Understanding How Sexual and Gender Minority Stigmas Influence Depression Among Trans Women and Men Who Have Sex with Men in India.

ABSTRACT

PURPOSE: Few studies have assessed how sexual and gender minority stigmas affect the mental health of trans women and self-identified men who have sex with men (MSM) in India, populations with a high HIV burden. We tested whether social support and resilient coping act as mediators of the effect of sexual and gender minority stigmas on depression as proposed by Hatzenbuehler's psychological mediation framework, or as moderators based on Meyer's minority stress theory. METHODS: We conducted a cross-sectional survey among trans women (n = 300) and MSM (n = 300) recruited from urban and rural sites in India. Standardized scales were used to measure depression (outcome variable), transgender identity stigma/MSM stigma (predictor variables), and social support and resilient coping (tested as moderators and parallel mediators). The mediation and moderation models were tested separately for trans women and MSM, using Hayes' PROCESS macro in SPSS. RESULTS: Participants' mean age was 29.7 years (standard deviation 8.1). Transgender identity stigma and MSM stigma were significant predictors (significant total and direct effects) of depression, as were social support and resilient coping. Among trans women and MSM, social support and resilient coping mediated (i.e., significant specific indirect effects), but did not moderate, the effect of stigma on depression, supporting the psychological mediation framework. CONCLUSION: Sexual and gender minority stigmas are associated with depression, with social support and resilient coping as mediators. In addition to stigma reduction interventions at the societal level, future interventions should focus on improving social support and promoting resilience among trans women and MSM in India.