Neighborhood social composition and refugee mental health – quasi-experimental evidence of associations from a Danish population register study

Abstract

Background 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 important. This is the first longitudinal study to examine this question for refugees and uses a novel quasi-experimental design. Methods We followed a cohort of 44 033 refugees from being first assigned housing under the Danish dispersal policy, operating from 1986 to 1998, until 2019. This comprised, in effect, a natural experiment whereby the influence of assigned neighborhood could be determined independently of endogenous factors. We examined three aspects of neighborhood social composition: proportion of co-nationals, refugees, and first-generation migrants; and subsequent incidence of different mental disorders. Results Refugees assigned to neighborhoods with fewer co-nationals (lowest v. highest quartile) were more likely to receive a subsequent diagnosis of non-affective psychosis, incident rate ratio (IRR) 1.25 (95% confidence interval (CI) 1.06–1.48), and post-traumatic stress disorder (PTSD), IRR 1.21 (95% CI I.05–1.39). A comparable but smaller effect was observed for mood disorders but none observed for stress disorders overall. Neighborhood proportion of refugees was less clearly associated with subsequent mental disorders other than non-affective psychosis, IRR 1.24 (95% CI 1.03–1.50). We found no statistically significant associations with proportion of migrants. Conclusions For refugees, living in a neighborhood with a lower proportion of co-nationals is related to subsequent increased risk of diagnosed mental disorders particularly non-affective psychosis and PTSD.

Yonder: Rural generalists, mental health of refugees, end-of-career GP reflections, and lung ultrasonography

“…This Danish study aimed to understand the impact of neighbourhood composition, which is particularly sensitive to these policies, on the risk of mental health diagnoses. 2 For refugees subject to the Danish dispersal policy from 1986-1998, being assigned to a neighbourhood with a lower density of people of shared national origin was associated with a slightly increased risk of non-affective psychosis and PTSD. The authors suggest this may be due to reduced social support and social capital, an important consideration when policies are designed and implemented.…”