Living Conditions and the Mental Health and Well-being of Refugees: Evidence from a Large-Scale German Survey
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ORIGINAL PAPER
Living Conditions and the Mental Health and Well‑being of Refugees: Evidence from a Large‑Scale German Survey Lena Walther1,2 · Lukas M. Fuchs2 · Jürgen Schupp2,3 · Christian von Scheve2,3
© The Author(s) 2020
Abstract Refugees are at an increased risk of mental health problems and low subjective well-being. Living circumstances in the host country are thought to play a vital role in shaping these health outcomes, which, in turn, are prerequisites for successful integration. Using data from a representative survey of 4325 adult refugees who arrived in Germany between 2013 and 2016, we investigated how different living conditions, especially those subject to integration policies, are associated with psychological distress and life satisfaction using linear regression models. Our findings show that an uncertain legal status, separation from family, and living in refugee housing facilities are related to higher levels of distress and decreased life satisfaction. Being employed, contact to members of the host society, and better host country language skills, by contrast, are related to reduced distress and higher levels of life satisfaction. These associations should inform decision making in a highly contested policy area. Keywords Refugees · Mental health · Well-being · Integration
Introduction Research has consistently shown that refugees are at a particular risk of facing mental health problems (reviewed in [1–5]). Despite a substantial between-study heterogeneity in refugees’ mental illness prevalence rates, forced migration has persistently been linked to increased rates of mental illnesses, chiefly, post-traumatic stress disorder (PTSD), depression, and anxiety disorder [5–7]. Even considering that those who embark on flight are likely to exhibit resilience (‘Healthy Immigrant Effect’ [8]), refugees are particularly at risk of facing psychological distress as sequelae Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10903-019-00968-5) contains supplementary material, which is available to authorized users. * Lena Walther [email protected] 1
Clinic for Psychiatry and Psychotherapy, Charité – University Medicine Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
2
Institute of Sociology, Freie Universität Berlin, Berlin, Germany
3
German Institute for Economic Research, Socioeconomic Panel, Berlin, Germany
of traumatic or stressful experiences before or during flight [4, 9, 10]. However, studies also indicate that the refugee mental health burden has roots beyond discrete traumatic experiences or the experience of displacement. A review of studies on refugee mental health and its predictors shows that the psychological burden of the refugee experience is substantially elevated even when refugee mental health is compared to the mental health of other groups exposed to war and violence [11]. Studies based on large-scale survey data have also shown substantially lower levels of overall subjective well-being amongst immigrant po
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