Trauma-Informed Care Adapted for Indian LGBTQ+ Community: A Narrative Review.

BACKGROUND

India has a complex relation with concepts of gender and sexuality. Existing stigma in Indian society results in complex trauma and high psychiatric morbidity. We suggest adaptations to trauma and dissociation-informed therapy to ideally support the Indian queer community.

METHOD: We searched PubMed using the keywords "LGBT India mental health", "LGBT Trauma psychotherapy", and "LGBT India", yielding 174 studies.

INCLUSION CRITERIA: relevant English original or meta-analytic studies from India.

EXCLUSION CRITERIA: non-English, non-Indian, inaccessible studies. After duplicate removal, abstract screening and full text analysis, a total of 37 studies (6 studies-LGBT statistics, 13 studies-struggles of LGBT Indian community, 11 studies-mental health impact, 9 studies-available resources, and 7 studies-trauma and dissociation-informed therapy) were included for this narrative review.

RESULTS

Familial, communal, and police violence against the LGBTQ+ still exists in India. Stigma, microaggressions, homophobia, and re-traumatization in healthcare cause complex PTSD and other psychiatric disorders. Government, non-profit, and community-based interventions are lacking.

DISCUSSION: Individually tailored, socially sensitive trauma-informed therapy would be ideal for the Indian queer community. "Narrative exposure therapy" creating culturally empowering narratives, "Mentalization-based therapy" reducing internalized stigma, "Prolonged exposure group therapy" building a support system, "Milan family therapy" combating negative stigma, and "somatic therapy" reclaiming one's body would help adapt existing Western trauma and dissociation-informed therapy models for the LGBTQ+ population in India.

CONCLUSION

By adapting a model of trauma-informed therapy for the Indian LGBTQ+ community, we provide culturally and ethically sensitive recommendations for mental health professionals through this narrative review.