A Cross-National Study of the Role of Neighbourhood Context in the Mental Health of Refugees

我们正处于全球难民危机之中，由于战争或迫害而被迫逃离原籍国的人数以比以往任何时候都更快的速度增长。这也是一场精神健康危机，据报道，近十分之一的难民患有创伤后应激障碍。难民也更有可能长期患有严重的精神疾病，精神分裂症等障碍的发病率是普通人口的三倍。我们已经知道，移民总体上精神障碍的风险更大，一些卫生专家将其描述为公共卫生悲剧。难民面临的风险更大，尽管与其他类型的移民相比，我们对难民抵达后对他们心理健康的影响知道得更少。但我们确实知道，难民发现自己生活的环境可能会对他们的心理健康产生影响。这一点特别重要，因为虽然我们不能改变导致难民逃离本国的创伤性事件，但我们可以影响他们目前的处境。然而，这确实取决于我们对难民心理健康的重要性的良好理解，这也是本研究的动机。这项研究将集中在难民所居住的地区的类型，以及邻里特征对他们的心理健康可能是如何重要的。这一点很重要，因为难民往往很少或根本无法控制他们的居住地，而且，根据我们对移民总体情况的研究，生活在特定类型的社区会影响他们的心理健康。大量研究表明，来自自己种族背景的人较少的地区的移民表现出较高的精神障碍发生率。从对普通人群的研究中，我们还知道，某些类型的社区；通常是那些更城市化、更贫穷和更不稳定的社区，与较差的精神健康有关。这些地区往往正是难民发现自己所居住的地区。然而，到目前为止，还没有研究关注难民可能会受到他们居住的地方的影响。这项拟议的研究将以多种方式对此进行调查。这项研究的第一部分将使用在大约30年的时间里收集的所有儿童时期抵达丹麦的难民的健康记录。这将与一系列数据来源相联系，使我们能够建立一幅他们所居住的社区可能如何影响他们的心理健康的图景。我之所以选择丹麦，是因为丹麦是少数几个长期大规模收集难民心理健康数据的国家之一，此前的研究表明，丹麦和英国的邻里关系对心理健康的影响类似。丹麦也有难民疏散政策，这意味着难民被送到各种各样的不同社区生活，就像英国一样，然后可以比较它们的效果。这项研究的第二部分将着眼于英国的难民，集中在一个特定地区(伦敦东南部的兰贝斯)的一个难民群体(来自索马里)。索马里人是英国最大的难民群体之一，这部分研究将考察他们的经历，他们的问题与丹麦的研究相同，但使用了更详细的当地数据。我们将使用该行政区所有患者的全科医生记录，这些记录也与精神病记录和人口普查数据相关联，这些数据告诉我们他们所居住的地区的类型。健康记录所能告诉我们的关于人们居住的地方会影响他们心理健康的潜在原因是有限的。因此，研究的第三部分将涉及采访兰贝斯索马里居民，以更多地了解他们如何看待自己的社区，以及他们认为社区对心理健康和福祉的重要性。

We are in the middle of a global refugee crisis with the number of people forced to flee their country of origin as a result of war or persecution increasing at a faster rate than ever before. This is also a mental health crisis with nearly 1 in 10 refugees reported to be suffering post-traumatic stress disorder. Refugees are also more likely to suffer long term severe mental illness, with rates of disorders such as schizophrenia up three times that of the general population. We already know that migrants in general are at a greater risk of mental disorder, and this has been described by some health experts as a public health tragedy. Refugees are at even greater risk although we know much less about what affects their mental health once they arrive than we do for other types of migrant.However, we do know that the circumstances in which refugees find themselves living can make a difference to their mental health. This is particularly important because, while we cannot alter the traumatic events that caused refugees to flee their home country, we can influence their present circumstances. This does, however, depend on our having a good understanding of what matters for refugee mental health and this is the motivation for the present study. The research will concentrate on the kind of areas in which refugees live and how neighbourhood characteristics might be important for their mental health. This matters because refugees often have little or no control over where they live and, from what we know based on research looking at migrants in general, living in certain types of neighbourhood affects their mental health. A large number of studies have shown that migrants in areas where there are fewer people from their own ethnic background show higher rates of mental disorder. We also know, from studies of the general population, that certain types of neighbourhood; typically, those that are more urban, more deprived and less stable; are associated with poorer mental health. These are often exactly the type of area that refugees find themselves living in. However, no studies until now have looked at how refugees might be affected by the place where they live. The proposed research will investigate this in a number of ways. The first part of the study will use health records collected for all refugees arriving in Denmark as children over roughly a 30-year period. This will be linked to a range of data sources allowing us to build up a picture of how the neighbourhoods in which they are living might influence their mental health. I have chosen Denmark because this is one of the few countries with available data about refugee mental health collected on a large scale over a long time period and previous studies show the effect of neighbourhood on mental health to be similar in Denmark and the UK. Denmark also has a refugee dispersal policy that means refugees are sent to live in a wide variety of different neighbourhoods, as in the UK, the effect of which can then be compared. The second part of the study will look at refugees in the UK, concentrating on one refugee group (from Somalia) in one specific area (Lambeth, South East London). Somalis are one of the largest refugee groups in the UK and this part of the study will examine their experiences looking at the same questions as the Danish study but using much more detailed local data. We will use GP records for all patients in the borough that have also been linked to psychiatric records and census data telling us about the type of area where they live. Health records are limited in what they can tell us about the underlying reasons why where people live effects their mental health. Therefore a third component of the research will involve interviewing Lambeth Somali residents to find out more about how they view their neighbourhood and what they think is important about neighbourhoods for mental health and wellbeing.