title: Perceived Discrimination Is an Independent Risk Factor for Suicidal Ideation among Sexual and Gender Minorities in Nepal.
abstract: Sexual and gender minorities experience an elevated burden of suicidality compared with the general population. Still, little is known about that burden and the factors generating it in the context of low- and middle-income countries. The present study assessed the prevalence of suicidal ideation, planned suicide, and attempted suicide among men who have sex with men (MSM) and transgender people (TG) in Nepal, and examined the association of perceived discrimination on the basis of sexual orientation with suicidal ideation and with attempted suicide. Data were obtained from a surveillance survey among MSM and TG in Nepal in 2012. A sample of 400 MSM and TG, recruited using respondent-driven sampling, completed a structured face-to-face interview. Throughout their lifetime, 26.8% of the participants had experienced suicidal ideation, 12.0% had made a suicide plan, and 9.0% had attempted suicide. In particular, more TG than MSM had experienced suicidal ideation (39.8% vs. 21.3%), had made a suicide plan (19.5% vs. 8.9%), and had attempted suicide (15.3% vs. 6.4%). Overall, the odds of having experienced suicidal ideation was significantly higher among the 38.3% of participants who had perceived discrimination based on their sexual orientation (AOR: 3.17; 95% CI: 1.83-5.48). Moreover, the odds of suicidal ideation was significantly higher as the extent of perceived discrimination increased (AOR: 1.35; 95% CI: 1.15-1.60). However, the odds of attempted suicide was not significantly associated with perceived discrimination (AOR: 1.40; 95% CI: 0.62-3.15). The findings highlight perceived discrimination as an independent risk factor for suicidal ideation. Future suicide prevention programs should target sexual and gender minorities and include elements focusing on discrimination.
authors.affiliation: Karolinska Institutet, Stockholm, Sweden.
authors.forename: Verena
authors.initials: V
authors.lastname: Kohlbrenner
authors.affiliation: Public Health and Environment Research Center, Kathmandu, Nepal.|Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Keshab
authors.initials: K
authors.lastname: Deuba
authors.affiliation: Department of Health Science, Nobel College, Pokhara University, Kathmandu, Nepal.
authors.forename: Deepak Kumar
authors.initials: DK
authors.lastname: Karki
authors.affiliation: Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.|Department of Infectious Disease, Karolinska Hospital, Stockholm, Sweden.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Marrone
mesh_terms: D015986:Confounding Factors, Epidemiologic; D004192:Discrimination, Psychological; D005260:Female; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D009390:Nepal / Q000453:epidemiology; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D012725:Sexual Behavior / Q000706:statistics & numerical data; D000072339:Sexual and Gender Minorities / Q000706:statistics & numerical data*; D059020:Suicidal Ideation; D063106:Transgender Persons