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Supplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Open

Strømme EM, et al. BMJ Open 2022; 11:e046454. doi: 10.1136/bmjopen-2020-046454

 BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance
Supplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Open

Supplementary table 1. Differences in sociodemographic, migration related factors and outcome variables between responders and loss-to-follow-up
Included at T1 and T2 Loss-to-follow-up at T2 P-value (Fisher exact, t-test)
SOCIODEMOGRAPHIC FACTORS AT BASELINE N =353 N=153
Gender (women), n (%) 181 (51) 74 (48) 0.56
Age (years), median (IQR) 34 (27-41) 35 (29-41) 0.17
Mother tongue, n (%) 0.71
Arabic 335 (95) 146 (95)
Kurmanji 15 (4) 7 (5)
Marital status, n (%)
Married 265 (75) 112 (73) 0.39
Co-habiting with partner 260 (98) 112 (99) 0.68
Number of children, median (IQR) 3 (2-4) 3 (2-4) 0.54
Education (years), median (IQR) 8 (6-10) 8 (6-10) 0.70
Work participation prior to flight (n, %) 187 (38) 60 (40) 0.48

MIGRATION RELATED FACTORS AT BASELINE

Time since flight at baseline (years), median (IQR) 5 (4-6) 5 (4-5) 0.08
No residence permit in Lebanon at baseline, n (%) 242 (69) 95 (63) 0.18
Migrating alone to Lebanon, n (%) 55 (16) 20 (13) 0.50
Exposed to potentially traumatic event(s), n (%) 135 (40) 66 (45) 0.37

MAIN OUTCOMES
Chronic pain n (%) 104 (30) 36 (24) 0.16
HSCL-score, median (IQR) 1.5 (1.1, 2.0) 1.5 (1.1, 2.1) 0.30
Anxiety/depression, HSCL-10 cut-off 1.85, n (%) 118 (33) 60 (39) 0.23
HTQ-score, median (IQR) 1.4 (1.1, 1.9) 1.5 (1.2, 1.9) 0.14
PTSD, HTQ-cut-off 2.5, n (%) 14 (5) 12 (8) 0.13

*IQR = interquartile range

Strømme EM, et al. BMJ Open 2022; 11:e046454. doi: 10.1136/bmjopen-2020-046454

 BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance
Supplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Open

Supplementary table 2. Missing values in variables used*

Missing (n)
Variable T1, n=353 T2, n=353

Exposure variables
Age 9 0
Gender 1 3
Trauma exposure 15 3
Solo-migration 6 4
No residency (in transit) 4 -
Poor personal relationships 9 3
Poor support from friends 5 3
Poor safety 3 1
Poor physical environment 0 0
Poor economy 8 3
Poor information 14 2
Poor leisure activities 7 1
Poor living place 1 1
Poor access to health care 5 3
Poor transportation 4 2

Outcomes variables
Chronic pain 5 2
Anxiety/depression symptoms 30 6
PTSD symptoms 43 7
Poor sleep 6 0
Painkillers 8 0
Antidepressants 16 1

*We find no pattern that the same individuals have missing

both at baseline (T1) and follow-up (T2) for the same variables.

Strømme EM, et al. BMJ Open 2022; 11:e046454. doi: 10.1136/bmjopen-2020-046454

 BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance
Supplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Open

Supplementary table 3. Association between sociodemographic variables at T1 and T2 (exposure) and missing main outcomes (outcome) n=353

Missing "Chronic pain item" Missing "HSCL-score" Missing "HTQ-score"

T1 T2 T1 T2 T1 T2
Missing, n (%) 5 (1.4) 2 (0.6) 30 (8.5) 6 (1.7) 43 (12.2) 7 (2.0)

Univariate associations OR (95% CI) OR (95% CI) OR (95% CI)

Age 1.0 (0.9, 1.1) 0.9 (0.8, 1.1) 0.9 (0.9, 1.0) 1.1 (0.9, 1.1) 1.0 (0.9, 1.0) 1.0 (0.9, 1.1)
Gender 1.4 (0.2, 8.6) 0.9 (0.1, 15.0) 1.1 (0.5, 2.3) 0.9 (0.2, 4.7) 0.7 (0.4, 1.4) 0.4 (0.1, 1.9)
Education 1.1 (0.8, 1.4) 1.1 (0.8, 1.6) 1.0 (0.9, 1.1) 0.9 (0.7, 1.1) 0.9 (0.9, 1.1) 0.9 (0.8, 1.2)
Trauma 0.5 (0.1, 4.8) 1.3 (0.1, 21.0) 1.2 (0.5, 2.7) 0.3 (0.0, 2.2) 0.8 (0.4, 1.6) 0.9 (0.2, 4.4)

Strømme EM, et al. BMJ Open 2022; 11:e046454. doi: 10.1136/bmjopen-2020-046454

 BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance
Supplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Open

Supplementary table 4. Associations between migration related factors (exposure) and chronic pain (outcome) at baseline and follow-up
BASELINE FOLLOW-UP INTERACTION TEST***
N Chronic pain, n(%) RR (95% CI) N Chronic pain, n(%) RR (95% CI)
Model 1* Model 2** Model 1* Model 2** p
Trauma exposure
No 203 51 (25.5) 1 1 198 41 (20.8) 1 1
Yes 135 51 (38.1) 1.5 (1.1, 2.1) 1.4 (1.0, 2.0) 152 55 (36.4) 1.8 (1.2, 2.5) 1.6 (1.2, 2.3) 0.339
Solo-migration
No 292 86 (30.0) 1 1 341 93 (27.4) 1 1
Yes 55 18 (32.7) 1.1 (0.7, 1.7) 1.0 (0.6, 1.6) 8 3 (37.5) 1.4 (0.6, 3.4) 1.1 (0.5, 2.6) 0.881
No residency (in transit)
No 107 30 (29.1) 1 1 - 29 (27.6) 1 1
Yes 242 73 (30.3) 1.0 (0.7, 1.5) 1.1 (0.7, 1.5) - 68 (28.1) 1.0 (0.7, 1.5) 1.1 (0.8, 1.6) -
Poor personal relationships
No 319 90 (28.7) 1 1 324 87 (27.0) 1 1
Yes 25 9 (36.0) 1.3 (0.7, 2.2) 1.3 (0.7, 2.3) 26 11 (42.3) 1.5 (0.9, 2.3) 1.3 (0.9, 2.0) 0.727
Poor support from friends
No 220 60 (27.7) 1 1 315 84 (26.8) 1 1
Yes 128 44 (34.7) 1.3 (0.9, 1.7) 1.2 (0.8, 1.6) 35 14 (40.0) 1.5 (1.0, 2.3) 1.5 (1.0, 2.3) 0.564
Poor safety
No 174 48 (28.1) 1 1 346 93 (27.0) 1 1
Yes 176 55 (31.6) 1.1 (0.8, 1.6) 1.1 (0.8, 1.6) 6 4 (66.7) 2.5 (1.4, 4.5) 3.0 (1.6, 5.6) 0.028
Poor physical environment
No 115 32 (28.6) 1 1 345 94 (27.4) 1 1
Yes 238 72 (30.5) 1.1 (0.8, 1.5) 1.1 (0.8, 1.6) 8 4 (50.0) 1.8 (0.9, 3.7) 1.8 (0.9, 3.3) 0.339
Poor economy
No 58 9 (15.8) 1 1 299 73 (24.6) 1 1
Yes 287 92 (32.5) 2.1 (1.1, 3.8) 2.3 (1.1, 4.6) 51 24 (47.1) 1.9 (1.4, 2.7) 1.9 (1.4, 2.7) 0.652
Poor information
No 178 50 (28.4) 1 1 304 76 (25.2) 1 1
Yes 161 51 (32.3) 1.1 (0.8, 1.6) 1.1 (0.8, 1.6) 47 22 (46.8) 1.9 (1.3, 2.7) 1.8 (1.2, 2.5) 0.093

Strømme EM, et al. BMJ Open 2022; 11:e046454. doi: 10.1136/bmjopen-2020-046454

 BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance
Supplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Open

Poor leisure activities

No 96 29 (30.5) 1 1 184 44 (24.2) 1 1
Yes 250 71 (28.9) 0.9 (0.7, 1.4) 0.9 (0.6, 1.2) 168 54 (32.1) 1.3 (0.9, 1.9) 1.1 (0.8, 1.6) 0.379
Poor living place
No 141 36 (25.9) 1 1 313 81 (26.1) 1 1
Yes 211 68 (32.7) 1.3 (0.9, 1.8) 1.3 (0.9, 1.8) 39 17 (43.6) 1.7 (1.1, 2.5) 1.6 (1.1, 2.4) 0.394
Poor access to health care
No 118 28 (24.1) 1 1 323 85 (26.5) 1 1
Yes 230 73 (32.2) 1.3 (0.9, 1.9) 1.3 (0.9, 1.9) 27 12 (44.4) 1.7 (1.1, 2.7) 1.7 (1.1, 2.8) 0.385
Poor transportation
No 164 45 (27.8) 1 1 293 75 (25.7) 1 1
Yes 185 58 (31.9) 1.2 (0.8, 1.6) 1.1 (0.8, 1.6) 58 22 (38.6) 1.5 (1.0, 2.2) 1.7 (1.2, 2.5) 0.113

* Unadjusted
**Adjusted for age and gender
*** Does the association vary significantly according to migration phase (baseline in transit phase versus follow-up in the post-migration phase)? P-value from the
interaction term for Model 2.
RR= relative risk, CI= confidence interval.

Strømme EM, et al. BMJ Open 2022; 11:e046454. doi: 10.1136/bmjopen-2020-046454

 BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance
Supplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Open

Supplementary table 5. Associations between migration related factors (exposure) and poor mental health (outcome) at baseline and follow-up
BASELINE FOLLOW-UP INTERACTION TEST***
N Poor mental health, n(%) RR (95% CI) N Poor mental health, n(%) RR (95% CI)
Model 1* Model 2** Model 1* Model 2** p
Trauma exposure
No 203 53 (26.1) 1 1 198 12 (6.1) 1 1
Yes 135 59 (43.7) 1.7 (1.2, 2.3) 1.6 (1.2, 2.2) 152 25 (16.5) 2.7 (1.4, 5.2) 2.5 (1.3, 4.9) 0.155
Solo-migration
No 292 90 (30.8) 1 1 341 37 (10.9) 1 1
Yes 55 25 (45.5) 1.5 (1.1, 2.1) 1.8 (1.2, 2.6) 8 2 (25.0) 2.3 (0.7, 8.0) 2.2 (0.7, 6.6) 0.435
No residency (in transit)
No 107 34 (31.8) 1 1 16 (15.0) 1 1
Yes 242 83 (34.3) 1.1 (0.8, 1.5) 1.1 (0.8, 1.6) 23 (9.5) 0.6 (0.4, 1.2) 0.6 (0.3, 1.2) -
Poor personal relationships
No 319 104 (32.6) 1 1 324 25 (7.7) 1
Yes 25 11 (44.0) 1.3 (0.8, 2.2) 1.2 (0.7, 2.0) 26 13 (50.0) 6.5 (3.8, 11.1) 7.3 (4.2, 12.7) < 0.001
Poor support from friends
No 220 61 (27.7) 1 1 315 22 (7.0) 1
Yes 128 54 (42.2) 1.5 (1.1, 2.0) 1.6 (1.2, 2.1) 35 17 (48.6) 7.0 (4.1, 11.8) 6.2 (3.6, 10.8) < 0.001
Poor safety
No 174 48 (27.6) 1 1 346 34 (9.8) 1
Yes 176 69 (39.2) 1.4 (1.0, 1.9) 1.5 (1.1, 2.1) 6 4 (66.7) 6.8 (3.5, 13.0) 8.1 (3.2, 20.6) 0.002
Poor physical environment
No 115 35 (30.4) 1 1 345 36 (10.4) 1 1
Yes 238 83 (34.9) 1.1 (0.8, 1.6) 1.3 (0.9, 1.7) 8 3 (37.5) 3.6 (1.4, 9.3) 3.6 (1.4, 9.6) 0.127
Poor economy
No 58 16 (27.6) 1 1 299 21 (7.0) 1
Yes 287 99 (34.5) 1.3 (0.8, 2.0) 1.1 (0.7, 1.7) 51 18 (35.3) 5.0 (2.9, 8.8) 4.5 (2.6, 7.9) < 0.001
Poor information
No 178 54 (30.3) 1 1 304 21 (6.9) 1
Yes 161 61 (37.9) 1.3 (0.9, 1.7) 1.3 (0.9, 1.7) 47 18 (38.3) 5.5 (3.2, 9.6) 5.3 (3.1, 9.1) < 0.001

Strømme EM, et al. BMJ Open 2022; 11:e046454. doi: 10.1136/bmjopen-2020-046454

 BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance
Supplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Open

Poor leisure activities

No 96 24 (25.0) 1 1 184 11 (6.0) 1 1
Yes 250 92 (36.8) 1.5 (1.0, 2.2) 1.3 (0.9, 2.0) 168 28 (16.7) 2.8 (1.4, 5.4) 2.6 (1.3, 5.2) 0.134
Poor living place
No 141 35 (24.8) 1 1 313 30 (9.6) 1 1
Yes 211 83 (39.3) 1.6 (1.1, 2.2) 1.6 (1.1, 2.2) 39 9 (23.1) 2.4 (1.2, 4.7) 2.4 (1.3, 4.6) 0.204
Poor access to health care
No 118 32 (27.1) 1 1 323 34 (10.5) 1 1
Yes 230 85 (37.0) 1.4 (0.9, 1.9) 1.3 (0.9, 1.8) 27 4 (14.8) 1.4 (0.5, 3.7) 1.5 (0.5, 3.9) 0.799
Poor transportation
No 164 47 (28.7) 1 1 293 27 (9.2) 1 1
Yes 185 70 (37.8) 1.3 (1.0, 1.8) 1.3 (0.9, 1.7) 58 11 (19.0) 2.1 (1.1, 3.9) 3.3 (2.3, 4.7) 0.101

* Unadjusted
**Adjusted for age and gender
*** Does the association vary significantly according to migration phase (baseline in transit phase versus follow-up in the post-migration phase)? P-value from the interaction term
for Model 2.
RR= relative risk, CI= confidence interval

Strømme EM, et al. BMJ Open 2022; 11:e046454. doi: 10.1136/bmjopen-2020-046454