The mental health impacts of othering LGBTQ+ in Rwanda and Kenya: a mixed methods exploration

Abstract Background Globally lesbian, gay, bisexual, transgender, and queer (LGBTQ+) persons experience stigma across at multiple socioecological levels with health-harming impacts. The objectives of this study were to quantify and explore how stigma shapes mental health among LGBTQ+ persons living in Rwanda and Kenya. Methods Respondent-driven sampling was used in this mixed methods study of LGBTQ+ persons. In Rwanda, we surveyed 499 and conducted focus groups with 59 persons. In Kenya, we surveyed 1,573 persons, conducted focus groups with 40 persons, and conducted 113 individual interviews. We used thematic analysis for the qualitative data to examine how LGBTQ+ discuss what shapes their mental health. Results The average depression score was 6.3, which is categorized as mild depression. Additionally, 36% (n = 744) scored as mild, 14% (n = 289) as moderate, 5% (n = 110) as moderately severe, and 2.5% as severe (n = 52). Average scores were the same in Kenya and Rwanda. In regression models, as compared to cisgender males, cisgender females’ depression scores were 2.1 points higher (95% CI 1.5, 2.8), trans male scores were 1.6 points higher (95% CI 0.7, 2.5), trans female scores were 1.9 points higher (95% CI 1.1, 2.7), and gender non-conforming scores were 1.7 points higher (95% CI 1.0, 2.4). As compared to transgender people, lesbian & gay participants had depression scores that were 0.93 points lower and bisexual 1.3 points lower (p < 0.000). In adjusted regression models, we found that for every one-unit increase in discrimination, depression scores increased by 0.44 (95% 0.36, 0.52). Qualitatively, stigma was described as a prominent factor in negatively impacting mental health. Conclusions LGBTQ+ people in Rwanda and Kenya experience elevated mental health issues that arise from discrimination due to their stigmatized identity.