Type of Refugee Accommodation and Health of Residents: A Cross-Sectional, Population-Based Cluster Analysis in South-West Germany

Housing during the asylum process and its association with healthcare utilization for common mental disorders among refugees in Sweden: A nationwide cohort study

Refugees and asylum seekers face an increased risk of poor mental health, and evidence shows that housing in the post-migration context plays a crucial role in shaping their mental well-being. Research also suggests that institutional accommodations during the asylum process might be more detrimental to their mental health compared to private accommodations. We aimed to prospectively estimate the associations between housing type during the asylum process (institutional or self-organized accommodations) and healthcare utilization for common mental disorders (CMDs) after being granted a residence permit as a refugee in Sweden. This register-based cohort study includes all asylum seekers aged 18-60 who were granted residence permits in Sweden between 2010 and 2012, totaling 20,396 individuals, of whom 11,694 resided in self-organized housing (EBO) and 8,702 in accommodation centers (ABO). Using a generalized estimating equation (GEE), we estimated the associations between housing type (ABO or EBO) and prescriptions for antidepressants or anxiolytic medication, as well as specialized in- and outpatient visits with a diagnosis of CMDs, over a five-year follow-up period after being granted a residence permit. The adjusted odds ratio (controlled for sociodemographic factors) showed that those who had lived in ABO, compared with EBO, had a greater risk of any antidepressant or anxiolytic prescriptions (OR = 1.32, [1.21-1.44]) as well as any specialized in- or outpatient visits with a CMD diagnosis (OR = 1.41 [1.27-1.52]). Our results demonstrate that former asylum seekers who have lived in institutional housing use more mental healthcare services than those who have lived in self-organized housing, even when potential sociodemographic confounders and mediators are adjusted for. These associations persisted for up to five years after they had received a residence permit, highlighting that when asylum seekers live in institutional housing it is especially important to discuss how health can be promoted during the asylum-seeking period.

Urbanicity and anxiety disorders: current evidence and quo vadis?

PURPOSE OF REVIEW

There are few studies investigating the effects of urbanization on various anxiety-related conditions in specific population subgroups. This review aims to examine the effects of urbanization through the lens of population subgroups as well as anxiety disorder subtypes.

RECENT FINDINGS

There was more consistent evidence suggesting that those of a younger age group and from disadvantaged backgrounds (such as lower socioeconomic status, refugee status) may be more vulnerable to posttraumatic stress disorder (PTSD). When we examined the relationship between urbanization and anxiety disorder subtype, the results were largely mixed, with some evidence for the positive association between urbanization and PTSD. Many of the recent studies had been conducted in the context of the recent coronavirus disease 2019 (COVID-19) pandemic.

SUMMARY

The association between urbanicity and anxiety-related disorders in the various subgroups can be influenced by socio-demographic factors. Interventions and policies that aim to ameliorate the effects of urbanicity would need to identify vulnerable individuals early based on social or environmental factors. Given that the short and long-term psychological sequelae of the recent COVID-19 pandemic are still being evaluated, the inter-relationships between urbanization, external factors and specific anxiety disorders await further delineation.

Housing inequalities and health outcomes among migrant and refugee populations in high-income countries: a mixed-methods systematic review

BACKGROUND

Migrant and refugee populations are disproportionately affected by the housing crises reportedly impacting high-income countries around the globe. However, the health implications of housing inequalities within these communities and contexts remain relatively understudied. This review aimed to synthesise the evidence on housing and health inequalities prevalent among migrant and refugee populations in high-income countries, and to identify the pathways linking housing inequalities and health outcomes.

METHODS

This systematic review employed the Joanna Briggs Institute (JBI) methodology for mixed-methods systematic reviews using a convergent integrated approach to synthesis and integration. Electronic database searches were conducted using Medline (OVID), Web of Science (ISI), Embase (OVID), PsycInfo (OVID), Scopus, and CINAHL (EBSCO), supplemented by grey literature searches on Google Scholar, MedNar, and WHOLIS. Eligible studies included quantitative, qualitative, and mixed methods designs focused on understanding how housing inequalities are associated with physical and mental health outcomes.

RESULTS

A total of 65 studies published between 1995 and 2024 were included in this review, comprising 38 quantitative and 27 qualitative studies. Substandard housing conditions, such as overcrowding and poor ventilation, were consistently associated with adverse physical and mental health outcomes, including respiratory illnesses and experiences of anxiety and depression. The type of housing tenure also impacted both physical and mental health, specifically living in inadequate rental housing as opposed to self-owned homes, was linked with poorer physical health and increased risk of mental health issues. Similarly, housing insecurity stemming from unstable housing situations and insecure tenancy, as well as neighbourhood conditions such as safety concerns and living in deprived neighbourhoods, led to the exacerbation of both physical and mental health issues. Furthermore, housing affordability challenges and decreased housing satisfaction were linked with poor mental health outcomes such as experiences of depression and psychological distress.

CONCLUSIONS

This review highlights the critical role of housing as a social determinant of health and wellbeing for migrant and refugee populations in high-income countries, along with highlighting the potential pathways through which housing inequalities impact physical and mental health outcomes. Ensuring access to adequate, affordable, and secure housing, while also improving neighbourhood conditions, is essential for improving the health and wellbeing of migrant and refugee populations.

Does perceived social cohesion moderate the effect of parental stressors on depressive symptoms? A longitudinal, multi-level analysis before and during the COVID-19 pandemic

BACKGROUND

Perceived social cohesion (PSC) is a protective factor for mental health. Yet, evidence on social mechanisms influencing mental health is scarce.

AIMS

We examined the moderating role of PSC between parental stressors and depressive symptoms before and during the COVID-19 pandemic.

METHODS

We performed a multilevel moderated linear regression analysis using German Socio-Economic Panel (G-SOEP) data to investigate the interaction of PSC in 2018 and in 2020 with parental stressors (having pre-school-aged child(-ren), concerns about COVID-19 infection, financial insecurity, working from home, changes at work) and depressive symptoms (PHQ-4) in 2020 and 2021.

RESULTS

3,112 observations from 1,621 participants were included in the regression analyses. The parental stressors had mostly negative, although not always significant effects on PHQ-4. Both PSC measures positively moderated the association between experienced financial insecurity and PHQ-4. PCS 2020 positively moderated the association between the stressors "not working from home" and "being unemployed in 2020 or 2021" compared to "having no changes at work" for those employed. It negatively moderated the association between "having some concerns about infection" and PHQ-4.

CONCLUSIONS

PSC can act as a buffer for parental mental health. Social cohesion should be promoted in public health interventions, especially during pandemics or disasters.

Health care utilisation of asylum seekers and refugees in the South-West of Germany

BACKGROUND

Limited evidence on utilisation of health care by recently arrived asylum seekers and refugees in high-income countries is available. This study aims to describe the implementation of an integrated care facility (ICF) in an initial reception centre and measure the utilisation of care and the influence of operational parameters.

METHODS

In a retrospective cohort study design, using medical records, we followed inhabitants of a reception centre in Germany between 11.10.2015 and 30.05.2018. We assessed frequency of visits and revisits to a newly established integrated care facility (ICF), and the effects of the ICF on visits to the local emergency department (LED) in the regional tertiary hospital using survival analysis and time series regression. We also explore the influence of operational parameters on the different implementation phases; phase 1: provisional clinic with 1-2 hours of physician presence daily, phase 2: implementation of ICF with 2-4 hours of care by a team of doctors and nurses daily, phase 3: routine running of ICF with daily operational hours of 10am-2pm with care provided by an interdisciplinary team of doctors and nurses.

RESULTS

14,419 total medical visits were recorded from 1,883 persons seeking health care in the ICF. The absolute number of visits per day remained similar over the study period (19·9/day), yet the relative number of visits changed from 2·2 to 15 per 100 inhabitants from phase 2 to 3, respectively. Most visits were due to respiratory infections (612/3080, 20%), and trauma and musculoskeletal conditions (441/3080, 14%). The rate of revisits to ICF was 2·9 per person per month (95%CI 2·9-3), more for those older, female, from North Africa and those with a translator present. The ratio of visits to the LED changed from 0·3/100 inhabitants per day to 0·14/100 inhabitants after implementation of the ICF and back to 0·3/100 inhabitants during the routine running.

CONCLUSIONS

Though seasonal variation and referral practices must be considered, a high rate of revisits to the ICF were recorded. While visits to the LED decreased after the implementation of the ICF, visits returned to the pre-ICF levels during the routine running of the ICF. The results show that AS&R require reliable access to health care, yet the needs of specific groups of migrants may be different, especially those with language barriers, minority groups or those from certain regions. As such, care should be migrant sensitive and adapt to the changing needs of the population. Though more research is required to better understand the differing needs of migrants, this study may help to inform guidelines surrounding migrant sensitive standards of care in Germany.