title: Diverse Rates of Depression Among Men Who Have Sex with Men (MSM) Across India: Insights from a Multi-site Mixed Method Study.
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.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6648, Baltimore, MD, 21205, USA. ctomori1@jhu.edu.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Tomori
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6648, Baltimore, MD, 21205, USA.
authors.forename: Allison M
authors.initials: AM
authors.lastname: McFall
authors.affiliation: YR Gaitonde Centre for AIDS Research and Education, Chennai, India.
authors.forename: Aylur K
authors.initials: AK
authors.lastname: Srikrishnan
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6648, Baltimore, MD, 21205, USA.
authors.forename: Shruti H
authors.initials: SH
authors.lastname: Mehta
authors.affiliation: Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Sunil S
authors.initials: SS
authors.lastname: Solomon
authors.affiliation: YR Gaitonde Centre for AIDS Research and Education, Chennai, India.
authors.forename: Santhanam
authors.initials: S
authors.lastname: Anand
authors.affiliation: YR Gaitonde Centre for AIDS Research and Education, Chennai, India.
authors.forename: Canjeevaram K
authors.initials: CK
authors.lastname: Vasudevan
authors.affiliation: YR Gaitonde Centre for AIDS Research and Education, Chennai, India.
authors.forename: Suniti
authors.initials: S
authors.lastname: Solomon
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6648, Baltimore, MD, 21205, USA.
authors.forename: David D
authors.initials: DD
authors.lastname: Celentano
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology* / Q000523:psychology; D015658:HIV Infections / Q000208:ethnology* / Q000523:psychology; D018451:Homosexuality, Male / Q000208:ethnology / Q000523:psychology*; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D036301:Qualitative Research; D057545:Social Stigma; D012944:Social Support; D019966:Substance-Related Disorders / Q000453:epidemiology; D013405:Suicide / Q000208:ethnology* / Q000523:psychology; D011795:Surveys and Questionnaires; D014342:Truth Disclosure; D014505:Urban Population; D055815:Young Adult
keywords: Depression; HIV; India; Men who have sex with men; Suicidality