Health and Lifestyle, Safety, Relationship and Personality Factors Influence Gender, Sex and Sexuality Issues among Youth—A Case Record Analysis from Youth Mental Health Promotion Clinics in Karnataka, India

Round 1

Reviewer 1 Report

The aim of this study is to investigate  how several personality, health traits can influence gender  sex and sexuality issues. This study is part of a prevention project  that takes place in India.

In my opinion, this is an important tipo to discuss, even more in India. So, come this reason, I highly recommand  the pubblication  of this paper. 

In this article, the authors have 10340 Youth clients and they avere questione about health, gender and sex issues.

In my opinion the impprtance of this article  is the possibility to raise visibility and importance  on the sexual ills. 

The statistical analysis is well explained and well done.

The discussion can be Improved a little more, adding more references to the study's results.

 

 

Author Response

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Author Response File: Author Response.docx

Reviewer 2 Report

Please refer to the contents of the attached file

Comments for author File: Comments.pdf

Author Response

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Author Response File: Author Response.docx

Reviewer 3 Report

This paper will have important implications for youth with GSS issues in India if more public health evidence is accounted for. Below are my suggestions for the authors to ponder. The article should also be proofread for overall readability before resubmitting.

General comment: As a researcher who is guided by the social determinants of health framework, I have serious concerns for some of the phrases used in this paper. Phrases such as “affecting GSS among youth” or “increased risk of GSS issues among clients reporting suicidality” can be construed as victim-blaming and unnecessarily perpetuate pathologising perceptions on youth who present GSS issues. We know from previous studies (e.g., Meyer, 2003; Nayak et al., 2010) that GSS-specific victimisations have negative impacts on mental health. Yet, the authors are writing in a language that suggests inherent mental health pathology among young people with experiences of GSS, which I find extremely problematic and do not think align with the international public health evidence on risk factors for mental health. Please reframe GSS as the antecedent of mental health problems throughout the paper.

Materials and methods: For the purpose of replicability, it is essential for researchers to be transparent of the measurement tools used to assess GSS and mental health experiences. Some components as part of the broader “GSS issue” (e.g., gender role and gender discrimination) are enormous social constructs that ought to be appropriately defined. Can the authors explicitly provide a few examples of the questions asked under each construct? Alternatively, the authors can cite a study/report/document with the exact questions asked or attach this information as an appendix/supplemental file. Cronbach’s alpha for items within each construct should also be provided.

Statistical analysis: GSS issues should not be interpreted as an outcome (see my general comment). Furthermore, the researchers must be careful of not overclaiming causality based on cross-sectional analyses. I recommend the author to remove terms such as “affecting” or “outcome” throughout the article and use terms such as “associate” or “relationship”.

Statistical analysis: I wonder if Strata was in fact “Stata”?

Table 3 and 4: In line with my general comment, I suggest the authors to combine the data from these 2 tables and frame sociodemographic variables and GSS issues as independent variables, and mental health as dependent variables. Adjusted odds ratios that control for other significant sociodemographic variables (as covariates) can depict a clearer picture of the association between GSS issues and young people’s mental health.

Discussion:

• Can the author speculate and elaborate on the reasoning underlying the finding of alcohol use and reduced risk of GSS issues?
• The term “gender orientation” is not commonly used and I’m unsure what the authors meant.
• This is the first section where the authors mentioned the term “LGBT”. I understand that GSS issues will have a lot of relevance with LGBT people’s mental health and I think the authors should write a paragraph reviewing this evidence in the introduction section. I have included some great references below.
• Please provide an appropriate reference for this sentence “Societal acceptance, patriarchy, prevalence of male dominated social ecosystems might normalize these issues among women leading to lack of perception of such issues and thereby reduced reporting among women.”
• An academic paper is an ideal platform for researchers to advocate for change. I suggest the authors to think about the public health recommendations for increased risk of violence among married couples.

Nayak, M., Patel, V., Bond, J., & Greenfield, T. (2010). Partner alcohol use, violence and women's mental health: Population-based survey in India. British Journal of Psychiatry, 196(3), 192-199.

Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin. 2003; 129(5): 674–697

Logie CH, Newman PA, Chakrapani V, Shunmugam M. Adapting the minority stress model: associations between gender non-conformity stigma, HIV-related stigma and depression among men who have sex with men in South India. Social Science & Medicine. 2012;74(8):1261-8

Wandrekar JR, Nigudkar AS. What Do We Know About LGBTQIA+ Mental Health in India? A Review of Research From 2009 to 2019. Journal of Psychosexual Health. 2020;2(1):26-36.

Author Response

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Author Response File: Author Response.docx

Round 2

Reviewer 3 Report

The authors have been very responsive to my comments and have addressed most of them excellently.

Just two more points from me:

1. Please refrain from using a causal language in your title.
2. In section 2, I highly recommend the authors to be transparent with their measurement tools and provide a description/definition for each construct of GSS issues (Gender roles, Gender discrimination, Gender based violence, Child sexual abuse, Sexually transmitted diseases/infections) that is contextually relevant to India. While the questions under each construct may have been customised to suit a client’s background, I would imagine that there were similar essential questions asked across all participants? If this was not the case, how did the authors collate findings for different questions under each construct? Given that minimal details on the measurement tools have been provided, readers are inclined to scrutinise the study’s findings. The authors can consider present these details in a table.

There are also issues with spacing between words throughout the manuscript that need to be addressed.

Author Response

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Author Response File: Author Response.docx