title: Depression, substance abuse and stigma among men who have sex with men in coastal Kenya.
abstract: OBJECTIVE
  Mental health conditions can erode quality of life and interfere with health-related behaviours such as medication adherence. We aimed to determine the prevalence and correlates of depression and other psychosocial factors among self-identified men who have sex with men (MSM) in coastal Kenya.
  
  
  METHODS
  A cross-sectional survey.
  
  
  METHODS
  Psychosocial and mental health characteristics were assessed in an audio computer-assisted self-interview (ACASI) survey among 112 MSM participating in two ongoing HIV-positive and HIV-negative cohorts in Mtwapa, Kenya.
  
  
  RESULTS
  One-third of participants met criteria for major depressive disorder [16.1%, 95% confidence interval (95% CI) 9.8-24.2] or other depressive disorder (15.2%, 95% CI 9.1-23.2). Alcohol abuse was reported by 45% of respondents (95% CI 35.2-54.3) and other substance abuse by 59.8% (95% CI 50.1-69.0). Sexual and HIV stigma were moderate, with median scores of 11 [interquartile range (IQR) 6-17, potential range 0-33] and 25 (IQR 23-29, potential range 11-44), respectively. There were significant bivariate correlations between alcohol abuse, other substance abuse, sexual stigma and childhood and recent abuse. In a multivariable linear regression model, sexual stigma (beta = 0.17, 95% CI 0.03-0.32) and marriage to a woman (beta = -2.41 95% CI -4.74 to -0.09) were each associated with depression score.
  
  
  CONCLUSIONS
  We found moderate to high levels of depression and substance abuse, and moderate levels of sexual stigma. These variables were highly inter-correlated and associated with an experience of trauma or abuse. Comprehensive mental health services are needed in this population to address these issues.
authors.affiliation: aDepartment of Global Health, University of Washington, Seattle, Washington, USA bKenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya cDepartment of Psychology, University of Washington, Seattle, Washington, USA dNuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Headington, UK eDepartment of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands fDepartment of Medicine gDepartment of Epidemiology, University of Washington, Seattle, Washington, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Secor
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Wahome
authors.forename: Murugi
authors.initials: M
authors.lastname: Micheni
authors.forename: Deepa
authors.initials: D
authors.lastname: Rao
authors.forename: Jane M
authors.initials: JM
authors.lastname: Simoni
authors.forename: Eduard J
authors.initials: EJ
authors.lastname: Sanders
authors.forename: Susan M
authors.initials: SM
authors.lastname: Graham
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000453:epidemiology* / Q000523:psychology; D015658:HIV Infections / Q000453:epidemiology; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D011788:Quality of Life / Q000523:psychology; D057566:Self Report; D057545:Social Stigma; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000523:psychology