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

Background: 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. Methods: 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. Results: 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.

Individual-, Interpersonal- and Institutional-Level Factors Associated with HIV Stigma Among Youth in Kenya

“…We assessed the reliability of the scale using the Cronbach’s alpha [ 51 ]: overall stigma scale—α = 0.79; experienced stigma (3 questions)—α = 0.70; internalized stigma (3 questions)—α = 0.80; perceived community stigma (2 questions)—α = 0.74; disclosure concerns (2 questions)—α = 0.44. Social support was assessed using the 12-item Multidimensional Scale of Perceived Social Support (MPSS) [ 52 ]—α = 0.78, while the 2-item Connor Davidson Resilience Scale was used to assess resilience [ 53 ]—α = 0.59. Independence in care was measured using two questions assessing the AYWHIV’s ability to adhere to clinic schedules, and ability to adhere to medication without involvement of a caregiver.…”

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).…”

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

“…This scale demonstrated excellent internal consistency (Cronbach α = 0.93) and has also been used in other studies of depression. 27,32 Covariates Demographic characteristics, including age, relationship status, education, and annual household income were used as covariates.…”

“…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.…”