Cognitive Interviews Demographics (N=30)
Participants ranged in age from 20 to 40 years (mean=29.1, standard deviation [SD]= 5.3), and half (n=15, 50.0%) of participants identified as gay/homosexual. Most participants (n=18, 60.0%) reported their relationship status as single and more than three-fourths (n=23, 76.7%) had a university education or higher. Less than half (n=14, 46.7%) were currently employed and a majority (n=24, 80.0%) were Christian.
Cognitive Interview Findings
Of the 20 statements contained in the CESD-R scale, 8 were modified (Table 1). A majority of the modifications constituted changing a few words to make the phrase more understandable (for example, we changed “I had trouble keeping my mind of what I was doing” to “I had trouble concentrating on what I was doing”). Only one of the statements was completely modified (“I could not get going” to “I lacked motivation”).
Of the 12 statements contained in the MSPSS, 8 were modified (Table 1). In the significant other subscale, “special person” was replaced with “significant other”. The rest of the changes were minor word substitutions such as changing “I can talk about my problems with my family” to “I can share my problems with my family”
Of the combined 16 statements contained in the 5 subscales of the LGBT Minority Stress Measure, 11 were modified (Table 1). A majority of the modifications constituted changing a few words to make the phrase more understandable (for example, we changed “I feel like I am a part of the LGBT community” to “I feel like I am a member of the LGBT community”). A few statements were completely changed (for example, we changed “If I was offered the chance to be someone who is not LGBT I would accept the opportunity” to “If I could change from being LGBT to be straight, I would.”
Quantitative Sample Demographics (N=406)
Participants ranged in age from 18 to 60 years (mean=29.2, SD=5.8), the majority (n=231, 59.7%) identified as bisexual, and 62.2% were single. Most (n=238, 61.8%) participants reported experiencing high financial hardship and 22.3% reported a history of incarceration (n=86). One-fourth (n=99, 24.8%) of participants reported living with HIV and one third (n=124, 32.3%) reported a sexually transmitted infection diagnosis in the previous year.
Confirmatory Factor Analysis Results (N=406)
CESD-R
All items significantly loaded onto the one-factor depression construct except item #9 (I slept much more than usual), (β=0.25) (Table 2). The fit indices for the one-factor model were acceptable (RMSEA=0.10; CFI=0.82; TLI=0.80). This provides evidence that the CESD-R is a reasonable instrument to ascertain depressive symptoms among Nigerian GBMSM.
MSPSS
All items significantly loaded onto their respective factors (Table 3). The three-factor model measures three distinct sources of perceived social support (family, friends, and significant other). The fit indices for the one-factor model were acceptable (RMSEA=0.09; CFI=0.92; TLI=0.90). The better fit statistics and multidimensional nature of social support leads us to conclude that the three-factor model is parsimonious.
LGBT Minority Stress Scales
All items significantly loaded onto their respective factors (Table 4). The five-factor model measures five distinct experiences of minority stress (community connectedness, internalized stigma, rejection anticipation, identity concealment, and victimization events). The good fit statistics (RMSEA=0.08; CFI=0.91; TIL=0.90) and multidimensional nature of minority stress leads us to conclude that these measures accurately assessed various dimensions of experiences of minority stress among Nigerian GBMSM.
Scale Properties (N=406)
Scores on the CESD-R (20 items) ranged from 0 to 55 (M=11.4, SD=12.2). Internal consistency was high (Cronbach’s α=0.93). Scores on the MSPSS (12 items) ranged from 12 to 84 (M=58.4, SD=12.6). Internal consistency was high (Cronbach’s α=0.86). Scores on the community connectedness subscale (5 items) ranged from 5 to 25 (M=19.8, SD=4.5). Internal consistency was high (Cronbach’s α=0.86). Scores on the internalized stigma subscale (3 items) ranged from 3 to 15 (M=8.0, SD=3.5). Internal consistency was high (Cronbach’s α=0.80). Scores on the rejection anticipation subscale (4 items) ranged from 4 to 20 (M=9.8, SD=4.0). Internal consistency was acceptable (Cronbach’s α=0.72). Scores on the identity concealment subscale (4 items) ranged from 4 to 20 (M=13.1, SD=4.8). Internal consistency was high (Cronbach’s α=0.86). Scores on the victimization events subscale (3 items) ranged from 3 to 15 (M=5.4, SD=3.2). Internal consistency was very high (Cronbach’s α=0.92).
Construct Validity Analysis
To evaluate the convergent validity (Table 5), correlations (Pearson’s coefficients) were conducted between the CESD-R, the MSPSS, the LGBT Minority Stress Measure, and the UCLA Loneliness Scale. We hypothesized that there will be a positive significant relationship between depressive symptoms, minority stress, and loneliness. We also hypothesized a significant inverse relationship between perceived social support and loneliness. Upon calculation of Pearson’s coefficient, the UCLA Loneliness Scale was found to be correlated, but not strongly, in the expected direction with CESD-R (r=0.38, p<0.01), perceived social support (family [r=-0.23, p<.01], friends [r=-0.26, p<0.01], and significant other [r=-0.20, p<0.01]) and all but one of the minority stress scales (community connectedness [r=-0.09, not significant], internalized stigma [r=0.10, p<0.05], rejection anticipation [r=0.23, p<0.01], identity concealment [r=0.14, p<0.01], and victimization events [r=0.19, p<0.01]), thereby demonstrating evidence for convergent validity. Additionally, the social support and minority stress subscales were highly correlated with each other (|r|=0.23-0.48), p<0.01), providing evidence for concurrent validity.
To evaluate discriminant validity (Table 4), correlations (Pearson’s coefficients) were conducted between CESD-R, MSPSS, LGBT Minority Stress Measure, and healthcare utilization. We hypothesized that there will be no statistically significant relationship between depressive symptoms, perceived social support, minority stress and healthcare utilization. Upon calculation of Pearson’s coefficient, healthcare utilization was found to be not strongly correlated with the CESD-R (r=0.02, not significant), perceived social support (family [r=-0.01, not significant], friends [r=-0.07, not significant], and significant other [r=-0.05, not significant]) and all the minority stress scales (community connectedness [r=0.09, not significant], internalized stigma [r=-0.03, not significant], rejection anticipation [r=0.06, not significant], identity concealment [r=-0.02, not significant], and victimization events [r=0.05, not significant]), thereby demonstrating strong evidence for discriminant validity.