Barriers and Facilitators to Mental Health Service Utilization Among Refugees in Sweden

项目摘要 背景：大约有340万难民和寻求庇护者在高收入国家得到重新安置， 预计这一数字还会上升，因为越来越多的人为了躲避战争、冲突 和自然灾害。难民心理健康是瑞典的一个特别突出的问题，瑞典重新安置了难民。 这是2011年叙利亚冲突爆发后人均叙利亚难民人数最多的一年。尽管 在瑞典，公共资助的精神卫生服务的可用性，有证据表明这些服务利用不足， 由于各种结构性障碍，包括语言，交通， 信任和文化耻辱。 研究目的：了解难民成年人利用精神卫生保健的障碍和促进因素 在瑞典，使用国家登记数据和定性访谈，重点是叙利亚难民 人口从瑞典的例子中吸取的经验教训可用于理解以下方面的障碍和促进因素： 包括美国在内的其他高收入国家的精神卫生服务利用率。 具体目的：1）比较难民成年人与非难民成年人在一段时间内对精神卫生服务的利用情况 移民人口和瑞典本地人口; 2）确定精神卫生服务的预测因素 随着时间的推移，在瑞典的难民成年人的使用;和3）探讨心理障碍和促进因素， 在瑞典的叙利亚难民成年人的卫生保健利用情况。 方法：本研究采用解释性的顺序混合方法。目标1和2将包括 瑞典国家登记处提供的纵向数据的次级数据分析。目标1将使用考克斯 比例风险模型，以确定使用全国住院和 门诊登记。目标2将使用考克斯回归模型来确定精神健康服务的预测因素 利用率应用目标1和2的结果，目标3将定性探讨障碍和促进因素 通过对叙利亚成年难民的深入访谈，确定了目标1和2中所列的主要问题， 许多难民流离失所到瑞典。 奖学金信息：建议的研究是在实践博士论文的戴安娜女士 目前在约翰霍普金斯大学国际卫生系攻读博士学位的Rayes说。这 这项研究与NIMH的优先事项直接一致，以减少心理健康服务的差异和促进公平 和结果。培训和研究将由一名赞助商、一名共同赞助商、两名顾问提供支持， 以及一位特别贡献者，他们共同提供混合方法和健康差异研究方面的专业知识 因为它涉及受创伤影响的边缘化人口的健康。培训包括课程作业、实地 研究和其他机会，准备女士雷耶斯成为一个领先的研究人员在公共心理健康。

PROJECT SUMMARY Background: Approximately 3.4 million refugees and asylum-seekers are resettled in high-income countries, a figure which is projected to rise given increased displacements of individuals seeking safety from war, conflict, and natural disasters. Refugee mental health is a particularly salient issue in Sweden, which resettled the highest number of Syrian refugees per capita following the onset of the Syrian conflict in 2011. Despite the availability of publicly funded mental health services in Sweden, there is evidence of underutilization of these services among displaced populations due to various structural barriers, including language, transportation, trust, and cultural stigma. Study Objective: To understand barriers and facilitators to mental health care utilization among refugee adults in Sweden using national registry data and qualitative interviews, with a focus on the Syrian refugee population. Lessons from the Swedish example can be applied to understanding barriers and facilitators to mental health service utilization in other high-income countries, including the United States. Specific Aims: 1) To compare mental health service utilization over time by refugee adults to non-refugee migrant populations and to the native population in Sweden; 2) To identify predictors of mental health service utilization over time among refugee adults in Sweden; and 3) To explore barriers and facilitators of mental health care utilization among Syrian refugee adults in Sweden. Approach: This study utilizes an explanatory, sequential mixed methods approach. Aims 1 and 2 will include secondary data analysis of longitudinal data made available by Swedish national registries. Aim 1 will use Cox proportional hazards modelling to identify rates in mental health service utilization using national inpatient and outpatient registers. Aim 2 will use Cox regression modelling to identify predictors of mental health service utilization. Applying findings from Aims 1 and 2, Aim 3 will qualitatively explore barriers and facilitators identified in Aims 1 and 2 through in-depth interviews with Syrian refugee adults, who represent the highest number of refugees displaced to Sweden. Fellowship Information: The proposed research is in fulfillment of the doctoral dissertation of Ms. Diana Rayes, a current PhD student in the Department of International Health at Johns Hopkins University. This study directly aligns with NIMH’s priorities to reduce disparities and advance equity in mental health services and outcomes. The training and research will be supported by one Sponsor, one Co-Sponsor, two Consultants, and one Special Contributor who, combined, offer expertise in mixed methods and health disparities research as it pertains to the health of trauma-affected, marginalized populations. Training includes coursework, field research and other opportunities to prepare Ms. Rayes to become a leading researcher in public mental health.