Nombulelo Thembekile Crocco

University of KwaZulu-Natal, South Africa

Title: Psychological interventions for depression and/or anxiety among men who have sex with men: a systematic review

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Biography

Nombulelo Thembekile Crocco, a Practising Clinical Psychologist, pursuing her PhD Studies with University of KwaZulu-Natal as a PhD Fellow under the African Mental Health Research Initiative. A holder of a Master of Science degree in Community Psychology from Midlands State University (2016) and a Bachelor of Science (Hons) degree in Psychology from University of Zimbabwe (2008). Her main research interests focus on understanding and improving the mental health of LGBTQ community members. From 2009 to date, she has been in the clinical psychology department at Ingutsheni Central Hospital, the largest psychiatric institution in Zimbabwe. She has handled numerous cases of suicide, depression, anxiety and other mental disorders. She also lectures in the Department of Psychiatry, Social & Behavioural Sciences, Faculty of Medicine at the National University of Science and Technology from 2020 to date. She chairs the Zimbabwe Psychological Association Clinical Division. Nombulelo is also a passionate Human Rights Activist.

Abstract

Background: Globally lesbian, gay and bisexuals (LGB) are disproportionately affected by common mental disorders (CMD) than the general population. This is largely explained by minority stress theory (associated with sexual orientation concealment, internalised homophobia, rejection sensitivity and enacted stigma from society). Those in low- and middle-income countries (LMIC) tend to have worse outcomes. LGB-affirming interventions are needed to mitigate against the impact of minority stress on mental health in this population.

Objective: This review aimed to systematically appraise the evidence of effective psychological interventions for depression and/or anxiety among men who have sex with men (MSM).

Methods: This systematic review followed the PRISMA guidelines. A systematic search was performed in PubMed, CINAHL, PsycINFO, Web of Science, SCOPUS, Embase, Medline and Cochrane Library using tailored search strategies. Results were independently reviewed for eligibility by two reviewers. Data extracted was thematically analysed, while descriptive statistics were applied to study characteristics.

Results:  We screened 638 records of titles and abstracts, and 52 full articles, ultimately retaining 26 for this systematic review. Most interventions were based on Cognitive Behavioural Therapy (CBT), evaluated using randomized control trials, and delivered in a group format.  The most effective of them was the LGBQ-Affirmative CBT for Young Gay and Bisexual Men’s Mental and Sexual Health (ESTEEM). This was followed by the affirmative group-based CBT intervention, AFFIRM which was delivered by community health education workers with basic counselling skills who had experience working with sexual minorities. AFFIRM was found to be most effective and suitable for low-income areas, outperforming ESTEEM.

Conclusions: There remains paucity of empirical evidence to support marginalised groups’ mental health in most developing contexts. This systematic review helped identify the AFFIRM intervention as most feasible, acceptable and potentially effective intervention for reducing anxiety and depression among MSM, particularly in low- and middle-income countries.