This study explored how minority stress and social safety jointly shape mental health among Taiwanese sexual minority men (SMM) through the identification of psychosocial profiles and their associations with depression.
Methods:
Between April and May 2023, 415 Taiwanese SMM completed an online cross-sectional survey. Latent profile analysis (LPA) identified groups based on minority stress (sexuality-related discrimination, acceptance concerns, internalized homonegativity) and social safety (identity affirmation, family support, community connectedness) indicators. Multinomial logistic regression examined sociodemographic correlates of profile membership, and linear and binary logistic regressions assessed associations with depressive symptom severity (DSS) and major depressive disorder (MDD).
Results:
LPA identified three distinct profiles: “Moderate Minority Stress–Low Social Safety” (MMS–LSS; n = 201, 48.4%); “Low Minority Stress–High Social Safety” (LMS–HSS; n = 182, 43.9%); and “High Minority Stress–Moderate Social Safety” (HMS–MSS; n = 32, 7.7%). Individuals identifying as heterosexual men who have sex with men, pansexual, asexual, queer, or questioning had greater odds of belonging to the MMS–LSS (odds ratio [OR] = 5.00, 95% confidence interval [CI] = 1.42–17.63) and HMS–MSS (OR = 10.35, 95% CI = 2.32–46.13) profiles, relative to the LMS–HSS profile. Compared with individuals in the LMS–HSS profile, residence in the Central, Eastern, or Outer Island regions was associated with higher odds of HMS–MSS profile membership (OR = 3.58, 95% CI = 1.46–8.83). After adjusting for covariates, membership in the MMS–LSS (β = 0.16, 95% CI = 0.06–0.25; adjusted OR [aOR] = 1.87, 95% CI = 1.06–3.35) and HMS–MSS (β = 0.11, 95% CI = 0.01–0.20; aOR = 2.98, 95% CI = 1.13–7.69) profiles, relative to the LMS–HSS profile, was associated with greater DSS and higher odds of MDD.
Conclusion:
These findings revealed diverse experiences of minority stress and social safety among Taiwanese SMM and their implications for depression, supporting culturally responsive interventions.
MalikMH, IqbalS, NomanM, et al.Mental health disparities among homosexual men and minorities: A systematic review. Am J Mens Health, 2023; 17(3):15579883231176646; doi: 10.1177/15579883231176646
2.
ArgyriouA, GoldsmithKA, RimesKA. Mediators of the disparities in depression between sexual minority and heterosexual individuals: A systematic review. Arch Sex Behav, 2021; 50(3):925–959; doi: 10.1007/s10508-020-01862-0
3.
MeyerIH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychol Bull, 2003; 129(5):674–697; doi: 10.1037/0033-2909.129.5.674
4.
FrostDM, MeyerIH. Minority stress theory: Application, critique, and continued relevance. Curr Opin Psychol, 2023; 51:101579; doi: 10.1016/j.copsyc.2023.101579
5.
WeiD, WangX, YouX, et al.Prevalence of depression, anxiety and suicide among men who have sex with men in China: A systematic review and meta-analysis. Epidemiol Psychiatr Sci, 2020; 29:e136; doi: 10.1017/S2045796020000487
6.
FuH, FengT, WangT, et al.Reported prevalence of depression or depressive symptoms among men who have sex with men in China, 2004–2018: A systematic review and meta-analysis. J Affect Disord, 2020; 277:192–203; doi: 10.1016/j.jad.2020.08.011
7.
HuangYT, ChanRCH, CuiL. Filial piety, internalized homonegativity, and depressive symptoms among Taiwanese gay and bisexual men: A mediation analysis. Am J Orthopsychiatry, 2020; 90(3):340–349; doi: 10.1037/ort0000439
8.
LiangZ, HuangYT. “Strong together”: Minority stress, internalized homophobia, relationship satisfaction, and depressive symptoms among Taiwanese young gay men. J Sex Res, 2022; 59(5):621–631; doi: 10.1080/00224499.2021.1947954
9.
LeeKCK, ChungAKK, WongBCK. Chemsex, HIV, and psychiatric diagnosis in gay or bisexual men in Hong Kong. Subst Use Misuse, 2023; 58(7):841–850; doi: 10.1080/10826084.2023.2177970
10.
ChanRCH, HuangYT. A minority stress response model of health behaviors in gay and bisexual men: Results from a Taiwanese sample. LGBT Health, 2021; 8(3):209–221; doi: 10.1089/lgbt.2020.0194
11.
TsaiCS, HuangYT, YenCF. Experience of sexual orientation microaggression among young adult lesbian, gay, and bisexual individuals in Taiwan: Its related factors and association with mental health problems. Int J Environ Res Public Health, 2021; 18(22):11744; doi: 10.3390/ijerph182211744
12.
LeeJI, ChangYP, TsaiCS, et al.Internalized sexual stigma among lesbian, gay, and bisexual individuals in Taiwan: Its related factors and association with mental health problems. Int J Environ Res Public Health, 2022; 19(4):2427; doi: 10.3390/ijerph19042427
13.
HsuCY, YenCF. Taiwan: Pioneer of the health and well-being of sexual minorities in Asia. Arch Sex Behav, 2017; 46(6):1577–1579; doi: 10.1007/s10508-017-1036-z
14.
HatzenbuehlerML, PhelanJC, LinkBG. Stigma as a fundamental cause of population health inequalities. Am J Public Health, 2013; 103(5):813–821; doi: 10.2105/AJPH.2012.301069
15.
DiamondLM, AlleyJ. Rethinking minority stress: A social safety perspective on the health effects of stigma in sexually-diverse and gender-diverse populations. Neurosci Biobehav Rev, 2022; 138:104720; doi: 10.1016/j.neubiorev.2022.104720
16.
HaarmannL, LiekerE, FolkertsAK, et al.Higher risk of many physical health conditions in sexual minority men: Comprehensive systematic review and meta-analysis in gay- and bisexual-identified compared with heterosexual-identified men. LGBT Health, 2024; 11(2):81–102; doi: 10.1089/lgbt.2023.0084
17.
CorreroAN, NielsonKA. A review of minority stress as a risk factor for cognitive decline in lesbian, gay, bisexual, and transgender (LGBT) elders. J Gay Lesbian Ment Health, 2020; 24(1):2–19; doi: 10.1080/19359705.2019.1644570
18.
Hoy-EllisCP. Minority stress and mental health: A review of the literature. J Homosex, 2023; 70(5):806–830; doi: 10.1080/00918369.2021.2004794
19.
MeyerIH. Resilience in the study of minority stress and health of sexual and gender minorities. Psychol Sex Orientat Gend Divers, 2015; 2(3):209–213; doi: 10.1037/sgd0000132
20.
BaioccoR, ScandurraC, RosatiF, et al.Minority stress, resilience, and health in Italian and Taiwanese LGB+ people: A cross-cultural comparison. Curr Psychol, 2023; 42(1):104–115; doi: 10.1007/s12144-021-01387-2
21.
AuA. Network discrimination against LGBTQ minorities in Taiwan after same-sex marriage legalization: A Goffmanian micro-sociological approach. Crit Asian Stud, 2022; 54(4):594–618; doi: 10.1080/14672715.2022.2100803
22.
SunS, PachankisJE, LiX, et al.Addressing minority stress and mental health among men who have sex with men (MSM) in China. Curr HIV/AIDS Rep, 2020; 17(1):35–62; doi: 10.1007/s11904-019-00479-w
23.
AdamczykA, ChengYA. Explaining attitudes about homosexuality in Confucian and non-Confucian nations: Is there a ‘cultural’ influence? Soc Sci Res, 2015; 51:276–289; doi: 10.1016/j.ssresearch.2014.10.002
24.
WangCC, LinHC, ChenMH, et al.Effects of traditional and cyber homophobic bullying in childhood on depression, anxiety, and physical pain in emerging adulthood and the moderating effects of social support among gay and bisexual men in Taiwan. Neuropsychiatr Dis Treat, 2018; 14:1309–1317; doi: 10.2147/NDT.S164579
25.
WangCC, HsiaoRC, YenCF. Victimization of traditional and cyber bullying during childhood and their correlates among adult gay and bisexual men in Taiwan: A retrospective study. Int J Environ Res Public Health, 2019; 16(23):4634; doi: 10.3390/ijerph16234634
26.
WangP, KoN, HsiaoRC, et al.Suicidality among gay and bisexual men in Taiwan: Its relationships with sexuality and gender role characteristics, homophobic bullying victimization, and social support. Suicide Life Threat Behav, 2019; 49(2):466–477; doi: 10.1111/sltb.12451
27.
ChanRCH, HuangYT. A typology of intergenerational relationships between Taiwanese gay and bisexual men and their parents: Negotiating outness and co-residence in Chinese families. Sex Res Soc Policy, 2022; 19(1):295–307; doi: 10.1007/s13178-021-00542-5
28.
LauBHP, HuangYT, ForthMW, et al.Does same-sex marriage legalization make gay men want to have children? Findings from a panel study in Taiwan. Sex Res Social Policy, 2023; 20(3):1–9; doi: 10.1007/s13178-023-00801-7
29.
ChangCC, LuHY, ChangYP, et al.Perceived attitudes of family and peers toward same-sex marriage as a distal sexual minority stressor for gay and bisexual men in Taiwan. BMC Public Health, 2022; 22(1):2143; doi: 10.1186/s12889-022-14604-9
30.
HuangYT. Body dissatisfaction, sexual minority stress, and relationship satisfaction among sexual minority men in Taiwan. Clin Soc Work J, 2023; 51(1):100–111; doi: 10.1007/s10615-022-00855-x
31.
MayoD, LozanoA, WilliamsRS, et al.The relationship between intersectional oppression and affirmation and Latino sexual minority men’s mental health. LGBT Health, 2023; 10(8):629–638; doi: 10.1089/lgbt.2022.0212
32.
McConnellEA, BirkettMA, MustanskiB. Typologies of social support and associations with mental health outcomes among LGBT youth. LGBT Health, 2015; 2(1):55–61; doi: 10.1089/lgbt.2014.0051
33.
ShramkoM, ToomeyRB, AnhaltK. Profiles of minority stressors and identity centrality among sexual minority Latinx youth. Am J Orthopsychiatry, 2018; 88(4):471–482; doi: 10.1037/ort0000298
34.
PuckettJA, HorneSG, HerbitterC, et al.Differences across contexts: Minority stress and interpersonal relationships for lesbian, gay, and bisexual women. Psychol Women Q, 2017; 41(1):8–19; doi: 10.1177/0361684316655964
35.
HowardMC, HoffmanME. Variable-centered, person-centered, and person-specific approaches: Where theory meets the method. Organ Res Methods, 2018; 21(4):846–876; doi: 10.1177/1094428117744021
36.
MarcoulidesGA, SchumackerRE. New Developments and Techniques in Structural Equation Modeling. Psychology Press: London, UK; 2001.
37.
LiuF, RenZ, ChuiH, et al.Coming out among Chinese LGB adults: A latent profile analysis. Sex Res Soc Policy, 2024; 21(1):193–209; doi: 10.1007/s13178-023-00877-1
38.
HeA, BuH, ChenC, et al.Self-criticism and subjective emptiness among gay and bisexual men: A latent profile analysis. Sex Res Soc Policy, 2024; 21(3):1036–1046; doi: 10.1007/s13178-023-00885-1
39.
XuW, ZhengL, XuY, et al.Internalized homophobia, mental health, sexual behaviors, and outness of gay/bisexual men from Southwest China. Int J Equity Health, 2017; 16(1):36; doi: 10.1186/s12939-017-0530-1
40.
MayoD, HuangP. Exploring determinants of pre-exposure prophylaxis awareness and willingness among sexual minority men in Taiwan: A stochastic search variable selection approach. AIDS Care, 2025; 37(4):588–597; doi: 10.1080/09540121.2025.2458628
41.
MayoD, HuangP. Pre-exposure prophylaxis engagement among sexual minority men in Taiwan: A behavioral health perspective. J Behav Med, 2025; 48(4):694–705; doi: 10.1007/s10865-025-00572-z
42.
LiJ, HuangD, WindleM, et al.Minority stress, depression, and cigarette smoking among Chinese gay versus bisexual men: A two-group structural equation model analyses. BMC Public Health, 2021; 21(1):1358; doi: 10.1186/s12889-021-10888-5
43.
SunS, HoytWT, TarantinoN, et al.Cultural context matters: Testing the minority stress model among Chinese sexual minority men. J Couns Psychol, 2021; 68(5):526–537; doi: 10.1037/cou0000535
44.
LiuY. The Survey Study of Lesbian, Gay, Bisexual, and Transgender Identity in Taiwan. Master’s Dissertation. National Chi Nan University: Nantou County, Taiwan; 2015.
45.
SternthalMJ, SlopenN, WilliamsDR. Racial disparities in health: How much does stress really matter? Du Bois Rev, 2011; 8(1):95–113; doi: 10.1017/S1742058X11000087
46.
MohrJJ, KendraMS. Revision and extension of a multidimensional measure of sexual minority identity: The Lesbian, Gay, and Bisexual Identity Scale. J Couns Psychol, 2011; 58(2):234–245; doi: 10.1037/a0022858
47.
BrennerPS, SerpeRT, StrykerS. The causal ordering of prominence and salience in Identity Theory: An empirical examination. Soc Psychol Q, 2014; 77(3):231–252; doi: 10.1177/0190272513518337
48.
LöweB, KroenkeK, GräfeK. Detecting and monitoring depression with a two-item questionnaire (PHQ-2). J Psychosom Res, 2005; 58(2):163–171; doi: 10.1016/j.jpsychores.2004.09.006
49.
ChenIP, LiuSI, HuangHC, et al.Validation of the Patient Health Questionnaire for depression screening among the elderly patients in Taiwan. Int J Gerontol, 2016; 10(4):193–197; doi: 10.1016/j.ijge.2016.05.002
50.
LiuSI, YehZT, HuangHC, et al.Validation of Patient Health Questionnaire for depression screening among primary care patients in Taiwan. Compr Psychiatry, 2011; 52(1):96–101; doi: 10.1016/j.comppsych.2010.04.013
51.
AustF, DiedenhofenB, UllrichS, et al.Seriousness checks are useful to improve data validity in online research. Behav Res Methods, 2013; 45(2):527–535; doi: 10.3758/s13428-012-0265-2
52.
StekhovenDJ, BühlmannP. MissForest—Non-parametric missing value imputation for mixed-type data. Bioinformatics, 2012; 28(1):112–118; doi: 10.1093/bioinformatics/btr597
53.
WaljeeAK, MukherjeeA, SingalAG, et al.Comparison of imputation methods for missing laboratory data in medicine. BMJ Open, 2013; 3(8):e002847; doi: 10.1136/bmjopen-2013-002847
54.
SpurkD, HirschiA, WangM, et al.Latent profile analysis: A review and “how to” guide of its application within vocational behavior research. J Vocat Behav, 2020; 120:103445; doi: 10.1016/j.jvb.2020.103445
55.
NylundKL, AsparouhovT, MuthénBO. Deciding on the number of classes in latent class analysis and growth mixture modeling: A Monte Carlo simulation study. Struct Equ Model Multidiscip J, 2007; 14(4):535–569; doi: 10.1080/10705510701575396
56.
CeleuxG, SoromenhoG. An entropy criterion for assessing the number of clusters in a mixture model. J Classif, 1996; 13(2):195–212; doi: 10.1007/BF01246098
57.
MarshHW, LüdtkeO, TrautweinU, et al.Classical latent profile analysis of academic self-concept dimensions: Synergy of person- and variable-centered approaches to theoretical models of self-concept. Struct Equ Model Multidiscip J, 2009; 16(2):191–225; doi: 10.1080/10705510902751010
58.
XuC, MiaoL, TurnerD, et al.Urbanicity and depression: A global meta-analysis. J Affect Disord, 2023; 340:299–311; doi: 10.1016/j.jad.2023.08.030
59.
RossLE, SalwayT, TarasoffLA, et al.Prevalence of depression and anxiety among bisexual people compared to gay, lesbian, and heterosexual individuals: A systematic review and meta-analysis. J Sex Res, 2018; 55(4–5):435–456; doi: 10.1080/00224499.2017.1387755
60.
McParlandJ, CamicPM. Psychosocial factors and ageing in older lesbian, gay and bisexual people: A systematic review of the literature. J Clin Nurs, 2016; 25(23–24):3415–3437; doi: 10.1111/jocn.13251
61.
JespersenA, MaddenRA, WhalleyHC, et al.Socioeconomic status and depression—A systematic review. Epidemiol Rev, 2025; 47(1):mxaf011; doi: 10.1093/epirev/mxaf011
62.
Hoy-EllisCP, Fredriksen-GoldsenKI. Lesbian, gay, & bisexual older adults: Linking internal minority stressors, chronic health conditions, and depression. Aging Ment Health, 2016; 20(11):1119–1130; doi: 10.1080/13607863.2016.1168362
63.
RosenbergJ, BeymerP, AndersonD, et al.tidyLPA: An R package to easily carry out latent profile analysis (LPA) using open-source or commercial software. Joss, 2018; 3(30):978; doi: 10.21105/joss.00978
64.
WickhamH. Ggplot2: Elegant Graphics for Data Analysis. 2nd ed. 2016. Use R!. Springer International Publishing: Springer: Cham, Switzerland; 2016.
65.
VenablesWN, RipleyBD. Modern Applied Statistics with S. 4th ed. Statistics and Computing. Springer: New York, NY; 2002.
66.
Nylund-GibsonK, ChoiAY. Ten frequently asked questions about latent class analysis. Transl Issues Psychol Sci, 2018; 4(4):440–461; doi: 10.1037/tps0000176
67.
KaprinisS, CharalampakisA. Social exclusion and psychopathology in LGBTQ+ communities: A neuropsychosocial review. Front Sociol, 2025; 10:1638766; doi: 10.3389/fsoc.2025.1638766
68.
SlavichGM, RoosLG, MengelkochS, et al.Social Safety Theory: Conceptual foundation, underlying mechanisms, and future directions. Health Psychol Rev, 2023; 17(1):5–59; doi: 10.1080/17437199.2023.2171900
69.
BrainerA. Lesbian and gay parents, heterosexual kinship, and queer dreams: Making families in twenty-first century Taiwan. Positions Asia Crit, 2021; 29(3):633–656; doi: 10.1215/10679847-8978386
70.
ChenJ. Taiwanese gay fathers’ queer family making: Toward a temporal-relational path. LGBTQ Fam Interdiscip J, 2024; 20(1):35–54; doi: 10.1080/27703371.2023.2262425
71.
LeeH, ParkJ, ChoiB, et al.Association between discrimination and depressive symptoms among 2,162 lesbian, gay, and bisexual adults in South Korea: Does community connectedness modify the association? J Homosex, 2021; 68(1):70–87; doi: 10.1080/00918369.2019.1624456
72.
Skakoon-SparlingS, CoxJ, LachowskyNJ, et al.Minority stressors and connectedness among urban gay, bisexual, and queer men. Psychol Men Masculinities, 2022; 23(2):245–256; doi: 10.1037/men0000388
73.
HuangYT, LuoH, KoNY, et al.Perceived attitudes toward lesbian, gay, and bisexual (LGB) issues and mental health among Taiwanese LGB adults: The mediating role of self-acceptance. Arch Sex Behav, 2020; 49(5):1671–1682; doi: 10.1007/s10508-020-01686-y
74.
PerssonA, NewmanCE, ManolasP, et al.Challenging perceptions of “straight”: Heterosexual men who have sex with men and the cultural politics of sexual identity categories. Men Masculinities, 2019; 22(4):694–715; doi: 10.1177/1097184X17718586
75.
ThöniC, EisnerL, HässlerT. Not straight enough, nor queer enough: Identity denial, stigmatization, and negative affect among bisexual and pansexual people. Psychol Sex Orientat Gend Divers, 2024; 11(2):237–249; doi: 10.1037/sgd0000606
76.
MacNeelaP, MurphyA. Freedom, invisibility, and community: A qualitative study of self-identification with asexuality. Arch Sex Behav, 2015; 44(3):799–812; doi: 10.1007/s10508-014-0458-0
77.
HenriquezNR, AhmadN. “The message is you don’t exist”: Exploring lived experiences of rural lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) people utilizing health care services. SAGE Open Nurs, 2021; 7:23779608211051174; doi: 10.1177/23779608211051174
78.
McGarrityLA. Socioeconomic status as context for minority stress and health disparities among lesbian, gay, and bisexual individuals. Psychol Sex Orientat Gend Divers, 2014; 1(4):383–397; doi: 10.1037/sgd0000067
79.
ZhouM, ThayerWM, BridgesJFP. Using latent class analysis to model preference heterogeneity in health: A systematic review. Pharmacoeconomics, 2018; 36(2):175–187; doi: 10.1007/s40273-017-0575-4
80.
ItoH, SetoyaY, SuzukiY. Lessons learned in developing community mental health care in East and South East Asia. World Psychiatry, 2012; 11(3):186–190; doi: 10.1002/j.2051-5545.2012.tb00129.x
81.
MascayanoF, Toso-SalmanJ, HoYCS, et al.Including culture in programs to reduce stigma toward people with mental disorders in low- and middle-income countries. Transcult Psychiatry, 2020; 57(1):140–160; doi: 10.1177/1363461519890964
82.
MayoD, MayaDHA, PuccinelliM, et al.Exploring Latino cultural factors from the perspective of sexual minority men in the USA. Cult Health Sex, 2025; 27(7):852–867; doi: 10.1080/13691058.2024.2405938
83.
HuangYT, MaYT, CraigSL, et al.How intersectional are mental health interventions for sexual minority people? A systematic review. LGBT Health, 2020; 7(5):220–236; doi: 10.1089/lgbt.2019.0328
