Where refugees live affects their long-term mental health

A recently published study led by Dr Peter Schofield found that refugees living in areas with a higher proportion of refugees from the country were less likely to be diagnosed with mental illnesses such as schizophrenia and post-traumatic stress disorder (PTSD). The study is published in the journal Neurology. Psychology.

Refugees are at higher risk of mental illness, with research highlighting the contributing effects of post-migration factors. Studies of immigrant groups have shown that neighborhood social composition, such as ethnic density, is an important factor. However, despite the potential relevance of social composition, only one study to date on neighborhood ethnic density has looked specifically at refugees.

The study is the first longitudinal study to explore this issue for refugees, following 44,033 refugees from the time they were first allocated housing under the Danish deconcentration policy (which ran from 1986 to 1998) until 2019. For refugees, this policy meant that housing was allocated solely on the basis of a short questionnaire filled out upon arrival.

“Our study included all refugees who relocated to Denmark over a 12-year period. A strength of our study design is that we exploited the fact that refugees are allocated housing without meeting the housing authority, which meant we were able to examine the impact of where refugees are sent to live on their mental health, independent of other confounding factors,” says Dr Schofield, Senior Lecturer in Population Health in the School of Population Health Sciences.

The policy is a natural experiment, and the effects of assigned neighborhoods can be determined independently of endogenous factors, meaning that under the policy refugees are equally likely to be placed in neighborhoods with high or low proportions of their compatriots, and assumptions can be made about how the population is classified.

The researchers looked at three aspects of the social composition of the neighbourhoods, including the proportion of compatriots, refugees and first-generation immigrants, and then compared this with data from the Danish Central Psychiatric Register, which includes all psychiatric inpatients and outpatient consultations since 1995.

“Our research looks at where refugees end up and how that affects their mental health. We find that when refugees live in neighbourhoods with a high proportion of people from their home country, they are significantly less likely to be diagnosed with mental illnesses such as schizophrenia, bipolar disorder and post-traumatic stress disorder (PTSD). We find that simply living in an area with other immigrants makes little or no difference,” Dr Schofield said.

Although an association was found between diagnosis and number of co-nationals, no significant association was found between the overall proportion of immigrants and subsequent diagnosis.

The authors suggest that the results suggest that more attention should be paid to the social composition of neighbourhoods as a potentially protective or controlling factor for refugee mental health, and that future dispersal policies should take into account the potential impacts on mental health suggested by the study’s findings.