Validation of depressive symptoms, social support, and minority stress scales among Gay, Bisexual, and other men who have with men (GBMSM) in Nigeria, Africa: A Mixed Methods Approach

Abstract

<jats:title>Abstract</jats:title> <jats:p><jats:bold>Background</jats:bold>: Gay, bisexual, and other men who have sex with men (GBMSM) in Nigeria experience social marginalization, discrimination and violence due to their sexual identity, which may negatively impact physical, mental, and sexual health outcomes. Studies on GBMSM in Africa utilize measurement scales developed largely for populations in the Global North. The validity and reliability of these instruments—to our knowledge—have never been thoroughly investigated among GBMSM in Nigeria. The aim of the current study was to determine the validity and reliability of the English versions of the Center for Epidemiologic Studies Depression Scale (CESD-R), Multidimensional Scale of Perceived Social Support (MSPSS), and LGBT Minority Stress Measure among a large multi-state sample of GBMSM Nigeria.<jats:bold>Methods</jats:bold>: Between January and June 2019, we conducted cognitive interviews (N=30) and quantitative assessments (N=406) with GBMSM in Nigeria. The cognitive interviews assessed comprehension of scale items and elicited suggestions for scale modifications. The quantitative assessment was used to gather psychosocial health data and to evaluate psychometric properties and construct validity of the modified scales. We utilized confirmatory factor analysis to assess factor structure, correlation coefficients, and Cronbach’s alpha to examine scale validity and internal consistency. <jats:bold>Results</jats:bold>: Based on participant feedback from the cognitive interviews, we made slight modifications (i.e., culturally appropriate word substitutions) to all three scales. Results of quantitative analyses indicated good psychometric properties including high factor loadings, internal consistency and construct validity among the CESD-R, MSPSS, and LGBT Minority Stress Measure among GBMSM in Nigeria. <jats:bold>Conclusion</jats:bold>: These results suggests that modifying research scales to be more culturally relevant likely do not jeopardize their validity and reliability. We found that modified scales measuring depressive symptoms, perceived social support, and minority stress among GBMSM in Nigeria remained valid. More research is needed to explore whether the psychometric properties remain if the scales are translated into broken English (Pidgin) and other traditional Nigerian languages (Yoruba, Igbo and Hausa).</jats:p>

Parental Sexuality Disclosure, Discrimination, and Depression Among Black Sexual Minority Men and Black Transgender Women

“…Responses to each item were coded in integer form (from 0 to 3) and summed to create an index (ranging from 0 to 60); these were not scaled in percentage, as there is a well-established cutoff for depressive symptoms using this scale (values of ≥16). This scale demonstrated excellent internal consistency (Cronbach α = 0.93) and has also been used in other studies of depression 27,32…”

“…Minority Stress Theory posits that adverse health outcomes of racism and homophobia, including depression, suicidality, substance use, and sexual risk behaviors, produce a cumulative stress burden among minority populations 8,9,11,18,19,21–23. This theory has been used to study several outcomes among lesbian, gay, bisexual, transgender, queer (or sometimes questioning), and others (LGBTQ+) populations and other minority groups, including Black LGBTQ+ populations 5,7,24–27. For BSMM/BTW populations, extant literature illustrates that both homophobia and racism are associated with adverse health outcomes in this population, including substance use and sexual risk behaviors 9,21,23.…”

“…8,9,11,18,19,[21][22][23] This theory has been used to study several outcomes among lesbian, gay, bisexual, transgender, queer (or sometimes questioning), and others (LGBTQ+) populations and other minority groups, including Black LGBTQ+ populations. 5,7,[24][25][26][27] For BSMM/BTW populations, extant literature illustrates that both homophobia and racism are associated with adverse health outcomes in this population, including substance use and sexual risk behaviors. 9,21,23 Given the breadth of potential adverse health outcomes, racial and homophobic discrimination is an important health risk factor among BSMM and BTW, especially in the Deep South.…”

Significant Others and Not Family or Friend Support Mediate Between Stigma and Discrimination Among People Living With HIV in Lagos State, Nigeria: A Cross-sectional Study

“…The confirmatory factor analysis (oblique rotation) was used to assess the factor structure of the MSPSS tool (Chan & Mak, 2019; Ogunbajo et al, 2020). The MSPSS subscales showed good structure in this present study, and the tool has significant goodness-of-fit (χ 2 : 4,826.39, p < .001), acceptable comparative fit index (0.95), acceptable Tucker Lewis index (0.89), a close fit model with standardized root mean square residual (0.03), and root mean square error of approximation (0.09).…”

A commentary on COVID-19 and the LGBT community in Nigeria: Risks and resilience.

“…Prior to the outbreak of the COVID-19 pandemic, higher rates of mental health problems including depressive symptoms and suicidality had been reported among Nigerian gay and bisexual compared with heterosexual men (Oginni et al, 2018; Ogunbajo et al, 2020a) with this disparity being partly attributable to stress due to sexual minority status including discriminatory experiences, expectation of discrimination, concealment of sexual orientation, and internalized stigma (Oginni et al, 2018; Ogunbajo et al, in press; Ogunbajo et al, 2020b; Meyer, 2013). The restriction on physical movement and closure of educational institutions may increase exposure of LGBT individuals to minority stress.…”