Faculty of Social Work, University of Calgary, Calgary, Canada.
Soc Sci Med. 2012 Apr;74(8):1261-8. doi: 10.1016/j.socscimed.2012.01.008. Epub 2012 Feb 21.
Marginalization and stigmatization heighten the vulnerability of sexual minorities to inequitable mental health outcomes. There is a dearth of information regarding stigma and mental health among men who have sex with men (MSM) in India. We adapted Meyer's minority stress model to explore associations between stigma and depression among MSM in South India. The study objective was to examine the influence of sexual stigma, gender non-conformity stigma (GNS) and HIV-related stigma (HIV-S) on depression among MSM in South India. A cross-sectional survey was administered to MSM in urban (Chennai) (n=100) and semi-urban (Kumbakonam) (n=100) locations in Tamil Nadu. The majority of participants reported moderate/severe depression scores. Participants in Chennai reported significantly higher levels of GNS, social support and resilient coping, and lower levels of HIV-S and depression, than participants in Kumbakonam. Hierarchical block regression analyses were conducted to measure associations between independent (GNS, HIV-S), moderator (social support, resilient coping) and dependent (depression) variables. Sexual stigma was not included in regression analyses due to multicollinearity with GNS. The first regression analyses assessed associations between depression and stigma subtypes. In Chennai, perceived GNS was associated with depression; in Kumbakonam enacted/perceived GNS and vicarious HIV-S were associated with depression. In the moderation analyses, overall GNS and HIV-S scores (subtypes combined) accounted for a significant amount of variability in depression in both locations, although HIV-S was only a significant predictor in Kumbakonam. Social support and resilient coping were associated with lower depression but did not moderate the influence of HIV-S or GNS on depression. Differences in stigma, coping, social support and depression between locations highlight the salience of considering geographical context in stigma analyses. Associations between HIV-S and depression among HIV-negative MSM emphasize the significance of symbolic stigma. Findings may inform multi-level stigma reduction and health promotion interventions with MSM in South India.
边缘化和污名化使性少数群体更容易出现心理健康状况不平等的情况。目前，关于印度男男性行为者（MSM）的污名和心理健康的信息很少。我们改编了 Meyer 的少数群体应激模型，以探讨南印度 MSM 中的污名与抑郁之间的关联。本研究的目的是检验性污名、性别非规范污名（GNS）和与 HIV 相关的污名（HIV-S）对南印度 MSM 抑郁的影响。我们在泰米尔纳德邦的城市（金奈）（n=100）和半城市（孔巴科南）（n=100）的 MSM 中进行了横断面调查。大多数参与者报告有中度/重度抑郁评分。与孔巴科南的参与者相比，金奈的参与者报告的 GNS、社会支持和弹性应对水平较高，HIV-S 和抑郁水平较低。我们进行了分层块回归分析，以衡量独立（GNS、HIV-S）、调节（社会支持、弹性应对）和依赖（抑郁）变量之间的关联。由于与 GNS 存在多重共线性，因此未将性污名纳入回归分析。第一次回归分析评估了抑郁与污名亚型之间的关联。在金奈，感知到的 GNS 与抑郁有关；在孔巴科南，实施/感知到的 GNS 和替代性 HIV-S 与抑郁有关。在调节分析中，尽管 HIV-S 仅在孔巴科南是一个显著的预测因子，但总体 GNS 和 HIV-S 评分（亚型组合）在两个地点的抑郁中都占了很大的可变性。社会支持和弹性应对与较低的抑郁有关，但不能调节 HIV-S 或 GNS 对抑郁的影响。地点之间在污名、应对、社会支持和抑郁方面的差异突显了在污名分析中考虑地理背景的重要性。在 HIV 阴性的 MSM 中，HIV-S 与抑郁之间的关联强调了象征性污名的重要性。研究结果可能为印度南部 MSM 的多层次污名减少和健康促进干预措施提供信息。
