Loneliness as a mediator of social relationships and health-related quality of life among refugees living in North Rhine-Westphalia, Germany

Heiko Becher,Alexander Kraemer,Matthias Hans Belau

doi:10.1186/s12889-021-12303-5

Abstract

BackgroundSince 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.MethodsThe 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.ResultsThe 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]).ConclusionsLoneliness 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.

Highlights

Since 2015, more than one million people fled to Germany – mainly from war-affected countries
The majority of respondents were affected by social isolation, perceiving a moderate degree of loneliness and social support
Concerning mediation analyses, our results suggest that the perception of social support, and to some extent social integration itself, determine the level of loneliness and, through this pathway, influence refugees’ health-related quality of life (HRQoL)

Summary

Introduction

Since 2015, more than one million people fled to Germany – mainly from war-affected countries. 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. Experiences of war-related violence and torture in the countries of origin, traumatic events during the journey such as physical assault, extortion, and sexual violence as well as the stressors of the asylum process and poor living conditions in the host country lead to a significant burden of mental illness such as post-traumatic stress disorder (PTSD), depression, and anxiety [3,4,5]. In Germany, refugees have limited access to medical care during their asylum process [8]. Many refugees are dealing with loneliness and the experience of loss of friends and family members throughout the migratory journey to Germany [2]. The family in particular, as an element of resilience, is assigned a central role in promoting and maintaining health and well-being [13]

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