| Abstract|| |
Background: Men who have sex with men (MSM), a unique group of people, feel, and believe they will face hardships in society once their identity is disclosed, but this does not deter them from dressing and behaving like the opposite sex in public life or fighting for their rights.
Objectives: To study the mental health status of MSM and their determinants.
Materials and Methods: Descriptive cross-sectional study was conducted among 410 MSM in the drop in centers of non-governmental organization working for MSM in Ahmedabad city through purposive sampling.
Results : Prevalence of psychiatric morbidity was 52.9%. The mean score obtained in anxiety/insomnia subscale (5.4 ± 4.2) and severe depression (5.4 ± 4.6) was higher than other two subscale somatic symptoms (4.0 ± 3.2) and social dysfunction symptoms (4.6 ± 3.8). Among General Health Questionnaire 28 questions, more MSM had a "more than usual feeling" that they are "getting difficulty in staying asleep once you are off," "lost much sleep over worry," "been getting edgy and bad tempered," "felt constantly under strain," "been feeling nervous and strung-up all time." Prevalence of psychiatric morbidity is more in never married MSM and also in less educated MSM. MSM with sexually transmitted infection (STI) symptoms suffer from psychiatric illness more than MSM who didn't have STI symptoms.
Conclusion: Various determinants like partner characteristic, presence of STI symptoms, marital status, and living arrangement affect the mental health of MSM.
Keywords: Men who have sex with men, psychiatric morbidity, sexually transmitted infection
|How to cite this article:|
Prajapati AC, Parikh S, Bala D V. A study of mental health status of men who have sex with men in Ahmedabad city. Indian J Psychiatry 2014;56:161-4
| Introduction|| |
Men who have sex with men (MSM) is the term used to denote all men who have sex with other men as a matter of preference or practice, regardless of their sexual identity or sexual orientation and irrespective of whether they also have sex with women or not. MSM is a very important subgroup of targeted intervention (TI) for National AIDS Control Program (NACP) Phase III.
Being gay, lesbian, bisexual, or transgender is not a mental illness. However, lesbian, gay, bisexual, and transgender people face unique risks to their mental health. Many face discrimination from coworkers, family members and peers, as well as society at large. Recent studies indicate that experiencing social discrimination is a strong predictor of mental health issues. 
Sexual orientation represents an important, but relatively understudied, individual characteristic shaping risk for psychiatric morbidity.  No wonder, the inner conflicts in a MSM grows day-by-day and it takes a toll on their social life and hurts their mind. As a result, psychiatric morbidities such as depression, anxiety, psychotic disorders, and even suicidal tendencies are common in this group.  Very few studies have been conducted to evaluate mental health status in MSM and their risk factors for psychiatric morbidity.
The present study was conducted in the drop in centers (DICs) in Ahmedabad city with the help of non-governmental organization (NGO), which is working for MSM. The present study attempts to find determinants of mental health, but also to fill a crucial gap in available mental health information of MSM.
| Objective|| |
To study the mental health status of MSM and their determinants.
| Materials and Methods|| |
In the Ahmedabad Municipal Corporation (AMC) area, NACP is implemented by AIDS Control Society (ACS) in which NGO has taken responsibility for TI for MSM. Present study was conducted on registered MSM of Ahmedabad city after taking permission from AMCACS, CHUWAL GRAM VIKASH TRUST UNIT 1, 2 and SWAVLAMBI CHUWAL MANDAL UNIT, Ahmedabad. Through purposive sampling, 10% MSM (410 MSM) from each unit were selected out of total 4100 MSM who were coming in DIC of their respective unit to attend meetings. After taking informed consent interview of MSM was conducted personally through pretested, prestructured questionnaire during the study period with the help of counselor, out-reach workers and peer educators to get correct and reliable answer as they have good rapport with MSM. In the study, sexually transmitted infections (STIs) were considered on the basis of any of the STI symptoms present as examined by the medical officer appointed by NACO in MSM at the time of interview.
Mental health status of MSM was evaluated through General Health Questionnaire 28 (GHQ 28). It is the most common assessment tool of mental well-being is the GHQ 28.  GHQ 28 developed as a screening tool to detect those likely to have or be at risk of developing psychiatric disorders, it is a measure of the common mental health problems/domains of depression, anxiety, somatic symptoms, and social withdrawal. Tool GHQ 28 has self-reporting screening questionnaire, which identifies high probability of suffering from psychiatric illness. The scoring distinguishes chronic stable complaints from recent exacerbations. The four subscales, each containing seven items, are as follows:
- Somatic symptoms (items 1-7)
- Anxiety/insomnia (items 8-14)
- Social dysfunction (items 15-21)
- Severe depression (items 22-28).
Each was given a 4-point Likert scoring system (0-1-2-3) that ranges from a "better/healthier than normal option (allotted Score 0)," through a "same as usual (allotted Score 1)" and a "worse/more than usual (allotted Score 2)" to a much worse/more than usual (allotted score 3) option. According to that, higher the score worse is the condition. The range of the score is 0-84.
The cut-off score used was 24.  The MSM with threshold score more than 24 was considered mentally deviated. 24 score is the point where probability of case suffering from psychiatric morbidity was 50%. Therefore, MSM scored more than 24 considered as psychiatric morbid and counted as the numerator in prevalence rate.
The questionnaire was translated to local language (Gujarati) and retranslated back to English. The analysis was done using Trial version of Statistical Package for Social Science (SPSS) and mean, standard deviation, unpaired t-test, and Mann-Whitney U-test were applied.
| Results and Discussion|| |
To evaluate mental health status of MSM, GHQ 28 scale was used, which includes the somatic symptoms, anxiety and insomnia symptoms, social dysfunction symptoms and severe depression symptoms.
Median score in the present study was 25. Prevalence of psychiatric morbidity (>24) was 52.9%. In another similar study in central Kolkata, more than half (63.9%) of the MSM crossed the threshold score of 24 signaling a high risk of psychiatric illness in the MSM group.  Gay-bisexual men evidenced higher prevalence of depression, panic attacks, and psychological distress than heterosexual men. 
Higher the score, higher is the mental deviation. The mean score obtained in anxiety/insomnia subscale (5.4 ± 4.2) and severe depression (5.4 ± 4.6) was higher than other two subscale somatic symptoms (4.0 ± 3.2) and social dysfunction symptoms (4.6 ± 3.8).
[Table 1] shows how the study population fared with regards to GHQ scores, which was a reflection of the status of their physical, mental, and social health. The Likert scale of scoring (0-1-2-3) was used in GHQ 28. In each of the four subscales, that is, somatic symptoms, anxiety and insomnia, social dysfunction and severe depression-the maximum attainable score is 21 while the minimum possible score is 0. Higher the score worse is the condition. As regards to somatic symptoms 0.5% MSM had obtained more than 14 score while regarding anxiety and insomnia symptoms 0.3% MSM obtained more than 14 score while regarding social dysfunction symptoms 1.2% MSM obtained more than 14 score while regarding severe depression 0.7% MSM obtained more than 14 score. Using the recommended threshold score of >24 (threshold being defined as "just significant clinical disturbance" or that point where probability of being a "case" suffering from psychiatric morbidity is 50%), more than half (52.9%) of the MSM crossed the threshold score of 24 signaling a high risk of psychiatric illness in the study population.
|Table 1: Distribution of the study population according to GHQ scoring pattern|
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[Figure 1] shows the highest mean GHQ score was obtained in the age group 55-65 years of age followed by 15-25 years of age. In a similar study of Meyer et al., young lesbians, gay men, and bisexual individuals (aged 18-29 and 30-44) had lower mood disorder prevalence than did older individuals (aged 45-59). Younger respondents had fewer serious suicide attempts than did older respondents.  Gay men and bisexual and homosexually experienced heterosexual individuals had higher levels of psychological distress compared with exclusively heterosexual individuals. 
|Figure 1: Age-group-wise mean General Health Questionnaire score obtained by men who have sex with men|
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[Table 2] shows 6 questions of GHQ, MSM had obtained higher score than other questions.
[Figure 2] shows the prevalence of psychiatric morbidity was more seen in MSM living with the family as compared with living alone or with friends. Prevalence of psychiatric morbidity was more in never married MSM and also in less educated MSM. MSM with STI symptoms suffered from psychiatric illness more than MSM who didn't have STI symptoms. Furthermore, prevalence of psychiatric morbidity was higher in MSM having more than 2 partners (54.9%) as compared to MSM having 2 or less partner (49.3%). Prevalence of psychiatric morbidity was higher in MSM having regular partners (60.3%) than in MSM having casual partner (51.7%).
[Table 3] shows the various determinants for assessment of mental health of MSM were like partner characteristic (casual vs. regular), presence of STI symptoms, marital status, and living arrangement. All this determinants can affect the mental health of the person. In the present study, MSM with STI symptoms obtained significantly higher mean score than MSM without STI symptoms in all 4 GHQ subgroup scales Somatic symptoms, Anxiety symptoms, Social dysfunction and severe depression (P < 0.005, unpaired t-test). MSM with regular sexual partner had a higher score in all 4 subscale as compared to MSM with a casual partner which indicate higher score was found, but no significant association obtained between the characteristic of partner (either have a regular partner or casual partner) and mental health status of the MSM (P > 0.05, Mann-Whitney test). Furthermore, MSM living with family obtained higher mean score than living alone, which shows that MSM living with the family they may likely to suffer from psychiatric morbidity (P < 0.005, highly significant Mann-Whitney U-test).
| Conclusions|| |
Out of the total score 84, Median score of GHQ 28 was 25 in MSM. Hence, threshold median score of 24 or higher signaling a high risk of psychiatric illness in the population. Prevalence of psychiatric morbidity was 52.9%.
Prevalence of psychiatric morbidity was higher in MSM having more than 2 partners (54.9%), MSM having STI symptoms (59%) and also in MSM having regular partner (60.3%). Psychiatric morbidity was more in MSM may be because of shame, stigma, discrimination, and presence of STIs. Present study could not reveal whether psychiatric illness lead to high risk sexual behavior of MSM or high risk sexual behavior of MSM lead to psychiatric illness.
| Acknowledgments|| |
We would like to thank Dr. G. K. Vankar, Professor and Head, Department of Psychiatry, Civil Hospital, B. J. Medical College, Ahmedabad for support to carry out study. We are also thankful to Mr. Chandubhai (Project Manager) of CHUWAL GRAM VIKAS Trust Unit 1 and 2 and Swavlambi Chuwal Mandal Unit in Ahmedabad for their permission and continuous support to me.
| References|| |
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Dr. Arpit C Prajapati
22, Jay Somnath Society, Part II, Sukhbag Road, Palanpur - 385 001, Gujarat
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]