“Is it important to assess mental health problem in MSM?”

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Asian Journal of Psychiatry

journal homepage:www.elsevier.com/locate/ajp

Letter to the Editor

“Is it important to assess mental health problem in MSM?”

Men Who Have Sex with Men (MSM) is a growing and highlighted population in Indonesia with a 2-fold increase on prevalence to 2.6% in 2012 compared to 2009 (Kementerian Kesehatan Republik Indonesia, 2013). Mental disorder is closely related to MSM with 3 times higher possibility to be diagnosed with mental disorder, most common are depression and anxiety, compared to heterosexuals (Chandrasekaran et al., 2009). The psychopathologies found in MSM is influenced by the negative coping mechanism, such as self-blaming, which may be related to sexual orientation, and the desire for undoing, a defence mechanism, which may be the basis of obsessive-compulsive symptoms.

Globally, mental health problem is just a small fraction of LGBTQ+

+ issues. A study showed that lesbian, gay or bisexual individuals are 1.5 times more likely to have depression or anxiety disorders with 2.5 times more risk on attempting suicide (King et al., 2008). Moreover, around 26% to almost half of transgender have attempted suicide at least once in their lifetime with evidence associating it with the stress they possess in relation to discrimination, stigma, and unsupportive environment (Clements-Nolle and Marx, 2001;Grossman and D’Augelli, 2007). In Indonesia, poor mental health outcomes related to stigma and discrimination is also a problem. Eastern cultural and religious norms runs deep in society, hence making it difficult to accept homosexuality resulting in a lack of friendly health services to MSM. Another concern which adds to the mental health challenge in MSM is HIV/AIDS (Chandrasekaran et al., 2009). In early diagnosis of HIV/AIDS, MSM are prone to anxiety, distress, paranoia, sense of loss and mourning, suicidal ideas, and social isolation (Chandrasekaran et al., 2009).

Psychopathology in MSM is influenced by personality, resilience, self-esteem, coping, sexual positions and quality of life. The prevalence of personality disorders in MSM is predictably high and affects the mental disorder (Abdo et al., 20144). The typical resilience form of MSM is seroadaptation, a way to reduce the risk of HIV transmission without using a condom, as an example is serosorting (choosing a sexual partner with the same HIV status) where severe mental disorder is associated with a lower serosorting behaviour (Buttram et al., 2012).

Depression, eating disorders, suicidal ideation, drug use, dysthymia, and psychosis were associated with low self-esteem.¹⁴Typical negative coping were drug use and sexual behavior with high active and low avoidance coping were associated with low psychological suffering.

Receptive sexual positions were associated with depression (Chandrasekaran et al., 2009). Social support also impact the risk of depression, suicidal ideation and anxiety disorders with poor quality of life significantly related to the first two latter.

In Jakarta, a study conducted showed that the risk factors for psychopathology (depression, somatization and obsessive-compulsive symptoms) on MSM population were unhealthy sexual behavior, such as having sexual intercourse in the last three months with more than one partner and not using condom routinely (almost 50%), and disclosure of sexual orientation to the family members. Contrastly, study in Jamaica stated that the non-disclosure to the family would be a risk

factor for psychopathology in MSM (White et al., 2016). This difference may rise due to the cultural resistance to homosexuality in Indonesia.

The high rate of mental disorder and risk factors related in MSM should be basic knowledge possessed by healthcare workers (HCW) and MSM themeselves. It is important to understand that identifying ex- isting risk factors and initiating risk factor modification can prevent mental disorders occurrence. Identification of these risk factors in MSM through mental disorder screening can be done by HCW so treatment can start early.

From the discussion above it is clear that LGBTQ++ in general and MSM in particular have special needs in terms of health services that must be met. From the high prevalence of mental health disorder and harsh stigmatizing environment to the uncertainty of getting a qualified treatment in health services, these needs revolve around the handling of stigma and discriminating behaviour they feel when they come to health services. Studies showed that many LGBTQ++ still felt dis- criminated by HCW, including HCW in mental health services (MHS) (Dunbar et al., 2017). This can lead to poorer mental health outcomes caused by hesitation to access MHS.

The problem of discrimination in MHS is a worldwide issue. Studies from almost all continents show the same results with the discrimination, victimization, and negative stigma by mental health providers (Dunbar et al., 2017;Rutherford et al., 2012). The keyword here is “safe space”, where they can come and get the treatment needed from a place sensitive to their special conditions, not only in MHS, but also in health services that address physical problems.

Based on that problem, integrated service addressing physical and mental problems in MSM is needed to avoid double stigma such as an MSM-friendly health service clinic. Hence, capacity building for nurses and other health workers in the context of dealing with MSM is needed to eliminate negative stigma among health workers. Integrated and friendly MHS for MSM are expected to provide optimal therapy leading to quality of life improvement in MSM.

Financial disclosure None.

Conflicts of interest

The authors declare that they have no conflict of interest.

Acknowledgement

All authors had equal contribution in this article.

References

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Received 25 May 2018

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Putri Nugraheni, Heriani Tobing, Irmia Kusumadewi, Kristiana Siste^⁎ Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta Pusat, Jakarta, 10430, Indonesia E-mail address:ksiste@yahoo.com(K. Siste).

⁎Corresponding author.

Letter to the Editor Asian Journal of Psychiatry xxx (xxxx) xxx–xxx

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