Supplemental Table 1: Unweighted characteristics by depression status among 11,992 men who have sex with men in 12 Indian cities

Characteristica / No/mild depressionb (N=10388) / Depressionb
(N=1604) / p-valuec / Total (N=11992)
Site, n (row %)
Bengaluru
Belgaum
Bhopal
Chennai
Coimbature
New Delhi
Hyderabad
Lucknow
Madurai
Mangalore
Vijayawada
Visakhapatnam / 931 (93.1)
884 (88.4)
874 (87.6)
934 (93.4)
673 (67.3)
806 (80.8)
935 (93.7)
931 (93.1)
688 (68.7)
939 (93.9)
956 (95.6)
837 (83.7) / 69 (6.9)
114 (11.6)
124 (12.4)
66 (6.6)
327 (32.7)
191 (19.2)
63 (6.3)
69 (6.9)
313 (31.3)
61 (6.1)
44 (4.4)
163 (16.3) / <0.001 / 1000
998
998
1000
1000
997
998
1000
1001
1000
1000
1000
Region/State, n (row%)
Andhra Pradesh
Karnataka
Tamil Nadu
Central/North / 2728 (91.0)
2754 (91.9)
2295 (76.5)
2611 (87.2) / 270 (9.0)
244 (8.1)
706 (23.5)
384 (12.8) / <0.001 / 2998
2998
3001
2995
Median age (IQR) / 26 (21-33) / 28 (22-36) / <0.001 / 26 (22-34)
Marital Status, n (%)
Never married
Currently married/living with partner
Widowed/divorced/other / 6078(58.5)
3931 (37.8)
379 (3.7) / 758 (47.4)
706 (44.1)
137 (8.6) / <0.001 / 6836 (57.0)
4637 (38.7)
516 (4.3)
Sexual identity, n (%)
Panthi
Kothi
Double Deckers (DD)
Gay
MSM
Bisexual / 3470 (33.4)
2252 (21.7)
2401 (23.1)
179 (1.7)
698 (6.7)
1388 (13.4) / 461 (28.8)
562 (35.1)
396 (24.7)
17 (1.1)
30 (1.9)
135 (8.4) / <0.001 / 3931 (32.8)
2814 (23.5)
2797 (23.3)
196 (1.6)
728 (6.1)
1523 (12.7)
Education, n (%)
Primary school or less
Secondary school
High school and above / 2285 (22.0)
4478 (43.1)
3625 (34.9) / 376 (23.5)
726 (45.4)
499 (31.2) / 0.014 / 2661 (22.2) 5204 (43.4)
4124 (34.4)
Employment, n (%)
Monthly/weekly wages
Daily/seasonal wages
Unemployed
Other (student or retired) / 5102 (49.1)
3640 (35.0)
396 (3.8)
1250 (12.0) / 792 (49.5)
605 (37.8)
67 (4.2)
137 (8.6) / <0.001 / 5894 (49.2)
4245 (35.4)
463 (3.9)
1387 (11.6)
Median monthly income (IQR) (rupees) / 6000 (4000-8000) / 6000 (3500-8000) / 0.024 / 6000 (4000-8000)
Disclosure of being MSM, n (%)
No
Disclosure to spouse/family
Disclosure to others but not to spouse/family / 4192 (40.4)
804 (7.7)
5392 (51.9) / 457 (28.5)
264 (16.5)
880 (55.0) / <0.001 / 4649 (38.8)
1068 (8.9)
6272 (52.3)
HIV positive awareness and disclosure, n (%)
Negative
Known positive, undisclosed status
Known positive, disclosed status
Unknown positive / 9540 (91.8)
63 (0.6)
259 (2.5)
526 (5.1) / 1307 (81.5)
25 (1.6)
155 (9.7)
117 (7.3) / <0.001 / 10847 (90.5)
88 (0.7)
414 (3.5)
643 (5.4)
Sex work in prior 6 months, n (%)
No
Yes / 7896 (76.2)
2468 (23.8) / 955 (60.1)
633 (39.9) / <0.001 / 8851 (74.1)
3101 (25.9)
Unprotected anal sex in prior 6 months, n (%)
No
Yes
No anal sex in prior 6 months / 4154 (40.0)
5667 (54.6)
567 (5.5) / 498 (31.1)
980 (61.2)
123 (7.7) / <0.001 / 4652 (38.8)
6647 (55.4)
690 (5.8)
Median number of male partners in prior 6 months (IQR) / 1 (1-2) / 1 (1-3) / 0.006 / 1 (1-2)
Injection drug use in prior 6 months, n (%)
No
Yes / 10279 (99.0)
101 (1.0) / 1557 (97.4)
41 (2.6) / <0.001 / 11836 (98.8)
142 (1.2)
Any drug use in prior 6 months, n (%)
No
Yes / 7942 (76.5)
2441 (23.5) / 1284 (80.2)
317 (19.8) / 0.001 / 9226 (77.0)
2758 (23.0)
Alcohol use and dependence, n (%)
None/mild
Harmful/hazardous
Alcohol dependent / 6393 (61.5)
2211 (21.3)
1784 (17.2) / 783 (48.9)
259 (16.2)
559 (34.9) / <0.001 / 7176 (59.9)
2470 (20.6)
2343 (19.5)
Alcohol use before sex in prior 6 months, n (%)
No
Yes
No sex in prior 6 months / 4406 (42.4)
4413 (42.5)
1565 (15.1) / 532 (33.4)
778 (48.8)
284 (17.8) / <0.001 / 4938 (41.2)
5191 (43.3)
1849 (15.4)
Median social support scored (IQR) / 6 (2-11) / 8 (5-12) / <0.001 / 3 (7-11)
Median composite stigma scoree (IQR) / 5 (2-7) / 9 (6-13) / <0.001 / 5 (2-8)
Ever forced sex, n (%)
No
Yes / 7821 (75.7)
2509 (24.3) / 856 (53.8)
735 (46.2) / <0.001 / 8677 (72.8)
3244 (27.2)
Adult intimate partner violence, n (%)
No
Yes / 8960 (86.5)
1402 (13.5) / 1060 (66.5)
535 (33.5) / <0.001 / 10020 (83.8)
1937 (16.2)

aPercentages are column percentages, unless otherwise noted.

bNo or mild depression defined by a score of 9 or less on the PHQ-9 depression scale, depression defined as a score of 10 or more.

cP-value from Person chi-square test for categorical characteristics and Wilcoxon rank sum for continuous characteristics.

dSocial support score ranged from 0 to 20 with higher scores reflecting more social support.

eComposite stigma score was estimated by averaging stigma scores from 4 scales: vicarious stigma, enacted stigma, felt normative stigma, and internalized stigma; score ranged from 0 to 20 with higher scores reflecting more stigma.

Supplementary Table 2: Correlates ofdepressionaamong 11,997 men who have sex with men in 12 Indian cities

Unadjusted / Adjusted
Odds Ratio / 95% Confidence Interval / Odds Ratio / 95% Confidence Interval
Age (per 10 years) / 1.23 / 1.16, 1.31 / -- / --
Marital Status
Never married
Currently married/living with partner
Widowed/divorced/other / REF
1.40
2.05 / 1.25, 1.58
1.63, 2.57 / -- / --
Sexual identity
Panthi
Kothi
Double Deckers (DD)
Gay
MSM
Bisexual / REF
1.80
1.21
0.99
0.50
1.18 / 1.56, 2.07
1.04, 1.41
0.59, 1.66
0.33, 0.74
0.95, 1.47 / REF
1.60
1.17
1.01
0.49
1.16 / 1.37, 1.88
1.00, 1.37
0.60, 1.72
0.33, 0.73
0.93, 1.44
Disclosure of being MSM, n (%)
No
Disclosure to spouse/family
Disclosure to others but not to spouse/family / REF
2.54
1.44 / 2.11, 3.06
1.26, 1.65 / REF
1.71
1.23 / 1.40, 2.10
1.07, 1.42
HIV positive awareness and disclosure
Negative
Known positive, undisclosed status
Known positive, disclosed status
Unknown positive / REF
3.08
3.77
1.61 / 1.86, 5.12
3.01, 4.72
1.29, 2.01 / REF
3.19
3.72
1.30 / 1.92, 5.31
2.95, 4.69
1.03, 1.64
Sex work in prior 6 months / 2.01 / 1.78, 2.27 / -- / --
Number of male sex partners in prior 6 months (per 5 partner increase) / 1.02 / 1.01, 1.02 / -- / --
Unprotected anal sex in prior 6 months
No
Yes
No anal sex in prior 6 months / REF
1.45
1.47 / 1.28, 1.63
1.17, 1.85 / -- / --
Alcohol use and dependence (AUDIT)
None/mild
Harmful/hazardous
Alcohol dependence / REF
0.94
2.09 / 0.80, 1.09
1.83, 2.39 / REF
1.06
2.41 / 0.90, 1.24
2.10, 2.77
Alcohol use before sex in prior 6 months / 1.37 / 1.20, 1.56 / -- / --
Injection drug use in prior 6 months / 2.75 / 1.86, 4.08 / 2.14 / 1.43, 3.21
Social support (per 1 point increase) / 1.05 / 1.04, 1.06 / -- / --
Composite stigma (per 1 point increase) / 1.30 / 1.22, 1.38 / -- / --
Ever forced sex / 2.35 / 2.09, 2.64 / -- / --
Adult intimate partner violence / 2.58 / 2.27, 2.94 / -- / --

aDepression defined as a score of 10 or more on the PHQ-9.