Comparing and understanding the experiences of depressive symptoms and suicidal attempts in sexual and gender minorities, and heterosexual cisgender people of Nepal: A mixed-methods study

BackgroundViolence in sexual and gender minorities (SGMs) are multifaceted and intertwined which severely affects the mental well-being of SGM individuals. ObjectiveTo compare and understand depressive symptoms and suicidal attempts in sexual and gender minorities and heterosexual cisgender people. MethodsThis is an explanatory sequential mixed-method study with 190 participants. Ten in-depth interviews were conducted. Regression and thematic analysis were conducted to analyse quantitative and qualitative data respectively. FindingsIn model 1, the mean depressive symptoms of transgender participants were higher by 2.47 units (95% CI: 0.62, 4.31, p=0.009) compared to cisgender while it was higher by 2.47 units (95% CI: 1.14, 3.80, p<0.001) in sexual minorities compared to heterosexuals. In model 2, the mean depressive symptoms of sexual minorities were higher by 1.55 units (95% CI: 0.12, 2.99, p = 0.034) compared to heterosexuals, and it was higher by 2.11 units (95% CI: 0.71, 3.51, p=0.006) in victims of bullying. Participants who had depressive symptoms (PHQ-9 [&ge;]10) were 7.41 times (95% CI: 2.30, 23.9) more likely to attempt suicide. Qualitative findings showed financial issues, stress from exams, relationship issues and lack of support from friends and family as leading factors of depressive symptoms and suicidal attempts. ConclusionsDepression and suicide are more in SGM than in heterosexual cisgender people pertaining to bullying based on sexual orientation and gender identity. Clinical implicationsInclusive environment should be fostered in health facilities and bullying should be avoided in community to improve health-seeking behaviour and to decrease depression and suicide in SGM. What is already known on this topicThere is a dearth of studies related to sexual and gender minority groups in Nepal, however, studies in other parts of the world have revealed that there is an increased risk of suicide and poor mental health in LGBT people. It has been recommended that more studies are necessary on their mental health issues. What this study addsThis study indicates that there is increased risk of depression and suicide in people from SGM community. However, this risk is not just because of who they identify themselves as or because of their particular sexual preference, but this is ultimately more related to history of getting bullied by society based on their SOGI. How this study might affect research, practice or policyIt is necessary to create an accepting environment in health care facilities as well as society to decrease bullying of SGMs which in turn helps them to alleviate mental health issues.