Top

Published in:

Open Access 01-12-2021 | Mood Disorders | Research

Social and structural factors associated with depression and suicidality among men who have sex with men and transgender women in Nepal

Authors: Sanna Storm, Keshab Deuba, Rachana Shrestha, Lok Raj Pandey, Deepak Dahal, Madan Kumar Shrestha, Tara Nath Pokhrel, Gaetano Marrone

Published in: BMC Psychiatry | Issue 1/2021

Abstract

Introduction

The prevalence of depression and suicidality is high among men who have sex with men (MSM) and transgender women (TGW) worldwide. Stigma and discrimination are likely contributing factors. More research is needed in low-income, non-English speaking countries to assess the effects of social and structural factors on depression and suicidality among MSM and TGW.

Methods

Nepalese MSM and TGW (n = 340) were recruited using a respondent-driven sampling design and filled out a survey questionnaire. The outcomes were depression and suicidality. Data was analyzed using bivariate and multivariable logistic regression.

Results

More than half of the participants (59%) suffered from depression. Severe depression was more common among TGW compared to MSM (41 and 20%, respectively). When it comes to suicidality, TGW had higher lifetime prevalence of suicidal thoughts compared to MSM (32 and 5%, respectively). Depression was positively associated with sex work both for MSM (AOR: 7.9; 95% CI 3.4–18.2) and TGW (AOR: 6.5; 95% CI: 2.3–18.2). MSM who were evicted by family had high odds of suicidal thoughts (AOR: 6.2; 95% CI: 1.3–28.8). For TGW, suicidality was associated with being cheated and threatened (AOR: 3.9; 95% CI: 1.2–12.5) and having forced to marry a female (AOR: 2.2; 95% CI 1.1–5.1).

Conclusions

Nepalese MSM and TGW suffer from a high degree of mental and psychosocial health issues. Future studies should focus on intervention research and on collecting data from a larger variety of gender and sexual minorities.

Available only for authorised users

Svensk MeSH [Internet]. Stockholm: Karolinska institutet. Universitetsbiblioteket; 1998 -. [cited 2019 May 09]. Available from: https://mesh.kib.ki.se/term/D000072339/sexual-and-gender-minorities

Asia Pacific Forum of National Human Rights Institutions, United Nations Development Programme. Promoting and Protecting Human Rights in relation to Sexual Orientation, Gender Identity and Sex Characteristics: A Manual for National Human Rights Institutions [Internet]. Sydney: Asia Pacific Forum of National Human Rights Institutions; 2016. [cited 2019 Feb 12]. Available from: http://www.asia-pacific.undp.org/content/rbap/en/home/library/democratic_governance/hiv_aids/promoting-and-protecting-human-rights-in-relation-to-sexual-orie/

Freeland R, Rogers E, van Rooyen H, Darbes L, Saylor K, Stephenson R. Measurements of sexuality-based stigma among gay, bisexual, and other men who have sex with men (GBMSM) in resource poor settings: a review. AIDS Behav. 2018;22(5):1614–38. https://doi.org/10.1007/s10461-017-1975-3.CrossRefPubMed

Poteat T, Ackerman B, Diouf D, Ceesay N, Mothopeng T, Odette KZ, et al. HIV prevalence and behavioral and psychosocial factors among transgender women and cisgender men who have sex with men in 8 African countries: a cross-sectional analysis. PLoS Med. 2017;14(11):e1002422. https://doi.org/10.1371/journal.pmed.1002422.CrossRefPubMedPubMedCentral

Brennan DJ, Bauer GR, Bradley K, Tran OV. Methods used and topics addressed in quantitative Health Research on gay, bisexual and other men who have sex with men: a systematic review of the literature. J Homosex. 2017;64(11):1519–38. https://doi.org/10.1080/00918369.2016.1247537.CrossRefPubMed

Tantirattanakulchai P, Hounnaklang N. Perceived social support and its relationship with depression among Bangkok’s trans women. J Health Res. 2021. Online ahead of print. https://doi.org/10.1108/JHR-05-2020-0165.

Patel S, Prabhakar P, Saggurti N. Factors associated with mental depression among men who have sex with men in southern India. Health. 2015;7(09):1114–23. https://doi.org/10.4236/health.2015.79127.CrossRef

Vu N, Holt M, Phan H, La L, Tran G, Doan T, et al. Amphetamine-type-stimulants (ATS) use and homosexuality-related enacted stigma are associated with depression among men who have sex with men (MSM) in two major cities in Vietnam in 2014. Subst Use Misuse. 2017;52(11):1411–9. https://doi.org/10.1080/10826084.2017.1284233.CrossRefPubMed

Chakrapani V, Scheim A, Newman P, Shunmugam M, Rawat S, Baruah D, et al. Affirming and negotiating gender in family and social spaces: Stigma, mental health and resilience among transmasculine people in India. Cult Health Sex. 2021. Online ahead of print. https://doi.org/10.1080/13691058.2021.1901991.

10.

Salway T, Ross LE, Fehr CP, Burley J, Asadi S, Hawkins B, et al. A systematic review and Meta-analysis of disparities in the prevalence of suicide ideation and attempt among bisexual populations. Arch Sex Behav. 2019;48(1):89–111. https://doi.org/10.1007/s10508-018-1150-6.CrossRefPubMed

11.

Plöderl M, Tremblay P. Mental health of sexual minorities. A systematic review. Int Rev Psychiatry. 2015;27(5):367–85. https://doi.org/10.3109/09540261.2015.1083949.CrossRefPubMed

12.

Mathy R. Suicidality and sexual orientation in five continents: Asia, Australia, Europe, North America, and South America. Int J Sex Gend Stud. 2002;7(2/3):215–25. https://doi.org/10.1023/A:1015853302054.CrossRef

13.

Hall WJ. Psychosocial risk and protective factors for depression among lesbian, gay, bisexual, and queer youth: a systematic review. J Homosex. 2018;65(3):263–316. https://doi.org/10.1080/00918369.2017.1317467.CrossRefPubMed

14.

McParland J, Camic PM. Psychosocial factors and ageing in older lesbian, gay and bisexual people: a systematic review of the literature. J Clin Nurs. 2016;25(23–24):3415–37. https://doi.org/10.1111/jocn.13251.CrossRefPubMed

15.

Marshall E, Claes L, Bouman WP, Witcomb GL, Arcelus J. Non-suicidal self-injury and suicidality in trans people: a systematic review of the literature. Int Rev Psychiatry. 2016;28(1):58–69. https://doi.org/10.3109/09540261.2015.1073143.CrossRefPubMed

16.

Krueger EA, Meyer IH, Upchurch CH. Sexual orientation group differences in perceived stress and depressive symptoms among young adults in the United States. LGBT Health. 2018;5(4):242–9. https://doi.org/10.1089/lgbt.2017.0228.CrossRefPubMedPubMedCentral

17.

Ha H, Ross M, Risser JM, Nguyen HT. Determinants of homosexuality-related stigma among men who have sex with men in Hanoi. Vietnam Int J Sex Health. 2014;26(3):200–16. https://doi.org/10.1080/19317611.2013.858802.CrossRef

18.

Ha H, Risser JM, Ross MW, Huynh NT, Ngyen HT. Homosexuality- related stigma and sexual risk behaviors among men who have sex with men in Hanoi. Vietnam Arch Sex Behav. 2015;44(2):349–56. https://doi.org/10.1007/s10508-014-0450-8.CrossRefPubMed

19.

Philbin MM, Hirsch JS, Wilson PA, Ly AT, Giang LM, Parker RG. Structural barriers to HIV prevention among men who have sex with men (MSM) in Vietnam: diversity, stigma, and healthcare access. PLoS One. 2018;13(4):e0195000. https://doi.org/10.1371/journal.pone.0195000.CrossRefPubMedPubMedCentral

20.

Thompson LH, Shamshad K, du Plessis E, Lazarus L, Reza-Paul S, Hafeez Ur Rahman S, et al. Beyond internalised stigma: daily moralities and subjectivity among self-identified kothis in Karnataka, South India. Cult Health Sex. 2013;15(10):1237–51. https://doi.org/10.1080/13691058.2013.818714.CrossRefPubMed

21.

United Nations Development Programme, Asia Pacific Transgender Network. Legal gender recognition: a multi-country legal and policy review in Asia [internet]. Bangkok: United Nations Development Programme; 2017 [cited 2019 Feb 12]. Available from: http://www.asia-pacific.undp.org/content/rbap/en/home/library/democratic_governance/hiv_aids/legal-gender-recognition%2D%2Da-multi-country-legal-and-policy-revie.html

22.

Mendos LR. State-Sponsored Homophobia 2019 [Internet]. Geneva: International Lesbian, Gay, Bisexual, Trans and Intersex Association; 2019. [cited 2019 Apr 18]. Available from: https://ilga.org/downloads/ILGA_State_Sponsored_Homophobia_2019.pdf

23.

Winter S, Davis-McCabe C, Russell C, Wilde D, Chu TH, Suparak P, et al. Denied work: an audit of employment discrimination on the basis of gender identity in South-East Asia [internet]. Bangkok: Asia Pacific Transgender Network and United Nations Development Programme; 2018. [cited 2019 Feb 12]. Available from: https://www.undp.org/content/dam/rbap/docs/Research%20&%20Publications/hiv_aids/RBAP-HHD-2018-Denied-Work-An-Audit-of-Employment-Discrimination.pdf

24.

Gazette N. The constitution of Nepal [internet]. Kathmandu: Nepal Law Commission; 2015. [cited 2019 Feb 14]. Available from: https://www.mohp.gov.np/downloads/Constitution%20of%20Nepal%202072_full_english.pdf

25.

United Nations Development Programme, United States Agency for International Development. Being LGBT in Asia: Nepal Country Report [Internet]. Bangkok: UNDP Asia-Pacific Regional Centre; 2014. [cited 2018 Oct 25]. Available from: http://www.asia-pacific.undp.org/content/dam/rbap/docs/Research%20&%20Publications/hiv_aids/rbap-hhd-2014-blia-nepal-country-report.pdf

26.

Mahato R. The movement for human rights for sexual and gender minorities in Nepal: the beginning, 2001–2015 [master's thesis on the internet]. Worcester: Clark University; 2017. [cited 2018 Oct 25]. Available from: https://commons.clarku.edu/idce_masters_papers/148/

27.

Boyce P, Pant S. Rapid ethnography of male to male sexuality and sexual health [internet]. Kathmandu: Family Health International; 2001. [cited 2019 Mar 05]. Available from: https://www.who.int/hiv/topics/vct/sw_toolkit/ethnography_male_male_sexuality.pdf

28.

Oli N, Onta SR. Self-perception of stigma and discrimination among men having sex with men. J Nepal Health Res Counc. 2012;10(22):197–200.PubMed

29.

Network APT. From barriers to bridges: increasing access to HIV and other health services for trans people in Asia [internet]. Bangkok: Asia Pacific Transgender Network; 2017. [cited 2019 Feb 12]. Available from: http://www.asia-pacific.undp.org/content/dam/rbap/docs/Research%20%26%20Publications/hiv_aids/FBTB-Report-D3-Screen.pdf

30.

Knight K. Bridges to justice: case study of LGBTI rights in Nepal [internet]. New York: Astrea Lesbian Foundation for Justice; 2015. [cited 2019 Feb 14]. Available from: http://www.astraeafoundation.org/uploads/files/Astraea%20Nepal%20Case%20Study.pdf

31.

Tomicic A, Gálvez C, Quiros C, Martínez C, Fontbona J, Rodríguez J, et al. Suicide in lesbian, gay, bisexual and trans populations: systematic review of a decade of research (2004-2014). Rev Med Chil. 2016;144(6):723–33. https://doi.org/10.4067/S0034-98872016000600006.CrossRefPubMed

32.

Wilson E, Pant SB, Comfort M, Ekstrand M. Stigma and HIV risk among Metis in Nepal. Cult Health Sex. 2011;13(3):253–66. https://doi.org/10.1080/13691058.2010.524247.CrossRefPubMedPubMedCentral

33.

Kohlbrenner V, Deuba K, Karki DK, Marrone G. Perceived discrimination is an independent risk factor for suicidal ideation among sexual and gender minorities in Nepal. PLoS One. 2016;11(7):e0159359. https://doi.org/10.1371/journal.pone.0159359.CrossRefPubMedPubMedCentral

34.

Deuba K, Ekström AM, Shrestha R, Ionita G, Bhatta L, Karki DK. Psychosocial health problems associated with increased HIV risk behavior among men who have sex with men in Nepal: a cross-sectional survey. PLoS One. 2013;8(3):e58099. https://doi.org/10.1371/journal.pone.0058099.CrossRefPubMedPubMedCentral

35.

Logie CH, Lacombe-Duncan A, Kenny KS, Levermore K, Jones N, Marshall A, et al. Associations between police harassment and HIV vulnerabilities among men who have sex with men and transgender women in Jamaica. Health Hum Rights. 2017;19(2):147–54.PubMedPubMedCentral

36.

Stall R, Mills T, Williamson J, Hart T, Greenwood G, Paul J, et al. Association of co-Occurring Psychosocial Health Problems and Increased Vulnerability to HIV/AIDS among urban men who have sex with men. Am J Public Health. 2003;93(6):939–42. https://doi.org/10.2105/AJPH.93.6.939.CrossRefPubMedPubMedCentral

37.

National Centre for AIDS and STD Control. Integrated Biological and Behavioral Surveillance (IBBS) Survey among Men who have Sex with Men and Transgender in Tarai Highway District of Nepal- Round II [Internet]. Kathmandu: Ministry of Health and Population; 2018. [cited 2019 Feb 22]. Available from: https://www.aidsdatahub.org/sites/default/files/publication/Nepal_Report_IBBS_MSM_TG_Terai_Highway_2018.pdf37.

38.

Johnston LG, Sabin K. Sampling hard-to-reach populations with respondent driven sampling. Method Innov. 2010;5(2):38–48.

39.

Krieger N. Racial and gender discrimination: risk factors for high blood pressure. Soc Sci Med. 1990;30(12):1273–81. https://doi.org/10.1016/0277-9536(90)90307-E.CrossRefPubMed

40.

United Nations Development Programme, Williams Institute. Surveying Nepal’s sexual and gender minorities: an inclusive approach- executive summary [internet]. Bangkok: UNDP Asia-Pacific Regional Centre; 2014. [cited 2019 Feb 14]. Available from: https://www.undp.org/content/dam/rbap/docs/Research%20&%20Publications/hiv_aids/rbap-hhd-2014-surveying-nepals-sexual-and-gender-minorities-executive-summary.pdf

41.

Eaton W, Muntaner C, Smith C, Tien A, Ybarra M. Center of Epidemiologic Studies Depression Scale: review and revision (CESD and CESD-R). In: Maruish M, editor. The use of psychological testing for treatment planning and outcomes assessment. 3rd ed. Mahwah, NJ: Lawrence Erlbaum Associates; 2004. p. 363–77.

42.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C.: American Psychiatric Association; 2013. https://doi.org/10.1176/appi.books.9780890425596.CrossRef

43.

Nabbe P, Le Reste JY, Guillou-Landreat M, Munoz Perez MA, Argyriadou S, Claveria A, et al. Which DSM validated tools for diagnosing depression are usable in primary care research? A systematic literature review. Eur Psychiatry. 2017;39:99–105. https://doi.org/10.1016/j.eurpsy.2016.08.004.CrossRefPubMed

44.

Van Dam NT, Earleywine M. Validation of the Center for Epidemiologic Studies Depression Scale—Revised (CESD-R): pragmatic depression assessment in the general population. Psychiatry Res. 2011;186(1):128–32. https://doi.org/10.1016/j.psychres.2010.08.018.CrossRefPubMed

45.

Hequembourg AL, Panagakis C. Maximizing respondent-driven sampling field procedures in the recruitment of sexual minorities for health research. SAGE Open Med. 2019;7:1–13.CrossRef

46.

Chakrapani V, Newman PA, Shunmugam M, Logie CH, Samuel M. Syndemics of depression, alcohol use, and victimisation, and their association with HIV- related sexual risk among men who have sex with men and transgender women in India. Glob Public Health. 2017;12(2):250–65. https://doi.org/10.1080/17441692.2015.1091024.CrossRefPubMed

47.

Safren S, Thomas B, Mimiaga M, Chandrasekaran V, Menon S, Swaminathan S, et al. Depressive symptoms and human immunodeficiency virus risk behavior among men who have sex with men in Chennai. India Psychol Health Med. 2009;14(6):705–15. https://doi.org/10.1080/13548500903334754.CrossRefPubMed

48.

Hebbar Y, Singh B. Psychiatric morbidity in a selective sample of transgenders in Imphal, Manipur: a descriptive study. Ann Indian Psychiatry. 2017;1(2):114–7. https://doi.org/10.4103/aip.aip_24_17.CrossRef

49.

Kota K, Salazar L, Culbreth R, Crosby R, Jones J. Psychosocial mediators of perceived stigma and suicidal ideation among transgender women. BMC Public Health. 2020;20(1):125. https://doi.org/10.1186/s12889-020-8177-z.CrossRefPubMedPubMedCentral

50.

Wilton L, Chiasson M, Nandi V, Lelutiu-Weinberger C, Frye V, Hirshfield S, et al. Characteristics and correlates of lifetime suicidal thoughts and attempts among young black men who have sex with men (MSM) and transgender women. J Black Psychol. 2018;44(3):273–90. https://doi.org/10.1177/0095798418771819.CrossRef

51.

Secor A, Wahome E, Micheni M, Rao D, Simoni J, Sanders E, et al. Depression, substance abuse and stigma among men who have sex with men in coastal Kenya. AIDS. 2015;29(Supplement 3):S251–9. https://doi.org/10.1097/QAD.0000000000000846.CrossRefPubMed

52.

Ryan C, Huebner D, Diaz R, Sanchez J. Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults. Pediatrics. 2009;123(1):346–52. https://doi.org/10.1542/peds.2007-3524.CrossRefPubMed

53.

Srivastava A, Davis JP, Patel P, Daniel EE, Karkal S, Rice E. Polyvictimization, Sex Work, and Depressive Symptoms Among Transgender Women and Men Who Have Sex With Men. J Interpers Violence. 2021. Online ahead of print. https://doi.org/10.1177/0886260521990840.

54.

Clements-Nolle K, Marx R, Katz M. Attempted suicide among transgender persons: the influence of gender-based discrimination and victimization. J Homosex. 2006;51(3):53–69. https://doi.org/10.1300/J082v51n03_04.CrossRefPubMed

55.

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. https://doi.org/10.1037/0033-2909.129.5.674.CrossRefPubMedPubMedCentral

Title: Social and structural factors associated with depression and suicidality among men who have sex with men and transgender women in Nepal
Authors: Sanna Storm
Keshab Deuba
Rachana Shrestha
Lok Raj Pandey
Deepak Dahal
Madan Kumar Shrestha
Tara Nath Pokhrel
Gaetano Marrone
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Mood Disorders
Affective Disorder
Published in: BMC Psychiatry / Issue 1/2021
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-021-03477-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Social and structural factors associated with depression and suicidality among men who have sex with men and transgender women in Nepal

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

Childhood abuse and borderline personality disorder features in Chinese undergraduates: the role of self-esteem and resilience

The associations between maternal and child diet quality and child ADHD – findings from a large Norwegian pregnancy cohort study

Testing extra-linearity across a psychosis continuum

Temporal and diurnal variation in social media posts to a suicide support forum

Resilience, coping, and distress among healthcare service personnel during the COVID-19 pandemic

The role of mental health symptomology and quality of life in predicting referrals to special child and adolescent mental health services