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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 34  |  Issue : 3  |  Page : 245-248

A study on homosexuals and their psychiatric morbidities in a northeastern state of India, Manipur


Department of Psychiatry, RIMS, Imphal, Manipur, India

Date of Web Publication27-Sep-2018

Correspondence Address:
Dr. Y R Niranjan Hebbar
Department of Psychiatry, RIMS, Imphal, Manipur
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijsp.ijsp_111_17

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  Abstract 


Introduction: In recent years, India is witnessing a change in public attitude and concern toward sexual minority population. The study was undertaken as there are sparse data regarding homosexuality in India, where it is still considered punishable. Aim: This study aimed to assess sociodemographic profiles and psychiatric morbidities of homosexuals belonging to a northeastern state of India, Manipur. Materials and Methods: This was a cross-sectional study conducted on 32 consenting homosexuals from October 2016 to June 2017, using a semi-structured interview schedule and Mini-International Neuropsychiatry Interview-Plus scale. Results: Majority of the homosexuals were from urban areas and belonged to nuclear family. The current study reported increased psychiatric morbidities among the homosexuals, of which substance abuse was among the top followed by anxiety disorders, depressive disorders, and higher suicidal risk. Conclusion: Results clearly indicate that this population is at higher risk of developing psychiatric morbidities. Hence, this necessitates a different interventional model for the overall well-being of homosexuals.

Keywords: Depression, homosexuals, sexual minority, substance use disorders


How to cite this article:
Niranjan Hebbar Y R, Majumder U, Singh RL. A study on homosexuals and their psychiatric morbidities in a northeastern state of India, Manipur. Indian J Soc Psychiatry 2018;34:245-8

How to cite this URL:
Niranjan Hebbar Y R, Majumder U, Singh RL. A study on homosexuals and their psychiatric morbidities in a northeastern state of India, Manipur. Indian J Soc Psychiatry [serial online] 2018 [cited 2020 Jul 11];34:245-8. Available from: http://www.indjsp.org/text.asp?2018/34/3/245/242348




  Introduction Top


“Sexuality” is considered something more than physical sex and something less than all behaviors directed toward gaining pleasure. Sexuality has its complex dimension of four psychosexual factors which include sexual identity, gender identity, sexual orientation, and sexual behavior. Homosexuals are those who are emotionally and romantically attached to same-sex people, more often addressed as lesbians (females attracted toward females) and gays (males attracted toward males).[1],[2]

Although long ago it was considered as mental illness, it was in 1973 when the American Psychiatric Association removed homosexuality from its classification, which was later followed by the WHO's International Classification of Diseases -10 in 1992.[3]

Even then in the Indian scenario, still, it is considered as a punishable offense. The controversies raged post Supreme Court Judgment in 2013 which rejected the earlier Delhi High Court Judgment on Article 377 and there is a continuous struggle for decriminalization of homosexuality in India.[4] The prevalence of homosexuality is difficult to explore because of social repression; stigma; fear of disclosure of their sexuality during survey; and the variation between age, gender, ethnicity, and religion.[5]

Studies reported increased psychiatric morbidities among the homosexuals when compared to the general population. Stigma, negative perception of self, and discrimination pose a real threat for their well-being.[6],[7] These minority people are under constant duress mainly due to difficulties they face in the heterosexism nature of our society.[8]

Indian literature exists on men having sex with men (MSM), who are under high risk and vulnerable to the spread of HIV in India although there is a scarcity of studies done on homosexuality and its implication on mental health in India.[9],[10] MSM is a divergent group of people, which consists of homosexuals, bisexuals, or commercial sex workers. This study was conducted to assess the psychiatric morbidities of homosexuals from a northeastern state of India.


  Materials and Methods Top


It was a cross-sectional, single-interview study conducted from October 2015 to June 2017. Ethical clearance for the study was obtained from the Institutional Ethics Committee. Thirty-two consenting homosexuals aged above 18 years were interviewed at their workplaces/locality with the help of an nongovernmental organization (NGO) organization (All Manipur Nupi Manbi Association), which works for the welfare of sexual minority people of Manipur. Nonprobability convenience sampling from the general population was used. Those having significant neurological diseases or any comorbid medical illness were excluded along with those who were not willing to participate in the study. After obtaining written informed consent, each participant was interviewed individually and confidentiality was maintained.

A pretested, structured data collection form to obtain information on age, sex, locality, and other sociodemographic profile was used. A standardized questionnaire, namely Mini-International Neuropsychiatry Interview-Plus (MINI-Plus) scale was used to assess the presence of psychiatric illnesses such as major depressive disorder, dysthymia, and panic disorder. MINI-Plus scale has acceptable high validation and reliability scores and can be administered in a much shorter period of time (mean: 18.7 ± 11.6 min and median: 15 min). The data collected were checked, entered, and processed using Statistical Package for the Social Sciences (SPSS) for Windows, version 16.0 (SPSS Inc., Chicago, IL, USA). Descriptive statistics such as mean, standard deviation, and percentages were used. Chi-square test or Fisher's exact test was used to test the level of significance. P < 0.05 was considered statistically significant.


  Results Top


The study included 32 participants (20 gays and 12 lesbians) with a mean age of 28.3 years and standard deviation of 4.8 years. Detailed sociodemographic findings of our study population are summarized in [Table 1].
Table 1: Sociodemographic characteristics of the study sample

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Among psychiatric morbidities, 62.5% were abusing alcohol and 46.8% were abusing nonalcoholic substance. Nearly 25% of them were suffering from current episode of depression, while 18.7% had anxiety spectrum disorders. Almost 24.8% had suicidal risk behavior and 15.6% of them had a history of previous suicidal attempts. Psychiatric morbidities were found to be more common in gays than in lesbians; however, no statistical significance was found [Table 2].
Table 2: Axis 1 psychiatric morbidities assessed using MINI-plus

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  Discussion Top


Sivasubramanian et al.[9] reported 29% of the MSM to be suffering from current major depression in their study sample. Deb et al.[10] compared psychiatric morbidities and general health status among MSM clients and other male clients attending sexually transmitted disease clinic and reported significantly higher levels of depression among MSM group. A systematic review by King et al.[11] reported a lifetime prevalence of depression to be at least 1.5 times higher in lesbian, gay, and bisexual people. In addition, Cochran et al.[12] showed the lifetime prevalence of depression to be 34.4% among Latino and Asian-American lesbians and gays in 2007. Similar findings were found in our study where 25% of the participants had current episode of depression and 18.75% of them had a previous history of depression.

Sivasubramanian et al.[9] reported dysthymia in about 2.7%, hypomania in 9.5%, and manic episodes in 3.4% of their study population. Meyer et al.[13] studied the prevalence of lifetime mental disorders among lesbian, gay, bisexual, and transgender (LGBT) in New York in 2005 and found out the prevalence of dysthymia to be around 4.4% and any mood disorder to be around 2.6%. In concordance with the above studies, in our study, the prevalence of dysthymia was found to be 6.5% and that of hypomania was found to be 9.3%. Comparatively higher prevalence of these disorders in our study may be due to higher prevalence of overall mental health disorders in Manipur, as evidenced by the recent National Mental Health Survey 2015–2016.[14]

Our study shows the prevalence of generalized anxiety disorder to be 6.2% in the study sample. Nearly 3.1% of the individuals had panic disorders and 9.3% had social phobia. Although most of them were found among the lesbians when compared to gays, no significant difference was found between the two.

Similar results were found by Sivasubramanian et al.,[9] where 24% of the individuals were suffering from anxiety-related disorder. Deb et al.[10] reported significantly higher anxiety and insomnia symptoms in MSM group in their study. Meyer et al.,[12] who studied the prevalence of lifetime mental disorders among LGBT in New York, 2005, found out that 5.7% of the study sample suffered from panic disorder, 21.1% from social phobia, and 8.5% from generalized anxiety disorder in their study population. Furthermore, Cochran et al.[12] showed lifetime prevalence of anxiety disorders to be 18.7% in gays and 14.1% in lesbians, which is in consonance with our findings.

Higher prevalence of suicidal behaviors was reported by Sivasubramanian et al.[9] where 45% of their study population were having suicidal ideations at the time of interview and 66% were at low risk, 19% at moderate risk, and 15% at high risk. A meta-analysis by Marshal et al.[15] showed 26% of lesbians, gays, and bisexuals exhibiting suicidal risk behavior. Our study also reported an overall 24.8% of suicidal risk among the participants, also 15.6% of them had a history of suicidal attempt in their past. Although gays outnumbered the lesbians in suicidal risk behaviors, it was not proved statistically (P = 0.16).

In a systematic review by King et al.[11] it was found that lesbian and bisexual women were particularly at risk of substance dependence. Furthermore, Meyer et al.[13] studied the prevalence of lifetime mental disorders among LGBT in New York in 2005 and found out that 35.5% of people had substance use disorders. Comparative results were found in our study where 46.8% of them were abusing one or the other type of psychotropic substances, out of which maximum of 10 (40%) were abusing marijuana, followed by 8 (32%) narcotics, 3 (12%) stimulants, and 2 (8%) each abusing inhalants and tranquilizers. Higher incidence of drug abuse here is in part due to Manipur sharing its border with the infamous “golden triangle.”[16],[17]

King et al.[11] in their systematic review found lifetime prevalence of alcohol use disorders to be at least two times higher in lesbian, gay, and bisexual people (Risk ratio 1.51–4.00). Sivasubramanian et al.[9] reported over 15% of alcohol dependence in their study. In our study, 62.5% of the total participants were alcohol abusers, out of which 46.8% of them were abusing alcohol in a dependent manner. Comparatively higher prevalence of these in our study may be due to the higher prevalence of alcohol use disorders in Manipur, as evidenced by the recent National Mental Health Survey 2015–2016.[14]


  Conclusion Top


The study found out higher psychiatric morbidities in the selective sample of homosexuals of Manipur. As this population is at high risk of suffering psychiatric morbidities, it necessitates a skilled multilevel intervention for the overall well-being of homosexuals.

Limitations

One important limitation of our study was the small sample size; a larger sample size could have generated more comparable group sizes and greater predictability to detect differences. Second, NGO sampling bias; a community sampled random survey would have been better to state the exact prevailing psychiatric morbidities of homosexuals.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sadock VA. Normal human sexuality and sexual dysfunctions. In: Sadock BJ, Sadock VA, Ruiz P, editors. Kaplan and Sadock's Comprehensive Textbook of Psychiatry. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2009. p. 2057-9.  Back to cited text no. 1
    
2.
Hebbar YR, Magh S, Dash A. I am no male or female or any other, I have no sex: A case report on asexuality. Open J Psychiatry Allied Sci 2017;9:77-8.  Back to cited text no. 2
    
3.
Drescher J, Byne WM. Homosexuality, gay and lesbian identities and homosexual behaviour. In: Sadock BJ, Sadock VA, Ruiz P, editors. Kaplan and Sadock's Comprehensive Textbook of Psychiatry. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2009. p. 2060-89.  Back to cited text no. 3
    
4.
Koushal SK and another versus NAZ Foundation and others. Civil Appeal NO 10972; 2013. Available from: http://www.judis.nic.in/supremecourt/imgs1.aspx?filename=41070. [Last accessed on 2018 Jan 21].  Back to cited text no. 4
    
5.
Rao TS, Jacob KS. Homosexuality and India. Indian J Psychiatry 2012;54:1-3.  Back to cited text no. 5
    
6.
Meyer IH. Minority stress and mental health in gay men. J Health Soc Behav 1995;36:38-56.  Back to cited text no. 6
    
7.
Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychol Bull 2003;129:674-97.  Back to cited text no. 7
    
8.
Sathyanarayana Rao TS, Jacob KS. The reversal on gay rights in India. Indian J Psychiatry 2014;56:1-2.  Back to cited text no. 8
    
9.
Sivasubramanian M, Mimiaga MJ, Mayer KH, Anand VR, Johnson CV, Prabhugate P, et al. Suicidality, clinical depression, and anxiety disorders are highly prevalent in men who have sex with men in Mumbai, India: Findings from a community-recruited sample. Psychol Health Med 2011;16:450-62.  Back to cited text no. 9
    
10.
Deb S, Dutta S, Dasgupta A, Roy S. Hidden psychiatric morbidities and general health status among men who have sex with men and other clients of a sexually transmitted disease clinic of Kolkata: A comparative study. Indian J Community Med 2010;35:193-7.  Back to cited text no. 10
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11.
King M, Semlyen J, Tai SS, Killaspy H, Osborn D, Popelyuk D, et al. A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry 2008;8:70.  Back to cited text no. 11
    
12.
Cochran SD, Mays VM, Alegria M, Ortega AN, Takeuchi D. Mental health and substance use disorders among Latino and Asian American lesbian, gay, and bisexual adults. J Consult Clin Psychol 2007;75:785-94.  Back to cited text no. 12
    
13.
Meyer IH, Dietrich J, Schwartz S. Lifetime prevalence of mental disorders and suicide attempts in diverse lesbian, gay, and bisexual populations. Am J Public Health 2008;98:1004-6.  Back to cited text no. 13
    
14.
Murthy RS. National mental health survey of India 2015-2016. Indian J Psychiatry 2017;59:21-6.  Back to cited text no. 14
[PUBMED]  [Full text]  
15.
Marshal MP, Dietz LJ, Friedman MS, Stall R, Smith HA, McGinley J, et al. Suicidality and depression disparities between sexual minority and heterosexual youth: A meta-analytic review. J Adolesc Health 2011;49:115-23.  Back to cited text no. 15
    
16.
Hebbar YR, Singh B. Psychiatric morbidity in a selective sample of transgenders in Imphal, Manipur: A descriptive study. Ann Indian Psychiatry 2017;1:114-7.  Back to cited text no. 16
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17.
Kermode M, Longleng V, Singh BC, Hocking J, Langkham B, Crofts N, et al. My first time: Initiation into injecting drug use in Manipur and Nagaland, North-East India. Harm Reduct J 2007;4:19.  Back to cited text no. 17
    



 
 
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