Psychosocial symptom networks and high-risk sexual behaviors among men who have sex with men: a network analysis

Background Psychosocial problems are highly prevalent among men who have sex with men (MSM) and are linked to high-risk sexual behaviors. However, their interconnections—especially the roles of internalized homonegativity and sociosexual orientation—remain underexplored. This study aimed to: (1) model psychosocial symptom networks among MSM; (2) compare network structures across demographic subgroups; and (3) examine how central symptoms relate to high-risk sexual behaviors. Methods A cross-sectional survey was conducted among 405 MSM in Taizhou, China, using venue-based and online snowball sampling. Psychosocial variables—including depression, anxiety, self-esteem, internalized homonegativity, loneliness, perceived social support, and sociosexual orientation—were assessed using validated self-report scales. High-risk sexual behavior was measured based on condom use and number of sexual partners. Network analysis was used to examine symptom-level associations, and network comparison tests explored differences across demographic subgroups. Associations between central symptoms and high-risk behaviors were examined using correlation and regression analyses. Results Among 405 MSM, 12.4% reported moderate-to-severe depression and 10.1% had moderate-to-severe anxiety. Network analysis revealed the strongest connections between depressive and anxiety symptoms, as well as between loneliness and the desire for uncommitted sexual relationships. Central symptoms identified included ‘feeling nervous’ , desire for uncommitted sexual relationships, ‘feeling tired’ , ‘lacking companionship’, and ‘no good’ . Significant structural differences were found between participants < 33 years and those ≥ 33 years (p = 0.017), with older individuals showing generally weaker psychosocial connections. Central symptoms were significantly associated with risky sexual behaviors, especially in younger participants. Conclusions Central psychosocial problems—particularly emotional symptoms, low self-esteem, loneliness, and sociosexual desire—play a key role in driving high-risk sexual behaviors among MSM. Targeted, age-specific mental health interventions are essential to mitigate these risks and promote holistic well-being.