Abstract
In the US, lesbian, gay, bisexual, and transgender (LGBT) individuals report higher rates of depression compared with heterosexual and cisgender persons. To date, little is known about the mental health of LGBT adults in Thailand. Here, we examined rates and correlates of depression among a volunteer sample of Thai LGBTs. Data were collected as part of a larger cross-sectional survey study. Standardized measures of sexual orientation and gender identity, stress, coping style, and minority stressors were completed. Of the 411 participants, 40.3% met the criteria for depression. In multivariate analyses, the combined influences of sociodemographic factors, general stress, coping strategies, and minority-specific stress variables explained 47.2% of the variance in depression scores (F[16,367]= 20.48, p<.001). Correlates of depression included coping strategies and minority-specific stressors, including experiences of victimization, discrimination, and level of identity concealment. Study findings have implications for psychiatric nursing practice and the development of intervention research.
Abstrak
Pengaruh Stres Minoritas terhadap Tingkat Depresi pada LGBT Thailand. Di AS, individu lesbian, gay, biseksual, dan transgender (LGBT) melaporkan tingkat depresi yang lebih tinggi dibandingkan dengan orang heteroseksual dan cisgender. Saat ini, sedikit yang diketahui tentang kesehatan mental pada orang dewasa dengan LGBT di Thailand. Di sini, kami meneliti tingkat dan korelasi depresi di antara sampel sukarelawan LGBT Thailand. Data dikumpulkan sebagai bagian dari studi survei cross-sectional yang lebih besar. Pengukuran terstandar terhadap orientasi seksual dan identitas gender, stres, koping, dan stresor minoritas telah selesai. Dari 411 peserta, 40,3% memenuhi kriteria untuk depresi. Dalam analisis multivariat, pengaruh gabungan faktor sosiodemografi, stres umum, strategi koping, dan variabel stres spesifik-minoritas menjelaskan 47,2% dari varians dalam skor depresi (F [16,367]= 20,48, p< 0,001). Korelasi depresi termasuk strategi koping dan stres spesifik-minoritas, termasuk pengalaman viktimisasi, diskriminasi, dan tingkat penyembunyian identitas. Temuan penelitian memiliki implikasi untuk praktik keperawatan psikiatris dan pengembangan penelitian intervensi.
Kata kunci: depresi, LGBT, minoritas seksual dan gender; stres minoritas, Thailand
References
- Albuquerque, G.A., de Lima Garcia, C., da Silva Quirino, G., Alves, M.J.H., Belém, J.M., dos Santos Figueiredo, F.W.,… & de Abreu, L.C. (2016). Access to health services by lesbian, gay, bisexual, and transgender persons: Systematic literature review. BMC International Health and Human Rights, 16 (2), 1–10.
- Baams, L., Grossman, A.H., & Russell, S.T. (2015). Minority stress and mechanisms of risk for depression and suicidal ideation among lesbian, gay, and bisexual youth. Developmental Psychology, 51 (5), 688–696.
- Beck, A.T., Steer, R.A., & Carbin, M.G. (1988). Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clinical Psychology Review, 8 (1), 77–100.
- Brislin, R.W. (1970). Back-translation for cross-cultural research. Journal of Cross-Cultural Psychology, 1(3), 185–216.
- Clark, F. (2014). Discrimination against LGBT people triggers health concerns. The Lancet, 383(9916), 500–502.
- Cochran, W.G. (1953). Sampling techniques (2nd Edition). New York: John Wiley and Sons. Inc.
- DMH. (2017). Thai Department of Mental Health News. Retrieved from http://www.prdmh. com/ข่าวสาร/ข่าวแจกกรมสุขภาพจิต/860-พบ-5-กลุ่มโรคหลัก ก่อปัญหาสุขภาพจิตคนไทยสูงถึง-7ล้านคน-คาดแนวโน้มม ากขึ้นโดยเฉพาะ“เหล้า-ยาเสพติด.”html.
- DMH. (2019). Department of Mental Health news. Retrieved from http://www.prdmh.com/ข่าวสาร /ข่าวแจกกรมสุขภาพจิต/1384-กรมสุขภาพจิต-ห่วงวัยรุ่นเยาวชนไ ทยมีภาวะซึมเศร้า-แนะคนรอบข้างรับฟังอย่างเข้าใจ.html.
- Hamburger, M.E., Basile, K.C., & Vivolo, A.M. (2011). Measuring bullying victimization, perpetration, and bystander experiences: A compendium of assessment tools. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.
- Hatzenbuehler, M.L., Nolen-Hoeksema, S., & Erickson, S.J. (2008). Minority stress predictors of HIV risk behavior, substance use, and depressive symptoms: results from a prospective study of bereaved gay men. Health Psychology, 27 (4), 455–462.
- Harkness, J., Pennell, B.E., & Schoua-Glusberg, A. (2004). Survey questionnaire translation and assessment. Methods for Testing and Evaluating Survey Questionnaires, 546, 453–473.
- Herek, G.M., Gillis, J.R., & Cogan, J.C. (2009). Internalized stigma among sexual minority adults: Insights from a social psychological perspective. Journal of Counseling Psychology. 56 (1), 32–43.
- Hoy-Ellis, C.P., & Fredriksen-Goldsen, K.I. (2016). Lesbian, gay, & bisexual older adults: Linking internal minority stressors, chronic health conditions, and depression. Aging & Mental Health, 20 (11), 1119–1130.
- Hughes, T.L., Johnson, T.P., Steffen, A.D., Wilsnack, S.C., & Everett, B. (2014). Lifetime victimization, hazardous drinking, and depression among heterosexual and sexual minority women. LGBT Health, 1 (3), 192–203.
- Institute of Medicine. (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better under-standing. Washington, DC: The National Academies Press.
- King, M., Semlyen, J., Tai, S., Killaspy, H., Osborn, D., Popelyuk, D., & Nazareth, I. (2008). Mental disorders, suicide, and deliberate self-harm in lesbian, gay and bisexual people: A systematic review of the literature. National Institute for Mental Health England, London.
- Kingston, J. (2019). The politics of religion, nationalism, and identity in Asia. Rowman & Littlefield Publishers, Maryland.
- Kittiteerasack, P. (2012). Trends and assessment of suicidal behavior. Thai Journal of Science and Technology, 20 (5), 468–477.
- Kittitteerasack, P., Steffen, A., & Matthews, A. K. (2019). The validity and linguistic testing of translated measures of sexual orientation and gender identity for research in lesbian, gay, bisexual, and transgender (LGBT) populations in Thailand. Nursing Journal, 46 (3), in press.
- Krieger, N., Smith, K., Naishadham, D., Hartman, C., & Barbeau, E. M. (2005). Experiences of discrimination: validity and reliability of a self-report measure for population health research on racism and health. Social Science & Medicine, 61 (7), 1576–1596.
- Lazarus, R.S. (2006). Emotions and interpersonal relationships: Toward a person centered conceptualization of emotions and coping. Journal of Personality, 74 (1), 9–46.
- Mallory, C., Hasenbush, A., & Sears, B. (2015). Discrimination and harassment by law enforcement officers in the LGBT community. The Williams Institute, University of California.
- McCarthy, M.A., Fisher, C.M., Irwin, J.A., Coleman, J.D., & Pelster, A.D.K. (2014). Using the minority stress model to understand depression in lesbian, gay, bisexual, and transgender individuals in Nebraska. Journal of Gay & Lesbian Mental Health, 18 (4), 346.
- Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychological Bulletin, 129 (5), 674–697.
- Mohr, J., & Fassinger, R. (2000). Measuring dimensions of lesbian and gay male experience. Measurement and Evaluation in Counseling and Development, 33 (2), 66.
- Pearkao, P (2013). Stress and depression among Thai gay, Kathoey (Transgender). Journal of Nursing Science & Health. 36 (2), 95–104.
- Reisner, S.L., Vetters, R., Leclerc, M., Zaslow, S., Wolfrum, S., Shumer, D., & Mimiaga, M.J. (2015). Mental health of transgender youth in care at an adolescent urban community health center: a matched retrospective cohort study. Journal of Adolescent Health, 56 (3), 274–279.
- Riggle, E.D., Rostosky, S.S., Black, W.W., & Rosenkrantz, D.E. (2017). Outness, concealment, and authenticity: Associations with LGB individuals’ psychological distress and well-being. Psychology of Sexual Orientation and Gender Diversity, 4 (1), 54–62.
- Silpakit, O. (2012). Srithanya stress scale. Journal of Mental Health of Thailand, 16 (3), 177–185.
- Snow, J., & Mann, M. (2013). Qualtrics survey software: Handbook for research professionals. Qualtrics Labs, Inc.
- Su, D., Irwin, J.A., Fisher, C., Ramos, A., Kelley, M., Mendoza, D.A.R., & Coleman, J.D. (2016). Mental health disparities within the LGBT population: A comparison between transgender and nontransgender individuals. Transgender Health, 1 (1), 12–20.
- Suphamongkhon, N. & Kotrajaras, S. (2004). Anxiety, social support, and coping strategies of university students. Master thesis. Faculty of Psychology, Chulalongkorn University, Thailand.
- The Excellence Center for Depression Disorder (2019). Depression Prevention and Solution. Retrieved from http://www.thaidepression. com/www.
- Toomey, R.B., Ryan, C., Diaz, R.M., & Russell, S.T. (2018). Coping with Sexual Orientation–Related Minority Stress. Journal of Homosexuality, 65 (4), 484–500.
- UNDP, USAID (2014). Being LGBT in Asia: Thailand Country Report. Bangkok.
- Whitehead, J., Shaver, J., & Stephenson, R. (2016). Outness, stigma, and primary health care utilization among rural LGBT populations. PloS one, 11 (1), 1–17.
- White Hughto, J.M., Pachankis, J.E., Willie, T.C., & Reisner, S.L. (2017). Victimization and depressive symptomology in transgender adults: The mediating role of avoidant coping. Journal of Counseling Psychology, 64(1), 41.
- WHO. (2017). "Depression: let’s talk” says WHO, as depression tops list of causes of ill health. Retrieved from https://www.who.int/news-room/detail/30-03-2017--depression-let-s-talk-says-who-as-depression-tops-list-of-causes-of-ill-health.
- WHO. (2018). Depression: Key facts. Retrieved from https://www.who.int/news-room/fact-sheets/detail/depression.
- Yadegarfard, M., Meinhold-Bergmann, M.E., & Ho, R. (2014). Family rejection, social isolation, and loneliness as predictors of negative health outcomes (depression, suicidal ideation, and sexual risk behavior) among Thai male-to-female transgender adolescents. Journal of LGBT Youth, 11(4), 347–363.
- Yarns, B.C., Abrams, J.M., Meeks, T.W., & Sewell, D.D. (2016). The mental health of older LGBT adults. Current Psychiatry Reports, 18 (6), 60.
- Zachau, U., & Cortez, C. (2017). LGBTI in Thailand: New Data Paves Way for More Inclusion. Retrieved from https://blogs.world bank.org/eastasiapacific/lgbti-in-thailand-new-data-paves-way-for-more-inclusion.