Research Synopsis PPT.pptx

SYNOPSIS
INCREASING PSYCHOLOGICAL WELLBEING OF LGBT GROUP WITH
INEFFECTIVE COPING, DEPRESSION AND SUICIDAL IDEATIONS
THROUGH TALKING THERAPY
SARVEPALLI RADHAKRISHNAN UNIVERSITY, BHOPAL, M.P.
RKDF COLLEGE OF NURSING, BHOPAL M.P.
SUBMITTED BY-
MR. ADWIN ANAND VERMA
SCHOLAR NO.-----------------
Ph.D. NURSING (SCHOLAR)
SUPERVISOR CO- SUPERVISOR
DR. ARCHANA SEVLAN. DR. BHARTI BATRA
PRINCIPAL HOD MENTAL HEALTH
DEPARTMENT OF NURSING

BACKGROUND OF THE STUDY
• LGBT are a subgroup vulnerable to depression and suicidality along with
difficult coping skills due to dissemination of perceived thoughts and
feelings. The prevalence of depression among them is three times higher
than the general adult population. Because depression is a known risk
factor for suicide, LGBT groups are also at high risk for suicidality. Within
this context, there is strong evidence that LGBT groups are more likely than
heterosexuals to experience suicidality, ineffective coping skills and
depression. In India LGBT groups 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 persons
belonging to LGBT groups in Mumbai, India at The Humsafar Trust, the
largest non-governmental organization serving

• LGBT groups in India. The interview collected information on socio-
demographics 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). LGBT
groups 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, LGBT groups HIV prevention and
treatment services may benefit from incorporating mental
health services and referrals into their programs.

NEED OF THE STUDY
• The investigator felt the need to investigate the topic
because the ultimate sufferers are the people belonging
to LGBT groups who bare all the mental losses due to
their preferred sexual orientation causing to
stigmatization and a labels unsuitable to society without
realizing the strength and talent, capabilities that can
lead our society in a new way. Even though the country
has legalized their status of pursuit still on ground level,
the situation remains the same causing them difficult to
cope, landing themselves in depression and eventually
commit suicide and thus to release some of their
pressure and mental tension talking therapy is thought to
be an effective way to fulfill the goal. And to support the
topic various researches are stated below

The Economic Cost of Stigma and the Exclusion of LGBT People:
A Case Study of India
• Human rights and equality for lesbian, gay, bisexual, and
transgender (LGBT) people are usually considered through a social,
cultural, or ethical lens, but equality and inclusion of LGBT people
are also economic development issues. This report develops a
model to estimate the economic cost of stigma; negative attitudes
toward LGBT people and the exclusion of LGBT people in social
institutions such as education, employment, families, and health
care. The model is applied to a case study of India. Three major
findings emerge from this report. First, there is clear evidence of
stigma and exclusion exists for LGBT people in India. Data on public
opinion from 2016 shows that 41 percent of Indians would not want
a homosexual neighbor and 64 percent believe that homosexuality
is never justified. Negative attitudes have diminished over time,
however. Second, the effects of stigma and exclusion are potentially
costly to economies.

• A conceptual model links exclusion of LGBT people and
economic development through (1) lower productivity
and lower output as a result of employment
discrimination and constraints on labor supply; (2)
inefficient investment in human capital because of lower
returns to education and discrimination in educational
settings; (3) lost output as a result of health disparities
that are linked to exclusion; and (4) social and health
services required to address the effects of exclusion that
might be better spent elsewhere. Third and lastly, in
India, existing research does not allow for a precise
estimate of the cost of LGBT exclusion, but the cost
could be substantial.

Surveying Indian gay men for coping
skills
• Surveying vulnerable and incarcerated
populations is often challenging. Newer methods
to reach and collect sensitive information in a
safe, secure, and valid manner can go a long
way in addressing this unmet need. Homosexual
men in India live with inadequate social support,
marginalization, and lack legal recognition.
These make them less reachable by public
health agencies, and make them more likely to
continue with high-risk behaviors

Aims
• To understand coping skills of homosexual
men versus heterosexual men.

Materials and Methods
An internet based study using a secure web
platform and an anonymised
questionnaire. The brief COPE Inventory
was used to assess coping styles.

Results
• A total of 124 respondents were studied.
Homosexual men used negative coping
skills such as behavioral disengagement
more often than heterosexual men.
Heterosexual respondents used positive
coping skills more often. The most
commonly used coping skill by
heterosexual men was instrumental coping
and by homosexual men was acceptance.

STATEMENT OF THE PROBLEM
• “A study to assess the effectiveness of
talking therapy on ineffective coping,
depression and suicidal ideation and fear
associated with risk of HIV infection to
improve psychological wellbeing among
individuals of LGBT group in selected
areas of Madhya Pradesh in the year
2020-2021.”

OBJECTIVES OF THE STUDY
• To assess the ineffective coping among
individuals of LGBT group.
• To specify the possibility of depression among
• To determine suicidal ideation among individuals
of LGBT group.
• To identify the risk of HIV infection among

• To evaluate the pre-test score of ineffective coping,
depression and suicidal ideation among individuals of
LGBT group.
• To find the association between pre-test score and
selected demographic variables
• To assess the effectiveness of talking therapy on
ineffective coping, depression and suicidal ideation
among individuals of LGBT group.
• To compare pre-test score with post-test score of talking
therapy on ineffective coping, depression and suicidal
ideation among individuals of LGBT group.

HYPOTHESES
• H1 There is a significant association
between ineffective coping, depression
and suicidal ideation among individuals of
LGBT group and selected demo-graphic
variables at the level of p<0.05.
• H2 There is a significant difference
between ineffective coping, depression
and suicidal ideation among individuals of
LGBT group after the administration of
talking therapy at the level p<0.05

OPERATIONAL DEFINITIONS
• Assess: In this study assess refers to as the
measurement of ineffective coping, depression and
suicidal ideation among individuals of LGBT group.
• Effectiveness: In this study effectiveness refers to as
the degree to which talking therapy is successful in
producing the desired result.
• Talking therapy- In this study, talking therapy refers to
as the one to one conversation in confidence with
individuals of LGBT group having ineffective coping,
depression and suicidal ideation involving 12-20
sessions.

• Ineffective coping- In this research ineffective coping refers to as
the individuals of LGBT group having psychological disengagement,
attempt to reject the reality of the stressful events, turning to the use
of alcohol or other drugs as a way out, not getting emotional support
or sympathy from others, not getting advice on what to do, giving up
attitude, withdrawing from attempting to achieve a goal, decrease
awareness of one’s emotional distress, negative thinking, non
confronting the stressors, inability to ventilate feelings, decrease
religious activities and blaming self for being born different.
• Depression- In this research depression refers to as the individuals
of LGBT group having feeling of prolonged sadness, low mood,
feeling of worthlessness, guilt and impaired ability to think,
concentrate, or make decisions.

• Suicidal ideation- In this research suicidal ideation refers to as the
individuals of LGBT group having feeling or appearing to feel
trapped or hopeless, feeling intolerable emotional pain, having mood
swings, either happy or sad experiencing changes in personality,
routine, or sleeping patterns, engaging in risky behavior, such as
driving carelessly or taking drug increased isolation, talking about
being a burden to others, saying goodbye to others as if it were the
last time, self criticism, talking about suicide or dying, expressing
regret about being alive or ever having been born.
• Fear associated with risk of HIV infection - In this research, fear
associated with risk of HIV infection refers to as the perceived threat
to develop HIV infection due to unprotected and unnatural sexual
intercourse among the individuals of LGBT group.

• Psychological Wellbeing- In this research
psychological wellbeing refers to as the individuals of
LGBT group who are able to effectively deal with
ineffective coping, depression and suicidal ideations.
• Individuals- In this research, individual refers to as the
persons irrespective of their sex belonging to a group or
community of LGBT.

• LGBT- In this research, LGBT refers to as individuals
who are self-identified as lesbian, gay, and bi-sexual and
transgender based on their sexual orientation and
preferences. The terms are described as follows-
• Lesbian- a homosexual woman having sexual affinity
towards a woman.
• Gay- a homosexual man having sexual affinity towards a
man
• Bisexual- a person having sexual affinity towards both
men and women.
• Transgender- a person whose gender identity is the
opposite of assigned sex.
•

REVIEW OF LITERATURE
A review of literature is an essential aspect of research project. The
reviewed literature for the present study was organized under the following
heading:
 Literature related to ineffective coping styles among the individuals of LGBT
group.
 Literature related to depression among the individuals of LGBT group.
 Literature related to suicidal ideations among the individuals of LGBT group.
 Literature related to fear associated with risk of HIV infection among the
individuals of LGBT group
 Literature related promoting psychological wellbeing among the individuals
of LGBT group.
 Literature related to talk therapy used in the treatment of psychological
problems.
 Literature related to varied methods used to treat psychological issues
among the individuals of LGBT group.

Literature related to ineffective coping styles among
the individuals of LGBT group.
• Denton, F. N., Rostosky, S. S., & Danner, F. (2014) conducted a research
titled as Stigma-related stressors, coping self-efficacy, and physical health
in lesbian, gay, and bisexual individuals in America states that 2 types of
cognitive appraisals (proximal minority stressors and coping self-efficacy)
partially account for the association between perceived discrimination and
prejudice (distal minority stressor) and self-reported physical health
symptoms in a nationally recruited sample of 564 LGB individuals (270
women, 294 men) who participated in a web-based survey. Results
indicated that perceived experiences of discrimination and prejudice were
associated with expectations of rejection and internalized homo-negativity.
These 2 proximal stressors were associated with lower coping self-efficacy,
and the combined cognitive appraisal pathways were associated with higher
levels of self-reported physical symptom severity. The pathway through
emotion-focused coping self-efficacy was particularly salient in accounting
for the overall mediation. Interventions to address distal and proximal
minority stressors and improve emotion-focused coping self-efficacy may be
particularly helpful in reducing the negative effects of stigma on physical
health.

Literature related to depression among the individuals
of LGBT group
• Mark S. Friedman, 2014, conducted a research titled as Gay-related
Development, Early Abuse and Adult Health Outcomes among Gay Males
states that relationship between timing of gay-related developmental
milestones, early abuse, and emergence of poor health outcomes in
adulthood among 1,383 gay/bisexual men in the Urban Men’s Health Study.
Latent Profile Analysis grouped participants as developing early, middle or
late based on the achievement of four phenomena including age of first
awareness of same-sex sexual attractions and disclosure of sexual
orientation. Participants who developed early were more likely, compared to
others, to experience forced sex and gay-related harassment before
adulthood. They were more likely to be HIV seropositive and experience
gay-related victimization, partner abuse and depression during adulthood.
Early forced-sex, gay-related harassment and physical abuse were
associated with several negative health outcomes in adulthood including
HIV infection, partner abuse, and depression. This analysis suggests that
the experience of homophobic attacks against young gay/bisexual male
youth helps to explain heightened rates of serious health problems among
adult gay men.

Literature related to suicidal ideations among the individuals of
LGBT group
• Ellen Marshall conducted a systematic review in 2015 in UK on Non-
suicidal self-injury and suicidality in trans people and described high levels
of mental health problems among trans people, such as depression,
resulting in increased levels of non-suicidal self-injury (NSSI) behaviour and
suicidality (suicidal thoughts, suicide attempts and suicide rates). With the
aim of systematically reviewing the available literature in this field, this study
identifies 31 papers that explore the rates of NSSI and suicidality in trans
people. From reviewing the literature, it was revealed that trans people have
a higher prevalence of NSSI and suicidality compared to the cisgender
(non-trans) population. There appear to be some gender differences within
these rates, with trans men at a greater risk for NSSI behaviour. Prevalence
rates differ depending on the different stages of transition, but they are still
overall greater than the cisgender population. The study concludes that
trans individuals are at a greater risk of NSSI behaviour and suicidality than
the cisgender population, and discusses risk factors and the need to
develop effective preventative interventions.

Literature related to fear associated with risk of HIV infection among the
individuals of LGBT group
• Peter J. Smith et al (2015) conducted a review on HIV-related stigma within
communities of gay men in Chennai which stated that most published reports on HIV-
related stigma have assessed the attitudes of the general population. However,
stigmatization of HIV-positive individuals also occurs specifically within communities
of gay men whereby HIV-negative gay men associate mainly or exclusively with other
HIV-negative gay men, and vice versa. smith has linked this with observations that
HIV-positive gay men have an increased tendency to withdraw from both their usual
social scenes and wider society This polarization may negatively impact relationships
and other aspects of physical and emotional health, social life, HIV testing behavior,
disclosure, disease prevention, and medication and therapy adherence Such effects,
coupled with the fact that HIV prevalence and transmission rates in many developed
nations are high, and increasing among gay men highlight the need for interventions
to actively counter stigmatization aimed specifically at HIV-positive gay men. This
article reviews the fragmented and largely anecdotal literature on HIV-related stigma
among men who have sex with men (MSM), and within communities of gay men, in
order to inform future research and the development of more effective interventions.

Literature related promoting psychological wellbeing among the
• Robert M. Kertzner, (2016) wrote an article on Social and Psychological Well-being
in Lesbians, Gay Men, and Bisexuals and Transgendres : The Effects of Race,
Gender, Age, and Sexual Identity which specifies that using social stress perspective,
we studied the mental health effects of added burden related to socially
disadvantaged status (being African-American or Latino, female, young, and
identifying as bisexual versus gay or lesbian) in a community sample of 396 self-
identified lesbian, gay, and bisexual (LGBT) adults. Mental health outcomes were
social and psychological well-being contrasted with depressive symptoms. When
mental health deficiencies by disadvantaged social status were detected, we
examined if LGBT community connectedness and positive sexual identity valence
played a mediating role, reducing the social status disparity in outcome. We found
different patterns when looking at social vs. psychological well-being and positive vs.
negative mental health outcomes. Bisexuality and young age, but not gender and
racial/ethnic minority status, were associated with decreased social well-being. In
bisexuals, this relationship was mediated by community connectedness and sexual
identity valence. Though no differences in social or psychological well-being were
found by gender, female gender was associated with depressed mood. We conclude
that there is limited support for an additive stress model.

Literature related to talk therapy used in the treatment of psychological
problems.
• Mental-health conditions, such as post-traumatic stress disorder (PTSD),
obsessive–compulsive disorder (OCD), eating disorders, schizophrenia and
depression, affect one in four people worldwide. Depression is the third
leading contributor to the global burden of disease, according to the World
Health Organization. Psychological treatments have been subjected to
hundreds of randomized clinical trials and hold the strongest evidence base
for addressing many such conditions. These activities, techniques or
strategies target behavioral, cognitive, social, emotional or environmental
factors to improve mental or physical health or related functioning. Despite
the time and effort involved, they are the treatment of choice for most
people.
•
• Gavin Andrews (1996) wrote an article on Talk that works: the rise of
cognitive behavior therapy which states that talk therapy proved to be the
best ever psychological remedy to treat most of my cases (Published 14
December 1996) in THE BMJ.

Literature related to varied methods used to treat psychological issues
among the individuals of LGBT group
• An article published as Psychological treatments: A call for mental-health
science by Emily A. Holmes, 2019, in The Economist Newspaper Limited
states that Psychologists and other health practitioners frequently work with
patients whose symptoms only partially respond to traditional therapies.
Other patients may have been diagnosed with a medical illness and need
help coping with both the illness and its treatment. In these and other cases,
therapists may wish to consider interventions from among those collectively
known as complementary and alternative therapies. The most common
complementary and alternative therapies that have empirical support from
peer-reviewed journals and provides guidance on which therapies have
been most useful for which psychological and medical issues are massage
and acupressure, acupuncture, Tai Chi, yoga, exercise, hypnosis,
meditation, and other therapies, the author documents the positive
emotional, behavioral, physiological, and biochemical effects of these
therapies as well as proposed mechanisms of change.

MATERIAL AND METHODS
MATERIAL
• Design – Pre-experimental Pretest-Post-
test-only design will be used to assess the
effectiveness of on ineffective coping,
depression and suicidal ideation among
• Setting: The study will be conducted in
the selected areas of Madhya Pradesh.
•

METHOD
• Sampling technique: Snowball Sampling
Technique.
• Subject: In this study the subject are the
self identified individuals of LGBT group
• Sample size: nearly 500 or more.

Tools for assessing ineffective coping,
depression and suicidal ideation –
Socio demographic variable, Self structured
Sexual orientation questionnaire, COPE
Inventory, Ask right question 2, and SAFE
inventory for Suicide.

INCLUSION CRITERIA
• In this research only the self identified
individuals of LGBT group are included.
• Residents of Madhya Pradesh are
included.

EXCLUSION CRITERIA
• In this research persons who do not
identify self as individuals of LGBT group
are excluded.
• Residents out of Madhya Pradesh are
excluded

ANALYSIS AND STATISTICAL METHODS
• The data will be analyzed according to the
objectives of the study using descriptive
and inferential statistics

ETHICAL AND LEGAL ASPECTS
•
• The written permission will be obtained to conduct the study from
the administrative authorities of the institution.
• The procedure and the purpose of the study will be explained in
detail to each participant included in the study and informed consent
will be obtained during which they have the liberty to ask questions
or refuse to participate in the study at any point of time.
• The participants could refuse to participate in the study at any point
of time.
• Confidentiality will be maintained by assigning code to each subject.
• The study will be beneficial for self identified individuals of LGBT
group having ineffective coping, depression and suicidal ideation

Limitations of the study
• The study is limited to only self identified
individuals of LGBT group having
ineffective coping, depression and suicidal
ideation
• The study covers only the three aspects
namely ineffective coping, depression and
suicidal ideation among individuals of
LGBT group
•

Delimitation of the study:
• This will be an experimental study which
will be conducted with self identified
individuals of LGBT group having
ineffective coping, depression and suicidal
ideation. The use of psychological
principles will be used in the study. Also
the samples that are to be selected will not
randomly be selected but through
snowball sampling technique.

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