Abstract
A number of post-migration stressors have been shown to adversely affect mental health in refugees resettled in high-income countries, including poor social integration, financial difficulties and discrimination, and recent evidence suggests that these effects are gender specific. Social support has been found to buffer against post-migration stress in some studies on refugee populations, though the evidence on this is mixed. The present study used cross-sectional survey data from a nationwide, randomly sampled group of adult refugees from Syria resettled in Sweden between 2008 and 2013 (Nsample = 4,000, nrespondents = 1,215, response rate 30.4%) to investigate gender-specific associations between post-migration stressors and subjective well-being (SWB) and whether these associations were modified by social support. SWB was measured with the WHO-5 Well-being Index (scaled 0–100), dichotomized into high (≥50) and low (<50) SWB. Main analyses were stratified by gender, and regressed SWB on four domains of post-migration stress (financial strain, social strain, competency strain and discrimination) using logistic regression, adjusting for sociodemographic variables and traumatic experiences. Social support was tested as an effect modifier. In fully adjusted models, main risk factors for low SWB were high financial strain, especially in males (ORhigh vs. low strain, males = 10.30 [4.91–21.6], p < 0.001 vs. ORhigh vs. low strain, females= 3.84 [1.68–8.79], p = 0.002), and high social strain, only in males (ORhigh vs. low strain, males = 9.21 [3.96–21.4], p < 0.001 vs. ORhigh vs. low strain, females = 1.03 [0.40–2.64], p = ns). There was some evidence that social support buffered the adverse association of financial strain with SWB. In conclusion, the present study found clear support of gender-specific effects of post-migration stressors on SWB. Mitigation strategies and interventions should be aware of and sensitive to these potential gendered effects, and future research exploring mental health in the context of resettlement stress should have a heightened focus on the important role of gender.
Highlights
Due to the rapidly growing number of refugees from 2015 onwards, there is an urgency and considerable debate regarding durable solutions to meet the psychosocial needs of the 26 million refugees worldwide [1, 2]
Unadjusted and adjusted logistic models of subjective well-being (SWB) regressed on all post-migration stressors are presented in Table 3, with the latter two models stratified by gender to investigate gender-specific associations and evidence of interaction
There was very strong evidence that financial strain was associated with increased odds of low SWB in the fully adjusted model, and some evidence that this association was stronger in males (ORhigh vs. low financial strain, males = 10.30, 95% confidence intervals (95% CIs) 4.91–21.6, p < 0.001) compared to females (ORhigh vs. low financial strain, females = 3.84, 95% CI 1.68– 8.79, p = 0.001)
Summary
Due to the rapidly growing number of refugees from 2015 onwards, there is an urgency and considerable debate regarding durable solutions to meet the psychosocial needs of the 26 million refugees worldwide [1, 2]. The study found that strong family ties as well as English proficiency were associated with lower distress in females, but not males; that acculturation dissonance was associated with higher distress in males, but not females; and that gender ideology and distress were gender specific, with traditional women and egalitarian men experiencing less distress The latter points to the centrality of gender roles when trying to interpret gender-specific effects of resettlement stress on mental health, and the complex and often challenging processes that influence and shape gender roles in migrating populations relocating from societies and cultures with fairly marked gender separation, to societies where this separation is much smaller [18, 19].
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