Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, 5020, Bergen, Norway.
Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, 5020, Bergen, Norway; Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.
Public Health. 2020 Sep;186:240-245. doi: 10.1016/j.puhe.2020.07.016. Epub 2020 Aug 28.
Conflict-driven displacement is an indisputable social determinant of health. Yet, data on changes in health along the migration trajectories of refugees are scarce. This study aims to assess the longitudinal changes in somatic and mental health and use of medication among Syrian refugees relocating from a conflict-near transit setting in the Middle East to a resettlement setting in Europe. Further, we examine different health status trajectories and factors that predict health in the early postmigration period.
This is a prospective cohort study.
Survey data were collected during 2017-2018 among adult Syrian refugees in Lebanon selected for quota resettlement and at follow-up approximately one year after resettlement in Norway. Our primary outcomes were non-communicable disease (NCD), chronic impairment, chronic pain, anxiety/depression, post-traumatic stress symptoms, and daily use of drugs. We estimated longitudinal changes in prevalence proportions using generalized estimating equations and evaluated effect modification of health outcomes.
Altogether, 353 Syrians participated. NCDs declined (12%-9%), while the prevalence of chronic impairment, chronic pain, and use of drugs remained nearly unchanged (29%-28%, 30%-28%, and 20%-18%) between baseline and follow-up. Conversely, mental health outcomes improved (anxiety/depression 33%-11%, post-traumatic stress disorder 5%-2%). Effect modifiers for improvement over time included younger age, short length of stay, and non-legal status in the transit country before resettlement in Europe.
We find that mental health outcomes improve from a conflict-near transit setting in Lebanon to an early resettlement setting in Norway, while somatic health outcomes remain stable. Temporal changes in health among moving populations warrant attention, and long-term changes need further scrutiny.
冲突驱动的流离失所是健康的一个不可争议的社会决定因素。然而，关于难民在移民轨迹中健康变化的数据却很少。本研究旨在评估从中东冲突临近过境地区向欧洲重新安置地区迁移的叙利亚难民的躯体和心理健康以及用药情况的纵向变化。此外，我们还研究了不同的健康状况轨迹和预测早期移民后健康状况的因素。
这是一项前瞻性队列研究。
2017-2018 年，在黎巴嫩，我们对通过配额重新安置选择的成年叙利亚难民进行了调查，大约在重新安置到挪威一年后进行了随访。我们的主要结局是非传染性疾病（NCD）、慢性损伤、慢性疼痛、焦虑/抑郁、创伤后应激症状和每日用药。我们使用广义估计方程估计流行率的纵向变化，并评估健康结果的效应修饰。
共有 353 名叙利亚人参与。NCD 的患病率下降（12%-9%），而慢性损伤、慢性疼痛和药物使用的患病率在基线和随访之间几乎保持不变（29%-28%、30%-28%和 20%-18%）。相反，心理健康结果有所改善（焦虑/抑郁 33%-11%，创伤后应激障碍 5%-2%）。随时间改善的效应修饰因素包括年龄较小、在进入欧洲重新安置之前在过境国停留时间较短和非法律地位。
我们发现，从黎巴嫩的冲突临近过境地区到挪威的早期重新安置地区，心理健康结果有所改善，而躯体健康结果保持稳定。流动人口的健康随时间变化值得关注，长期变化需要进一步研究。
