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Biddle L, Stacherl B, Heidinger E. Perceived discrimination among migrants in Germany: Does social capital moderate harmful effects on mental health? Soc Sci Med 2025; 370:117854. [PMID: 40022956 DOI: 10.1016/j.socscimed.2025.117854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 01/06/2025] [Accepted: 02/12/2025] [Indexed: 03/04/2025]
Abstract
BACKGROUND The harmful mental health effects of perceived discrimination for migrant populations are well established. The potential buffering effect of regional-level social capital, however, has not previously been explored. METHODS Using data from the German Socio-Economic Panel (SOEP; 2009-2018) we apply multilevel models to assess the effect of frequent or infrequent perceived discrimination on mental health (MCS subscale of the SF-12) adjusting for individual- and regional-level confounding in a cross-sectional research design. We assess interaction with general social capital (civic engagement, electoral participation, generalised trust) and migrant-specific resources (proportion of non-nationals). We juxtapose non-refugee migrants (n = 13478) with refugees subject to mobility restrictions (n = 5558) to account for bias introduced by selective mobility into regions. RESULTS In the non-refugee sample, we confirm the negative effects of discrimination experiences on MCS (ß frequent: -3.74, 95%-CI: [-4.40; -3.09]/ß infrequent: -1.88, 95%-CI: [-2.24; -1.52]). Moderation analyses among non-refugees show no buffering of general social capital, but a negative interaction effect of the proportion of non-nationals with experiences of discrimination (ß frequent: -0.54, 95%-CI: [-0.87; -0.21]/ß infrequent: -0.68, 95%-CI: [-1.29; -0.07]). Analyses among refugees also demonstrate a negative effect of discrimination on MCS with stronger overall effects than in the migrant sample (ß frequent: -6.24, 95%-CI: [-7.44; -5.05]/ß infrequent: -3.56, 95%-CI: [-4.25; -2.86]). In the refugee sample, the effect is exacerbated by the proportion of non-nationals (ß frequent: -1.70, 95%-CI: [-2.84; -0.56]) and buffered by generalised trust (ß: 0.87, 95%-CI: [0.13; 1.60]). CONCLUSIONS When faced with experiences of discrimination, levels of community trust seem to buffer the negative mental health impacts for refugees. We do not find buffering effects of social capital on the mental health of non-refugee migrants, possibly due to established social networks. Furthermore, our results suggest that the proportion of non-nationals within a community may have a negative reinforcing impact on the relationship between discrimination and mental health for both migrant samples. As this dynamic is currently underexplored in the German context, more community-based research is needed to develop appropriate policy interventions.
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Affiliation(s)
- Louise Biddle
- Socio-Economic Panel, German Institute for Economic Research (DIW Berlin), Mohrenstraße 58, 10117, Berlin, Germany; Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Universitätsstraße 25, 33501, Bielefeld, Germany
| | - Barbara Stacherl
- Socio-Economic Panel, German Institute for Economic Research (DIW Berlin), Mohrenstraße 58, 10117, Berlin, Germany
| | - Ellen Heidinger
- Socio-Economic Panel, German Institute for Economic Research (DIW Berlin), Mohrenstraße 58, 10117, Berlin, Germany
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Blume M, Bartig S, Wollgast L, Koschollek C, Kajikhina K, Bug M, Hapke U, Hövener C. Determinants of Mental Health Inequalities Among People With Selected Citizenships in Germany. Int J Public Health 2024; 69:1607267. [PMID: 39258269 PMCID: PMC11383781 DOI: 10.3389/ijph.2024.1607267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 08/12/2024] [Indexed: 09/12/2024] Open
Abstract
Objectives Mental health is essential for overall health and is influenced by different social determinants. The aim of this paper was to examine which determinants are associated with mental health inequalities among people with selected citizenships in Germany. Methods Data were derived from the multilingual interview survey "German Health Update: Fokus (GEDA Fokus)" among adults with Croatian, Italian, Polish, Syrian, or Turkish citizenship (11/2021-05/2022). Poisson regressions were used to calculate prevalence ratios for symptoms of depression (PHQ-9) and anxiety disorder (GAD-7). Results Sociodemographic (sex, income, age, household size) and psychosocial (social support and self-reported discrimination) determinants were associated with symptoms of depression and/or anxiety disorder. The prevalence of mental disorders varied most by self-reported discrimination. Conclusion Our findings suggest mental health inequalities among people with selected citizenships living in Germany. To reduce these, social inequities and everyday discrimination need to be addressed in structural prevention measures as well as in interventions on the communal level. Protective factors (e.g., social support) are also important to reduce mental health inequalities on the individual and community level.
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Affiliation(s)
- Miriam Blume
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Susanne Bartig
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
- Institute of Sociology, Freie Universität Berlin, Berlin, Germany
| | - Lina Wollgast
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Carmen Koschollek
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Katja Kajikhina
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Marleen Bug
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Ulfert Hapke
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Claudia Hövener
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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Ruhnke SA, Hertner L, Köhler J, Kluge U. Social ecological determinants of the mental distress among Syrian refugees in Lebanon and Turkey: A transnational perspective. Soc Sci Med 2024; 346:116700. [PMID: 38430874 DOI: 10.1016/j.socscimed.2024.116700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/29/2023] [Accepted: 02/15/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE Refugees are frequently shown to have worse mental health outcomes than non-displaced populations. This fact is commonly attributed to traumatic pre-displacement experiences. While important, the focus on trauma risks overlooking the role socioeconomic living-conditions in different arrival and transit contexts can play in determining refugees' mental distress. Building on the ecological model of refugee distress, we investigate how social ecological conditions relate to the mental distress of Syrians in Lebanon and Turkey. Both countries present important spaces of arrival and transit for millions of displaced Syrians, each with a specific historical, political, social and economic context. METHODS The empirical analysis is based on data gathered in early 2021 in face-to-face surveys among displaced Syrians in Lebanon (N = 1127) and Turkey (N = 1364). Individual mental distress is evaluated using the Patient Health Questionnaire (PHQ-8) score as the dependent variable in a multivariate regression analysis. RESULTS Social ecological factors do not only differ in their extent of deprivation between Lebanon and Turkey. They also differ in their relationship with individual mental health outcomes. In Lebanon, limited access to the health care system and having family in the same city are major risk factors for elevated mental distress, whereas in Turkey, these are low education, poverty, unemployment as well as employment as day laborer. Discrimination and social isolation emerge as relevant predictors in both countries. CONCLUSION Based on this analysis, we argue that a context-specific understanding of mental distress amidst the social ecology refugees face in countries of refuge and transit is necessary. This approach needs to be pursued to provide adequate support and alleviate refugees' mental distress both, in the country of first refuge and after possible onward migration. In addition to clinical implications, the study particularly highlights the important role anti-discrimination and social inclusion policies could play in promoting refugee mental health.
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Affiliation(s)
- Simon A Ruhnke
- Berlin Institute for Empirical Integration and Migration Research, Humboldt Universität zu Berlin, Unter den Linden 6, 10099, Berlin, Germany.
| | - Laura Hertner
- Berlin Institute for Empirical Integration and Migration Research, Humboldt Universität zu Berlin, Unter den Linden 6, 10099, Berlin, Germany; Department of Psychiatry and Psychotherapy at the Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of the Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Judith Köhler
- Berlin Institute for Empirical Integration and Migration Research, Humboldt Universität zu Berlin, Unter den Linden 6, 10099, Berlin, Germany; Department of Psychiatry and Psychotherapy at the Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of the Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Ulrike Kluge
- Berlin Institute for Empirical Integration and Migration Research, Humboldt Universität zu Berlin, Unter den Linden 6, 10099, Berlin, Germany; Department of Psychiatry and Psychotherapy at the Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of the Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Biddle L, Bozorgmehr K. Effect of area-level socioeconomic deprivation on mental and physical health: A longitudinal natural experiment among refugees in Germany. SSM Popul Health 2024; 25:101596. [PMID: 38304416 PMCID: PMC10832457 DOI: 10.1016/j.ssmph.2023.101596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/18/2023] [Accepted: 12/29/2023] [Indexed: 02/03/2024] Open
Abstract
Existing studies on contextual health effects struggle to account for compositional bias, limiting causal interpretation. We use refugee dispersal in Germany as a natural experiment to study the effect of area-level socioeconomic deprivation on mental and physical health, while considering the potential mediating role of neighbourhood characteristics. Refugees subject to dispersal (n = 1466) are selected from a nation-wide longitudinal refugee study (IAB-SOEP-BAMF Panel; 2016-2018). Multi-level linear regression models, adjusted for age, sex, education, country of origin, federal state, asylum status and length of residence in Germany, are fitted to the change in mental and physical health subscales of the SF-12 depending on quintiles (Q1 - Q5) of commune-level socioeconomic deprivation (German Index of Socioeconomic Deprivation, GISD). This is followed by sensitivity analyses and mediation analyses for housing, social cohesion, proportion of non-citizens in the neighbourhood, access to green space, population density and primary care physician density. Residency in districts with moderate-high deprivation (Q4) has a negative impact on physical health (coef.: -2.2, 95%CI: -4.1;-0.2) compared to lowest deprivation (Q1). Moderate-high deprivation (Q4) has a positive impact on mental health, but the effect is statistically insignificant (coef.: 1.6, 95%CI: -0.7; 3.9). Comparisons with other deprivation quintiles are statistically insignificant. Sensitivity analyses confirm results of the final models, while no mediating factors show a substantial impact on the observed relationship. The results point to gaps in health and social service provision for refugees living in the most deprived regions, but further research is required to understand the precise mechanisms behind the observed relationships. Further research using longer timeframes and larger sample sizes are required to confirm results.
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Affiliation(s)
- Louise Biddle
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Universitätsstraße 25, 33501, Bielefeld, Bielefeld, Germany
- German Socio-Economic Panel, German Institute for Economic Research (DIW Berlin), Mohrenstraße 58, 10117, Berlin, Germany
| | - Kayvan Bozorgmehr
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Universitätsstraße 25, 33501, Bielefeld, Bielefeld, Germany
- Section Health Equity Studies & Migration, Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
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Mohsenpour A, Biddle L, Bozorgmehr K. Exploring contextual effects of post-migration housing environment on mental health of asylum seekers and refugees: A cross-sectional, population-based, multi-level analysis in a German federal state. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001755. [PMID: 38150435 PMCID: PMC10752521 DOI: 10.1371/journal.pgph.0001755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 11/21/2023] [Indexed: 12/29/2023]
Abstract
Asylum seekers and refugees (ASR) in Germany are dispersed quasi-randomly to state-provided, collective accommodation centres. We aimed to analyse contextual effects of post-migration housing environment on their mental health. We drew a balanced random sample of 54 from 1 938 accommodation centres with 70 634 ASR in Germany's 3rd largest federal state. Individual-level data on depression and anxiety as well as sociodemographic- and asylum-related covariates, were collected and linked to contextual geo-referenced data on housing environment ('Small-area Housing Environment Deterioration' index, number of residents, remoteness, urbanity, and German Index of Multiple Deprivation). We fitted two-level random-intercept models to exploratively estimate adjusted contextual effects. Of 411 surveyed participants, 45.53% and 44.83%, respectively, reported symptoms of depression or anxiety. 52.8% lived in centres with highest deterioration, 46.2% in centres with > = 50 residents, 76.9% in urban, and 56% in deprived districts. 7.4% of centres were remote. We found statistically significant clustering in reporting anxiety on the level of accommodation centres. The model resulted in an intraclass correlation of 0.16 which translated into a median odds ratio of 2.10 for the accommodation-level effects. No significant clustering was found for symptoms of depression. The highest degree of deterioration, large accommodation size, remoteness, and district urbanity showed higher, but statistically not significant, odds for reporting anxiety or depression. District deprivation demonstrated higher odds for anxiety and lower odds for depression yet remained statistically insignificant for both. Evidence for contextual effects of housing environment on mental health of ASR could not be established but residual confounding by length of stay in the accommodation centre cannot be ruled out. Confirmatory analyses with prior power calculations are needed to complement these exploratory estimates.
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Affiliation(s)
- Amir Mohsenpour
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
- Section for Health Equity Studies and Migration, Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
- Department for Psychiatry, Psychotherapy and Psychosomatic Medicine, Vitos Kurhessen, Kassel, Germany
| | - Louise Biddle
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
- Section for Health Equity Studies and Migration, Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Kayvan Bozorgmehr
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
- Section for Health Equity Studies and Migration, Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
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Solfrank M, Nikendei C, Zehetmair C, Friederich HC, Nagy E. The burden of substance use and (mental) distress among asylum seekers: a cross sectional study. Front Psychiatry 2023; 14:1258140. [PMID: 38173702 PMCID: PMC10761509 DOI: 10.3389/fpsyt.2023.1258140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/30/2023] [Indexed: 01/05/2024] Open
Abstract
Background Asylum seekers are a particularly vulnerable population due to a wide range of external stressors. Traumatic events and difficult social/economic prospects can lead to an elevated susceptibility for substance use disorders. The aim of the present study was to determine whether asylum seekers suffering from mental or physical distress present higher levels of substance use disorder (SUD) in a state reception center in Germany and whether there are identifiable risk or protective factors. Methods We performed a hierarchical logistic regression on data of N = 238 people who had applied for asylum in Germany to analyze the SUD variance explanation by (1) sociodemographic, (2) flight-specific, and (3) psychometric (ERQ, SOC-9 L, SCL-K9) variables. On level (4), we included the location of data collection (walk-in clinic or accommodation,) as an indicator of individual's need for a psychologist's or General practitioner's help in order to assess for the participant's (mental) distress. Results Low educational level, lower sense of coherence, and mental distress (location of data collection in the psychosocial or general medical outpatient clinic) were associated with SUD. Those suffering from SUD seemed to be less aware of external stressors as SUD was also associated with low levels of reported post-migratory stress. Discussion The association of SUD with psychological distress and lower education reaffirms the concept that some vulnerable groups are at a higher risk for substance-related difficulties. Strengthening the sense of coherence with targeted interventions might enable at-risk groups to cope better with forthcoming burdens and help with abstaining from current or future consumption.
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Affiliation(s)
- Maximilian Solfrank
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | | | | | | | - Ede Nagy
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
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Borho A, Morawa E, Schug C, Erim Y. Perceived post-migration discrimination: the perspective of adolescents with migration background. Eur Child Adolesc Psychiatry 2023; 32:2427-2438. [PMID: 36127567 PMCID: PMC10682162 DOI: 10.1007/s00787-022-02084-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 09/10/2022] [Indexed: 11/29/2022]
Abstract
Discrimination has a negative impact on mental health and wellbeing of persons affected. The aim of the present study was to investigate perceived discrimination of migrant adolescents. Focus groups with migrant adolescents were conducted, audio-recorded and transcribed verbatim. The transcripts were analyzed using the manifest qualitative content analysis by Mayring. The foci of interest (persons discriminated against and by whom, where and how the discrimination took place, which behavioral and emotional reactions the affected persons showed to the experiences and which reasons they assumed for the discrimination) were determined based on the pre-defined guideline, and inductive subcategories were extracted from the transcripts and grouped into main categories. Five focus groups with students with migration background (n = 35, 13 females, mean age: 18.78, SD = 2.26, range 16-24) were conducted. The adolescents in our focus groups and their acquaintances (families and friends) experienced discrimination in Germany in several forms (verbal and non-verbal), places and on an individual as well as institutional level, with an impact on their emotional well-being. To combat discrimination, culturally sensitive information must be provided on the part of those affected as well as their perpetrators.
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Affiliation(s)
- Andrea Borho
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Eva Morawa
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany.
| | - Caterina Schug
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
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Bartig S, Bug M, Koschollek C, Kajikhina K, Blume M, Siegert M, Heidemann C, Walther L, Neuhauser H, Hövener C. [Health of people with selected citizenships in Germany: prevalence of non-communicable diseases and associated social as well as migration-related factors]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:1071-1082. [PMID: 37728772 PMCID: PMC10539419 DOI: 10.1007/s00103-023-03767-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/24/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Health chances and risks of people with a history of migration vary according to a wide range of factors. This paper aims to describe the health of people with selected citizenships on the basis of four non-communicable diseases (chronic disease or long-term health problem in general, coronary heart disease, diabetes mellitus, depression) and to identify associated social and migration-related factors. METHODS Analyses are based on data from the multilingual and multimodal interview survey "German Health Update: Fokus" (GEDA Fokus), which was conducted among 18- to 79-year-olds with Croatian, Italian, Polish, Syrian, or Turkish citizenship living in Germany (November 2021 to May 2022). Poisson regressions were used to calculate prevalence ratios and 95% confidence intervals to examine the association between the individual indicators and social as well as migration-related characteristics. RESULTS In particular, a low sense of belonging to the society in Germany and self-reported experiences of discrimination in everyday life are associated with higher prevalence of a chronic disease or long-term health problem and - according to self-reported medical diagnoses - with depression and partly with coronary heart disease and diabetes. DISCUSSION Given the importance of subjective sense of belonging to the society in Germany and self-reported experience of discrimination for the health outcomes studied, the results point to health inequalities among people with selected citizenships that may indicate mechanisms of social exclusion.
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Affiliation(s)
- Susanne Bartig
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
| | - Marleen Bug
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland.
| | - Carmen Koschollek
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
| | - Katja Kajikhina
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
- Abteilung für Infektionsepidemiologie, Robert Koch-Insitut, Berlin, Deutschland
| | - Miriam Blume
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
| | - Manuel Siegert
- Forschungszentrum des Bundesamts für Migration und Flüchtlinge, Nürnberg, Deutschland
| | - Christin Heidemann
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
| | - Lena Walther
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
| | - Hannelore Neuhauser
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
| | - Claudia Hövener
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
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Führer A. [Determinants of asylum seekers' health and medical care in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:1083-1091. [PMID: 37707509 PMCID: PMC10539189 DOI: 10.1007/s00103-023-03762-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/18/2023] [Indexed: 09/15/2023]
Abstract
Asylum seekers in Germany are exposed to a variety of health-related stressors, while their access to medical care is impaired. This review explains some of the determinants that structure this situation, for example by elaborating on how the Asylum Seekers' Benefits Act (ASBA), billing via treatment vouchers, and accommodation in refugee shelters affect asylum seekers' health and healthcare utilization. Hereby, it becomes clear that the exclusion of asylum seekers from the welfare system is detrimental to their health, is expensive, and raises ethical and legal questions. In particular, the huge discretionary scope of the social welfare offices in the assumption of costs as well as the different models for billing medical services for asylum seekers are potentially unjust and lead to a plurality of care, which lacks legal and ethical justification.The second part of the article shows that asylum seekers generally suffer from the same health problems as people with statutory health insurance-with the exception of mental illnesses, which are substantially more common among asylum seekers, but are often undiagnosed and frequently inadequately treated.This leads to three practical conclusions: (1) asylum seekers should be integrated into statutory health insurance, (2) from a public health point of view, accommodation in refugee shelters should be avoided in favor of decentralized accommodation, and (3) to ensure diversity-sensitive care for all patients, the healthcare system must make adjustments to its structures and practices.
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Affiliation(s)
- Amand Führer
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Deutschland.
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Führer A, Taché S, Riemenschneider H, Bozorgmehr K, Diaz-Monsalve S, Knipper M, Mews C, Schwienhorst-Stich EM, Siebert U, Strelow KU, Ziegler S. [The Migration and Health Teaching Network: consolidating and developing education and training]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:1130-1134. [PMID: 37737318 PMCID: PMC10539183 DOI: 10.1007/s00103-023-03765-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/22/2023] [Indexed: 09/23/2023]
Abstract
Patients with migration history often encounter barriers to accessing healthcare in Germany, which lowers the quality of care available to them and can affect their overall health. These barriers in access to healthcare are due to both adverse health policies and a lack of migration-related - and diversity-sensitive - content in medical and other health profession teaching. Although most healthcare professionals regularly care for patients with individual or generational migration experience in Germany, teaching content relevant to the healthcare of these patients has not yet been anchored in the curriculum. At best, it is taught in the form of electives or other optional courses.To address this gap, the Teaching Network Migration and Health was created with the goal of promoting the development of human rights-based, diversity-sensitive, and equity-oriented curricula at medical and healthcare professions schools. It aims to (1) connect individuals active in teaching and promote the exchange and collaborative development of teaching materials, (2) use this collective knowledge and experience to develop a model course on migration and health, and (3) develop strategies for the longitudinal implementation of this course into the regular medical and other health professional school curricula. These efforts are flanked by evaluative accompanying research. Anyone interested in joining the network is invited to join and strengthen the network by contacting the authors.
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Affiliation(s)
- Amand Führer
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Stephanie Taché
- Bereich Allgemeinmedizin, Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - Henna Riemenschneider
- Bereich Allgemeinmedizin, Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - Kayvan Bozorgmehr
- Sektion Health Equity Studies & Migration, Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
- AG Bevölkerungsmedizin und Versorgungsforschung, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld, Deutschland
| | - Sonia Diaz-Monsalve
- Zentrum für Medizin und Gesellschaft, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Michael Knipper
- Professur für Global Health, Migration und Kulturwissenschaften in der Medizin, Institut für Geschichte, Theorie und Ethik der Medizin, Justus-Liebig-Universität Gießen, Gießen, Deutschland
| | - Claudia Mews
- Institut und Poliklinik für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Eva-Maria Schwienhorst-Stich
- Institut für Allgemeinmedizin und Lehrklinik der Medizinischen Fakultät, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Ute Siebert
- Projekt "Empowerment für Diversität - Allianz für Chancengleichheit in der Gesundheitsversorgung", Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Kai-Uwe Strelow
- Rudolf Frey Lernklinik, Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Sandra Ziegler
- Sektion Health Equity Studies & Migration, Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
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11
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Mohsenpour A, Dudek V, Bozorgmehr K, Biddle L, Razum O, Sauzet O. Type of Refugee Accommodation and Health of Residents: A Cross-Sectional, Population-Based Cluster Analysis in South-West Germany. Int J Public Health 2023; 68:1605786. [PMID: 37736387 PMCID: PMC10509756 DOI: 10.3389/ijph.2023.1605786] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 08/21/2023] [Indexed: 09/23/2023] Open
Abstract
Objectives: Few studies have assessed whether refugees' health is associated with accommodation characteristics. We aimed to devise a typology of refugee accommodation based on variables on the accommodation and its physical context before assessing its association with health in multivariate analyses. Methods: We performed a cluster analysis based on a hierarchal, agglomerative clustering algorithm using Euclidean Distance and Ward's method. We analysed accommodation clusters based on number of inhabitants, degree of housing deterioration, urbanity of location (urban/rural distinction), and remoteness (walking distance to shops, medical or administrative services). In total, we analysed health and accommodation data of 412 refugees and asylum seekers from 58 different accommodation facilities in the federal state of Baden-Württemberg in the south-west of Germany. Results: Accommodations with a moderate occupation, lowest levels of deterioration, and a central urban location showed the best health outcomes in terms of subjective general health status, depression, and generalized anxiety disorder (GAD). Associations were strongest for GAD and weakest for depression. Conclusion: Our findings inform policymakers on layout and location of refugee collective accommodation centres.
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Affiliation(s)
- Amir Mohsenpour
- Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Verena Dudek
- Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Kayvan Bozorgmehr
- Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
- Section for Health Equity Studies and Migration, Department of General Practice and Health Services Research, Heidelberg University Hospital, Marsilius Arkaden, Heidelberg, Germany
| | - Louise Biddle
- Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Oliver Razum
- Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Odile Sauzet
- Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
- Data Analysis Group, Department of Business Administration and Economics, Bielefeld University, Bielefeld, Germany
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12
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Nowak AC, Nutsch N, Brake TM, Gehrlein LM, Razum O. Associations between postmigration living situation and symptoms of common mental disorders in adult refugees in Europe: updating systematic review from 2015 onwards. BMC Public Health 2023; 23:1289. [PMID: 37407937 DOI: 10.1186/s12889-023-15931-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/18/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Refugees and asylum seekers have a high prevalence of psychiatric disorders such as post-traumatic stress disorder (PTSD), anxiety, and depression. The postmigration context inheres different risk and protective factors for mental health of refugees and asylum seekers in host countries. We conducted a systematic review to update knowledge on the association between characteristics of the postmigration living situation (PMLS) and mental health outcomes in Europe since 2015. METHODS We searched in five databases according to the PRISMA statement. From a total of 5,579 relevant studies published in 2015-22, 3,839 were included for title and abstract screening, and 70 full texts screened for eligibility. Out of these, 19 studies on refugees and asylum seekers conducted in European countries after 2014 were included in this systematic review. The quality of studies was assessed by using the Mixed Methods Appraisal Tool (MMAT) - version 2018. We performed a narrative synthesis using the four layers of the social determinants of health framework. RESULTS A wide range of risk and protective factors for mental health in the PMLS were identified as exposure measures, which included individual factors (e.g., language skills), social and community networks (e.g., family concerns, loneliness and social support, discrimination), living and working conditions (e.g., legal status, duration of residence, unemployment and financial hardship, housing) as well as general socio-economic, cultural and environmental factors (e.g., social status, acculturation). We found postmigration stressors are positively associated with symptoms of depression, anxiety, and PTSD, albeit not consistently so. Especially, the general socio-economic, cultural and environmental factors showed weak associations with mental health. CONCLUSIONS Heterogenous study characteristics likely explain the inconsistent associations between characteristics of the PMLS and mental health outcomes. However, broken down in its component layers, most risk and protective factors of the PMLS were significantly associated with symptoms of mental disorders showing the same direction of association across the included studies, while the association between some stressors or resources of the PMLS and mental health turns out to be less homogeneous than expected. Characteristics of the PMLS contribute to the high prevalence of mental diseases of refugees and asylum seekers. Disadvantages in general socio-economic conditions, living and working conditions, in access to social and community networks need to be redressed, in addition to better access to health care.
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Affiliation(s)
- Anna Christina Nowak
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany.
| | - Niklas Nutsch
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Tessa-Maria Brake
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Lea-Marie Gehrlein
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
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13
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Murphy A, Bartovic J, Bogdanov S, Bozorgmehr K, Gheorgita S, Habicht T, Richardson E, Azzopardi-Muscat N, McKee M. Meeting the long-term health needs of Ukrainian refugees. Public Health 2023; 220:96-98. [PMID: 37290174 DOI: 10.1016/j.puhe.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/31/2023] [Accepted: 04/21/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Since Russia's full-scale invasion of Ukraine on 24 February 2022, millions of people have fled the country. Most people have gone to the neighbouring countries of Poland, Slovakia, Hungary, Romania, and Moldova. This vulnerable population has significant healthcare needs. Among the most challenging to address will be chronic non-communicable diseases (NCDs), including mental disorders, as these require long-term, continuous care and access to medicines. Host country health systems are faced with the challenge of ensuring accessible and affordable care for NCDs and mental disorders to this population. Our objectives were to review host country health system experiences and identify priorities for research to inform sustainable health system responses to the health care needs of refugees from Ukraine. STUDY DESIGN In-person conference workshop. METHODS A workshop on this subject was held in November 2022 at the European Public Health Conference in Berlin. RESULTS The workshop included participants from academia and non-governmental organisations, health practitioners, and World Health Organisation regional and country offices. This short communication reports the main conclusions from the workshop. CONCLUSION Addressing the challenges and research priorities identified will require international solidarity and co-operation.
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Affiliation(s)
- A Murphy
- Centre for Global Chronic Conditions, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
| | - J Bartovic
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - S Bogdanov
- Centre for Mental Health and Psychosocial Support, The National University of Kyiv Mohyla, Kyiv, Ukraine
| | - K Bozorgmehr
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - S Gheorgita
- World Health Organization Moldova Country Office, Chișinău, Republic of Moldova
| | - T Habicht
- World Health Organization Barcelona Office for Health Systems Financing, Barcelona, Spain
| | - E Richardson
- Centre for Global Chronic Conditions, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK; World Health Organization European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, London, UK
| | - N Azzopardi-Muscat
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - M McKee
- Centre for Global Chronic Conditions, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Brake TM, Dudek V, Sauzet O, Razum O. Psychosocial Attributes of Housing and Their Relationship With Health Among Refugee and Asylum-Seeking Populations in High-Income Countries: Systematic Review. Public Health Rev 2023; 44:1605602. [PMID: 37213704 PMCID: PMC10193459 DOI: 10.3389/phrs.2023.1605602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/17/2023] [Indexed: 05/23/2023] Open
Abstract
Objectives: Housing as a social determinant of health should provide not only shelter, but also a feeling of home. We explored psychosocial pathways creating a sense of home and influencing the relationship between housing and health among asylum seekers and refugees (ASR) in high-income countries. Methods: We performed a systematic review. To be included, studies had to be peer-reviewed, published between 1995 and 2022, and focus on housing and health of ASR in high-income countries. We conducted a narrative synthesis. Results: 32 studies met the inclusion criteria. The psychosocial attributes influencing health most often identified were control, followed by expressing status, satisfaction, and demand. Most attributes overlap with material/physical attributes and have an impact on ASR's mental health. They are closely interconnected with each other. Conclusion: Psychosocial attributes of housing play an essential role in the health of ASR; they are closely associated with material/physical attributes. Therefore, future research on housing and health of ASR should routinely study psychosocial attributes, but always in association with physical ones. The connections between these attributes are complex and need to be further explored. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42021239495.
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15
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Bartig S, Koschollek C, Bug M, Blume M, Kajikhina K, Geerlings J, Starker A, Hapke U, Rommel A, Hövener C. Health of people with selected citizenships: results of the study GEDA Fokus. JOURNAL OF HEALTH MONITORING 2023; 8:7-33. [PMID: 37064418 PMCID: PMC10091045 DOI: 10.25646/11143] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/14/2022] [Indexed: 04/18/2023]
Abstract
Background The health situation of people with a history of migration is influenced by a variety of factors. This article provides an overview of the health of people with selected citizenships using various indicators. Methods The analyses are based on the survey 'German Health Update: Fokus (GEDA Fokus)', which was conducted from November 2021 to May 2022 among people with Croatian, Italian, Polish, Syrian and Turkish citizenship. The prevalence for each health outcome is presented and differentiated by sociodemographic and migration-related characteristics. Poisson regressions were performed to identify relevant factors influencing health situation. Results Self-assessed general health, the presence of depressive symptoms, prevalence of current smoking and the utilisation of general and specialist healthcare differed according to various factors considered here. In addition to sociodemographic determinants, the sense of belonging to society in Germany and self-reported experiences of discrimination were particularly associated with health outcomes. Conclusions This article highlights the heterogeneity of the health situation of people with a history of migration and points to the need for further analyses to identify the reasons for health inequalities.
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Affiliation(s)
- Susanne Bartig
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
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16
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Walg M, Löwer F, Bender S, Hapfelmeier G. Domain-specific discrepancies between self- and caseworkers’ proxy- reports of emotional and behavioral difficulties in unaccompanied refugees. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2022. [DOI: 10.1080/13632752.2022.2129369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Marco Walg
- Department of Child and Adolescent Psychiatry, Sana-Klinikum , Remscheid, Germany
| | | | - Stephan Bender
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Gerhard Hapfelmeier
- Department of Child and Adolescent Psychiatry, Sana-Klinikum , Remscheid, Germany
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17
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Schönfeld S, Sauzet O, Razum O. [Is There a Association Between the Conditions in Accommodations and the Mental Health of Refugees in Germany? - A Cross-Sectional Study]. DAS GESUNDHEITSWESEN 2022; 84:617-624. [PMID: 35835096 PMCID: PMC11248260 DOI: 10.1055/a-1802-4530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Crowded conditions, noise and little privacy and other characteristics of refugee accommodations can have a negative impact on the mental health of the partially traumatized refugees. The study investigates, whether there are correlations between satisfaction with certain accommodation features in individual and shared accommodation and mental health. METHOD We used the IAB-BAMF-SOEP survey from Germany 2016 (n=4491 refugees). Linear regression models are calculated to test the association between mental health and the type of accommodation (single accommodation/shared accommodation) and satisfaction with the accommodation (general satisfaction, satisfaction with food quality/noise level/privacy/leisure activities/access to public transport/security, german language courses). We adjust for sociodemographic factors, potentially traumatic experiences prior to arrival in Germany and postmigrant exposures (e. g. asylum status). RESULTS Within the two accommodation types, there is high heterogeneity with respect to the characteristics examined. Refugees with poor mental health were significantly more likely to live in shared accommodation. When the above covariates were controlled for, the association disappeared. The other eight accommodation characteristics remained significantly associated with poorer mental health. The largest effects on mental health were observed for the satisfaction with safety, privacy, and general satisfaction. Here, the difference between persons who were barely satisfied compared with persons who were very satisfied amounted to 5-6 points on the SF-12 mental sum scale. CONCLUSION International results on the relationship between accommodation conditions and mental health of refugees were confirmed for Germany. This results in an increased need for mental health services in subjectively worse housing. Questions about satisfaction (especially safety, privacy, and general satisfaction) are more suitable for identifying critical accommodations than the classification into single or shared accommodations, because shared accommodations were assessed very differently. Screening instruments can help identify problematic shelters. However, reverse causality cannot be conclusively ruled out.
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Affiliation(s)
- Simone Schönfeld
- Epidemiologie und International Public Health, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld, Germany
- Institut für Integrative Gesundheitsversorgung und Gesundheitsförderung (IGVF), Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Germany
| | - Odile Sauzet
- Epidemiologie und International Public Health, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld, Germany
| | - Oliver Razum
- Epidemiologie und International Public Health, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld, Germany
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18
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Dudek V, Razum O, Sauzet O. Association between housing and health of refugees and asylum seekers in Germany: explorative cluster and mixed model analysis. BMC Public Health 2022; 22:48. [PMID: 34996414 PMCID: PMC8742454 DOI: 10.1186/s12889-021-12458-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 12/21/2021] [Indexed: 12/02/2022] Open
Abstract
Background Accommodation for asylum seekers and refugees (ASR) in Germany differs in many ways depending on a range of political, structural, social, and environmental factors. These contextual differences present a challenge for assessing health impacts of refugee accommodation. We aimed to devise a broad typology of refugee accommodation that allows to assess associations between housing and health of ASR. Methods We performed a cluster analysis of population-based, cross-sectional secondary data in Germany to identify clusters of refugee accommodation. We then assessed health disparities across clusters by performing bivariate analysis and linear mixed model regression analysis. Results We identified four clusters, three of them reflected different types of private accommodation and one pointed to collective accommodation. The collective accommodation cluster clearly differed from the private accommodation clusters in terms of space, area, level of restrictions, social connections and respondent satisfaction. Across private accommodation clusters we also found differences in space, area, and level of restrictions. In regression analysis, belonging to one of the private accommodation cluster was significantly associated with better mental health compared to belonging to the collective accommodation cluster. Physical health was significantly lower in one private accommodation cluster characterized by poor access to public transport and a higher level of restrictions compared to a private accommodation cluster showing better connections and a lower level of restrictions. Conclusion We demonstrate that unfavourable conditions cluster in collective accommodation with negative outcomes for mental health but not for physical health. We also found health disparities across types of private accommodation. We conclude that housing plays a role in the production of health inequalities in ASR but needs to be assessed in a differentiated, multidimensional way. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12458-1.
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Affiliation(s)
- Verena Dudek
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, P. O. Box 100131, 33501, Bielefeld, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, P. O. Box 100131, 33501, Bielefeld, Germany
| | - Odile Sauzet
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, P. O. Box 100131, 33501, Bielefeld, Germany. .,Chair of Data Analysis, Department of Business Administration and Economics, Bielefeld University, Bielefeld, Germany.
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19
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Belau MH, Becher H, Kraemer A. Loneliness as a mediator of social relationships and health-related quality of life among refugees living in North Rhine-Westphalia, Germany. BMC Public Health 2021; 21:2233. [PMID: 34879832 PMCID: PMC8656054 DOI: 10.1186/s12889-021-12303-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 11/19/2021] [Indexed: 12/15/2022] Open
Abstract
Background Since 2015, more than one million people fled to Germany – mainly from war-affected countries. Nevertheless, little is known about social determinants in refugees located in Germany. This study aims to test the mediation effect of loneliness between social relationships, comprising social integration and social support, and health-related quality of life among refugees living in North Rhine-Westphalia, Germany. Methods The investigation utilizes data from the FlueGe Health Study (N=326), a cross-sectional study conducted by Bielefeld University. The data was collected between February and November 2018 and included interviews and examinations. Participants were recruited from shared and private accommodation in several cities in North Rhine-Westphalia, Germany. We first analyzed correlations between social integration, social support, loneliness, and physical and mental component of health-related quality of life. We then conducted mediation analyses using structural equation modeling. Results The majority of respondents were socially isolated, perceiving a moderate degree of loneliness and social support. In addition, the physical and mental components of health-related quality of life indicate that participants predominantly experienced mental rather than physical impairments. Results from mediation analyses showed indirect effects of loneliness on the association between social integration and mental health (ß = 0.495, 95% bias-corrected and accelerated confidence interval (BCa CI) = [0.018, 0.972]), and between social support and both physical (ß = 0.022, 95% BCa CI = [0.004, 0.040]) and mental health (ß = 0.067, 95% BCa CI = [0.037, 0.097]). Conclusions Loneliness played a mediating role in the association between social relationships and health-related quality of life among refugees living in North Rhine-Westphalia, Germany. The results provide implications for both, health policy and the host society. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12303-5.
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Affiliation(s)
- Matthias Hans Belau
- School of Public Health, Bielefeld University, Bielefeld, Germany. .,Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. .,University Medical Center Hamburg-Eppendorf, Institute of Medical Biometry and Epidemiology, Martinistraße 52, D-20246, Hamburg, Germany.
| | - Heiko Becher
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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20
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Hajak VL, Sardana S, Verdeli H, Grimm S. A Systematic Review of Factors Affecting Mental Health and Well-Being of Asylum Seekers and Refugees in Germany. Front Psychiatry 2021; 12:643704. [PMID: 33815176 PMCID: PMC8012840 DOI: 10.3389/fpsyt.2021.643704] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/23/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Since the onset of the 2015 European refugee crisis, ~4. 46 million people have sought asylum in the European Union, with Germany logging the largest share of all asylum applications. In addition to the severe adversities before and during flight, the process of settling into a new environment involves stressors that affect psychological well-being and mental health. The aim of this systematic review was to examine contextual factors during post-migration that influence the mental health and well-being of asylum seekers and refugees (ASRs) in Germany. Methods: Following PRISMA guidelines, a systematic review was conducted across multiple databases for English and German studies published between 2015 and 2020 with index keywords. Results: From a total of 303 articles, 156 duplicates were removed and, after title review, another 87 were excluded for not meeting the inclusion criteria. After assessing the abstracts of the remaining 60 articles, 39 were excluded. Full texts of 21 articles were assessed for eligibility and after excluding 8 articles, 13 articles were included in the review. The results demonstrate high rates of psychological distress among ASRs in Germany and the significant influence of contextual factors on their mental health and psychological well-being. The risk factors for poor mental health include an uncertain asylum status, living in shared asylum accommodations, separation from the nuclear family, lack of German language skills, integration issues and discrimination, while employment is a protective factor. Conclusion: Asylum seekers and refugees have high prevalence rates of psychological distress directly influenced by contextual factors in Germany. Based on these findings, policy makers are strongly recommended to apply preventive strategies to reduce mental health problems of ASRs in Germany.
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Affiliation(s)
- Vivien L. Hajak
- Department of Psychology, Medical School Berlin, Berlin, Germany
| | - Srishti Sardana
- Global Mental Health Laboratory, Teachers College, Columbia University, New York, NY, United States
| | - Helen Verdeli
- Global Mental Health Laboratory, Teachers College, Columbia University, New York, NY, United States
| | - Simone Grimm
- Department of Psychology, Medical School Berlin, Berlin, Germany
- Department of Psychiatry, Charité, Campus Benjamin Franklin, Berlin, Germany
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Biddle L, Hintermeier M, Mohsenpour A, Sand M, Bozorgmehr K. Monitoring the health and healthcare provision for refugees in collective accommodation centres: Results of the population-based survey RESPOND. JOURNAL OF HEALTH MONITORING 2021; 6:7-29. [PMID: 35146304 PMCID: PMC8734199 DOI: 10.25646/7863] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/11/2021] [Indexed: 11/18/2022]
Abstract
To date, the integration of refugees in German health surveys is insufficient. The survey RESPOND (Improving regional health system responses to the challenges of forced migration) aimed to collect valid epidemiological data on refugee health status and healthcare provision. The core elements of the survey consisted of a population-based sampling procedure in Baden-Württemberg, multilingual questionnaires and a face-to-face approach of recruitment and data collection in collective accommodation centres with multilingual field teams. In addition, data on the geographical locations of accommodation centres and their structural quality were obtained. The results indicate a high overall health burden. The prevalence of depression (44.3%) and anxiety symptoms (43.0%) was high. At the same time, high unmet needs were reported for primary (30.5%) and specialist (30.9%) care. Despite sufficient geographical accessibility of primary care services, frequent ambulatory care sensitive hospitalisations, i.e. hospitalisations that could potentially have been avoided through primary care (25.3%), as well as subjective deficits in the quality of care, suggest barriers to accessing healthcare services. Almost half of all refugees (45.3%) live in accommodation facilities of poor structural quality. Collecting valid data on the health situation of refugees is possible through a combination of targeted sampling, multilingual recruitment and survey instruments as well as personal recruitment. The presented approach could complement established procedures for conducting health surveys and be extended to other federal states.
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Affiliation(s)
- Louise Biddle
- Section Health Equity Studies and Migration, Department of General Practice and Health Services Research, University Hospital Heidelberg
- AG Population Medicine and Health Services Research, School of Public Health, Bielefeld University
| | - Maren Hintermeier
- Section Health Equity Studies and Migration, Department of General Practice and Health Services Research, University Hospital Heidelberg
| | - Amir Mohsenpour
- AG Population Medicine and Health Services Research, School of Public Health, Bielefeld University
| | - Matthias Sand
- GESIS Leibniz Institute for the Social Sciences, Mannheim
| | - Kayvan Bozorgmehr
- Section Health Equity Studies and Migration, Department of General Practice and Health Services Research, University Hospital Heidelberg
- AG Population Medicine and Health Services Research, School of Public Health, Bielefeld University
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