Sexual and gender minorities (SGMs) have been documented in every region of the world. In spite of reported
abuse, discrimination and stigma, little is known about their mental health (MH). Even less is known about the
development of appropriate MH treatment interventions. Evidence-based treatments (EBTs) addressing poor
MH are being implemented in low- and middle-income countries (LMICs) using appropriate, affordable and
sustainable delivery modalities (e.g. lay providers, mHealth). These advances create opportunities to provide
MH care to SGMs not previously possible. To develop and implement EBTs, longitudinal research is necessary
to inform us of the unique MH needs, determinants and treatment preferences of this understudied population.
Pilot data for this study suggest that: SGMs can be identified and recruited in LMICs across SGM groups;
prevalence of depression, anxiety, suicidal ideation, and posttraumatic stress disorder among SGMs is
extremely high; and there are variations in MH symptomatology and determinants by SGM group and country.
There is an urgent need for longitudinal cohort studies that include SGMs from heterogeneous LMICs to
understand the influence of culture and context on MH needs, predictors and EBT preferences, and to develop
locally sustainable EBTs and methods for generalizability. Inclusion of methods (i.e. Discrete Choice
Experiments) that identify optimal EBT approaches specific to SGM groups, culture and context will accelerate
the translation of observational research to EBT implementation and provide a model that can be used to
identify appropriate EBTs for SGMs in other diverse contexts and low resource settings. The SGM Mental
Health in LMICs (SMILE) study represents paradigm-shifting research by defining SGMs based on gender
identity and attraction -inherent biological characteristics- rather than sexual behavior. SMILE study aims are:
¿ Aim 1: Estimate prevalence of anxiety, depression, PTSD, suicidal ideation and substance abuse
symptomatology among 7 SGM groups in 3 culturally diverse LMICs (Brazil, Kenya, Vietnam)
¿ Aim 2: Identify cultural, contextual, interpersonal and individual determinants of MH over time, by and
across SGM group and country.
¿ Aim 3: Determine SGMs’ MH intervention preferences through Discrete Choice Experiments (DCEs).
To accomplish these aims we will use a two-pronged recruitment strategy that includes respondent-driven
sampling and a mass media campaign to develop a cohort of 10,500 SGM (500 participants from 7 SGM
groups in 3 countries). Study participants will complete online surveys at baseline, 12- and 24-months to
assess MH symptomology, determinants, and treatment preferences. DCEs will be developed and included in
the 24-month survey to elicit preferences for EBTs that are SGM group, culture and context specific.
SMILE addresses all three NIMH priorities identified in the Notice of Special Interest in Research on Health
of SGM Populations (NOT-MD-19-001) and priorities of two other NIH Program Announcements.