A Description of Common Mental Disorders in Men Who Have Sex with Men (MSM) Referred for Assessment and Intervention at an MSM Clinic in Cape Town, South Africa
First Online: 27 March 2013 DOI:
Cite this article as: Stoloff, K., Joska, J.A., Feast, D. et al. AIDS Behav (2013) 17: 77. doi:10.1007/s10461-013-0430-3 Abstract
Men who have sex with men (MSM) have a higher prevalence of common mental disorders (CMD), as compared with heterosexual men. HIV infection is independently associated with higher rates of CMD. Given this context, and the high background community prevalence of HIV in South Africa, MSM are at even greater risk of developing CMD. The aim of this research was to investigate neuropsychiatric symptoms and disorders in MSM who were referred for assessment and management of mental health problems, in an MSM Clinic in urban Cape Town, South Africa. Twenty-five men were screened using the MINI, AUDIT, DUDIT, and IPDE Screener. Depression, suicidality, as well as alcohol and drug use disorders were highly prevalent in this group (44, 56, 48, and 56 % respectively). The personality disorder screening was suggestive of a high prevalence of personality disorders. The high prevalence of neuropsychiatric disorders in this sample supports the idea that integrated mental health services are needed to address the complex needs of this population. Adequate input into the mental health needs of this population could reduce the potential for HIV acquisition and transmission, improve adherence to treatment and care, and ensure the provision a comprehensive health service for MSM.
Keywords MSM HIV/AIDS South Africa Mental health DUDIT MINI AUDIT IPDE References
Gillman SE, Cochrane SD, Mays VM, Hughes M, Ostrow DG, Kessler RC. Risks of psychiatric disorders among individuals reporting same-sex sexual partners in the National Comorbidity Survey. Am J Public Health. 2001;91:933.
Sandfort TG, de Graaf R, Bijl RV, Schnabel P. Same-sex sexual behavior and psychiatric disorders: findings from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Arch Gen Psychiatry. 2001;58:85–91.
Herrel R, Goldberg J, Ramakrishnam V, Lyons M, Eisen S, Tsuang MT. Sexual orientation and suicidality: a co-twin control study in adult men. Arch Gen Psychiatry. 1999;56:867–74.
Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129(5):674–97.
Lane T, Raymond F, Dladla S, Rasethe J, Struthers H, McFarland W, et al. High HIV prevalence among men who have sex with men in Soweto, South Africa: results from the Soweto Men’s Study. AIDS Behav. 2009;15(3):626–34.
Burrell E, Mark D, Grant R, Wood R, Bekker LG. Sexual risk behaviours and HIV-1 prevalence among urban men who have sex with men in Cape Town, South Africa. Sex Health. 2010;7(2):149–53.
Bing EG, Burnam MA, Longshaw D, Fleishman JA, Sherbourne CD, London AS. Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States. Arch Gen Psychiatry. 2001;58(8):721–8.
Ciesla JA, Roberts JE. Meta-analysis of the relationship between HIV infection and risk for depressive disorders. Am J Psychiatry. 2001;158(5):725–30.
Fairfield KM, Libman H, Davis RB, Eisenberg DM. Delays in protease inhibitor use in clinical practice. J Gen Intern Med. 1999;14(7):395–401.
Ickovics JR, Hamburger ME, Vlahov D, Schoenbaum EE, Schuman P, Boland RJ. Mortality, CD4 cell count decline, and depressive symptoms among HIV-seropositive women: longitudinal analysis from the HIV Epidemiology Research Study. JAMA. 2001;285(11):1466–74.
Ironson G, Balbin E, Stuetzler R, Fletcher MA, O’Cleirigh C, Laurenceau JP. Dispositional optimism and the mechanisms by which it predicts slower HIV: proactive behaviour, avoidant coping, and depression. J Behav Med. 2005;12(2):86–97.
Ammassari A, Trotta MP, Murri R, Castelli F, Narciso P, Noto P. Correlates and predictors of adherence to highly active anti-retroviral therapy: overview of published literature. J Acquir Immune Defic Syndr. 2002;31(S3):123–7.
Nakimuli-Mpungu E, Mutamba B, Othengo M, Musisi S. Psychological Distress and adherence to highly active anti-retroviral therapy (HAART) in Uganda: a pilot study. Afr Health Sci. 2009;9(S1):S2–7.
Vu L, Tun W, Sheehy M, Nel D. Levels and correlates of internalized homophobia among men who have sex with men in Pretoria, South Africa. AIDS Behav. 2011;16(3):717–23.
Simbayi LC, Kalichman SC, Strebel A, Cloete A, Henda N, Mqeketo A. Internalized stigma, discrimination, and depression among men and women living with HIV/AIDS in Cape Town, South Africa. Soc Sci Med. 2007;64:1823–31.
Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I): the development and validation of a structured diagnostic psychiatric interview for DSM-4 and ICD-10. J Clin Psychiatry. 1998;59(S20):S22–33.
Myer L, Smit J, Roux LL, Parker S, Stein DJ, Seedat S. Common mental disorders among HIV-infected individuals in South Africa: prevalence, predictors, and validation of brief psychiatric rating scales. AIDS Patient Care and STDS. 2008;22(2):147–58.
Loranger AW, Sartorius N, Andreoli A, Berger P, Bucheim P, Channabasavanna SM, et al. The International Personality Disorder Examination. The World Health Organization/Alcohol, Drug Abuse, and Mental Health Administration international pilot study of personality disorders. Arch Gen Psychiatry. 1994;51(3):215–24.
Samet JH, Horton NJ, Meli S, Freedberg KA, Palepu A. Alcohol consumption and anti-retroviral adherence among HIV-infected persons with alcohol problems. Alcohol Clin Exp Res. 2004;28(4):572–577572.
Lucas M, Stevenson D. Violence and abuse in psychiatric in-patient institutions: a South African Perspective. Int J Law Psychiatry. 2006;29(3):195–203.
Kalichman SC, Simbayi LC, Cain D, Jooste S. Alcohol expectancies and risky drinking among men and women at high-risk for HIV infection in Cape Town, South Africa. Addict Behav. 2007;32(10):2304–10.
Kalichman SC, Simbayi LC, Kagee A, Toefy Y, Jooste S, Cain D. Associations of poverty, substance use, and HIV transmission risk behaviors in three South African communities. Soc Sci Med. 2006;62(7):1641–9.
Simbayi LC, Kalichman SC, Jooste S, Mathirti V, Cain D, Cherry C. Alcohol use and sexual risks for HIV infection among men and women receiving sexual transmitted infection clinic services in Cape Town, South Africa. J Stud Alcohol. 2004;65(4):434–42.
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