msm is a very important subgroup of targeted intervention ( ti ) for national aids control program ( nacp ) phase iii . however , lesbian , gay , bisexual , and transgender people face unique risks to their mental health . many face discrimination from coworkers , family members and peers , as well as society at large . recent studies indicate that experiencing social discrimination is a strong predictor of mental health issues . sexual orientation represents an important , but relatively understudied , individual characteristic shaping risk for psychiatric morbidity . no wonder , the inner conflicts in a msm grows day - by - day and it takes a toll on their social life and hurts their mind . as a result , psychiatric morbidities such as depression , anxiety , psychotic disorders , and even suicidal tendencies are common in this group . very few studies have been conducted to evaluate mental health status in msm and their risk factors for psychiatric morbidity . the present study was conducted in the drop in centers ( dics ) in ahmedabad city with the help of non - governmental organization ( ngo ) , which is working for msm . the present study attempts to find determinants of mental health , but also to fill a crucial gap in available mental health information of msm . in the ahmedabad municipal corporation ( amc ) area , nacp is implemented by aids control society ( acs ) in which ngo has taken responsibility for ti for msm . present study was conducted on registered msm of ahmedabad city after taking permission from amcacs , chuwal gram vikash trust unit 1 , 2 and swavlambi chuwal mandal unit , ahmedabad . through purposive sampling , 10% msm ( 410 msm ) from each unit were selected out of total 4100 msm who were coming in dic of their respective unit to attend meetings . after taking informed consent interview of msm was conducted personally through pretested , prestructured questionnaire during the study period with the help of counselor , out - reach workers and peer educators to get correct and reliable answer as they have good rapport with msm . in the study , sexually transmitted infections ( stis ) were considered on the basis of any of the sti symptoms present as examined by the medical officer appointed by naco in msm at the time of interview . mental health status of msm was evaluated through general health questionnaire 28 ( ghq 28 ) . it is the most common assessment tool of mental well - being is the ghq 28 . ghq 28 developed as a screening tool to detect those likely to have or be at risk of developing psychiatric disorders , it is a measure of the common mental health problems / domains of depression , anxiety , somatic symptoms , and social withdrawal . tool ghq 28 has self - reporting screening questionnaire , which identifies high probability of suffering from psychiatric illness . the four subscales , each containing seven items , are as follows : somatic symptoms ( items 1 - 7)anxiety / insomnia ( items 8 - 14)social dysfunction ( items 15 - 21)severe depression ( items 22 - 28 ) . somatic symptoms ( items 1 - 7 ) anxiety / insomnia ( items 8 - 14 ) social dysfunction ( items 15 - 21 ) severe depression ( items 22 - 28 ) . each was given a 4-point likert scoring system ( 0 - 1 - 2 - 3 ) that ranges from a  better / healthier than normal option ( allotted score 0 ) ,  through a  same as usual ( allotted score 1 )  and a  worse / more than usual ( allotted score 2 )  to a much worse / more than usual ( allotted score 3 ) option . according to that , higher the score worse is the condition . 24 score is the point where probability of case suffering from psychiatric morbidity was 50% . therefore , msm scored more than 24 considered as psychiatric morbid and counted as the numerator in prevalence rate . the questionnaire was translated to local language ( gujarati ) and retranslated back to english . the analysis was done using trial version of statistical package for social science ( spss ) and mean , standard deviation , unpaired t - test , and mann  whitney u - test were applied . to evaluate mental health status of msm , ghq 28 scale was used , which includes the somatic symptoms , anxiety and insomnia symptoms , social dysfunction symptoms and severe depression symptoms . prevalence of psychiatric morbidity ( > 24 ) was 52.9% . in another similar study in central kolkata , more than half ( 63.9% ) of the msm crossed the threshold score of 24 signaling a high risk of psychiatric illness in the msm group . gay - bisexual men evidenced higher prevalence of depression , panic attacks , and psychological distress than heterosexual men . the mean score obtained in anxiety / insomnia subscale ( 5.4  4.2 ) and severe depression ( 5.4  4.6 ) was higher than other two subscale somatic symptoms ( 4.0  3.2 ) and social dysfunction symptoms ( 4.6  3.8 ) . table 1 shows how the study population fared with regards to ghq scores , which was a reflection of the status of their physical , mental , and social health . the likert scale of scoring ( 0 - 1 - 2 - 3 ) was used in ghq 28 . in each of the four subscales , that is , somatic symptoms , anxiety and insomnia , social dysfunction and severe depression - the maximum attainable score is 21 while the minimum possible score is 0 . msm had obtained more than 14 score while regarding anxiety and insomnia symptoms 0.3% msm obtained more than 14 score while regarding social dysfunction symptoms 1.2% msm obtained more than 14 score while regarding severe depression 0.7% msm obtained more than 14 score . using the recommended threshold score of > 24 ( threshold being defined as  just significant clinical disturbance  or that point where probability of being a  case  suffering from psychiatric morbidity is 50% ) , more than half ( 52.9% ) of the msm crossed the threshold score of 24 signaling a high risk of psychiatric illness in the study population . distribution of the study population according to ghq scoring pattern figure 1 shows the highest mean ghq score was obtained in the age group 55 - 65 years of age followed by 15 - 25 years of age . in a similar study of meyer et al . , young lesbians , gay men , and bisexual individuals ( aged 18 - 29 and 30 - 44 ) had lower mood disorder prevalence than did older individuals ( aged 45 - 59 ) . gay men and bisexual and homosexually experienced heterosexual individuals had higher levels of psychological distress compared with exclusively heterosexual individuals . age - group - wise mean general health questionnaire score obtained by men who have sex with men table 2 shows 6 questions of ghq , msm had obtained higher score than other questions . higher score obtained in some of individual ghq questions figure 2 shows the prevalence of psychiatric morbidity was more seen in msm living with the family as compared with living alone or with friends . prevalence of psychiatric morbidity was more in never married msm and also in less educated msm . msm with sti symptoms suffered from psychiatric illness more than msm who did nt have sti symptoms . furthermore , prevalence of psychiatric morbidity was higher in msm having more than 2 partners ( 54.9% ) as compared to msm having 2 or less partner ( 49.3% ) . prevalence of psychiatric morbidity was higher in msm having regular partners ( 60.3% ) than in msm having casual partner ( 51.7% ) . determinants of psychiatric morbidity table 3 shows the various determinants for assessment of mental health of msm were like partner characteristic ( casual vs. regular ) , presence of sti symptoms , marital status , and living arrangement . in the present study , msm with sti symptoms obtained significantly higher mean score than msm without sti symptoms in all 4 ghq subgroup scales somatic symptoms , anxiety symptoms , social dysfunction and severe depression ( p < 0.005 , unpaired t - test ) . msm with regular sexual partner had a higher score in all 4 subscale as compared to msm with a casual partner which indicate higher score was found , but no significant association obtained between the characteristic of partner ( either have a regular partner or casual partner ) and mental health status of the msm ( p > 0.05 , mann furthermore , msm living with family obtained higher mean score than living alone , which shows that msm living with the family they may likely to suffer from psychiatric morbidity ( p < 0.005 , highly significant mann out of the total score 84 , median score of ghq 28 was 25 in msm . hence , threshold median score of 24 or higher signaling a high risk of psychiatric illness in the population . prevalence of psychiatric morbidity was higher in msm having more than 2 partners ( 54.9% ) , msm having sti symptoms ( 59% ) and also in msm having regular partner ( 60.3% ) . psychiatric morbidity was more in msm may be because of shame , stigma , discrimination , and presence of stis . present study could not reveal whether psychiatric illness lead to high risk sexual behavior of msm or high risk sexual behavior of msm lead to psychiatric illness .
background : men who have sex with men ( msm ) , a unique group of people , feel , and believe they will face hardships in society once their identity is disclosed , but this does not deter them from dressing and behaving like the opposite sex in public life or fighting for their rights.objectives:to study the mental health status of msm and their determinants.materials and methods : descriptive cross - sectional study was conducted among 410 msm in the drop in centers of non - governmental organization working for msm in ahmedabad city through purposive sampling.results:prevalence of psychiatric morbidity was 52.9% . 
 the mean score obtained in anxiety / insomnia subscale ( 5.4  4.2 ) and severe depression ( 5.4  4.6 ) was higher than other two subscale somatic symptoms ( 4.0  3.2 ) and social dysfunction symptoms ( 4.6  3.8 ) . among general health questionnaire 28 questions , 
  
 more msm had a more than usual feeling  that they are  getting difficulty in staying asleep once you are off  ,  lost much sleep over worry 
 ,  been getting edgy and bad tempered  , 
 felt constantly under strain 
 ,  been feeling nervous and strung - up all time . 
 prevalence of psychiatric morbidity is more in never married msm and also in less educated msm . 
 msm with sexually transmitted infection ( sti ) symptoms suffer from psychiatric illness more than msm who did nt have sti symptoms.conclusion:various determinants like partner characteristic , presence of sti symptoms , marital status , and living arrangement affect the mental health of msm .