{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T13:42:04Z","timestamp":1780926124387,"version":"3.54.1"},"reference-count":30,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2021,5,13]],"date-time":"2021-05-13T00:00:00Z","timestamp":1620864000000},"content-version":"unspecified","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R21HD089820"],"award-info":[{"award-number":["R21HD089820"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,4,15]]},"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Displaced 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).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Between 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Sixty-three per cent of Syrian participants met criteria for depression compared with 43.8% of Lebanese participants (p&lt;0.001); 21.3% of Syrians met criteria for severe anxiety compared with 13.1% of Lebanese participants (p&lt;0.05) and 33.0% of Syrians met criteria for post-traumatic stress disorder compared with 18.4% of Lebanese participants (p&lt;0.001). Among Syrian MSM and transgender women, sociodemographic characteristics, displacement-related stressors and stigma-related stressors were uniquely associated with psychiatric morbidity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Displaced 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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-046996","type":"journal-article","created":{"date-parts":[[2021,5,13]],"date-time":"2021-05-13T13:20:07Z","timestamp":1620912007000},"page":"e046996","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["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"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9626-8460","authenticated-orcid":false,"given":"Kirsty","family":"Clark","sequence":"first","affiliation":[{"name":"Social and Behavioral Sciences, Yale University School of Public Health, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Pachankis","sequence":"additional","affiliation":[{"name":"Social and Behavioral Sciences, Yale University School of Public Health, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaveh","family":"Khoshnood","sequence":"additional","affiliation":[{"name":"Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut, USA"},{"name":"Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Br\u00e4nstr\u00f6m","sequence":"additional","affiliation":[{"name":"Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Seal","sequence":"additional","affiliation":[{"name":"Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"Khoury","sequence":"additional","affiliation":[{"name":"American University of Beirut, Beirut, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fouad M","family":"Fouad","sequence":"additional","affiliation":[{"name":"American University of Beirut, Beirut, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russell","family":"Barbour","sequence":"additional","affiliation":[{"name":"Biostatistics, Yale University School of Public Health, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Heimer","sequence":"additional","affiliation":[{"name":"Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut, USA"},{"name":"Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,5,13]]},"reference":[{"key":"2025101811494875000_11.5.e046996.1","unstructured":"UNHCR the UN refugee agency. Lebanon: Fact sheet, 2020. Available: https:\/\/reporting.unhcr.org\/sites\/default\/files\/UNHCR%20Lebanon%20Fact%20Sheet%20-%20January%202020.pdf"},{"key":"2025101811494875000_11.5.e046996.2","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.comppsych.2016.09.007","article-title":"Post-traumatic stress disorder in a sample of Syrian refugees in Lebanon","volume":"72","author":"Kazour","year":"2017","journal-title":"Compr Psychiatry"},{"key":"2025101811494875000_11.5.e046996.3","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.comppsych.2016.04.002","article-title":"Prevalence of depression in Syrian refugees and the influence of religiosity","volume":"68","author":"Naja","year":"2016","journal-title":"Compr Psychiatry"},{"key":"2025101811494875000_11.5.e046996.4","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1016\/S2215-0366(15)00419-8","article-title":"Mental health of Syrian refugees: looking backwards and forwards","volume":"2","author":"Abou-Saleh","year":"2015","journal-title":"Lancet Psychiatry"},{"key":"2025101811494875000_11.5.e046996.5","unstructured":"Yassin N , Osseiran T , Rassi R . No place to stay? Reflections on the Syrian refugee shelter policy in Lebanon. Beirut, Lebanon: United Nations Human Settlements Programme and the American University of Beirut, 2015."},{"key":"2025101811494875000_11.5.e046996.6","article-title":"Violence and discrimination against men who have sex with men in Lebanon: the role of international displacement and migration","author":"Orr","year":"2019","journal-title":"J Interpers Violence"},{"key":"2025101811494875000_11.5.e046996.7","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1002\/jts.22346","article-title":"Traumatic stress among sexual and gender minority refugees from the middle East, North Africa, and Asia who fled to the European Union","volume":"31","author":"Alessi","year":"2018","journal-title":"J Trauma Stress"},{"key":"2025101811494875000_11.5.e046996.8","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1080\/13691058.2013.775345","article-title":"Sexual stigma, psychological well-being and social engagement among men who have sex with men in Beirut, Lebanon","volume":"15","author":"Wagner","year":"2013","journal-title":"Cult Health Sex"},{"key":"2025101811494875000_11.5.e046996.9","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1080\/15532739.2015.1117406","article-title":"Suicide risk factors among trans feminine individuals in Lebanon","volume":"17","author":"Kaplan","year":"2016","journal-title":"Int J Transgend"},{"key":"2025101811494875000_11.5.e046996.10","doi-asserted-by":"publisher","DOI":"10.1037\/0033-2909.129.5.674"},{"key":"2025101811494875000_11.5.e046996.11","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1071\/SH16083","article-title":"Mental health in 2020 for men who have sex with men in the United States","volume":"14","author":"Batchelder","year":"2017","journal-title":"Sex Health"},{"key":"2025101811494875000_11.5.e046996.12","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)00684-X"},{"key":"2025101811494875000_11.5.e046996.13","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1007\/s13178-018-0352-y","article-title":"Major depression among young men who have sex with men in Beirut, and its association with structural and sexual minority-related stressors, and social support","volume":"16","author":"Wagner","year":"2019","journal-title":"Sex Res Social Policy"},{"key":"2025101811494875000_11.5.e046996.14","doi-asserted-by":"publisher","DOI":"10.2307\/3096941"},{"key":"2025101811494875000_11.5.e046996.15","doi-asserted-by":"publisher","DOI":"10.1080\/09540120802032627"},{"key":"2025101811494875000_11.5.e046996.16","doi-asserted-by":"publisher","DOI":"10.1177\/014662167700100306"},{"key":"2025101811494875000_11.5.e046996.17","first-page":"163","article-title":"The Beck anxiety inventory: psychometric properties","volume":"12","author":"Ulusoy","year":"1998","journal-title":"J Cogn Psychother"},{"key":"2025101811494875000_11.5.e046996.18","doi-asserted-by":"publisher","DOI":"10.1023\/A:1025714729117"},{"key":"2025101811494875000_11.5.e046996.19","doi-asserted-by":"publisher","DOI":"10.1007\/s00127-005-0943-9"},{"key":"2025101811494875000_11.5.e046996.20","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1027\/1015-5759\/a000010","article-title":"Validation of the Arabic center for epidemiological studies depression (CES-D) scale in a Lebanese community sample","volume":"26","author":"Kazarian","year":"2010","journal-title":"Europ J Psychol Assess"},{"key":"2025101811494875000_11.5.e046996.21","doi-asserted-by":"publisher","DOI":"10.1177\/1363461515569755"},{"key":"2025101811494875000_11.5.e046996.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2009.12.008"},{"key":"2025101811494875000_11.5.e046996.23","doi-asserted-by":"crossref","DOI":"10.2307\/1229039","article-title":"Mapping the margins: intersectionality, identity politics, and violence against women of color","volume":"43","author":"Crenshaw","year":"1991","journal-title":"Stanford Law Rev"},{"key":"2025101811494875000_11.5.e046996.24","doi-asserted-by":"publisher","DOI":"10.1037\/a0016441"},{"key":"2025101811494875000_11.5.e046996.25","doi-asserted-by":"publisher","DOI":"10.1037\/0021-843X.87.1.49"},{"key":"2025101811494875000_11.5.e046996.26","doi-asserted-by":"publisher","DOI":"10.1037\/0003-066X.61.1.10"},{"key":"2025101811494875000_11.5.e046996.27","article-title":"An overview of systematic reviews on mental health promotion, prevention, and treatment of common mental disorders for refugees, asylum seekers, and internally displaced persons","volume":"9","author":"Uphoff","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"key":"2025101811494875000_11.5.e046996.28","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1089\/aid.2019.0203","article-title":"Pilot results from the first HIV\/AIDS intervention among transgender women in the middle East: gender affirmation and social support from within trans communities in Beirut, Lebanon","volume":"36","author":"Kaplan","year":"2020","journal-title":"AIDS Res Hum Retroviruses"},{"key":"2025101811494875000_11.5.e046996.29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12914-016-0092-0","article-title":"\u201cIt\u2019s for us \u2013newcomers, LGBTQ persons, and HIV-positive persons. You feel free to be\u201d: a qualitative study exploring social support group participation among African and Caribbean lesbian, gay, bisexual and transgender newcomers and refugees in Toronto, Canada","volume":"16","author":"Logie","year":"2016","journal-title":"BMC Int Health Hum Rights"},{"key":"2025101811494875000_11.5.e046996.30","doi-asserted-by":"publisher","DOI":"10.1037\/ccp0000508"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2020-046996","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T18:49:54Z","timestamp":1760813394000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2020-046996"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5]]},"references-count":30,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,5,13]]},"published-print":{"date-parts":[[2021,5]]}},"alternative-id":["10.1136\/bmjopen-2020-046996"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2020-046996","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5]]}}}