Abstract
Borrowing concepts from public health, we examined the association of several social determinants with the mental health of middle-aged and older queer men in India by combining quantitative and qualitative methodologies. A cross-sectional survey guided by Meyer’s Minority Stress Model was carried out to assess the links between minority stressors (internalized homophobia and degree of closetedness), age-related stressors (ageism and fear of ageing) and psychological wellbeing (loneliness, depressive symptoms and sexual compulsivity) among 207 Indian men (aged 40 years and above) who identified themselves as non-heterosexuals. Results from simple and multivariable linear regression models showed significant positive associations of ageism, internalized homophobia, and fear of ageing with loneliness, even after accounting for sociodemographic and stress mitigating factors. Ageism was not significantly related to depressive symptoms. However, fear of ageing and internalized homophobia was positively associated with depressive symptoms after accounting for covariates. Further, regression models demonstrated a consistent and statistically significant inverse association between income and adverse psychological outcomes suggesting the centrality of social class in the lived experience of Indian gay and bisexual men. The qualitative inquiry addressed the same research questions as the quantitative survey through in-depth interviews of thirty middle-aged and older gay and bisexual men in Mumbai. We found that older and midlife gay and bisexual men with higher income (a proxy for social class) found ways to manage their masculinities with no discernible adverse psychological outcomes. Depressive symptoms and loneliness in this population made them further vulnerable to excessive sexual impulses, especially in the older queer men who were passing off as heterosexuals. Overall, the theory-driven empirical findings suggest that even in India, where family and friends are social insurance for later life, the issues of ageism and internalized homophobia have the potential to lead to worse mental health outcomes among older queer men.
Highlights
MethodsThe present study employed a mixed methods approach to address the research questions
BackgroundSince the 2009 Delhi High Court verdict decriminalizing homosexual acts in India, homosexuality has gained considerable visibility in the country
A majority of the respondents reported facing discrimination related to their age in the form of prejudiced views and actions, which were found to have a negative impact on their mental health, especially when they lacked social support or economic resources
Summary
The present study employed a mixed methods approach to address the research questions. While the quantitative study explored how the minority stressors and the stress ameliorating factors were related to the psychological wellbeing of older queer men in India, the qualitative component attempted to understand how the stressors were formed and what their influence was on mental health. We looked at the life histories of the men in our sample and explored their experiences growing up as queer men in the Indian heteronormative society. Following a convergent parallel design [28], a small qualitative preliminary study was conducted in early October 2018 to conceptualize the study and refine the research questions. The qualitative and quantitative data collection and analysis were carried out concurrently from December 2018 through February 2019
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