Suicidality, clinical depression, and anxiety disorders are highly prevalent in men who have sex with men in Mumbai, India: findings from a community-recruited sample

In India men who have sex with men (MSM) are a stigmatized and hidden population, vulnerable to a variety of psychosocial and societal stressors. This population is also much more likely to be HIV-infected compared to the general population. However, little research exists about how psychosocial and societal stressors result in mental health problems. A confidential, quantitative mental-health interview was conducted among 150 MSM in Mumbai, India at The Humsafar Trust, the largest non-governmental organization serving MSM in India. The interview collected information on sociodemographics and assessed self-esteem, social support and DSM-IV psychiatric disorders using the Mini International Neuropsychiatric Interview (MINI). Participants' mean age was 25.1 years (SD?=?5.1); 21% were married to women. Forty-five percent reported current suicidal ideation, with 66% low risk, 19% moderate risk, and 15% high risk for suicide per MINI guidelines. Twenty-nine percent screened in for current major depression and 24% for any anxiety disorder. None of the respondents reported current treatment for any psychiatric disorder. In multivariable models controlling for age, education, income, and sexual identity, participants reporting higher levels of self-esteem and greater levels of satisfaction with the social support they receive from family and friends were at lower risk of suicidality (self-esteem AOR?=?0.85, 95% CI: 0.78-0.93; social support AOR?=?0.76, 95% CI: 0.62-0.93) and major depression (self-esteem AOR?=?0.79, 95% CI: 0.71-0.89; social support AOR?=?0.68, 95% CI: 0.54-0.85). Those who reported greater social support satisfaction were also at lower risk of a clinical diagnosis of an anxiety disorder (AOR?=?0.80; 95% CI: 0.65-0.99). MSM in Mumbai have high rates of suicidal ideation, depression, and anxiety. Programs to improve self-esteem and perceived social support may improve these mental health outcomes. Because they are also a high-risk group for HIV, MSM HIV prevention and treatment services may benefit from incorporating mental health services and referrals into their programs.     

Assessment of a “Transgender Identity Stigma” scale among trans women in India: Findings from exploratory and confirmatory factor analyses

Background: Sexual minority stigma has been shown to influence mental health and sexual risk, but limited research is available on measuring transgender-identity stigma among trans women in India. We adapted an Exposure to Transphobia scale to the Indian context and tested a 14-item Transgender Identity Stigma Questionnaire (TGISQ) among trans women in India. We aimed to assess and validate the factor structure of the TGISQ and to assess its reliability.

Methods: Data were from a cross-sectional survey among 300 trans women (including hijras/thirunangais) from six urban/semi-urban sites in India. The TGISQ consisted of self-reported ratings on 14 items. We initially conducted exploratory factor analysis, using principal axis factoring (PAF) and promax rotation, and assessed reliability (internal consistency) using Cronbach's alpha; we then conducted confirmatory factor analysis to assess construct validity (factorial validity). Construct validity of the final 13-item Transgender Identity Stigma Scale (TGISS) was also examined by computing Pearson's correlations between TGISS and relevant theoretical constructs (e.g., depression, social support).

Results: PAF identified two factors: enacted stigma (5 items) and felt normative stigma (8 items). The final 13-item TGISS had high reliability and acceptable construct validity.

Conclusions: The TGISS was found to have adequate psychometric properties, making it the first valid and reliable scale to measure stigma and discrimination faced by trans women in India. Future studies can further refine TGISS, which might help in comparing the differences in stigma experiences among diverse subgroups of trans women, and in monitoring and evaluating the success of stigma reduction programs.     

Should a school honor a student's DNR order?

Physicians first present the case of a sixteen-year-old cardiac patient who has refused a heart transplant and cardiac resuscitation. Her family and physicians accept the decision. The family has asked the school system to honor her do not resuscitate order if she goes into cardiac arrest in school The school system has refused to do so. Following the case presentation, a lawyer, a physician/ethicist, and an educator consider the important issues raised by this ongoing case.     

Reasoning as simulation

The theory that human cognition proceeds through mental simulations, if true, would provide a parsimonious explanation of how the mechanisms of reasoning and problem solving integrate with and develop from mechanisms underlying forms of cognition that occur earlier in evolution and development. However, questions remain about whether simulation mechanisms are powerful enough to exhibit human-level reasoning and inference. In order to investigate this issue, we show that it is possible to characterize some of the most powerful modern artificial intelligence algorithms for logical and probabilistic inference as methods of simulating alternate states of the world. We show that a set of specific human perceptual mechanisms, even if not implemented using mechanisms described in artificial intelligence, can nevertheless perform the same operations as those algorithms. Although this result does not demonstrate that simulation theory is true, it does show that whatever mechanisms underlie perception have at least as much power to explain non-perceptual human reasoning and problem solving as some of the most powerful known algorithms.