Pre-migration socioeconomic status and post-migration health satisfaction among Syrian refugees in Germany: A cross-sectional analysis


Autoři: Jan Michael Bauer aff001;  Tilman Brand aff002;  Hajo Zeeb aff002
Působiště autorů: Department of Management, Society and Communication, Copenhagen Business School, Copenhagen, Denmark aff001;  Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany aff002;  Health Sciences Bremen, University of Bremen, Bremen, Germany aff003
Vyšlo v časopise: Pre-migration socioeconomic status and post-migration health satisfaction among Syrian refugees in Germany: A cross-sectional analysis. PLoS Med 17(3): e32767. doi:10.1371/journal.pmed.1003093
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003093

Souhrn

Background

The large increase in numbers of refugees and asylum seekers in Germany and most of Europe has put the issue of migration itself, the integration of migrants, and also their health at the top of the political agenda. However, the dynamics of refugee health are not yet well understood. From a life-course perspective, migration experience is associated with various risks and changes, which might differ depending on the socioeconomic status (SES) of refugees in their home country. The aim of this paper was to analyze the relationship between pre-migration SES and self-reported health indicators after migration among Syrian refugees. Specifically, we wanted to find out how their SES affects the change in health satisfaction from pre- to post-migration.

Methods and findings

We used data from the 2016 refugee survey, which was part of the German Socio-Economic Panel (GSOEP). Although cross-sectional by design, this survey collected information referring to the current situation as a refugee in Germany as well as to their situation before migration. Using a sample of 2,209 adult Syrian refugees who had entered Germany between 2013 and 2016, we conducted a cross-sectional and a quasi-longitudinal (retrospective) analysis. The mean ± SD age was 35 ± 11 years, with 64% of the participants being male. Our results showed a positive association between pre-migration self-reported SES and several subjective health indicators (e.g., health satisfaction, self-reported health, mental health) in the cross-sectional analysis. However, the quasi-longitudinal analysis revealed that the socioeconomic gradient in health satisfaction before migration was strongly attenuated after migration (SES-by-time interaction: −0.48, 95% CI −0.61 to −0.35, p < 0.001; unstandardized regression coefficients, 5-point SES scale and 11-point health outcome scale). Similar results were produced after controlling for sociodemographic characteristics, experiences during the migration passage, and the current situation in Germany. A sex-stratified analysis showed that while there was some improvement in health satisfaction among men from the lowest SES over time, no improvement was found among women. A limitation of this study is that it considers only the first months or years after migration. Thus, we cannot preclude that the socioeconomic gradient regains importance in the longer run.

Conclusions

Our findings suggest that the pre-migration socioeconomic gradient in health satisfaction is strongly attenuated in the first years after migration among Syrian refugees. Hence, a high SES before crisis and migration provides limited protection against the adverse health effects of migration passage.

Klíčová slova:

Behavioral and social aspects of health – Economics of migration – Germany – Health statistics – Children – Mental health and psychiatry – Socioeconomic aspects of health – Syria


Zdroje

1. IOM. World Migration Report 2018 | International Organization for Migration. 2018 [cited 2020 Feb 24]. Available from: http://www.iom.int/wmr/world-migration-report-2018

2. United Nations, Department of Economic and Social Affairs, Population Division. International Migration Report 2017: Highlights. 2017 [cited 2020 Feb 24]. Available from: https://www.un.org/development/desa/publications/international-migration-report-2017.html

3. Lindert J, Ehrenstein OS vo., Priebe S, Mielck A, Brähler E. Depression and anxiety in labor migrants and refugees—A systematic review and meta-analysis. Soc Sci Med. 2009;69: 246–257. doi: 10.1016/j.socscimed.2009.04.032 19539414

4. Brady H, Humphris R, Newall D, Phillimore J. Public health aspects of migrant health: a review of the evidence on health status for refugees and asylum seekers in the European Region. Copenhagen WHO Reg Off Eur (Health Evid Netw synth report 44). 2015.

5. Abbas M, Aloudat T, Bartolomei J, Carballo M, Durieux-Paillard S, Gabus L, et al. Migrant and refugee populations: A public health and policy perspective on a continuing global crisis. Antimicrob Resist Infect Control. 2018;7: 1–11. doi: 10.1186/s13756-017-0291-z

6. OECD. 2019 International Migration and Displacement Trends and Policies Report to the G20. 2019; 35 [cited 2020 Feb 24]. Available from: http://www.oecd.org/migration/mig/G20-migration-and-displacement-trends-and-policies-report-2019.pdf

7. WHO. Promoting the health of refugees and migrants (Resolution 70.15). Seventieth World Heal Assem. 2017;1: 1–11.

8. Commission EU. Communication from the Commission to the European Parliament, the European Council and the Council: Progress report on the implementation of the European Agenda on Migration. 2019;53: 1689–1699.

9. Spallek J, Zeeb H, Razum O. What do we have to know from migrants’ past exposures to understand their health status? A life course approach. Emerg Themes Epidemiol. 2011;8: 1–8. doi: 10.1186/1742-7622-8-1

10. Razum O, Wenner J, Bozorgmehr K. [When Chance Decides About Access to Health Care: The Case of Refugees in Germany]. Wenn Zufall über den Zugang zur Gesundheitsversorgung bestimmt: Geflüchtete in Deutschland. Gesundheitswesen. 2016;78: 711–714. doi: 10.1055/s-0042-116231 27756088

11. Präg P, Mills MC, Wittek R. Subjective socioeconomic status and health in cross-national comparison. Soc Sci Med. 2016;149: 84–92. doi: 10.1016/j.socscimed.2015.11.044 26708244

12. Cutler DM, Lleras-Muney A, Vogl T. Socioeconomic Status and Health: Dimensions and Mechanisms. In: Glied S and Smith PC, editors. The Oxford Handbook of Health Economics. 2012. (doi: 10.1093/oxfordhb/9780199238828.013.0007)

13. Sen K, Al-Faisal W, Alsaleh Y. Syria: Effects of conflict and sanctions on public health. J Public Heal (United Kingdom). 2013;35: 195–199.

14. Ghobarah HA, Huth P, Russett B. The post-war public health effects of civil conflict. Soc Sci Med. 2004;59: 869–884. doi: 10.1016/j.socscimed.2003.11.043 15177842

15. Justino P, Brück T, Verwimp P. Micro-Level Dynamics of Conflict, Violence, and Development: A New Analytical Framework. In: Justino P, Brück T, Verwimp P, editors. A Micro-Level Perspective on the Dynamics of Conflict, Violence and Development. Oxford University Press, Oxford; 2013. pp. 2–29.

16. Bundervoet T, Verwimp P, Akresh R. Health and Civil War in Rural Burundi. J Hum Resour. 2008;44: 536–563.

17. Lundberg J, Kristenson M, Starrin B. Status incongruence revisited: Associations with shame and mental wellbeing. Sociol Heal Illn. 2009;31: 478–493.

18. Aleksynska M, Tritah A. Occupation-education mismatch of immigrant workers in Europe: Context and policies. Econ Educ Rev. 2013;36: 229–244.

19. Kroh M, Kühne S, Jacobsen J, Siegert M, Siegers R. Sampling, Nonresponse, and Integrated Weighting of the 2016 IAB-BAMF-SOEP Survey of Refugees (M3/M4), revised version. SOEP Surv Pap. 2017; 477.

20. Kühne S, Jacobsen J, Kroh M. Sampling in Times of High Immigration: The Survey Process of the IAB-BAMF-SOEP Survey of Refugees. Surv Methods Insights from the Field. 2019; 1–9.

21. DIW. IAB-BAMF-SOEP Survey of Refugees 2016. 2018. doi: 10.5684/soep.iab-bamf-soep-mig.2016

22. Löwe B, Wahl I, Rose M, Spitzer C, Glaesmer H, Wingenfeld K, et al. A 4-item measure of depression and anxiety: Validation and standardization of the Patient Health Questionnaire-4 (PHQ-4) in the general population. J Affect Disord. 2010;122: 86–95. doi: 10.1016/j.jad.2009.06.019 19616305

23. Tibubos AN, Beutel ME, Schulz A, Klein EM, Brähler E, Michal M, et al. Is assessment of depression equivalent for migrants of different cultural backgrounds? Results from the German population-based Gutenberg Health Study (GHS). Depress Anxiety. 2018;35: 1178–1189. doi: 10.1002/da.22831 30156742

24. Bardo AR, Yamashita T. Validity of Domain Satisfaction Across Cohorts in the US. Soc Indic Res. 2014;117: 367–385.

25. Idler EL, Benyamini Y. Self-Rated Health and Mortality: A Review of Twenty-Seven Community Studies. J Health Soc Behav. 1997;38: 21–37. 9097506

26. Adler NE, Epel E, Casterllazzo G, Ickovics J. Relationship of subjective and objective social status with psychological and physical health in healthy white women. Heal Psychol. 2000;19: 586–592.

27. Evans MDR. Subjective Social Location: Data From 21 Nations. Int J Public Opin Res. 2004;16: 3–38.

28. Demakakos P, Nazroo J, Breeze E, Marmot M. Socioeconomic status and health: The role of subjective social status. Soc Sci Med. 2008;67: 330–340. doi: 10.1016/j.socscimed.2008.03.038 18440111

29. Elgar FJ, McKinnon B, Torsheim T, Schnohr CW, Mazur J, Cavallo F, et al. Patterns of Socioeconomic Inequality in Adolescent Health Differ According to the Measure of Socioeconomic Position. Soc Indic Res. 2016;127: 1169–1180.

30. Nobles J, Weintraub MR, Adler NE. Subjective socioeconomic status and health: Relationships reconsidered. Soc Sci Med. 2013;82: 58–66. doi: 10.1016/j.socscimed.2013.01.021 23453318

31. Hoebel J, Maske UE, Zeeb H, Lampert T. Social inequalities and depressive symptoms in adults: The role of objective and subjective socioeconomic status. PLoS ONE. 2017;12(1): e0169764. https://doi.org/10.1371/journal.pone.0169764

32. Hoebel J, Lampert T. Subjective social status and health: Multidisciplinary explanations and methodological challenges. J Health Psychol. 2020;25: 173–185 doi: 10.1177/1359105318800804 30230391

33. Macleod J, Davey G, Metcalfe C, Hart C, Smith GD, Metcalfe C, et al. Is subjective social status a more important determinant of health than objective social status? Evidence from a prospective observational study of Scottish men. Soc Sci Med. 2005;61: 1916–1929. doi: 10.1016/j.socscimed.2005.04.009 15916842

34. Cundiff JM, Matthews KA. Is subjective social status a unique correlate of physical health? A meta-analysis. Heal Psychol. 2017;36: 1109–1125.

35. Ostrove JM, Adler NE, Kuppermann M, Washington AE. Objective and subjective assessments of socioeconomic status and their relationship to self-rated health in an ethnically diverse sample of pregnant women. Heal Psychol. 2000;19: 613–618.

36. Cundiff JM, Smith TW, Uchino BN, Berg CA. Subjective social status: Construct validity and associations with psychosocial vulnerability and self-rated health. Int J Behav Med. 2013;20: 148–158. doi: 10.1007/s12529-011-9206-1 22200973

37. Singh-Manoux A, Adler NE, Marmot MG. Subjective social status: Its determinants and its association with measures of ill-health in the Whitehall II study. Soc Sci Med. 2003;56: 1321–1333. doi: 10.1016/s0277-9536(02)00131-4 12600368

38. Ferrer-i-Carbonell A, Frijters P. How Important is Methodology for the estimates of the determinants of Happiness? Econ J. 2004;114: 641–659.

39. Stillman S, McKenzie D, Gibson J. Migration and mental health: Evidence from a natural experiment. J Health Econ. 2009;28: 677–687. doi: 10.1016/j.jhealeco.2009.02.007 19349087

40. Straiton ML, Reneflot A, Diaz E. Mental Health of Refugees and Non-refugees from War-Conflict Countries: Data from Primary Healthcare Services and the Norwegian Prescription Database. J Immigr Minor Heal. 2017;19: 582–589.

41. Gezie LD, Yalew AW, Gete YK, Azale T, Brand T, Zeeb H. Socio-economic, trafficking exposures and mental health symptoms of human trafficking returnees in Ethiopia: using a generalized structural equation modelling. Int J Ment Health Syst. 2018;12:62. doi: 10.1186/s13033-018-0241-z 30386421

42. Phelan JC, Link BG, Tehranifar P. Social Conditions as Fundamental Causes of Health Inequalities: Theory, Evidence, and Policy Implications. J Health Soc Behav. 2010;51: 28–40.

43. Kherallah M, Sahloul Z, Jamil G, Alahfez T, Eddin K. Health care in Syria before and during the crisis. Avicenna J Med. 2012;2: 51–53. doi: 10.4103/2231-0770.102275 23826546

44. Peter R, Gässler H, Geyer S. Socioeconomic status, status inconsistency and risk of ischaemic heart disease: A prospective study among members of a statutory health insurance company. J Epidemiol Community Health. 2007;61: 605–611. doi: 10.1136/jech.2006.047340 17568052

45. Rasmussen A, Crager M, Baser R, Chu T, Gany F. Onset of posttraumatic stress disorder and major depression among refugees and voluntary migrants to the United States. J Trauma Stress. 2012;25: 705–712. doi: 10.1002/jts.21763 23184423

46. Stillman S, Gibson J, McKenzie D, Rohorua H. Miserable migrants? Natural experiment evidence on international migration and objective and subjective well-being. World Dev. 2015;65: 79–93.

47. von Werthern M, Grigorakis G, Vizard E. The mental health and wellbeing of Unaccompanied Refugee Minors (URMs). Child Abus Negl. 2019;98: 104146.

48. Huang IC, Frangakis C, Atkinson MJ, Willke RJ, Leite WL, Vogel WB, et al. Addressing ceiling effects in health status measures: A comparison of techniques applied to measures for people with HIV disease. Health Serv Res. 2008;43: 327–339. doi: 10.1111/j.1475-6773.2007.00745.x 18211533

49. Beegle K, Himelein K, Ravallion M. Frame-of-reference bias in subjective welfare. J Econ Behav Organ. 2012;81: 556–570.

50. Brickman P, Campbell DT. Hedonic relativism and planning the good society. In: Appley MH, editor. Adaptation level theory A symposium. Cambridge, Mass.: Academic Press; 1971. pp. 287–302.

51. Luhmann M, Hofmann W, Eid M, Lucas RE. Subjective well-being and adaptation to life events: A meta-analysis. J Pers Soc Psychol. 2012;102: 592–615. doi: 10.1037/a0025948 22059843

52. Bauer JM, Cords D, Sellung R, Sousa-Poza A. Effects of different life events on life satisfaction in the Russian Longitudinal Monitoring Survey. Econ Lett. 2015;129: 91–94.

Štítky
Interní lékařství

Článek vyšel v časopise

PLOS Medicine


2020 Číslo 3

Nejčtenější v tomto čísle

Tomuto tématu se dále věnují…


Kurzy Doporučená témata Časopisy
Přihlášení
Zapomenuté heslo

Nemáte účet?  Registrujte se

Zapomenuté heslo

Zadejte e-mailovou adresu se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.

Přihlášení

Nemáte účet?  Registrujte se

VIRTUÁLNÍ ČEKÁRNA ČR Jste praktický lékař nebo pediatr? Zapojte se! Jste praktik nebo pediatr? Zapojte se!

×