背景
藥愛是男男性行為者間以藥助性的一種形式，目的是使用藥物來促進、增強或延長性行為。過去探討藥愛與憂鬱間相關性的研究呈現了不一致的結果，可能肇因於橫斷性的設計且這些研究並未區辨不同藥愛型態對憂鬱的影響。本研究目的是利用長期追蹤資料方法來探討藥愛軌跡的異質性，以及藥愛軌跡與憂鬱的相關性。

方法
本研究在兩個性健康門診招募受試者。收案條件為符合年齡大於20歲，且提供至少兩波藥愛及憂鬱問卷資料之男男性行為者。藥愛測量是詢問性行為中使用特定藥物，如methamphetamine、ketamine或GHB/GBL，的比例。憂鬱程度以PHQ-9量表評估，總分10分以上為中重度憂鬱症狀。統計分析使用群組化軌跡模式進行藥愛軌跡分組、以廣義估計方程式之多元羅吉斯迴歸分析藥愛軌跡與憂鬱在兩年追蹤期間的相關性。

結果
在2017年11月到2021年12月間共有256位受試者被納入分析，共分析出三種不同的藥愛軌跡：很少使用（87.4%）、持續使用（8.8%）、高度下降後復用（3.8%）；高度下降後復用組在初期報告高度使用藥愛並在三個月後下降，但在結束追蹤前復用。與很少使用組相比，被歸類在持續使用組及高度下降後復用組與憂鬱變化並無顯著相關（持續使用組：aOR=1.34, 95% CI= 0.42-4.27；高度下降後復用組：aOR=1.68, 95% CI=0.51-5.53）。

結論
本研究結果指出男男性行為者藥愛行為的異質性，然不同藥愛軌跡對憂鬱變化沒有顯著影響。藉由瞭解不同的藥愛型態和潛在憂鬱風險差異，臨床照顧專業人員可以提供人本中心介入以滿足不同亞群體的需求。

Background
Chemsex is a form of sexualized drug use to facilitate, enhance or prolong sexual experiences among men who have sex with men (MSM). Previous research has linked chemsex use to depression but revealed inconsistent results, probably owing to cross-sectional design and failure to distinguish the chemsex patterns. This study aims to explore the heterogenous profiles of chemsex trajectory and the association with depression using a longitudinal approach.

Methods
Participants were recruited from two sexual health clinics. MSM were eligible if they were 20 years old or above and provided at least two waves of outcome measurements at baseline and follow-up questionnaires. Chemsex was measured by proportions of certain drug use in a sexual context, such as methamphetamine, ketamine and γ-hydroxybutyrate/γ-butyrolactone (GHB/GBL). Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9) with a cutoff of 10 indicating moderate to severe depressive symptoms. Group-based trajectory modeling was used to identify trajectories of chemsex, and multivariable generalized estimating equations logistic model was used to examine the association between chemsex trajectories and depression over 2 years of follow-up.

Results
During November 2017 and December 2021, 256 MSM were included in this analysis. Three chemsex trajectory groups were identified, including “rarely use” (87.4%), “consistently use” (8.8%), and “high decreasing and relapse” (3.8%) who reported highest proportion of chemsex at the initial visit then declined after three months but relapse at the end of follow-up. “Consistently use” and “high decreasing and relapse” were not associated with depression when compared to “rarely use” (adjusted odds ratio [aOR]=1.34, 95% confidence interval [CI]= 0.42-4.27; aOR=1.68, 95% CI=0.51-5.53; respectively).

Conclusion
The findings of the present study suggest the heterogeneity of chemsex behaviors among MSM but no association between chemsex trajectories and depression. By understanding diverse patterns of chemsex and potential disproportionate risks of depression, healthcare professionals can provide person-centered approaches to meet specific needs of different subgroups.

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