Migrant Health Research Articles

Advancing migration and health research by examining return migration

This essay offers an analysis of research on return migration and health by adopting the social determinants of health (SDH) framework proposed by the WHO. Specifically, we argue that the...

Immigration, Educational Attainment, and Subjective Health in the United States.

Although educational attainment is a major social determinant of health, according to Marginalization-related Diminished Returns (MDRs), the effect of education tends to be weaker for marginalized groups compared to the privileged groups. While we know more about marginalization due to race and ethnicity, limited information is available on MDRs of educational attainment among US immigrant individuals. This study compared immigrant and non-immigrant US adults aged 18 and over for the effects of educational attainment on subjective health (self-rated health; SRH). Data came from General Social Survey (GSS) that recruited a nationally representative sample of US adults from 1972 to 2022. Overall, GSS has enrolled 45,043 individuals who were either immigrant (4,247; 9.4%) and non-immigrant (40,796; 90.6%). The independent variable was educational attainment, the dependent variable was SRH (measured with a single item), confounders were age, gender, race, employment and marital status, and moderator was immigration (nativity) status. Higher educational attainment was associated with higher odds of good SRH (odds ratio OR = 2.08 for 12 years of education, OR = 2.81 for 13-15 years of education, OR = 4.38 for college graduation, and OR = 4.83 for graduate studies). However, we found significant statistical interaction between immigration status and college graduation on SRH, which was indicative of smaller association between college graduation and SRH for immigrant than non-immigrant US adults. In line with MDRs, the association between educational attainment and SRH was weaker for immigrant than non-immigrant. It is essential to implement two sets of policies to achieve health inequalities among immigrant populations: policies that increase educational attainment of immigrants and those that increase the health returns of educational attainment for immigrants.

Prevalence and associated factors for poor mental health among young migrants in Sweden: a cross-sectional study

ABSTRACT Background Young migrants face multiple challenges that can affect their mental, sexual and reproductive health. Objective To assess the prevalence of self-reported poor mental health and its associated demographic, post-migration and sexual risk behaviour factors among young migrants (aged 15–25) in Sweden. Methods Data were drawn from a cross-sectional survey conducted with migrants aged 15–65 years old in Sweden between December 2018 and November 2019 (n = 6449). Among these, 990 participants aged 15–25 were eligible for the study. Mental health was measured using the Refugee Health Screener-13. Missing data indicator analysis and multivariable logistic regression models were conducted to estimate the association between mental health, sexual risk behaviour, demographic and migration-related variables. Results Of the 990 participants, 59% reported poor mental health. Participants reporting poor mental health were more likely to be female (AOR:1.63, 95% CI:1.18–2.25), to have lived in Sweden more than three years (AOR:2.16, 95% CI:1.17–3.97), to engage in any sexual risk behaviour (AOR:1.99, 95% CI:1.25–3.17), and to live alone (AOR:1.95, 95% CI:1.25–3.03) or with friends they already knew (AOR:1.60, 95% CI:1.37–4.91). People arriving from the Americas (AOR:0.54, 95% CI:0.33–0.88), Asia (AOR:0.44, 95% CI:0.22–0.86), Europe (AOR:0.30, 95% CI:0.14–0.61) and Africa (AOR 0.37, 95% CI: 0.23–0.60) had lower odds of poor mental health than those arriving from Syria. Conclusion The prevalence of poor mental health among young migrants in Sweden was high, with specific subgroups (women, asylum seekers, people arriving from Syria, and those residing longer in Sweden) being particularly vulnerable. Our results indicate the interconnectedness between poor mental health and sexual risk behaviour in this population. Thus, policies targeting young migrants should ensure that healthcare services screen for both poor sexual and mental health at the same time.

Depression and anxiety in female refugees from East Africa and the Middle East displaced to Germany: cross-sectional results of the female refugee study, taking sociodemographic and migration-related factors into account.

At the end of 2022, 108.4 million people around the world were forcibly displaced, the highest number ever recorded. Of these, 50% were women. Despite this situation, little is known about the mental health of female refugees. The first aim of this study was to examine the prevalence of depression and anxiety symptoms among female refugees in Germany. The second aim was to examine which sociodemographic and migration-related variables have an impact on refugees' mental health, and the third aim was to assess the potential predictors of their mental health. A sample of 92 female refugees from East Africa and the Middle East living in Germany were interviewed. Symptoms of depression and anxiety were assessed using the Hopkins Symptom Checklist (HSCL-25). The experience of potentially traumatic events (PTEs) was assessed using the Posttraumatic Diagnostic Scale (PDS) and the Harvard Trauma Questionnaire (HTQ). In our sample of female refugees, 65.2% reported symptoms of depression, and 60.9% reported symptoms of anxiety. Symptoms of depression or anxiety were associated with being from the Middle East, having a higher level of education, and reporting more PTEs. The multiple regression model for anxiety was able to explain 32.4% of the variance in anxiety symptoms. The findings highlight the high burden of mental health problems that female refugees bear. The identified predictors of depressive and anxiety symptoms should sensitize medical and refugee professionals to identify vulnerable individuals and groups, refer them to appropriate psychological treatment, and, where possible, modify the identified predictors.

Trick or treat? The Brexit effect on immigrants’ mental health in the United Kingdom

This paper investigates changes in the mental health of immigrants living in the United Kingdom (UK) during the European Union (EU) referendum. Using the UK Household Longitudinal Study, this paper assesses how the mental health of immigrants has changed before and after the referendum, compared to natives. Findings suggest that following the EU referendum result, mental health significantly improved overall for naturalised immigrants as a whole and for non-EU immigrants, relative to the changes in natives. Further, there is no evidence that mental health worsened even for EU immigrants. Our results vary by gender, with non-EU women experiencing a statistically significant improvement in mental health. The results are robust to several checks, including using balanced panel data and individual fixed effects. Our findings are consistent with the idea that the end of free movement for EU immigrants has alleviated the perception of discrimination against non-EU immigrants. This interpretation is supported by empirical results from a multinomial logit showing that non-EU migrants, particularly women, are more likely to perceive discrimination for race-related reasons when denied a job, an effect which is no longer significant in the post-referendum period.

Effect of area-level socioeconomic deprivation on mental and physical health: A longitudinal natural experiment among refugees in Germany

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.

Predictors associated with symptoms of depression & anxiety during the COVID-19 among MENA immigrants in Houston, Texas

Very limited knowledge is available regarding the mental health of the immigrant population in the USA. We aim to assess the factors affecting the mental health of immigrants living in Houston from war-inflicted and stable countries of Middle Eastern and North African (MENA) origin during the pandemic. This cross-sectional study was conducted among the MENA immigrants using a validated survey of sociodemographic, general health, and COVID-19 questions. Multivariable logistic regression models assessed sociodemographic and clinical predictors of depression and anxiety. The outcome of interest was categorized as “moderate or severe” versus “minimal or mild” for depression and anxiety. Total of 94 participants completed the study, with the sample rate of "moderate or severe" symptoms of anxiety and depression being 29.78% and 64.89%, respectively. Multivariable regression analysis for depression showed that immigrants from war-inflicted countries of origin were less likely to report “moderate or severe” depression compared to immigrants from stable countries (OR = 0.082, 95% CI 0.012–0.551). Individuals with excellent overall health (OR = 0.074, 95% CI = 0.013–0.414) had a significantly lower likelihood of “moderate or severe” depression than those who reported fair/poor health. Non-smokers (OR = 0.068, 95% CI = 0.012–0.377) were less likely to report “moderate or severe” depression in comparison to those who engage in smoking behavior. Participants who responded to the question that they tried hard to avoid thoughts of COVID-19 were less likely to have symptoms of “moderate or severe” depression compared to participants who responded, “No” (OR = 0.110, 95% CI = 0.017–0.712). Those who have” excellent/good knowledge” (OR = 0.0146, 95% CI = 0.022–0.946) about the prevention of COVID-19 spread were less likely to have “moderate or severe” depression compared to those who had “average/poor/terrible”. Multivariable regression analysis revealed smoking as a significant predictor of anxiety, with non-smokers demonstrating a lower likelihood of experiencing "moderate or severe" anxiety than smokers (OR = 0.21, 95% CI = 0.06–0.84). MENA immigrant communities in the USA have diverse immigration experiences, cultural backgrounds, and instability issues in their home countries, possibly elevating the risk of depression and anxiety during the COVID-19 crisis. Predictors identified should be considered by policymakers when developing targeted interventions to ensure the mental and social well-being of immigrant communities in the USA.

Modeling the general health of Iranian immigrants based on cognitive flexibility and perfectionism with the mediation of acculturation stress

Background and purpose: Migration is a dual factor that creates a stressful environment and requires the creation of new adaptations, creating psychological pressures. The present study was conducted with the aim of determining the fit of the proposed model of general health of Iranian immigrants based on cognitive flexibility and perfectionism with the mediation of acculturation stress. Research method: The method of this study was correlation type. The statistical population of this study included all Iranian immigrants who lived legally in one of the countries of Western Europe, North America or Oceania for more than one year. 224 people were selected using available sampling method. Data collection was done by publishing Goldberg General Health Questionnaire (1972), Dennis and Vanderwaal Cognitive Flexibility Questionnaire (2010), Hill et al. Findings: The results showed that cognitive flexibility has a negative effect on the general health of immigrants (β=-0.46, P=0.001). Perfectionism has a negative effect on the general health of immigrants (β=-0.42, P=0.001). Acculturation stress has a positive effect on the general health of immigrants (β=0.76, P=0.001). Conclusion: The evaluation of the proposed model with the method of path analysis showed that the proposed model of general health of Iranian immigrants based on cognitive flexibility and perfectionism with the mediation of acculturation stress is suitable; As a result, cultivating cognitive flexibility and positive perfectionism helps to reduce acculturation stress and maintain mental health in immigrants.

Research breakdowns: A constructive critique of research practice involving grief, trauma and displaced people.

Impactful research on refugee mental health is urgently needed. To mitigate the growing refugee crisis, researchers and clinicians seek to better understand the relationship between trauma, grief and post-migration factors with the aim of bringing better awareness, more resources and improved support for these communities and individuals living in host countries. As much as this is our intention, the prevailing research methods, that is, online anonymous questionnaires, used to engage refugees in mental health research are increasingly outdated and lack inclusivity and representation. With this perspective piece, we would like to highlight a growing crisis in global mental health research; the predominance of a Global North-centric approach and methodology. We use our recent research challenges and breakdowns as a learning example and possible opportunity to rebuild our research practice in a more ethical and equitable way.

COMMUNITY AND CROSS CULTURAL PHYCHOLOGY

Community psychology is a field of psychology that focuses on the relationship between individuals and their communities. It seeks to understand how social and environmental factors can influence mental health and well-being. Cross-cultural psychology is a subfield of psychology that studies the similarities and differences in human behaviour across cultures. These two fields of psychology intersect in the study of cross-cultural communities. Cross-cultural communities are those that are made up of people from different cultures. These communities can be found in both urban and rural settings, and they can be composed of immigrants, refugees, or people who have simply chosen to live in a community that is different from their own culture. Cross-cultural communities can face several challenges, including language barriers, discrimination, and cultural misunderstandings. These challenges can have a negative impact on the mental health and well-being of community members. Community psychologists can play a valuable role in helping cross-cultural communities. They can work to improve communication and understanding between people from different cultures. They can also help to develop programs and services that meet the needs of the community. One example of a community psychology program that is designed to help cross-cultural communities is the Refugee Mental Health Program in the United States. This program provides mental health services to refugees and immigrants who are struggling to adjust to life in the United States. The program also provides education and support to community members about refugee and immigrant mental health issues. Another example of a community psychology program that is designed to help cross-cultural communities is the Intercultural Community Development Program in Canada. This program works to build bridges between different cultural groups in Canadian communities. The program provides training and resources to community leaders and organizations on how to promote intercultural understanding and respect.

Housing environment and external migration as factors influencing population health

This article investigates the impact of housing quality and type on the health of migrants in developing countries, emphasizing factors such as overcrowding, sanitation, and access to healthcare. It further explores how specific aspects of housing quality, including structural integrity, ventilation, insulation, and access to utilities, influence population health. A comprehensive review of relevant literature is conducted, presenting evidence on the relationship between housing conditions and the prevalence of respiratory diseases, cardiovascular diseases, and mental disorders. The study focuses on Kyrgyzstan, aiming to elucidate how various living conditions affect the health of its population. The analysis utilizes secondary data from sociological studies and scientific research from various countries, offering recommendations applicable to Kyrgyzstan. Numerous contributing factors are identified, including the economic and social damage associated with inadequate housing, housing construction, and improvements in living conditions; air quality; indoor temperature and warmth; infestation by parasites and pests; and sanitary and hygienic conditions. The article concludes with practical recommendations for policy and intervention.

For Worse or for Better? The Unintended Impacts of an Initial Employment Prohibition on Refugee Health

For Worse or for Better? The Unintended Impacts of an Initial Employment Prohibition on Refugee Health

“Garima Means to Live with Pride:” A Case Study on Provider Perspectives and Local Government Response to Health of Internal Migrant Laborers in Kerala

Background: Addressing the health needs of interstate migrants in India is a complex challenge. We undertook a case study of Garima, a migrant health intervention in Kozhikode district, Kerala, and explored the perspectives of the health system and the role of local governments with regard to the programs targeting the health of migrant laborers in Kerala. Methods: We used a qualitative descriptive case study approach as described by Baxter and Jack and used Braun and Clarke’s intermediate Q thematic analysis approach. We conducted one key informant interview (KII) and one in-depth interview (IDI) and review of 23 documents obtained from the corporation health department and online sources, including media and social media review. We also did two KIIs with experts and nine IDIs with field workers of the health department of the state. Results: Intervention execution was mainly through inspectorial health teams comprising representatives from multiple sectors, including local governments, law enforcement, and health. Actions included registration, screening, disease surveillance, and care provisioning through regular medical camps. Referral and follow-up through regional health-care centers were consistently made available in Garima. Migrant health programs increasingly focus on living conditions, including hygiene and sanitation, and employers, contractors, or building owners are to take responsibility for these. Conclusions: The Garima project for the health of interstate migrant laborers reflected a shift in the Kerala health system toward welfare rather than disease control and intersectoral coordination. Local governments hold the promise of advancing such interventions and scaling them up across the state.

The impact of the health microinsurance M-FUND on the utilization of health services among migrant workers and their dependents in Thailand: A case-control study

BackgroundEven though Thailand has launched multiple migrant health policies, migrants still face various barriers in accessing health care. To some extent, these barriers may be reduced by health microinsurance. The M-FUND is a low-cost, not-for-profit health protection scheme for migrant workers in Thailand, created by Dreamlopments Social Enterprise and Foundation to support sustainable access to quality healthcare services for migrants. We aimed to investigate the impact of the M-FUND on utilization of health services. MethodsOver a period of three months, we conducted quantitative face-to-face interviews with 408 M-FUND members, and 452 age, sex and location matched non-member controls in Tak Province, Thailand. We compared utilization of health services between members and non-members using logistic regression controlling for a number of socio-demographic variables and variables related to migration such as years in Thailand, legal status, etc. FindingsM-FUND members were more likely to have utilized outpatient services (adjusted odds ratio: 1·74, 95 % confidence interval: 1·24–2·44), inpatient services (2·96, 1.11–7·92), and emergency care (1·89, 0·78–4·56), although the latter was not statistically significant. Members were more likely not to have purchased medicines over-the-counter (1·67, 1·22–2·27) than non-members. Members were also more likely to have utilized any additional specific service during a consultation (2·31, 1·49–3·58) including any type of imaging method (2·62, 1·29–5·29) and blood tests (1·64, 0·99–2·71). There were some differences between men and women, but most were not statistically significant. InterpretationThe M-FUND health microinsurance was positively associated with the utilization of all major types of health services among migrant workers and their dependents in Thailand. For migrants, particularly vulnerable migrant workers and their dependents, the M-FUND appears to be a good approach to reducing barriers to health care. This study of the impact of health microinsurance for migrants provides important information for policy and program planners in the field of migrant health. However, more research is needed on health microinsurance schemes for migrants in different settings and for other underserved communities as well as the sex-specific impact on health service utilization.

Caregivers with limited language proficiency and their satisfaction with paediatric emergency care related to the use of professional interpreters: a mixed methods study

ObjectivesCommunication is a main challenge in migrant health and essential for patient safety. The aim of this study was to describe the satisfaction of caregivers with limited language proficiency (LLP)...

Determinants for the humanitarian workforce in migrant health at the US-Mexico border: optimizing learning from health professionals in Matamoros and Reynosa, Mexico.

Shortages of health professionals is a common problem in humanitarian settings, including among migrants and refugees at the US-Mexico border. We aimed to investigate determinants and recruitment recommendations for working with migrants to better understand how to improve health professional participation in humanitarian efforts. Semi-structured interviews were conducted with health professionals working with migrants at the US-Mexico border in Matamoros and Reynosa, Mexico. The study aimed to identify motivations, facilitators, barriers, and sacrifices to humanitarian work, and recommendations for effective learning approaches to increase participation. Participants included health professionals working within humanitarian organizations to deliver healthcare to migrants living in non-permanent encampments. Interviews lasted approximately 45 min and were analyzed in NVivo14 using a validated codebook and team-based methodology. Among 27 participants, most were female (70%) with median age 32. Health professionals included nurses (41%), physicians (30%), logisticians (11%), social workers (7%), an EMT (4%), and a pharmacist (4%) from the US (59%), Mexico (22%), Cuba (11%), Peru (4%), and Nicaragua (4%) working for four organizations. Participants expressed internal motivations for working with migrants, including a desire to help vulnerable populations (78%), past experiences in humanitarianism (59%), and the need to address human suffering (56%). External facilitators included geographic proximity (33%), employer flexibility (30%), and logistical support (26%). Benefits included improved clinical skills (63%), sociocultural learning (63%), and impact for others (58%). Negative determinants included sacrifices such as career obligations (44%), family commitments (41%), and safety risks (41%), and barriers of limited education (44%) and volunteer opportunities (37%). Participants criticized aspects of humanitarian assistance for lower quality care, feeling useless, and minimizing local capacity. Recommendations to increase the health workforce caring for migrants included integration of humanitarian training for health students (67%), collaborations between health institutions and humanitarian organizations (52%), and improved logistical and mental health support (41%). Health professionals from diverse roles and countries identified common determinants to humanitarian work with migrants. Recommendations for recruitment reflected feasible and collaborative approaches for professionals, organizations, and trainees to pursue humanitarian health. These findings can be helpful in designing interventions to address workforce shortages in humanitarian migrant contexts.

“People are still living with pains of the war”: An assessment of long-term adjustment and consequences of war-related traumatic stress among Liberian refugees

A dearth of empirical research examines the adjustment and wellbeing of long-term refugees in the United States and globally. The goal of this hermeneutic phenomenological needs assessment study was to examine stakeholders’ perceptions of individual, relational, and community-level adjustment in one of the largest Liberian refugee communities in the U.S. Twenty 60–90-minute key informant interviews were conducted and analyzed using hermeneutic phenomenology coding protocols. Six themes emerged in key informants’ perceptions of long-term adjustment and wellbeing among war-affected Liberian refugees: 1) unresolved traumatic stress, 2) substance use, 3) mental health stigma, 4) adverse relational effects, 5) disrupted community dynamics, and 6) lack of access to culturally relevant services. This study expands on refugee and global mental health research by empirically documenting adjustment experiences in a long-term and underrepresented refugee community, which can inform prevention and intervention efforts with communities displaced from war. Clinical, research, and policy implications are also described alongside efforts to enhance support for refugees across their adjustment phases. (162 words)

Understanding mental health service needs and treatment characteristics for Latin American immigrants and refugees: A focus on CBT strategies for reducing acculturative stress

Abstract Acculturative stress is a key social driver of health impacting the mental health of immigrants and refugees from Latin America, which contributes to inequities experienced by them. While there is a robust scientific literature describing and evaluating evidence-based treatments targeting a range of psychiatric disorders, these treatments often do not primarily target acculturative stress. Thus, the present study examined how psychotherapists ought to treat acculturative stress directly in their clinical practice. Ten therapists were interviewed using a qualitative descriptive approach. Rapid contemporary content analysis was used to describe Latino/Hispanic immigrants’ most common presenting problems, the context in which they provide care for these problems, and the psychotherapeutic approaches currently utilized or considered effective in mitigating acculturative stress. Findings revealed that common mental health conditions that therapists addressed among this population, including depression, anxiety and trauma-related somatization, including the unique context in which therapy was delivered. Additionally, specific strategies for addressing acculturative stress such as the importance of acknowledging this stressor, drawing out immigration journey narratives, and behavioural activation approaches were shared. The results from this study can be used to improve the effectiveness of mental health interventions addressing acculturative stress among immigrant and refugee populations. Key learning aims (1) To explore how acculturative stress represents a key driver of mental health for immigrants and refugees from Latin America. (2) To consider ways that cognitive behavioural therapy (CBT) elements can be applied to treating acculturative stress and mental health problems among immigrants and refugees from Latin America. (3) To expand upon strategies that can be helpful in rapport-building and establishing trust with patients who are struggling with acculturative stress.

Public policies and access to health of migrants and refugees during the Covid-19 pandemic: compared global perspective

Resumo Trata-se de uma Revisão Integrativa, com recorte entre 2020 e 2022, com objetivo de análise das políticas públicas globais implementadas durante a pandemia de Covid-19 para salvaguardar a saúde e os direitos humanos de migrantes e refugiados. A análise foi baseada em 24 artigos de 424 recuperados das bases de dados: Pubmed, Scopus, BVS e Wiley. A partir da análise, emergiram três eixos temáticos: Saúde, Trabalho e Proteção Social. As medidas adotadas pelos Estados foram múltiplas e heterogêneas, variando a cada realidade e status migratório dos indivíduos, como forma de oportunizar ou privar seu acesso às políticas de saúde, trabalho e seguridade social. Dessa forma, tais políticas também serviram como processos de estratificação e controle biopolítico. Portanto, é necessário superar barreiras estruturais e dirimir desigualdades, combater a xenofobia e o racismo, e aplicar plenamente os dispositivos dos tratados internacionais e proteger essas populações contra o arbítrio.

Factors contributing to the mental wellbeing of Afghan migrants in Iran during the COVID-19 pandemic

This study aims to explore the factors contributing mental health of Afghan migrants residing in Iran during the COVID-19 pandemic. With a deep understanding of the unique challenges encountered by migrants, especially during times of crisis, this research delves into the influential factors of experienced anxiety, social cohesion, and stress and their significant contribution to the development of depression among Afghan migrants. The study included a sample of 469 individuals from the Afghan migrant community, aged 15 to 80 years. Data collection took place from December to March 2022 in Iran. The study revealed that anxiety and the burden of the COVID-19 pandemic significantly influenced the occurrence of depression among Afghan migrants. Furthermore, the relationship between these factors and depression was mediated by the experience of stress. Conversely, higher levels of perceived social cohesion in the host country were linked to reduced stress and depression among the migrants. As Afghan migrants in Iran face a heightened risk of developing depression, the importance of social support and integration is underscored by the association between higher levels of perceived social cohesion in the host country and reduced levels of stress and depression. Recognizing the vulnerabilities of this population, it becomes evident that fostering social support networks and promoting integration can play a crucial role in mitigating the negative impact of migration-related stressors and enhancing mental wellbeing among this population.