Mental Health Challenges and Needs among Sexual and Gender Minority People in Western Kenya.
Mental Health Challenges and Needs among Sexual and Gender Minority People in Western Kenya.
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DOI：
10.3390/ijerph18031311
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发表时间：
2021-02-01
影响因子：
--
通讯作者：
Wilson BDM
中科院分区：
文献类型：
--
作者：
Harper GW;Crawford J;Lewis K;Mwochi CR;Johnson G;Okoth C;Jadwin-Cakmak L;Onyango DP;Kumar M;Wilson BDM
背景：肯尼亚的性和性别少数群体（SGM）面临着普遍的社会文化和结构性歧视。反性生殖器切割的污名和偏见造成的持续压力可能使性生殖器切割者面临更大的负面心理健康结果风险。本研究探讨了肯尼亚西部SGM成人的暴力经历（亲密伴侣暴力和基于SGM的暴力）、心理健康结果（心理困扰、创伤后应激障碍症状和抑郁症状）、酒精和其他物质使用以及社区需求的优先次序。方法：本研究由美国学术机构和肯尼亚LGBTQ公民社会组织（CSO）之间的合作研究伙伴关系的成员进行。从社区场所招募了527名SGM成年人（92.7%年龄在18-34岁之间）的方便样本，通过书面或在线安全平台完成横断面调查。结果：为了进行比较分析，我们创建了三个性取向和性别认同（SOGI）群体：(1)顺性少数群体女性（SMW; 24.9%），(2)顺性少数群体男性（SMM; 63.8%），(3)性别少数群体个体（GMI; 11.4%）。总体而言，11.7%的参与者报告了临床显著水平的心理困扰，53.2%的参与者报告了临床显著水平的创伤后应激障碍（PTSD）症状，26.1%的参与者报告了临床显著水平的抑郁症状。在SOGI组中，这些心理健康问题的临床水平没有统计学上的显著差异。总体而言，76.2%的参与者报告曾经饮酒，45.6%的人使用自制啤酒，43.5%的人使用烟草，39.1%的人使用大麻，27.7%的人使用阿拉伯茶或阿拉伯茶。统计上显著的SOGI组在潜在问题物质使用方面的差异表明，GMI参与者每天使用酒精和烟草的可能性较低；而SMM参与者更有可能每天使用大麻。42.5%的参与者报告了终生亲密伴侣暴力（IPV）， 43.4%的参与者报告了终生基于伴侣的暴力（SGMV）。GMI参与者比其他SOGI组更有可能同时经历IPV和SGMV。经历过SGMV的参与者有明显更高的临床显著抑郁和PTSD症状的发生率。结论：尽管目前肯尼亚的SGM成年人表现出了适应力，但迫切需要为这一人群开发和提供文化上合适的心理健康服务。鉴于反性侵暴力行为的普遍存在，在提供服务时应采用创伤知情原则，并对肯尼亚性侵成人的生活经历保持敏感。需要在社区和政策层面采取干预措施，以减少基于性生殖器切割的耻辱和暴力，提高性生殖器切割的知名度和接受度，并为精神卫生保健创造安全和肯定的场所。要实现可持续的变革，就需要在政治上优先考虑性暴力受害者的心理健康问题。
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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