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

The link between anticipated and internalized stigma and depression: A systematic review

Stigmatized groups may experience psychological distress. Yet, some studies show no significant relation between stigma and mental health outcomes. This systematic review investigates the link between anticipated and internalized stigma, and one mental health outcome, depression. We aimed to (1) determine whether anticipated and internalized stigma predict levels of depression, and (2) review the quality of evidence for this link. We searched PsycInfo, PubMed and EMBASE databases. Eighty-three studies (N = 34,705) met our inclusion criteria, across five stigma categories: Sexual and gender minorities; HIV/AIDS; Illness or disability-related (non-HIV); Weight, and Other. We reviewed evidence within each category and study design and developed a narrative synthesis. Sixty studies (72.3%) supported the proposed link, which varied across categories from 53.6% to 100%. Using the NIH quality assessment tool, most studies were of fair quality. Most cross-sectional studies (76.7%) straightforwardly supported the positive relation between internalized and/or anticipated stigma and depression, while only 40% of longitudinal studies did. Implications for the study of stigma and mental health outcomes are discussed.

Experiences of stigma, mental health, and coping strategies in Lebanon among Lebanese and displaced Syrian men who have sex with men: A qualitative study

BACKGROUND

In Lebanon, men who have sex with men (MSM) face high rates of stigma, discrimination, and violence. Minority stress, or the unique stressors related to anti-MSM stigma and discrimination, negatively impacts the mental health of MSM. These stressors are heightened for those with intersectional minority identities such as displaced Syrian MSM in Lebanon.

METHODS

In this qualitative study conducted in 2020-21, part of a larger study focused on the mental and sexual health risks among MSM, we collected qualitative data from Lebanese and displaced Syrian MSM living in Lebanon and analyzed reports of their experiences with stigma, mental health, and coping strategies. We conducted semi-structured, in-depth interviews with 12 displaced Syrian MSM and 13 Lebanese MSM.

RESULTS

Our findings highlight how MSM in Lebanon navigate stigma and the mental health risks that result. Common stressors among Lebanese and displaced Syrian MSM were related to finances, sexual orientation discrimination, and social isolation. Comparing the two groups, we found that stressors specific to displaced Syrian MSM were related to adverse childhood experiences, recent exposure to the Syrian war, displacement, and discrimination in Lebanon based on their intersectional identities as MSM and Syrians. For Lebanese participants, the most common stigma coping strategies were avoidance, drinking alcohol, using drugs, or having sex. As for displaced Syrian MSM, the most common stigma coping strategy was seeking the freely available mental health services offered to them through non-governmental organizations.

CONCLUSION

Our findings suggest that increased targeted mental health and social support interventions, informed by the unique experiences of Lebanese and displaced Syrian MSM, are highly needed to improve the coping and mental health resources of all MSM in Lebanon.

Internalized Sexual Orientation Stigma and Mental Health in a Religiously Diverse Sample of Gay and Bisexual Men in Lebanon

This study explores the correlates of internalized sexual orientation stigma, psychological distress and depression in a religiously diverse sample of gay and bisexual men in Lebanon. A convenience sample of 200 participants completed a cross-sectional survey. Bisexual men reported greater internalized sexual orientation stigma and less outness to their family and were more likely to face family pressure to have a heterosexual marriage than gay men. People of no religion reported more outness than Muslims and Christians but also higher psychological distress and depression. Multiple regression analyses showed that religiosity, outness, family pressure to marry and being bisexual were positively associated with internalized sexual orientation stigma; and that frequency of attending one's place of worship was negatively associated with psychological distress and depression. Individuals may be coping with adversity through engagement with institutionalized religion, which also appears to be a source of negative social representations concerning their sexuality.

Predicting sexual risk and sexual health screening in a sample of university students in Lebanon: a cross-sectional study

OBJECTIVE

The present study focuses on factors that predict sexual risk behaviors and sexual health screening behaviors in a sample of university students in Lebanon.

PARTICIPANTS

A convenience sample of 250 undergraduate students was recruited at a private university in Beirut, Lebanon.

METHODS

Students completed measures of religiosity, psychological distress, contraceptives usage, human immunodeficiency virus (HIV)/sexually transmitted infections (STI) screening, and sexual risk behaviors.

RESULTS

Religiosity was negatively associated with a range of risky sexual behaviors whereas psychological distress was positively associated with these behaviors. Sex under the influence of alcohol/drugs, discussing methods of contraception, and engaging in sexual activities later regretted had significant effects on having had condomless vaginal sex. Gender (being female) and sex under the influence of alcohol had significant effects on STIs screening.

CONCLUSION

Interventions that focus on managing drug and alcohol use in students, unwanted pregnancy, religion, stigma related to screening, and sexual health education are recommended.

Sexual and gender minority health in the Middle East and North Africa Region: A scoping review

Background

Researchers in studies from multiple countries suggest that sexual and gender minority people experience high rates of violence, stigma, and discrimination, as well as mistrust of health care providers and systems. Despite growing evidence related to sexual and gender minority health in North America and Europe, we know little about the health of this population in the Middle East and North Africa.

Objectives

We aimed to comprehensively examine the literature related to the health of sexual and gender minority people in the Middle East and North Africa and to identify research gaps and priorities.

Design

We conducted a scoping review informed by the framework recommended by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) tool.

Data sources

We searched the following databases: PubMed (using Medline All on the Ovid platform), PsycINFO (Ovid), CINAHL (Ebsco), and Embase (Ovid). The search strategy combined terms for the geographic region of interest (Middle East and North Africa) and the population of interest (sexual and gender minority). Each was operationalized using multiple search terms and, where available, controlled vocabulary terms.

Review Methods

Research articles were identified and assessed for inclusion using an explicit strategy. Relevant information was extracted and synthesized to present a descriptive summary of existing evidence.

Results

Research designs of the 98 articles we reviewed included quantitative (n = 73), qualitative (n = 20), and mixed methods (n = 5). Most studies were conducted in Lebanon (n = 33), Pakistan (n = 32), and Iran (n = 23) and focused mainly on gender minority individuals (n = 46) and men who have sex with men (n = 32). Five themes emerged from the review: sexual health (52; 53%); mental health (20; 20%); gender identity (17; 17%); violence and discrimination (7; 7%); and experiences with the healthcare system (2; 2%). Although researchers focused on multiple health outcomes in some studies, we included them under the theme most closely aligned with the main objective of the study.

Conclusion

Although our study is limited to few countries in the Middle East and North Africa region, we found that sexual and gender minority individuals face multiple adverse sexual and mental health outcomes and experience high rates of stigma, discrimination, and violence. More research is needed from countries outside of Lebanon, Pakistan, and Iran, including community-based participatory approaches and multi-level intervention development. Nurses and other healthcare providers in the region need training in providing inclusive care for this population.

Gender operationalisation and stress measurement in research with adolescent males: a scoping review

Aim

Stress measurement in adolescent males is in its relative infancy, which is likely to influence the effectiveness of mental health services for this heterogeneous population. Although evidence suggests the prevalence of mental health difficulties increases during adolescence, the relationship between gender and stress measurement is less explored or understood. This review summarizes findings on gender operationalisation and stress measurement in research with adolescent males.

Methods

For this scoping review, six electronic databases across social and life sciences were searched using terms linked to adolescence, male, stress and research design. Articles were screened, data were extracted, and a narrative synthesis used to characterise studies by research design, adaptation of method for participants’ cultural context, operationalisation of gender, and measurement of stress.

Results

Searches identified 3259 citations, 95 met inclusion criteria and were reviewed. Findings suggest that research on psychological stress in adolescence is a developing field, but one that is currently dominated by Western studies. Furthermore, the results indicate that stress measurement research with adolescent males tends not to make adaptations relative to participants' gender, age, or context.

Conclusions

Stress research with adolescent males is lacking in scope. This review highlights the need for researchers to consider stress responses as more than a biological response, as it has been conceptualised historically. Recommendations for researchers to report research design and protocol more clearly are made to support readers to understand how stress and gender have been operationalised and measured and how this may influence research methodology. Future research should avoid conflating biological differences with gendered experience and demonstrate greater sensitivity to how gender identity may intersect with age and location to perpetuate gendered inequalities.

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

BACKGROUND

Depression due to stigma resulting from their sexual identity, isolation, social exclusion, and insufficient access to care and counseling services has become a health problem among men who have sex with men (MSM).

OBJECTIVES

This study aimed to determine the global prevalence of depression among MSM as a systematic review and meta-analysis.

METHODS

This study was a systematic review and meta-analysis performed in five steps of search strategy, screening and selecting articles, data extraction, evaluation of the risk of bias, and meta-analysis. In this study, the determined keywords were searched in the databases of PubMed, Scopus, Embase, and Web of Science from January 1913 to July 2021 to find the initial articles, from which data were extracted according to the set checklist in the data extraction stage. Finally, the studies were included in the present meta-analysis according to the inclusion and exclusion criteria, to be evaluated using the Newcastle Ottawa scale checklist. I Square and Q Cochrane were also used to assess the degree of heterogeneity. The analyses were performed using the random-effects model in STATA 16.

RESULTS

The results showed the quality score of the majority of cross-sectional studies included in the meta-analysis (62 studies) was equal to six or seven (moderate), and five ones had a high-quality score. After combining these studies, the pooled prevalence of depression among MSM in the world was 35% (95% CI 31%-39%, I square; 98.95%, P-value < 0.001). Population subgroup analysis showed the pooled prevalence of depression among MSM living with HIV was 47% (95% CI 39%-55%, I square; 95.76%, P-value < 0.001). Continent subgroup analysis showed the highest pooled prevalence of depression among Asian MSM at 37% (95% CI 31%-43%, I square; 99.07%, P-value < 0.001). Also, in the subgroup analysis of the sampling method, the pooled prevalence in the studies which used the respondent-driven sampling method was equal to 34% (95% CI 25%-43%, I square; 99.32%, P-value < 0.001). Sensitivity analysis revealed the pooled prevalence of depression in studies included in the meta-analysis was near or around the pooled estimate.

CONCLUSION

The pooled prevalence of depression among MSM was almost three times higher than the general male population. Therefore, particular and therapeutic interventions such as screening, and harm reduction programs for mental disorders, especially depression, are suggested to be considered in service packages.

Mental Health of LGBTQ Individuals Who are Arab or of an Arab Descent: A Systematic Review

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals are at a higher risk of mental illness when compared to their heterosexual and cisgender counterparts. Most research emanates from Western countries, with a paucity of studies in the Arab world. We systematically reviewed studies assessing the mental health of LGBTQ individuals who live in the Arab world or are of Arab descent. Of 261 articles, seven were eligible for analysis. Depression was the most common psychiatric disorder. Suicidal ideations and attempts were frequent in trans women. Post-traumatic stress disorder was also common, with the majority of precipitating traumatic events being related to sexual orientation and/or gender identity. Societal and familial stressors in the Arab culture are major contributors to the increased vulnerability of the LGBTQ community to mental health challenges. Further research is of utmost need while taking into consideration the Arab socio-cultural context.

Longitudinal influence of COVID-19-related stress on sexual compulsivity symptoms in Chinese undergraduates

BACKGROUND

The coping theory shows that stressful life events are associated with individuals' psychology/behaviors; meanwhile, the coronavirus disease of 2019 (COVID-19) pandemic is known to have impacted individuals' physical and mental health. Prior studies revealed that undergraduates have many sexual behavior and emotion disorders, which may be impacted during an isolation period, such as the one brought by COVID-19. However, few studies have explored the longitudinal associations between COVID-19-related stress and sexual compulsivity symptoms (SCS), and the mediating effect of emotions (i.e., depression and anxiety) on this relationship. This longitudinal study aimed to investigate these associations.

METHODS

We employed a cross-lagged design (2020/2/12: Time 1, 3219 participants; 2020/6/6: Time 2, 2998 participants) and recruited Chinese undergraduates through an online system to respond to a survey.

RESULTS

Our results showed that COVID-19-related stress at Time 1 directly influenced SCS at Time 1, and there was an indirect influence via depression and anxiety at Time 1. COVID-19-related stress at Time 1 positively correlated with depression, anxiety, and SCS at Time 2, and the first could directly and positively predict SCS at Time 2. Moreover, albeit depression at Time 2 was negatively linked to SCS at Time 2, anxiety at Time 2 enhanced the effect of COVID-19-related stress on SCS.

CONCLUSIONS

Our findings extend the literature on SCS, showing that the higher the COVID-19-related stress, the higher the SCS, and the longer-lasting effect was associated with anxiety in undergraduates. Furthermore, depression does not mediate the relationship between COVID-19-related stress and SCS.

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

BACKGROUND

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).

METHODS

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.

RESULTS

Sixty-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.

CONCLUSION

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.