Mental health among men who have sex with men in Cambodia: Implications for integration of mental health services within HIV programmes

Abstract

BackgroundPoor mental health contributes to poor HIV prevention, treatment and care outcomes. This paper documents factors associated with psychological distress among men who have sex with men (MSM) in Cambodia and discusses potential ways in which routine mental health management could be integrated into HIV services.MethodsA cross-sectional study was conducted in 2014 among 394 MSM randomly selected from two provinces using a two-stage cluster sampling method. A structured questionnaire was used to assess psychological distress, sexual behaviors, substance use, adverse childhood experiences and family dysfunction. Multivariate logistic regression analysis was performed to explore factors associated with levels of psychological distress.ResultsIn total, 10.7 % of the respondents reported having suicidal thoughts and 6.6 % reported having attempted to commit suicide in the past three months, while 38.8 % had a higher level of psychological distress (GHQ-12 > 3), which indicates poor mental health. Higher levels of psychological distress were independently associated with older age (AOR = 1.09, 95 % CI 1.03–1.14), alcohol use (AOR = 3.3, 95 % CI 1.36–7.83), illicit drug use (AOR = 3.53, 95 % CI 1.12–11.18), poor self-reported quality of life (AOR = 7.45, 95 % CI 1.79–3.04), and reduced condom use at last sex (AOR = 0.40, 95 % CI 0.21–0.73). MSM with higher levels of psychological distress were significantly more likely to report that a family member said hurtful things to them (AOR = 1.80, 95 % CI 1.10–2.97), a parent or guardian had been physically abused (AOR = 3.51, 95 % CI 1.86–6.62), and a family member had been mentally ill (AOR = 4.01, 95 % CI 2.06–7.81) when they were growing up.ConclusionsIn order to mitigate psychological distress among MSM in Cambodia, integration of mental health interventions within HIV programmes should be strengthened. To achieve optimal impact, these interventions should also address alcohol and other substance use, and low condom use among distressed MSM. In addition, training of clinical and non-clinical HIV service providers to screen for mental health symptoms, and subsequent provision of peer-based outreach and social support for MSM identified with psychological distress is required.

Prevalence and correlates of alcohol and tobacco use among key populations in Togo in 2017: a cross-sectional study

“…This is consistent with other studies that found a relationship between alcohol and drug abuse and psychological symptoms such as depression, anxiety and suicidal ideation among key populations 29 36 37. Consistent with our findings, a study conducted in Cambodia among MSM found that 38.8% had severe psychological distress and that severe psychological distress was associated with alcohol and drug use, poor self-reported quality of life and reduced condom use at last sex 36. In southern India, a study among FSW found a significant relationship between major depression and alcohol use 38.…”

“…Severe psychological distress was at least twice higher among people with a hazardous/harmful alcohol consumption and people who were binge drinking. This is consistent with other studies that found a relationship between alcohol and drug abuse and psychological symptoms such as depression, anxiety and suicidal ideation among key populations 29 36 37. Consistent with our findings, a study conducted in Cambodia among MSM found that 38.8% had severe psychological distress and that severe psychological distress was associated with alcohol and drug use, poor self-reported quality of life and reduced condom use at last sex 36.…”

Prevalence and correlates of psychological distress among drug users in Phnom Penh, Cambodia

“…GHQ-12 scores can vary from one place to another (Goldberg et al, 1998). However, in the absence of studies assessing psychological distress among the general populations using the same scale, we used this cut off based on our previous (Brody et al, 2016) and ongoing (Yi et al, 2016) studies.…”

The psychological health and associated factors of men who have sex with men in China: A cross-sectional survey

“…Another study revealed that higher levels of psychological distress are independently associated with older age, alcohol use, poor self-reported quality of life, and reduced condom use at last sexual encounter [ 20 ]. Discrimination, stigma, and socially related stress are often cited as potential contributing factors for the observed elevated psychological distress experienced by MSM [ 21 , 22 ].…”