Mental health literacy in India and Australia and its relationship to attitudes towards LGBT people

Arvind A., Pandya A., Amin L., Aggarwal M., Agrawal D., Tiwari K., Singh S., Nemkul M., Agarwal P.

Rees S.N., Crowe M., Harris S.

WHAT IS KNOWN ON THE SUBJECT?: There is evidence that the LGBT communities experience greater health disparities, particularly in relation to their mental health needs. The LGBT communities are often faced with stigma and discrimination within mental health services. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: People within the LGBT communities have identified that their experiences of mental health services reinforce stigma and lack an understanding of their specific needs. Their needs can be addressed by mental health services that challenge heteronormative assumptions and promote self-acceptance and equity. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The existing heteronormative culture in mental health nursing practice needs to be challenged. Practice needs to demonstrate self-awareness of personal and societal LGBT biases, prejudices, and stigma. Practice needs to demonstrate knowledge of important LGBT health care and psychosocial issues. Practice needs to reflect LGBT clinical skills grounded in professional ethics, guidelines, and standards of care.INTRODUCTION: The lesbian, gay, bisexual and transgender (LGBT) communities are a minority population that experience a range of health disparities, including mental health. Because these groups have higher rates of mental disorder than the general population it is, therefore, pertinent to identify their specific mental health needs and their experiences when accessing mental health care.To identify the mental health needs of the LGBT communities and their experiences of accessing mental health care.An integrative review of qualitative studies was conducted.A total of fourteen studies were selected for this review. The studies identified that participants' experiences of accessing mental health care were related to (a) experiencing stigma and (b) staff's lack of knowledge and understanding of LGBT people's needs. They identified a need for mental health care that promotes the principles of equity, inclusion and respect for diversity.The LGBT communities while not a homogenous group, face unique challenges when dealing with their mental health needs. Services that promote health equity and self-acceptance are important for this group.It is vital that mental health nursing education incorporate models that promote equity, inclusion and respect for diversity regarding this group of people.

Pachankis J.E., Mahon C.P., Jackson S.D., Fetzner B.K., Bränström R.

Identity concealment affects all sexual minority individuals, with potentially complex mental health implications. Concealing a sexual minority identity can simultaneously generate the stress of hiding, protect against the stress of discrimination, and keep one apart from sexual minority communities and their norms and supports. Not surprisingly, existing studies of the association between sexual orientation concealment and mental health problems show contradictory associations-from positive to negative to null. This meta-analysis attempts to resolve these contradictions. Across 193 studies (n = 92,236) we find a small positive association between sexual orientation concealment and internalizing mental health problems (i.e., depression, anxiety, distress, problematic eating; ESr = 0.126; 95% CI [0.102, 0.151]) and a small negative association between concealment and substance use problems (ESr = -0.061; 95% CI [-0.096, -0.026]). The association between concealment and internalizing mental health problems was larger for those studies that assessed concealment as lack of open behavior, those conducted recently, and those with younger samples; it was smaller in exclusively bisexual samples. Year of data collection, study location, and sample gender, education, and racial/ethnic composition did not explain between-study heterogeneity. Results extend existing theories of stigma and sexual minority mental health, suggesting potentially distinct stress processes for internalizing problems versus substance use problems, life course fluctuations in the experience of concealment, distinct experiences of concealment for bisexual individuals, and measurement recommendations for future studies. Small overall effects, heavy reliance on cross-sectional designs, relatively few effects for substance use problems, and the necessarily coarse classification of effect moderators in this meta-analysis suggest future needed methodological advances to further understand the mental health of this still-increasingly visible population. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Camp J., Vitoratou S., Rimes K.A.

Many individuals who identify as lesbian, gay, bisexual, queer, and with other non-heterosexual orientations (LGBQ+) experience stigma, prejudice, and/or discrimination because of their sexuality. According to minority stress and identity development theories, these experiences can contribute to difficulties with self-acceptance of sexuality. Lower self-acceptance is considered a risk factor for adverse mental health outcomes. The current review aims to investigate whether self-acceptance of sexuality is associated with minority stressors or difficulties with mental health in LGBQ+ individuals, as well as whether there are differences in self-acceptance between different sexual orientations. Five bibliographic databases were searched. Thirteen studies were identified which used quantitative methodology to investigate associations between self-acceptance, minority stressors, and/or mental health within LGBQ+ samples, or differences in self-acceptance between different sexual orientations. The results from these cross-sectional studies suggested that lower self-acceptance of sexuality was associated with higher levels of self-reported minority stressors, including a lack of acceptance from friends and family, a lack of disclosure to others, and internalized heterosexism. Lower self-acceptance of sexuality was associated with poorer mental health outcomes, including greater global distress, depression symptoms, and lower psychological well-being. There was no significant relationship with suicidality. Studies also found that LGBQ+ individuals had lower general self-acceptance compared to heterosexual participants, bisexual individuals had lower sexuality self-acceptance compared to lesbian/gay individuals, and lesbian women had lower sexuality self-acceptance compared to gay men. Given the potential importance of self-acceptance for LGBQ+ populations, further research is required with more robust methodology. Self-acceptance could be a potential target in clinical interventions for LGBQ+ individuals.

Gunjawate D.R., B. Kumar R., Ravi R., Kunnath L.S.

Gautham M.S., Gururaj G., Varghese M., Benegal V., Rao G.N., Kokane A., Chavan B.S., Dalal P.K., Ram D., Pathak K., Lenin Singh R.K., Singh L.K., Sharma P., Saha P.K., Ramasubramanian C., et. al.

Background: Recognizing the need for good quality, scientific and reliable information for strengthening mental health policies and programmes, the National Mental Health Survey (NMHS) of India was implemented by National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, in the year 2015–2016. Aim: To estimate the prevalence, socio-demographic correlates and treatment gap of mental morbidity in a representative population of India. Methods: NMHS was conducted across 12 Indian states where trained field investigators completed 34,802 interviews using tablet-assisted personal interviews. Eligible study subjects (18+ years) in households were selected by a multi-stage, stratified, random cluster sampling technique. Mental morbidity was assessed using MINI 6. Three-tier data monitoring system was adopted for quality assurance. Weighted and specific prevalence estimates were derived (current and lifetime) for different mental disorders. Mental morbidity was defined as those disorders as per the International Statistical Classification of Diseases, Tenth Revision Diagnostic Criteria for Research (ICD-10 DCR). Multivariate logistic regression was conducted to examine risk for mental morbidity by different socio-demographic factors. Survey was approved by central and state-level institutional ethical committees. Results: The weighted lifetime prevalence of ‘any mental morbidity’ was estimated at 13.67% (95% confidence interval (CI) = 13.61, 13.73) and current prevalence was 10.56% (95% CI = 10.51, 10.61). Mental and behavioural problems due to psychoactive substance use (F10–F19; 22.44%), mood disorders (F30–F39; 5.61%) and neurotic and stress-related disorders (F40–F48; 3.70%) were the most commonly prevalent mental morbidity in India. The overall prevalence was estimated to be higher among males, middle-aged individuals, in urban-metros, among less educated and in households with lower income. Treatment gap for overall mental morbidity was 84.5%. Conclusion: NMHS is the largest reported survey of mental morbidity in India. Survey estimated that nearly 150 million individuals suffer from one or the other mental morbidity in India. This information is to be used for planning, delivery and evaluating mental health programming in the country.

Moreno A., Ardila R., Zervoulis K., Nel J.A., Light E., Chamberland L.

Lesbian, gay, bisexual, transgender and queer psychology (LGBTQ psychology) is a branch of psychology that promotes inclusiveness in theory and practice across the science of psychology, affirming ...

Snow A., Cerel J., Loeffler D.N., Flaherty C.

AbstractContemporary research suggests that transgender and gender-nonconforming (TGNC) adults encounter formidable barriers to health care, including access to quality therapeutic interventions. This systematic review is one of the first to specifically explore obstacles to TGNC mental health care. A rigorous literature review identified eight relevant studies: six qualitative designs and two quantitative designs. Thematic synthesis revealed three major barriers to care and five corresponding subthemes: (1) personal concerns, involving fear of being pathologized or stereotyped and an objection to common therapeutic practices; (2) incompetent mental health professionals, including those who are unknowledgeable, unnuanced, and unsupportive; and (3) affordability factors. Results indicate an acute need for practitioner training to ensure the psychological well-being of TGNC clients.

Roberts L.L.

While the acceptance of homosexuality has risen across many Western countries, we know little about whether or why attitudes have changed in the rest of the world. Here I investigate these questions while also testing the relative utility of three theories of what drives worldwide attitudinal change: (1) the postmaterialist thesis, which casts existential security as a main determinant; (2) world society theory, which emphasizes the influence of a diffusing global culture; and (3) multiple modernities theory, which points to the effect of region-specific cultural programs. Drawing on data from the integrated World Values Survey/European Values Survey (1981-2012), I use a longitudinal multilevel design to model worldwide change in the societal acceptance of homosexuality. In line with world society theory, the results show a broad worldwide upswing in the acceptance of homosexuality, driven largely by the diffusion of favorable global cultural messages. The results provide strong evidence that global culture has shaped collective attitudes globally, although the impact here is found to be less in more religious societies. At the same time, the analysis finds a widening attitudinal gap between countries, and, consistent with multiple modernities theory, suggests this is due in part to the role of region-specific cultural programs. Contrary to the postmaterialist thesis, existential security is not found to have influenced attitudes.

Mongelli F., Perrone D., Balducci J., Sacchetti A., Ferrari S., Mattei G., Galeazzi G.M.

Campbell M., Hinton J.D., Anderson J.R.

Background: Prejudice against transgender people is widespread, yet in spite of the prevalence of this negativity relatively little is known about the antecedents and predictors of these attitudes. One factor that is commonly related to prejudice is religion, and this is especially true for prejudice targets that are considered to be "value violating" (as is the case for transgender individuals). Method: In this paper, we present the findings of our systematic search of the literature on this topic and present the synthesized evidence. Our search strategy was conducted across five databases and yielded 29 studies (across 28 articles). Results: We found consistent evidence that self-identifying as with either being "religious" or as Christian (and to a lesser extent, being Muslim) was associated with increased transprejudice relative to being nonreligious (and to a lesser extent, being Jewish). Additionally, we found consistent evidence that certain forms of religiosity were also related to transprejudice - specifically religious fundamentalism, church attendance, and interpretations of the bible as literal (transprejudice was unrelated to religious education). Conclusion: Although this young, but important field of research is growing, more empirical exploration is needed to fully understand that nuances of the religion-transprejudice relationship.

Furnham A., Swami V.

An increasing number of scholarly works have attempted to understand the reasons for poor rates of help-seeking for symptoms of mental health disorders all around the world. One particular body of work has focused on “mental health literacy” (MHL), defined as knowledge about mental health disorders that is associated with their recognition, management, and prevention. In this article, we report a nonsystematic review of studies on MHL, to give nonexpert academics, policymakers, and practitioners an understanding of the field. We find that studies consistently show that the general public have relatively poor recognition of the symptoms of mental health disorders and appear to emphasize self-help over traditional medical treatments. In addition, we find that there are age, gender, educational, urban−rural, and cross-cultural differences in MHL, which may differentially affect rates of help-seeking in different contexts. Implications and future directions for research are considered in conclusion.

McAllister I., Snagovsky F.

Austin D.W., Bhola P., Tebble C., Shandley K.

Online mental health services provide a point-of-access to mental healthcare that may otherwise be unavailable or limited, particularly in developing countries. Nevertheless, there is a lack of research into individual differences between those who prefer online mental health services and those who prefer traditional in-person services, and whether these differences vary as a function of culture. This study investigated differences in preferences for online or in-person mental health services on e-health literacy, age, education level, and comfort using the internet in a general community sample recruited from Australia and India. A total of 487 participants (31.6% male; mean age = 33.55, SD = 12.20, range 18–78), 297 Australians and 190 Indians, completed an online or paper-and-pencil survey. A significant negative relationship between age and e-health literacy was found with younger ages associated with higher e-health literacy. Furthermore, e-health literacy scores were significantly higher for the Australian sample. Age, e-health literacy, country-of-residence, education level, and comfort in using the internet did not predict mental health service preference. The results suggest that preference for in-person or online mental healthcare is independent of demographic and cultural factors and indicate that online mental health services may be acceptable to Indian health service consumers.

Billard T.J.

A series of three studies were conducted to generate, develop, and validate the Attitudes toward Transgender Men and Women (ATTMW) scale. In Study 1, 120 American adults responded to an open-ended questionnaire probing various dimensions of their perceptions of transgender individuals and identity. Qualitative thematic analysis generated 200 items based on their responses. In Study 2, 238 American adults completed a questionnaire consisting of the generated items. Exploratory factor analysis revealed two non-identical 12-item subscales (ATTM and ATTW) of the full 24-item scale. In Study 3, 150 undergraduate students completed a survey containing the ATTMW and a number of validity-testing variables. Confirmatory factor analysis verified the single-factor structures of the ATTM and ATTW subscales, and the convergent, discriminant, predictive, and concurrent validities of the ATTMW were also established. Together, our results demonstrate that the ATTMW is a reliable and valid measure of attitudes toward transgender individuals.

Li Y., Wu J., Gao H.

Raj P., Dubey A.

Objective: In India research on health issues of transgender populations are very recent and limited though transgenders are an important sub-group of the population. Hence, this study attempts to understand the state of transgender health research in India through a systematic review of literature.Methods: A systematic literature review was conducted using bibliometric analysis. Initially, 132 studies were identified, and only 37 articles meeting selection criteria were subsequently selected for review using PRISMA 2020 guidelines. The research landscape was examined with tools such as Biblioshiny, Arc-GIS (10.1), and Vos-Viewer.Results: The review highlights that existing literature on transgender health in India mainly focuses on sexual health while neglecting their overall health status. It also emphasises the skewed geographical coverage of these studies. Based on the analysis, the interdisciplinary nature of the subject is illustrated in a three-field plot and through term co-occurrence. These indicate the need for culture-specific gender-affirmative services promoting a holistic approach to comprehend the health of transgender populations in India.Conclusion: In India research on transgender health is lopsided and at an initial stage. There is a need to develop diverse research focus on various health issues of transgenders that should also be geographically representative. Future in-depth research on this subject will enable optimizing resource allocation, developing effective gender-inclusive policies, and support holistic planning for better health status of transgender people in India, and other countries with similar socio-cultural background.

Roshan K. M., Dugaje M.

Purpose The purpose of this study is to examine the advancement of cultural transformation over time demands certain alterations in human perceptions. It also aims to examine the 21st century’s many radical changes in India, the constant legal battles to decriminalize homosexuality, and challenges to the rigid dichotomy between heterosexuality and homosexuality. Besides, it influences popular culture among the masses, which has turned out to create a more visible space for the lesbian community. In India, lesbian literature begins synchronously under the shades of women’s writing and feminism that wires new hopes for their identity. Design/methodology/approach This paper examines a primary text as Indian writer Abha Dawesar’s Babyji (2005). There comes the iconic work of Abha Dawesar’s Babyji (2005), which creates a turning point by introducing the life, inner conflict and turbulence of a teenage girl. In addition, a textual analysis of this novel brings forth an analysis of attributes such as sexuality, gender and the interplay of caste and class that meld lesbian childhood and adolescence. This paper also examines how a lesbian girl adapts to and negotiates her maturation amidst vivid social scenarios and cultural conditioning. Findings A few studies (Hidalgo, et al., 2013; Bem, 1989; Pyne, 2016) show many children have reached or crossed their teenage life without accurate or affirmative knowledge of sexuality and gender. Parents, teachers and even other intellectuals of the adult world fail to transfer their knowledge effectively to children. Definitely, the relevance of sex education is paramount, but more important is what implementation tactics should be used for the same cause. The point is that sex education should not be condensed into a certain gender or perpetuate parochial discrimination. It needs to adapt an age-appropriate curriculum for the cognitive and emotional development of the individuals. Considering these factors, understanding comprehensive sex education is what is most likely to find sustainable remedies for this matter. Gerald writes about a socialization process and gays and lesbians hiding their identity from family and society; a fear of rejection; there is a social gap in peer and family spheres. These fears prevent lesbian or gay young persons from fully developing their identities (1999). Rao and Mason tested a model derived from minority stress theory in which the perceived impact of Section 377 increases depressive symptoms of sexual minorities by increasing concealment stress, leading to a diminished sense of belonging. Because of their minority status, they are more vulnerable to and have a higher prevalence of mental illness than heterosexual individuals (2018). Originality/value Babyji has created a discourse to perpetuate normativity and gives importance to the mental health of the excluded lesbian group. It opens a door to studying teenage groups’ issues and their challenges to understanding social and mental issues regarding their identity. A study on this untouched area is required to highlight their issues and mental health problems. This research is an initiative step to create and provide a platform to raise awareness in society.

Kharwar S., Singh P.

Evidence of experienced discrimination by the lesbian, gay, bisexual and transgender (LGBT) individuals makes it necessary to investigate antecedents of prejudice towards them. Desired social contact (DSC) and social distancing practices towards LGBT community may be related to the knowledge about and attitudes towards the LGBT community. However, the inter-construct mechanism underlying such practices needs to be investigated. Considering this need, the present study explored the relationship between knowledge, attitude, DSC and social distance practices towards the LGBT community. A total of 315 heterosexual participants (male—184, female—131; Mage = 24.66, SDage = 3.38) were contacted through emails and social media between November 2021 and February 2022 and requested to fill the questionnaires. The findings indicate that the relationships between knowledge, DSC and social distancing practices are significantly mediated by attitudes towards the LGBT community. The standardized indirect effect of knowledge (via attitude) on DSC was statistically significant (β = 0.47; 95% CI, 0.54, 0.40; p = 0.005). Also, knowledge’s standard indirect effect (via attitude) on social distancing was statistically significant (β =  − 0.25; 95% CI, − 0.32, − 0.16; p = 0.005). The findings assert that knowledge about and attitude towards LGBT community play a crucial role in shaping social contact and social distancing practices towards them. Increased knowledge about alternative sexualities may effectively reduce negative attitudes and social distancing practices and create a more inclusive and accepting society for sexual minority groups. Policymakers should strive to enhance the knowledge of general populations concerning sexuality and homosexual attractions through awareness programs and formal teaching.