New beginnings, new challenges : health & housing of asylum seekers and refugees in their early post-migration period in Sweden

Asylum seekers and recently resettled refugees are at an increased risk of poor mental health. Besides pre-migration experiences, the early post-migration period in host countries presents numerous challenges that can negatively impact their mental health and well-being, including challenges such as poor housing, and socioeconomic difficulties. Additionally, Sweden has adopted more restrictive migration policies, which risk leading to a growing tension between mental health needs and the policy objectives of reducing migration. Gaining a deeper understanding of day-to-day challenges faced during the early post- migration period is crucial to effectively address and mitigate their potential adverse impact on the mental health of asylum seekers and refugees.

Study I, a cross-sectional population-based survey, utilized the generic EQ-5D- 5L scale to assess the health-related quality of life index value in a study population of 1,215 individuals from Syria who recently resettled in Sweden. The results showed that the most frequently reported problem on the EQ-5D-5L scale was depression/anxiety, and a low index value was associated with being a woman, older age, and low social support. Study II is a qualitative study based on semi-structured interviews with fourteen asylum seekers at two accommodation centers in Sweden, exploring their experiences of living in these centers. The results indicated that their experiences were heavily influenced by the uncertainty of the asylum process and the constraints imposed by limited resources and housing conditions, often described as living a frozen life. This frozen life was a source of constant worry, leading to concerns about potential long-term effects on their health. Despite these challenges, the asylum seekers highlighted care practices that arose spontaneously among the residents, reflecting a shared concern for each other's well-being. Study III, a qualitative study utilizing the same data collection process used in Study II, explored the experiences of asylum seekers during the COVID-19 pandemic. The findings revealed that the living conditions at the centers shaped how the pandemic was experienced. The asylum seekers reported feeling increasingly excluded from society, a sentiment reinforced by a pandemic response from authorities that was perceived as lacking understanding or care for their unique situation. Study IV is a register-based prospective longitudinal cohort study that includes all adult asylum seekers who received residence permits between 2010 and 2012. The study investigated the association between housing type during the asylum process (institutional or self-organized) and the prescriptions of antidepressants or anxiolytic medication, as well as specialized in- and outpatient visits with diagnoses of CMDs, over a five-year follow-up period after being granted refugee status. The results indicated that individuals who had lived in institutional housing were at greater risk of having more prescriptions for antidepressants or anxiolytic medication, as well as a higher likelihood of specialized in- and outpatient visits with diagnoses of CMDs, compared to those who had lived in self-organized housing.

The thesis emphasizes the importance of post-migration living conditions in shaping the mental health of asylum seekers and refugees in Sweden, with a particular focus on the asylum process and housing as key factors associated with distress. It also suggests that collective institutional accommodation tends to be more harmful to mental health than self-organized housing. Overall, the findings advocate for context-sensitive interventions addressing individual, community, and structural factors, with a focus on improving housing conditions, alleviating day-to-day challenges, and strengthening social support networks to prevent long-term mental health issues. Additionally, the thesis also calls for a transparent and fast-tracked asylum process.

List of scientific papers

I. Gottvall, M., Sjölund, S., Arwidson, C., & Saboonchi, F. (2020). Health-related quality of life among Syrian refugees resettled in Sweden. Quality of Life Research. https://doi.org/10.1007/s11136-019-02323-5

II. van Eggermont Arwidson, C., Holmgren, J., Gottberg, K., Tinghög, P., & Eriksson, H. (2022). Living a frozen life: a qualitative study on asylum seekers' experiences and care practices at accommodation centers in Sweden. Conflict and Health 2022, 16(1):1-47. https://doi.org/10.1186/s13031-022-00480-y

III. van Eggermont Arwidson, C., Holmgren, J., Tinghög, P., Eriksson, H., & Gottberg, K. (2024). (Over)crowded house: exploring asylum seekers' experiences of the COVID-19 pandemic while living at accommodation centers in Sweden. BMC Public Health, 24(1): 622. https://doi.org/10.1186/s12889-024-18089-6

IV. van Eggermont Arwidson, C., Holmgren, J., Gottberg, K., & Tinghög, P. Housing during the asylum process and its association with healthcare utilization for common mental disorders among refugees in Sweden: A nationwide cohort study. [Submitted]