Where refugees live matters to their long term mental health

A recently published study led by Dr. Peter Schofield found that refugees living in a neighborhood with a higher proportion of co-nationals were less likely to be diagnosed with a psychotic disorder, like schizophrenia, or post-traumatic stress disorder (PTSD). The study is published in the journal Psychological Medicine.

Refugees are at an elevated risk of some mental disorders with studies highlighting the contributing role of post-migration factors. Studies of migrant groups show neighborhood social composition, such as ethnic density, to be an important factor. However, despite the potential relevance of social composition, only one neighborhood ethnic density study to date has looked specifically at refugees.

The study, the first longitudinal study to examine this question for refugees, followed a cohort of 44,033 refugees from being first assigned housing under the Danish dispersal policy (operating from 1986 to 1998) until 2019. For refugees the policy allocated housing based solely on a brief questionnaire completed on arrival.

"Our study looked at all refugees moving to Denmark over a 12-year period. A strength of our study design was that we took advantage of the fact that refugees were assigned housing without ever meeting housing officials. This meant we could look at the influence of where they were sent to live on their mental health independently of other confounding factors," said Dr. Schofield, Senior Lecturer in Population Health, Department of Population Health Sciences.

The policy comprised a natural experiment, whereby the influence of assigned neighborhood could be determined independently of internal factors. This meant that assumptions could be made on how the cohort would be sorted, with refugees under the policy equally likely to be housed in areas with a higher or lower proportion of co-nationals.

The researchers examined three aspects of neighborhood social composition, including the proportion of co-nationals, refugees and first-generation migrants. This was then compared with data from the Danish Psychiatric Central Register, including all psychiatric in-patient admissions and, since 1995, all out-patient visits.

"In our study we look at the type of places where refugees end up living and how this can influence their mental health. We found that refugees in neighborhoods with more people from their own country were noticeably less likely to be diagnosed with a psychotic disorder, like schizophrenia or bipolar disorder, or post-traumatic stress disorder (PTSD). It was noticeable that simply living in an area with other migrants made little difference," said Dr. Schofield.

Although a link was identified between diagnosis and the number of co-nationals, it was found there was no significant associations between the proportion of migrants overall and subsequent diagnosis.

The authors suggests that the results imply that more attention should be paid to neighborhood social composition as a potentially protective and controllable factor for refugee mental health. Suggesting that future dispersal policies should consider the potential mental health consequences implied by the study results.