Risk for mental illness and family composition after migration to Sweden

PLOS ONE RESEARCH ARTICLE Risk for mental illness and family composition after migration to Sweden Elisabeth Mangrio ID1,2*, Karin Sjöström1, Mathias Grahn3, Slobodan Zdravkovic1,2 1 Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden, 2 MIM, Malmö Institute for Studies of Migration, Diversity and Welfare, Malmö University, Malmö, Sweden, 3 Unit for Safety and Security, Municipality of Malmö, Malmö, Sweden * a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 Abstract Objectives The aim of the present study is to determine how marital status and certain post-migration family structures are associated with the risk of mental illness among recently arrived Arabic- speaking refugees in Sweden. OPEN ACCESS Citation: Mangrio E, Sjöström K, Grahn M, Zdravkovic S (2021) Risk for mental illness and family composition after migration to Sweden. PLoS ONE 16(5): e0251254. https://doi.org/ 10.1371/journal.pone.0251254 Editor: Johnson Chun-Sing Cheung, The University of Hong Kong, HONG KONG Methods A cross-sectional study was conducted during 2015 and 2016. The study population was recruited by inviting all adult refugees who participated in the mandatory public integration support programme. All refugees that participated had received refugee status. A total of 681 of the invited participants returned the GHQ-12 questionnaires, through which the risk for mental illness was measured and only Arabic- speaking refugees (N = 638) were included in the analyses. Received: September 14, 2020 Accepted: April 23, 2021 Results Published: May 7, 2021 Marital status per se was not associated with a risk for mental illness. However, for the whole study sample there was a statistical significant odds ratio of 1.72 (95% CI 1.03–2.86). For male Arabic-speaking refugees with a spouse or child left behind in the home country there was a borderline significant increased risk for mental illness, odds ratio = 1. 87 (95% CI 0.99–3.56). The risk for female Arabic-speaking refugees was non-significant, odds ratio = 1.35 (95% CI 0.55–3.33). Copyright: © 2021 Mangrio et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: The data underlying this study contain sensitive participant information and can not be shared publicly. Data access queries should be directed to the Regional Ethical Committee in Lund, Sweden (epn.se; ). Funding: This research was financed by the European Refugee Fund. Conclusions Arabic- speaking refugees who were separated from family members reported an increased risk for mental illness after arriving in the host country. Actions to facilitate family reunion after arriving as a refugee (in Sweden) seems to be an important factor to promote mental health among refugees. Competing interests: The authors have declared that no competing interests exist. PLOS ONE | https://doi.org/10.1371/journal.pone.0251254 May 7, 2021 1/9 PLOS ONE Risk for mental illness and family composition Introduction Sweden has received a high number of refugees during the last 4–5 years [1]. In the southern part of Sweden, recent research indicate that around 40% of newly arrived refugee men and 30% newly arrived refugee women are suffering from mental illness [2]. A Swedish study on mental illness among asylum seekers and immigrants, found that around 43% were mentally ill [3]. The prevalence of depression, anxiety and risk of PTSD among refugees in Sweden, is around 50% [4]. In consistence, refugees in Europe are suffering from various different mental illnesses such as PTSD, anxiety and depression to a higher extent compared to the populations in the host countries [5]. The prevalence of mental illness differs dependent on which migrant group that is of focus, but in general, migrants with poor socioeconomic status such as unemployment or isolation contribute to higher rates of depression during resettlement [5]. In addition to war experiences, refugees experience stressful events both during and after migration. Three main causes of stress for refugees are recognized, the violent trauma that takes place in the home country which leads to the migration, the journey, and the adjustment to the life in a new and foreign country [6]. The mental health of refugees, which may be influenced by the migration experience, is defined as ‘pre-migration trauma and post-migration living difficulties’. The uncertainty of refugee status adds up to the above mentioned factors that may increase the risk for mental ill-health [7]. Prevalence of mental illness was higher among those who had not yet received residence permits [4]. Qualitative studies on refugees and their situation during resettlement in Sweden indicate that refugees mental health is influenced by the challenge of family separation after the arrival in Sweden. The worry about family memebers left behind may suggest an additional psychological burden together with settlement challenges such as poor living conditions, lack of social integration, cultural attitudes or unemployment [8] and adapting to a new culture and social life after arrival [9]. The change from a socio-centric society to an egocentric society as a risk factor for mental illness because of isolation, especially if there is separation from family members after arrival [3]. The recent increase in migration to Europe in general and to Sweden in particular [10], led to some temporary political changes of the right of refugees to be granted permanent residence permits based on family reunion [11]. This change in policy led to difficulties for refugees to be reunited with their families in Sweden, in the case the family had been separated during the migration process [11]. The policy change means in practice that the family need to proof an economic stability in order to be reunited with family members [11]. The willingness of countries to authorize the reunification of migrant families is supported by international human rights law [12], which clearly states that the family is a natural and fundamental group in society that is entitled to the protection of the state and society. If families are split, they are deprived of this fundamental right. Host countries usually recognize family reunification, as it has been shown to be an effective mechanism for helping migrants adapt to the new society [13]. Another study on family reunification and its impact for refugees and their mental health and integration [14], showed that family reunification was widely perceived to influence resettlement outcomes for the whole family. Through the reunification process, refugees consistently reported that only when the family became a unified entity, the health and wellbeing of its members could be properly supported. A large exten (...truncated)