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

项目总结 背景：大约340万难民和寻求庇护者重新安置在高收入国家，a 这一数字预计将上升，因为寻求躲避战争、冲突和 和自然灾害。难民的心理健康在瑞典是一个特别突出的问题，瑞典重新安置了 2011年叙利亚冲突爆发后，人均叙利亚难民人数创历史新高。尽管 在瑞典，公共资助的精神健康服务的可用性，有证据表明这些服务没有得到充分利用 由于各种结构性障碍，包括语言、交通、 信任和文化污名。 研究目的：了解难民成人心理卫生保健利用的障碍和促进者 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教训可以用来理解障碍和促进者 包括美国在内的其他高收入国家的精神卫生服务利用情况。 具体目标：1)比较成年难民和非难民成年人随时间的心理健康服务利用情况 瑞典移民人口和土著人口；2)确定心理健康服务的预测因素 瑞典成年难民随时间的利用；以及3)探索心理障碍和促进者 瑞典成年叙利亚难民的卫生保健利用情况。 研究方法：本研究采用解释性、序贯混合方法。目标1和目标2将包括 瑞典国家登记处提供的纵向数据的二级数据分析。AIM 1将使用考克斯 用比例风险模型确定全国住院患者和精神卫生服务利用率 门诊登记簿。目标2将使用COX回归模型来确定精神卫生服务的预测因素 利用率。应用目标1和目标2的调查结果，目标3将定性地探索障碍和促进者 目标1和目标2通过与叙利亚难民成年人的深入访谈确定，他们代表最高 移居瑞典的难民人数。 奖学金信息：拟议的研究是为了完成戴安娜女士的博士论文 热衣斯目前是约翰·霍普金斯大学国际卫生系的博士生。这 这项研究直接与NIMH减少差距和促进精神健康服务公平的优先事项保持一致 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、 和一位特别贡献者，他们共同提供混合方法和健康差异研究方面的专业知识 因为它关系到受创伤影响的边缘化人群的健康。培训包括课程作业、实地考察 研究和其他机会，使热衣斯女士做好准备，成为公共心理健康领域的领先研究人员。

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.