Unpacking the link between adverse childhood experiences and mental health disparities among Chinese men who have sex with men: The mediating role of filial piety and internalized homophobia.

Adverse childhood experiences had a significant total effect on depressive symptoms among Chinese MSM.

• The total effect of ACEs on depressive symptoms was b = 0.8327, p < 0.001.
• 1085 MSM completed a self-administered, anonymous questionnaire after screening for eligibility.
• Participants were recruited between October 2023 and May 2024 from a gay-friendly NGO in Zhejiang Province, China.
• Serial mediation analyses were conducted using PROCESS macro model 80 with bootstrapping procedures.

Compassionate reverence (a dimension of filial piety) served as a significant mediator between ACEs and depressive symptoms.

• The indirect effect through compassionate reverence was β = 0.0696, 95% CI [0.0222, 0.1238].
• The confidence interval did not include zero, confirming statistical significance.
• Compassionate reverence represents one of two filial piety dimensions examined in the study.

Internalized homophobia served as a significant mediator between ACEs and depressive symptoms.

• The indirect effect through internalized homophobia was β = 0.0622, 95% CI [0.0288, 0.1039].
• The confidence interval did not include zero, confirming statistical significance.
• This pathway operated independently of filial piety dimensions.

A significant negative serial mediation effect was observed through pragmatic obligations followed by internalized homophobia.

• The serial mediation effect through pragmatic obligations and internalized homophobia was β = -0.0177, 95% CI [-0.0311, -0.0079].
• The negative direction of this effect indicates that pragmatic obligations may buffer the pathway from ACEs through internalized homophobia to depressive symptoms.
• Pragmatic obligations represent the second dimension of filial piety examined in the study.
• This finding revealed the complex and divergent roles of the two filial piety dimensions in mental health outcomes.

The two dimensions of filial piety showed distinct and opposing roles in the relationship between ACEs and mental health outcomes among Chinese MSM.

• Compassionate reverence showed a positive indirect effect (β = 0.0696) whereas pragmatic obligations showed a negative serial mediation effect (β = -0.0177) when combined with internalized homophobia.
• The study distinguished between pragmatic obligations and compassionate reverence as separate constructs within filial piety.
• These findings suggest that cultural values interact with sexual identity stigma in complex ways to shape mental health.