with participant recruitment and data collection.

This work was funded by the Fujian Provincial Health Technology Innovation Project (Grant No. 2024CXB024) and the Xiamen Science and Technology (Medical and Health) Guidance Project (Grant No. 3502Z20244ZD1312). Xiamen Xianyue Hospital, Xianyue Hospital Affiliated with Xiamen Medical College, Fujian Psychiatric Center, Fujian Clinical Research Center for Mental Disorders, Xiamen, Fujian, China Rubin Chen, Jianyu Que, Yanan Lin, Yuyun Huang & Yixiong Zheng First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China Pingtan Comprehensive Experimental Zone Hospital, Pingtan, Fujian, China Fujian Medical University, Fuzhou, Fujian, China Correspondence to Caixia Zheng or Yixiong Zheng. The authors declare no competing interests.

This research was conducted in accordance with the guidelines of the Declaration of Helsinki and was approved by the Ethics Committee of Xiamen Xianyue Hospital (Approval No. 3502Z20244ZD1312). Electronic informed consent was obtained from all participants before participation. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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