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      Mental Health Challenges and Needs among Sexual and Gender Minority People in Western Kenya

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          Abstract

          Background: Sexual and gender minority (SGM) people in Kenya face pervasive socio-cultural and structural discrimination. Persistent stress stemming from anti-SGM stigma and prejudice may place SGM individuals at increased risk for negative mental health outcomes. This study explored experiences with violence (intimate partner violence and SGM-based violence), mental health outcomes (psychological distress, PTSD symptoms, and depressive symptoms), alcohol and other substance use, and prioritization of community needs among SGM adults in Western Kenya. Methods: This study was conducted by members of a collaborative research partnership between a U.S. academic institution and a Kenyan LGBTQ civil society organization (CSO). A convenience sample of 527 SGM adults (92.7% ages 18–34) was recruited from community venues to complete a cross-sectional survey either on paper or through an online secure platform. Results: For comparative analytic purposes, three sexual orientation and gender identity (SOGI) groups were created: (1) cisgender sexual minority women (SMW; 24.9%), (2) cisgender sexual minority men (SMM; 63.8%), and (3) gender minority individuals (GMI; 11.4%). Overall, 11.7% of participants reported clinically significant levels of psychological distress, 53.2% reported clinically significant levels of post-traumatic stress disorder (PTSD) symptoms, and 26.1% reported clinically significant levels of depressive symptoms. No statistically significant differences in clinical levels of these mental health concerns were detected across SOGI groups. Overall, 76.2% of participants reported ever using alcohol, 45.6% home brew, 43.5% tobacco, 39.1% marijuana, and 27.7% miraa or khat. Statistically significant SOGI group differences on potentially problematic substance use revealed that GMI participants were less likely to use alcohol and tobacco daily; and SMM participants were more likely to use marijuana daily. Lifetime intimate partner violence (IPV) was reported by 42.5% of participants, and lifetime SGM-based violence (SGMV) was reported by 43.4%. GMI participants were more likely than other SOGI groups to have experienced both IPV and SGMV. Participants who experienced SGMV had significantly higher rates of clinically significant depressive and PTSD symptoms. Conclusions: Despite current resilience demonstrated by SGM adults in Kenya, there is an urgent need to develop and deliver culturally appropriate mental health services for this population. Given the pervasiveness of anti-SGM violence, services should be provided using trauma-informed principles, and be sensitive to the lived experiences of SGM adults in Kenya. Community and policy levels interventions are needed to decrease SGM-based stigma and violence, increase SGM visibility and acceptance, and create safe and affirming venues for mental health care. Political prioritization of SGM mental health is needed for sustainable change.

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          The PHQ-9: validity of a brief depression severity measure.

          While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
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            Stigma and Minority Stress as Social Determinants of Health Among Lesbian, Gay, Bisexual, and Transgender Youth: Research Evidence and Clinical Implications.

            In this article, we review theory and evidence on stigma and minority stress as social/structural determinants of health among lesbian, gay, bisexual, and transgender (LGBT) youth. We discuss different forms of stigma at individual (eg, identity concealment), interpersonal (eg, victimization), and structural (eg, laws and social norms) levels, as well as the mechanisms linking stigma to adverse health outcomes among LGBT youth. Finally, we discuss clinical (eg, cognitive behavioral therapy) and public health (eg, antibullying policies) interventions that effectively target stigma-inducing mechanisms to improve the health of LGBT youth.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                01 February 2021
                February 2021
                : 18
                : 3
                : 1311
                Affiliations
                [1 ]Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; jnicolem@ 123456umich.edu (J.C.); katlew@ 123456umich.edu (K.L.); gljohns@ 123456umich.edu (G.J.); ljadwin@ 123456umich.edu (L.J.-C.)
                [2 ]Western Kenya LBQT Feminist Forum, Kisumu 40100, Kenya; rucahwarren@ 123456yahoo.com
                [3 ]Nyanza Rift Valley and Western Kenya (NYARWEK) LGBTI Coalition, Kisumu 40100, Kenya; conchela12@ 123456gmail.com (C.O.); muksdan2010@ 123456gmail.com (D.P.O.)
                [4 ]Department of Psychiatry, School of Medicine, University of Nairobi, Nairobi 00100, Kenya; mkumar@ 123456uonbi.ac.ke
                [5 ]The Williams Institute, School of Law, University of California Los Angeles, Los Angeles, CA 90095, USA; WILSONB@ 123456law.ucla.edu
                Author notes
                [* ]Correspondence: gwharper@ 123456umich.edu
                Author information
                https://orcid.org/0000-0003-1011-1751
                https://orcid.org/0000-0001-5744-9632
                https://orcid.org/0000-0001-5842-5229
                Article
                ijerph-18-01311
                10.3390/ijerph18031311
                7908383
                33535647
                88d2a096-82eb-4526-b819-c6f9aa812333
                © 2021 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 31 December 2020
                : 26 January 2021
                Categories
                Article

                Public health
                kenya,mental health,sexual and gender minority,lgbtq,violence
                Public health
                kenya, mental health, sexual and gender minority, lgbtq, violence

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