Frequency and predictors of suicidality, depression and anxiety among men who have sex with men in Mumbai, India: implications for HIV prevention and treatment services
M. Sivasubramanian1, M. Mimiaga2,3, K. Mayer2,4, V. Anand1, C. Johnson2, S. Safren2,5
1The Humsafar Trust, Mumbai, India, 2Fenway Health, The Fenway Institute, Boston, United States, 3Harvard Medical School / Massachusetts General Hospital, Boston, United States, 4Brown Medical School/Miriam Hospital, Providence, United States, 5Harvard Medical School / Massachusetts General Hospital, Boston, United States
Background: Indian men who have sex with men (MSM) have disproportionately increased HIV prevalence compared to the general population; however, little research exists about their mental health, which may moderate their risk-taking and the effectiveness of HIV interventions.
Methods: A confidential quantitative and diagnostic interview was conducted among 150 MSM in Mumbai, India at The Humsafar Trust, a non-governmental organization, to assess MSM mental health. The interview collected information on sociodemographics and sexual risk-taking, and assessed self-esteem, social support and psychiatric disorders using the Mini-International-Neuropsychiatric-Interview (MINI). Logistic regression procedures examined behavioral, pychosocial, and demographic associations to suicidality, depression and anxiety.
Results: Participants' mean age was 25.1 years (SD=5.1); 21% were married to women. Forty-five percent reported current suicidal ideation, with 66% low risk, 19% medium risk, and 15% high risk for suicide per MINI guidelines. Twenty-nine percent were positive for current major depression; 24% for any anxiety-related disorder. No respondents reported current treatment for any psychiatric disorder. In multivariable models controlling for age, education, income and sexual identity, participants with higher levels of self-esteem and social support were less likely to have clinical diagnoses for suicidality (self-esteem AOR=0.85, 95% CI: 0.78-0.93; social support AOR=0.76, 95% CI: 0.62-0.93) and major depression (self-esteem AOR=0.79, 95% CI: 0.71-0.89; social support AOR=0.68, 95% CI: 0.54-0.85). Those who reported greater social support were less likely to have a clinical diagnosis of any anxiety-related disorder (AOR=0.80; 95% CI: 0.65-0.99). Participants with current major depression were at increased odds of unprotected anal sex with their most recent casual male partner, after adjusting for age and education (AOR=2.26; 95% CI: 1.02-5.01).
Conclusions: Mumbai MSM have high rates of suicidal ideation, depression and anxiety. Programs to improve self-esteem and social support may improve these mental health outcomes, and MSM HIV prevention and treatment services may benefit from incorporating mental health services and referrals.
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