Social integration and mental health - a decomposition approach to mental health inequalities between the foreign-born and native-born in Sweden
Social integration and mental health - a decomposition approach to mental health inequalities between the foreign-born and native-born in Sweden
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DOI：
10.1186/s12939-019-0950-1
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发表时间：
2019-04-03
影响因子：
4.8
通讯作者：
Dunlavy, Andrea
中科院分区：
文献类型：
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作者：
Brydsten, Anna;Rostila, Mikael;Dunlavy, Andrea
背景：瑞典本土出生者和外国出生者之间日益严重的心理健康不平等是一个重要的公共卫生问题。人们强调改善社会融合是应对这一发展的关键战略。虽然大量研究证实了社会融合对良好心理健康的重要性，但人们对不同类型的社会融合的作用以及它们与心理健康不平等的关系知之甚少。本研究旨在探讨社会融合指标在多大程度上解释本土出生者和外国出生者之间的心理健康不平等。 方法：根据 2011/2015 年瑞典西约塔兰省 (n=71,643) 的平等健康调查，对来自北欧、欧洲和非欧洲国家的本土和外国出生者进行了非线性瓦哈卡-布林德分解分析。一般健康问卷用于评估心理困扰，同时有 11 个项目评估就业条件和经济差异、社会关系和歧视经历，以衡量社会融合的不同方面。结果：社会融合的差异解释了大部分观察到的本土出生和外国出生的心理健康差异。重要指标包括社会活动水平低（20%）、对他人的信任度（17%）和社会支持（16%），但也包括劳动力市场的劣势，例如处于劳动力市场之外（15%）、失业（10%）和面临财务压力（16%）。在按原籍地区分层的分析中，对他人的低信任度和歧视导致了本土出生和欧洲出生（分别为 17% 和 9%）以及本土出生和非欧洲出生（分别为 19% 和 10%）之间的心理健康差距。不稳定的劳动力市场地位是本地出生和北欧血统（22%）以及非欧洲血统（36%）人口之间心理健康差距的一个特别重要的因素。结论：社会融合因素在解释瑞典本地人和移民之间的心理健康不平等方面发挥着核心作用。我们的研究结果表明，针对心理健康差距的公共卫生行动可以受益于关注瑞典本地人和移民之间社会和经济资源的不平等。优先领域包括改善移民的经济压力，以及增加对他人的信任以及社会支持和公民参与的机会。
Background: The increasing mental health inequalities between native- and foreign-born persons in Sweden is an important public health issue. Improving social integration has been stressed as a key strategy to combat this development. While a vast amount of studies have confirmed the importance of social integration for good mental health, less is known about the role of different types of social integration, and how they relate to mental health inequalities. This study aimed to examine the extent to which indicators of social integration explained mental health inequalities between the native- and foreign-born.Methods: Based on the Health on Equal Terms survey from 2011/2015 in Vastra Gotaland, Sweden (n=71,643), a non-linear Oaxaca-Blinder decomposition analysis was performed comparing native- and foreign-born individuals from Nordic-, European- and non-European countries. The General Health Questionnaire was used to assess psychological distress, while 11 items assessed employment conditions and economic disparities, social relations, and experiences of discrimination to measure different aspects of social integration.Results: Differences in social integration explained large proportions of observed mental health differences between the native- and foreign-born. Important indicators included low levels of social activity (20%), trust in others (17%) and social support (16%), but also labour market disadvantages, such as being outside the labour market (15%), unemployment (10%) and experiencing financial strain (16%). In analyses stratified by region of origin, low trust in others and discrimination contributed to the mental health gap between the native-born and European-born (17 and 9%, respectively), and the native-born and non-European-born (19 and 10%, respectively). Precarious labour market position was a particularly important factor in the mental health gap between the native-born and Nordic-origin (22%), and non-European origin (36%) populations.Conclusion: Social integration factors play a central role in explaining the mental health inequality between natives and migrants in Sweden. Our findings suggest that public health actions targeting mental health gaps could benefit from focusing on inequalities in social and economic recourses between natives and migrants in Sweden. Areas of priority include improving migrants' financial strain, as well as increasing trust in othersand social support and opportunities for civic engagement.