Sexual and Gender Minority Mental Health in Low- and Middle-Income Countries (SMILE)

  • 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, and even less is known about the development of appropriate mental health treatment interventions for these populations living in low- and middle-income countries (LMICs). 


    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 mental health symptomatology and determinants by SGM group and country.


    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 mental health over time, by and across SGM group and country.
    • Aim 3: Determine SGMs’ mental health intervention preferences using 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 recruit over 10,000 participants across the 3 countries. Study participants will complete online surveys at baseline, 12- and 24-months to assess mental health symptomatology, 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.

    • Principal Investigator: Kathryn Whetten, Sara LeGrand

    • CHPIR Staff: Hy Huynh, Amy Hobbie, Andrew Weinhold, Leonard Ng’Eno, Sarah Wilson

    • Partners: ACE Africa (Kenya), FIOCRUZ (Brazil), LIFE Centre (Vietnam)

    • Funder: National Institute of Mental Health (NIMH)
    • Project Dates: 05/01/2020 – 02/28/2025
    • Predecessor Project: Sexual and Gender Minorities Pilot Project