Effects of Social Support and Internalized Homophobia on the Association between Population Density and Mental Health among Gay and Bisexual Men

Background: Depression negatively impacts the health and wellbeing of gay and bisexual men (GBM). Yet, little is known about the contexts in which rural GBM live and the role social support and internalized homophobia may play in their overall mental health relative to those living in urban areas.

Methods: A nationally representative sample of 1,071 GBM was enrolled. Participants provided their zip codes, which were categorized according to population density and rank-normalized, and completed measures of internalized homophobia, social support, and depression. 

Results: Lower normalized population density was associated with lower social support (p=.01) and greater internalized homophobia (p=.001). In a model adjusted for race/ethnicity, college education, age, and relationship status, lower population density was significantly associated with higher depression scores (B=-.90, p=.006). Lower social support (B=-2.89, p<.001) and greater internalized homophobia (B=3.53, p<.001) were significantly associated with greater depression scores and reduced the effect of population density on depression (B=-.36, p=.23). Sobel’s test of the indirect effect of population density on depression through social support (p=.007) and internalized homophobia (p=.01) were statistically significant, suggesting evidence for mediation of the effects.

Conclusion: These results indicate that living in less inhabited areas acts upon depression through several mechanisms for GBM, including lower social support and higher internalized homophobia. These findings suggest that community organizations and service providers in rural areas working with GBM with depression should focus on efforts to increase social support and reduce internalized homophobia.