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Diverse Rates of Depression Among Men Who Have Sex with Men (MSM) Across India: Insights from a Multi-site Mixed Method Study

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Abstract

Poor psychosocial health contributes to HIV risk behavior and reduced engagement in treatment and care. This study investigates depression and its correlates among 11,992 MSM recruited via respondent driven sampling in 12 cities across India using the Patient Health Questionnaire-9 and supplemented by analysis of qualitative research from 15 sites with 363 MSM. Overall prevalence of depression was 11 %, with substantial variation across sites and subgroups of MSM, and high prevalence of suicidal thoughts among depressed MSM. In multivariable analyses identification as a kothi (feminine sexual identity) [adjusted odds ratio (aOR) = 1.91], disclosure of being MSM to non-family (aOR = 1.7) and family (aOR = 2.4), disclosure of HIV-status (aOR = 5.6), and substance use were associated with significantly higher odds of depression. Qualitative results emphasized dire social consequences of disclosing MSM- and HIV-status, especially to family, including suicidality. Combination prevention interventions should include mental health services that address disclosure, suicidality, and substance use.

Resumen

La mala salud psicosocial contribuye a los comportamientos de riesgo para el VIH y reduce la participación en el tratamiento y cuidado médico. Este estudio investiga la depresión y los factores que se encuentran correlacionados con ella en 11.992 HSH reclutados a través de un muestreo dirigido por entrevistados (MCE) en 12 ciudades de la India usando el Cuestionario sobre la Salud del Paciente-9 y complementado por una investigación cualitativa en 15 sitios con 363 HSH. La prevalencia general de la depresión fue del 11 %, con una variación sustancial entre los sitios y subgrupos de HSH y con alta prevalencia de pensamientos suicidas entre los HSH deprimidos. En el análisis multivariable, el identificarse como kothi (identidad sexual femenina) (odds ratio ajustada [ORa] = 1,91), el divulgarse como HSH a otra persona en el entorno familiar (ORa = 1,7), o fuera del entorno familiar (ORa = 2,4), el divulgar el estado serológico de VIH positivo (ORa = 5,6), y el consumo de sustancias, fueron los factores que estuvieron asociados significativamente con mayores probabilidades de depresión. Los resultados cualitativos enfatizan que existen consecuencias sociales graves en cuanto a la divulgación de ser HSH o a la divulgación de un estado serológico de VIH positivo, especialmente a la familia, incluyendo el riesgo suicida. Las intervenciones de prevención combinadas deben incluir servicios de salud mental que abarquen la divulgación, el riesgo suicida, y el uso de sustancias.

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Acknowledgments

This research has been supported by Grants from the National Institutes of Health R01MH89266 and R21MH101059, and the Johns Hopkins Center for AIDS Research (1P30AI094189).

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Authors and Affiliations

  1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6648, Baltimore, MD, 21205, USA

    Cecilia Tomori, Allison M. McFall, Shruti H. Mehta & David D. Celentano

  2. YR Gaitonde Centre for AIDS Research and Education, Chennai, India

    Aylur K. Srikrishnan, Santhanam Anand, Canjeevaram K. Vasudevan & Suniti Solomon

  3. Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA

    Sunil S. Solomon

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  1. Cecilia Tomori
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Correspondence to Cecilia Tomori.

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Tomori, C., McFall, A.M., Srikrishnan, A.K. et al. Diverse Rates of Depression Among Men Who Have Sex with Men (MSM) Across India: Insights from a Multi-site Mixed Method Study. AIDS Behav 20, 304–316 (2016). https://doi.org/10.1007/s10461-015-1201-0

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