Health  Vol.7 No.9 , September 2015
Factors Associated with Mental Depression among Men Who Have Sex with Men in Southern India
Abstract: Background: Mental health has been a largely neglected issue among Men Who Have Sex with Men (MSM) across the world. This study examines the prevalence and correlates of depression among MSM. Data and Methods: Data for this study are used from a cross-sectional Behavioral Tracking Survey—2012 conducted among 1176 MSM from Andhra Pradesh (undivided), a southern state of India. Depression of MSM was assessed using Patient Health Questionnaire-2 scale. Descriptive statistics, bivariate and multivariate logistic regression techniques were used for analysis. Results: More than one-third of MSMs (35%) in the survey reported to have depression. The likelihood of experiencing depression was 5 times higher among MSM who were mobile for sex work outside their place of residence (55% vs 17%, AOR: 5.2, 95% CI: 3.7 - 7.3) and had experienced physical or sexual violence (82% vs 33%, AOR: 6.0, 95% CI: 2.1 - 17.4) than their respective counterparts. Rates of depression were significantly higher among MSM who had experienced Sexually Transmitted Infections symptoms; knowledge of their HIV positivity; who didn’t use condoms during anal sex with any clients/partners; those who consumed alcohol and were in financial debt at the time of survey than others. Those who were associated with any community groups have significantly less chances of reporting depression. Discussion: The study certainly highlighted that the HIV prevention efforts with MSM in India require an integrated approach on addressing the mental health issues. To support this, programs and research-based evidence will be highly needed to ensure that mental health issues are properly addressed among MSM and other high risk groups.
Cite this paper: Patel, S.K., Prabhakar, P. and Saggurti, N. (2015) Factors Associated with Mental Depression among Men Who Have Sex with Men in Southern India. Health, 7, 1114-1123. doi: 10.4236/health.2015.79127.

[1]   WHO (2011) Mental Health Atlas, 2011. World Health Organization, Geneva.

[2]   UN (2007) Men Who have Sex with Men: The Missing Piece in National Responses to AIDS in Asia and the Pacific. United Nations, Geneva.

[3]   Herek, G.M. and Garnets, L.D. (2007) Sexual Orientation and Mental Health. Annual Review of Clinical Psychology, 3, 353-375.

[4]   CDC (2008) HIV Survelliance Report 2008. Centre for Disease Control, Atlanta.

[5]   Corboz, J., et al. (2008) Feeling Queer and Blue: A Review of the Literature on Depression and Related Issues among Gay, Lesbian, Bisexual and Other Homosexually Active People. LaTrobe University, Melbourne.

[6]   SPA (2009) Position Statement Suicide and Self-Harm among Gay, Lesbian, Bisexual and Transgender Communities. Suicide Prevention Australia, Sydney.

[7]   Safren, S.A., Thomas, B.E., Mimiaga, M.J., Chandrasekaran, V., Menon, S., Swaminathan, S. and Mayer, K.H. (2009) Depressive Symptoms and Human Immunodeficiency Virus Risk Behavior among Men Who Have Sex with Men in Chennai, India. Psychology, Health & Medicine, 14, 705-715.

[8]   Alvy, L.M., McKirnan, D.J., Mansergh, G., Koblin, B., Colfax, G.N., Flores, S.A. and Hudson, S. (2011) Depression Is Associated with Sexual Risk among Men Who Have Sex with Men, But Is Mediated by Cognitive Escape and Self-Efficacy. AIDS and Behavior, 15, 1171-1179.

[9]   Leonard, W., et al. (2012) Private Lives 2: The Second National Survey of the Health and Wellbeing of Gay, Lesbian, Bisexual and Transgender (GLBT) Australians. Australian Research Centre in Sex, Health and Society, LaTrobe University, Melbourne.

[10]   Sandfort, T.G., de Graaf, R., Bijl, R.V. and Schnabel, P. (2001) Same-Sex Sexual Behavior and Psychiatric Disorders: Findings from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Archives of General Psychiatry, 58, 85-91.

[11]   Cochran, S.D. and Mays, V.M. (2000) Lifetime Prevalence of Suicide Symptoms and Affective Disorders among Men Reporting Same-Sex Sexual Partners: Results from NHANES III. American Journal of Public Health, 90, 573-578.

[12]   Cochran, S.D., Mays, V.M. and Sullivan, J.G. (2003) Prevalence of Mental Disorders, Psychological Distress, and Mental Health Services Use among Lesbian, Gay, and Bisexual Adults in the United States. Journal of Consulting and Clinical Psychology, 71, 53-61.

[13]   Mills, T.C., Paul, J., Stall, R., Pollack, L., Canchola, J., Chang, Y.J., Moskowitz, J.T. and Catania, J.A. (2004) Distress and Depression in Men Who Have Sex with Men: The Urban Men’s Health Study. American Journal of Psychiatry, 161, 278-285.

[14]   Wilkinson, R. and Marmot, M. (2003) Social Determinants of Health—The Solid Facts. World Health Organization, Geneva.

[15]   Rosenstreich, G. (2011) Discrimination, LGBTI Mental Health and Suicide. Australian Journal on Psychosocial Rehabilitation Spring, 2011, 16-19.

[16]   Yan, H., Wong, F.Y., Zheng, T., Ning, Z., Ding, Y., Nehl, E.J., Lin, L. and He, N. (2014) Social Support and Depressive Symptoms among “Money” Boys and General Men Who Have Sex with Men in Shanghai, China. Sex Health, 11, 285-287.

[17]   Savin-Williams, R. (1994) Verbal and Physical Abuse as Stressors in the Lives of Lesbian, Gay Male, and Bisexual Youths: Running away, Substance Abuse, Prostitution, and Suicide. Journal of Counseling and Clinical Psychology, 62, 261-269.

[18]   Patel, V. (2007) Mental Health in Low- and Middle-Income Countries. British Medical Bulletin, 81-82, 81-96.

[19]   Collins, P.Y., Holman, A.R., Freeman, M.C. and Patel, V. (2006) What Is the Relevance of Mental Health to HIV/ AIDS Care and Treatment Programs in Developing Countries? A Systematic Review. AIDS, 20, 1571-1582.

[20]   Freeman, M., Patel, V., Collins, P.Y. and Bertolote, J. (2005) Integrating Mental Health in Global Initiatives for HIV/ AIDS. British Journal of Psychiatry, 187, 1-3.

[21]   Diaz, R.M., Ayala, G. and Bein, E. (2004) Sexual Risk as an Outcome of Social Oppression: Data from a Probability Sample of Latino Gay Men in Three U.S. Cities. Cultural Diversity & Ethnic Minority Psychology, 10, 255-267.

[22]   Deuba, K., Ekstrom, A.M., Shrestha, R., Ionita, G., Bhatta, L. and Karki, D.K. (2013) Psychosocial Health Problems Associated with Increased HIV Risk Behavior among Men Who Have Sex with Men in Nepal: A Cross-Sectional Survey. PLoS ONE, 8, e58099.

[23]   Hutton, H.E., Lyketsos, C.G., Zenilman, J.M., Thompson, R.E. and Erbelding, E.J. (2004) Depression and HIV Risk Behaviors among Patients in a Sexually Transmitted Disease Clinic. American Journal of Psychiatry, 161, 912-914.

[24]   Klein, H. (2014) Depression and HIV Risk Taking among Men Who Have Sex with Other Men and Who Use the Internet to Find Partners for Unprotected Sex. Journal of Gay & Lesbian Mental Health, 18, 164-189.

[25]   Trevor, A., Brian, M., Daniel, T., Pamina, M., Ron, D., Pamela, J. and Michael, P. (2014) Depression and Sexual Dysfunction among HIV-Positive and HIV-Negative Men Who Have Sex with Men: Mediation by Use of Antidepressants and Recreational Stimulants. Archives of Sexual Behavior, 44, 399-409.

[26]   Houston, E., Sandfort, T., Dolezal, C. and Carbal-lo-Dieguez, A. (2012) Depressive Symptoms among MSM Who Engage in Bareback Sex: Does Mood Matter? AIDS and Behavior, 16, 2209-2215.

[27]   Prajapati, A.C., Parikh, S. and Bala, D.V. (2014) A Study of Mental Health Status of Men Who Have Sex with Men in Ahmedabad City. Indian Journal of Psychiatry, 56, 161-164.

[28]   Fendrich, M., Avci, O., Johnson, T.P. and Mackesy-Amiti, M.E. (2013) Depression, Substance Use and HIV Risk in a Probability Sample of Men Who Have Sex with Men. Addictive Behaviors, 38, 1715-1718.

[29]   Buller, A.M., Devries, K.M., Howard, L.M. and Bacchus, L.J. (2014) Associations between Intimate Partner Violence and Health among Men Who Have Sex with Men: A Systematic Review and Meta-Analysis. PLoS Medicine, 11, e1001609.

[30]   Thomas, B., Mimiaga, M.J., Kumar, S., Swaminathan, S., Safren, S.A. and Mayer, K.H. (2011) HIV in Indian MSM: Reasons for a Concentrated Epidemic & Strategies for Prevention. Indian Council of Medical Research, 134, 920-929.

[31]   Patel, S.K., Saggurti, N., Pachauri, S. and Prabhakar, P. (2015) Correlates of Mental Depression among Female Sex Workers in Southern India. Asia-Pacific Journal of Public Health, Online First.

[32]   Magnani, R., Sabin, K., Saidel, T. and Heckathorn, D. (2005) Review of Sampling Hard-to-Reach and Hidden Populations for HIV Surveillance. AIDS, 19, S67-S72.

[33]   Saidel, T., Adhikary, R., Mainkar, M., Dale, J., Loo, V., Rahman, M., Ramesh, B.M. and Paranjape, R.S. (2008) Baseline Integrated Behavioural and Biological Assessment among Most At-Risk Populations in Six High-Prevalence States of India: Design and Implementation Challenges. AIDS, 22, S17-S34.

[34]   Kroenke, K. and Spitzer, R. (2002) The PHQ-9: A New Depression Diagnostic and Severity. Psychiatric Annals, 32, 1-7.

[35]   Kroenke, K., Spitzer, R.L. and Williams, J.B. (2003) The Patient Health Questionnaire-2: Validity of a Two-Item Depression Screener. Medical Care, 41, 1284-1292.

[36]   Alliance (2014) Strengthening Capacity in MSM, Transgender and Hijra Communities to Improve HIV Prevention Impact. India HIV/AIDS Alliance.

[37]   Safren, S.A., Reisner, S.L., Herrick, A., Mimiaga, M.J. and Stall, R.D. (2010) Mental Health and HIV Risk in Men Who Have Sex with Men. Journal of Acquired Immune Deficiency Syndromes, 55, S74-S77.

[38]   The Lancet (2015) Don’t Forget Health When You Talk about Human Rights. The Lancet, 385, 481.