Peer Counselling to Reduce Psychological Distress and Exposure to Violence Among Sexual and Gender Minorities

Summary

Lesbian, Gay, Bisexual, Transgender, Intersex, Queer, Asexual, and other sexually or gender diverse (LGBTIQA+) communities in many countries face high levels of mental health problems compared to the general population. This is often due to discrimination, being excluded, abuse, and unfair treatment. In many low- and middle-income countries, including Nepal, the mental health needs of LGBTIQA+ people are not met, and the violence they experience is often ignored because they are seen as breaking gender norms. The low number of trained mental health specialists in a country like Nepal imply that any short-term effort to alleviate the mental health problems among LGBTIQA+ must rely on other type of support workers such as peers. There is growing evidence that help from community members-such as counselling given by non-professionals-can improve mental well-being. Considering that discrimination of LGBTIQA+ is common also within the health services, this study will look at whether peer counselling-support provided by trained LGBTIQA+ community members-can work well in Nepal. We have improved a counselling program called 'Problem Management Plus' (PM+), developed by the World Health Organization, by adding new parts that focus on reducing the risk of some of the contributing causes of mental distress, namely violence, marginalisation and loneliness. The added components include safety planning, counselling that builds confidence and strength, and goal setting strategies to help study participants use the skills they learn and reach the desired impact. In addition, peer-led monthly group meetings will be conducted to enhance social cohesion, strengthen interpersonal networks, and reduce feeling of loneliness. The study uses a community based participatory research approach, meaning LGBTIQA+ people are invited to give inputs throughout the study from study design to being involved as peer advocates to deliver the counselling. The trial will recruit at least 960 LGBTIQA+ individuals aged 18 to 55 years living in seven districts of Nepal. Study participants will be randomly allocated to one of three arms: one arm receiving individual augmented PM+ counselling with six weekly sessions; one arm receiving the individual augmented PM+ counselling followed by 11 monthly group sessions; and one control arm. There will be a one year follow-up to examine whether the peer support helps improve mental health and reduce exposure to violence among LGBTIQA+ people. The study findings will help guide programmes to improve the mental health of LGBTIQA+ in other low- and middle-income countries where they also experience discrimination, exclusion, and violence.

Conditions

• Mental Health
• Psychological Distress
• Secondary Violence Reduction
• Discrimination
• Sexual and Gender Minorities
• Minority Groups
• Homosexuality
• Domestic Violence
• Gender Based Violence

Interventions

BEHAVIORAL

SAATHI intervention (Augmented PM+ counseling)

Study participants in this arm will attend six weekly peer-led sessions, each approximately 90-minutes in length, designed to empower them to make decisions about their lives and build resilience. PM+ is a psychological intervention developed by the World Health Organization, based on principles of cognitive behavioural therapy. It includes components such as understanding adversity and psychoeducation on mental health, managing stress, problem-solving, behavioural activation, and strengthening social support. The PM+ model in this study is augmented with additional elements, including self-empowerment strategies, motivational interviewing, psychoeducation on intimate partner and community violence, mindful meditation and safety planning. Participants will also be introduced to best practices and lessons learned that support danger assessments and avoidance of risk of future violence. The intervention aims to improve participants' overall circumstances and mental well-being.

BEHAVIORAL

SAATHI intervention with Peer-Led Group Meetings

These 11-monthly peer-led group sessions are designed to enhance social support, build resilience, and reinforce the application of augmented PM+ strategies in daily life. They provide a safe space for reflection and mutual encouragement among study participants. The group sessions focus on managing stress, strengthening self-regulation, building self-esteem, fostering social connectedness, and promoting positive identity development. Group sessions involve identifying and discussing the barriers and facilitators related to practicing slow breathing techniques, problem-solving strategies, maintaining physical activity, navigating intimate partner and community violence, understanding social support networks, and planning for safety in various situations faced by sexual and gender minorities.

Sponsors & Collaborators

• Department of Global Public Health and Primary Care, University of Bergen

  collaborator UNKNOWN

• Blue Diamond Society, Nepal

  collaborator UNKNOWN

• Sahayatri Samaj, Parsa

  collaborator UNKNOWN

• Friends Hetauda, Makwanpur

  collaborator UNKNOWN

• Pahichan Nepal, Sarlahi

  collaborator UNKNOWN

• Manab Sachet Samaj, Chitwan

  collaborator UNKNOWN

• Sunaulo Bihani Samaj, Dhanusha

  collaborator UNKNOWN

• CruiseAIDS Nepal, Kathmandu

  collaborator UNKNOWN

• Parichaya Samaj, Lalitpur

  collaborator UNKNOWN

• Public Health and Environment Research Centre (PERC), Nepal

  lead OTHER

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Max Age

55 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2025-05-20

Primary Completion

2026-12-31

Completion

2027-04-30

Countries

• Nepal

Study Locations