Stigma, displacement stressors and psychiatric morbidity among displaced Syrian men who have sex with men (MSM) and transgender women: a cross-sectional study in Lebanon

Abstract

BackgroundDisplaced Syrians face psychiatric morbidity often resulting from displacement-related stressors (eg, resource scarcity). Both men who have sex with men (MSM) and transgender women among the displaced Syrians are particularly vulnerable to mental health challenges given that they also often face stigma-related stressors (eg, discrimination).MethodsBetween January and December 2019 in greater Beirut, 258 Lebanese-born MSM and transgender women and 230 displaced Syrian MSM and transgender women were recruited via respondent-driven sampling to complete an in-person survey assessing displacement-related stressors, stigma-related stressors, depression, anxiety and post-traumatic stress disorder. In the total sample, we first documented the prevalence of psychiatric morbidity among the displaced Syrians; we then assessed associations among displacement-related and stigma-related stressors and each psychiatric outcome.ResultsSixty-three per cent of Syrian participants met criteria for depression compared with 43.8% of Lebanese participants (p<0.001); 21.3% of Syrians met criteria for severe anxiety compared with 13.1% of Lebanese participants (p<0.05) and 33.0% of Syrians met criteria for post-traumatic stress disorder compared with 18.4% of Lebanese participants (p<0.001). Among Syrian MSM and transgender women, sociodemographic characteristics, displacement-related stressors and stigma-related stressors were uniquely associated with psychiatric morbidity.ConclusionDisplaced Syrian MSM and transgender women experience higher levels of psychiatric comorbidities than Lebanese MSM and transgender women in part due to compounding exposure to displacement-related stressors and stigma-related stressors. Informed by tenets of minority stress theory and intersectionality theory, we discuss mental health intervention implications and future directions.

LGBTQI + Migrants: A Systematic Review and Conceptual Framework of Health, Safety and Wellbeing during Migration

“…One study in Lebanon reported that 30% of recently migrated Syrian men experienced discrimination for being gay compared to 6% recently migrated Iraqi men or 8% Lebanese-born Palestinians ( p < 0.001) [ 59 ]. Another study in Lebanon found higher levels of sexual minority discrimination ( p < 0.01) and sexual minority assault ( p < 0.001) among displaced Syrians when compared to the non-displaced Lebanese population [ 57 ]. Several quantitative studies reported on employment and income.…”

“…A study on LGBTQ asylum seekers in Canada found that 72.4% of participants were employed, and in Lebanon the proportion of MSM refugees that were working was similar [ 58 , 59 ]. Two Lebanese studies reported that displaced participants received lower income compared to participants who hadn’t been displaced [ 57 , 59 ].…”

“…Five studies reported quantitative results related to mental health, using different measurement tools. Studies in Europe and in Lebanon measured prevalence of a provisional diagnosis of PTSD using either the PCL5 or the PCL-C. For those in Europe, 64.9% of participants met the provisional criteria for PTSD, whereas for displaced Syrians in Lebanon 33% met the PTSD cut-off (significantly higher than the non-displaced Lebanese comparative group, p < 0.001) [ 55 , 57 ]. These two studies cannot be directly compared as the study populations and settings are very different.…”

“…Two studies, in Lebanon and Germany, examined prevalence of depression and anxiety when compared to other populations. Higher proportions of depression and anxiety were seen in the displaced population in the Lebanese study compared to the non-displaced group (depression 63% vs. 43.8%, p < 0.001; severe anxiety 21.3% vs. 13.1%, p < 0.05), and a higher proportion of the LGBTIQ population screened positive for depression and/or anxiety in the German study when compared to non-LGBTIQ group (70% vs. 34%, OR 4.5 [1.79–12.47], p < 0.001) [ 53 , 57 ]. Being displaced was also associated with depression and PTSD on linear regression models in Lebanon when adjusting for sociodemographic characteristics ( p < 0.05 depression, p < 0.001 PTSD).…”

What is the global prevalence of depression among men who have sex with men? A systematic review and meta-analysis

“…Also, the overall mean age in the meta-analysis was 32 years. In the present meta-analysis, the first study to report the prevalence of depression in MSM was the article of Mills et al [ 55 ], and the most recent study which measured the prevalence of depression in MSM was the article of Clark et al [ 32 ]. The highest number of studies was related to 2018 with 14 articles [ 26 , 31 , 34 , 46 , 47 , 50 , 58 , 60 , 62 , 69 , 71 , 77 , 84 , 89 ] and 2017 with 11 articles [ 28 , 30 , 38 , 40 , 41 , 43 , 54 , 56 , 67 , 70 , 73 ].…”