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Vollebregt SJC, Scholte WF, Hoogerbrugge A, Bolhuis K, Vermeulen JM. Help-Seeking Undocumented Migrants in the Netherlands: Mental Health, Adverse Life Events, and Living Conditions. Cult Med Psychiatry 2023; 47:1067-1089. [PMID: 35907149 PMCID: PMC10654188 DOI: 10.1007/s11013-022-09790-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 11/30/2022]
Abstract
Undocumented migrants are a particularly vulnerable group regarding (mental) health, living conditions, and restricted access to health care. The aim and objective of the study was to examine the prevalence and correlates of mental health problems in a help-seeking population of undocumented migrants. Observational study was performed by integrating cross-sectional questionnaire data with retrospective electronic patient record data. Undocumented migrants attending medical and psychological consultation hours of a Netherlands-based non-governmental organization completed the Self-Reporting Questionnaire (SRQ). We examined scores of the instrument's 24 items version (SRQ-24) and its 20 items version (SRQ-20). Correlates of mental health were estimated using parametric tests. On the SRQ-20, 85% (95% CI 77-91%) of the sample (N = 101) scored ≥ 8, the clinical cut-off value for common mental disorders; mean = 12.4 ± 4.6, range 0-20. Adverse life events like physical and sexual assault were reported in 37% of the medical records (N = 99) and had a medium-to-large effect (Cohen's d = 0.76) on SRQ-24 scores. Mental health problems are common in help-seeking undocumented migrants. This study underlines the need of improving access to mental health care for undocumented migrants.
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Affiliation(s)
| | - Willem F Scholte
- Amsterdam UMC, Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Koen Bolhuis
- Amsterdam UMC, Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Jentien M Vermeulen
- Amsterdam UMC, Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands.
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Supakul S, Jaroongjittanusonti P, Jiaranaisilawong P, Phisalaphong R, Tanimoto T, Ozaki A. Access to Healthcare Services among Thai Immigrants in Japan: A Study of the Areas Surrounding Tokyo. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6290. [PMID: 37444137 PMCID: PMC10341320 DOI: 10.3390/ijerph20136290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/31/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023]
Abstract
Numerous undocumented and uninsured foreigners living in Japan have faced barriers when trying to obtain appropriate healthcare services, which have occasionally led to issues with unpaid medical bills to medical institutions. Although information on health and socioeconomic status is essential to tackle such issues, relevant data has been unavailable due to difficulties in contacting this population. This study involved a cross-sectional survey using questionnaires concerning the general demographic characteristics, socioeconomic status, health profiles, information access, and knowledge/attitude/practice of health insurance of Thai nationals living in Japan. The study participants included Thai nationals who lived in Tokyo and the surrounding prefectures. The survey was conducted mainly at public religious events from September 2022 to December 2022. Overall, the questionnaires were obtained from 84 participants, though 67 participants were included in the final analysis after excluding missing variables. There were participants with unspecified visa status (32.8%) and uninsured status (40.3%). Among them, 86.4% expressed positive attitudes towards health insurance. However, multivariate multivariable regression analyses revealed the low insurance practice status among the unspecified visa group (aOR, 0.02; 95% CI, 0.00-0.13). Overall, the results reveal limited access to healthcare services in subgroups of Thai immigrants in Japan.
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Affiliation(s)
- Sopak Supakul
- Graduate School of Medicine, Keio University, Tokyo 160-8582, Japan
- Medical Governance Research Institute, Tokyo 108-0074, Japan
| | - Pichaya Jaroongjittanusonti
- Medical Governance Research Institute, Tokyo 108-0074, Japan
- Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
| | | | | | - Tetsuya Tanimoto
- Medical Governance Research Institute, Tokyo 108-0074, Japan
- Navitas Clinic, Tokyo 190-0012, Japan
| | - Akihiko Ozaki
- Medical Governance Research Institute, Tokyo 108-0074, Japan
- Department of Breast and Thyroid Surgery, Jyoban Hospital of Tokiwa Foundation, Fukushima 972-8322, Japan
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Refle JE, Fakhoury J, Burton-Jeangros C, Consoli L, Jackson Y. Impact of legal status regularization on undocumented migrants’ self-reported and mental health in Switzerland. SSM Popul Health 2023; 22:101398. [PMID: 37123558 PMCID: PMC10130692 DOI: 10.1016/j.ssmph.2023.101398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/05/2023] [Accepted: 04/05/2023] [Indexed: 04/08/2023] Open
Abstract
Undocumented migrants face cumulative difficulties like precarious living and working conditions or exclusion from health services that might negatively influence their health. Little is known about the evolution of undocumented migrants' self-reported health (SRH) and mental health after they get documented. This study aims to observe the effect of legal status regularization on SRH and mental health in a cohort of migrants undergoing regularization in Geneva, Switzerland. We evaluate SRH with the first item of the Short Form Survey (SF12) and depression as a proxy of mental health with the PHQ-9 questionnaire over four years among 387 undocumented and newly documented migrants. Using hybrid linear models, our data show that regularization has no direct effect on SRH, but has direct positive effects on mental health in a longitudinal perspective, even when controlling for competing factors. The arrival of the pandemic did not alter these effects. Migrants tend to evaluate their subjective health status more positively than the prevalence of screened depression shows. Those findings point towards better targeted policies that could reduce the burden of depression among undocumented migrants.
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Affiliation(s)
- Jan-Erik Refle
- LIVES, Swiss Centre of Expertise in Life Course Research, University of Geneva, Geneva, Switzerland
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland
| | - Julien Fakhoury
- LIVES, Swiss Centre of Expertise in Life Course Research, University of Geneva, Geneva, Switzerland
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland
| | - Claudine Burton-Jeangros
- LIVES, Swiss Centre of Expertise in Life Course Research, University of Geneva, Geneva, Switzerland
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland
- Institute of Sociological Research, University of Geneva, Geneva, Switzerland
| | - Liala Consoli
- LIVES, Swiss Centre of Expertise in Life Course Research, University of Geneva, Geneva, Switzerland
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland
- Institute of Sociological Research, University of Geneva, Geneva, Switzerland
| | - Yves Jackson
- Division of Primary Care Medicine, Geneva University Hospital and University of Geneva, Geneva, Switzerland
- Corresponding author. Division of Primary Care Medicine, Geneva University Hospital and University of Geneva, Rue Gabrielle Perret Gentil 4, 1211, 14 Geneva, Switzerland.
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Ponce-Blandón JA, Mérida-Martín T, Jiménez-Lasserrotte MDM, Jiménez-Picón N, Macías-Seda J, Lomas-Campos MDLM. Analysis of Prehospital Care of Migrants Who Arrive Intermittently at the Coasts of Southern Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17061964. [PMID: 32192156 PMCID: PMC7143934 DOI: 10.3390/ijerph17061964] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 03/15/2020] [Indexed: 01/02/2023]
Abstract
Background: The aim of this study is to identify the sociodemographic characteristics and the most frequent diseases and nursing interventions carried out on migrants arriving by sea at southern Spain. Method: Cross-sectional, descriptive, and retrospective study based on the database of the Spanish Red Cross Intervention Activation System. All migrants who arrived on the coasts of a southern province during 2016 and were assisted by the Red Cross were included. Results: A total of 2027 people were registered, mostly males, aged between 18 and 40 years. Of these, 4.9% required healthcare, and 2.9% were referred to hospital. Highlighted diagnoses were headaches (15.6%), pregnancy (12.8%), and lower-limb wounds (6.4%), and outstanding nursing interventions were “care of wounds” (24.7%), “pain management” (21.9%), and “prenatal care” (15.2%). Statistically significant relationships were found between the diagnosed diseases and gender, geographic area of origin, and seasonal time of the year, as well as between nursing interventions performed and those three variables. Conclusions: Although in general, a good health condition was observed in most of the migrants treated, the most frequent health situations attended were related to dermatological, gynecological, and headache problems. The most performed nursing interventions were related to skin/wound care and promotion of physical comfort, requiring a low need for hospital transfers. Female gender, origin from sub-Saharan Africa and arrival in the summer period carry a greater risk of suffering health problems when migrants reach Spanish coasts.
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Affiliation(s)
- José Antonio Ponce-Blandón
- Centro Universitario de Enfermería de la Cruz Roja, Universidad de Sevilla, 41009 Sevilla, Spain;
- Correspondence: ; Tel.: +34615585859
| | | | | | - Nerea Jiménez-Picón
- Centro Universitario de Enfermería de la Cruz Roja, Universidad de Sevilla, 41009 Sevilla, Spain;
| | - Juana Macías-Seda
- Facultad de Enfermería, Fisioterapia y Podología. Universidad de Sevilla, 41009 Sevilla, Spain; (J.M.-S.); (M.d.l.M.L.-C.)
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Agrawal M, Burisch J, Colombel JF, C Shah S. Viewpoint: Inflammatory Bowel Diseases Among Immigrants From Low- to High-Incidence Countries: Opportunities and Considerations. J Crohns Colitis 2020; 14:267-273. [PMID: 31359034 DOI: 10.1093/ecco-jcc/jjz139] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The inflammatory bowel diseases [IBDs], inclusive of Crohn's disease [CD] and ulcerative colitis [UC], are chronic, progressive immune-mediated diseases associated with high morbidity and substantial economic impact. The pathogenesis implicates a complex interaction between environmental determinants and genetic susceptibility. Of concern, the incidence and prevalence of IBD are increasing globally, with the highest relative increase observed in developing and recently developed countries. One high-risk yet underappreciated population is immigrants from countries of low to high IBD incidence, as evidenced by epidemiologic studies demonstrating higher risk of IBD among second- versus first-generation and younger versus older immigrants from low- to high-incidence countries [LTHICs]. The reasons underlying these emerging patterns among immigrants are incompletely understood and provide enormous opportunities to better define the pathophysiology of IBD and move toward disease prevention or at least earlier diagnosis. The rapidity of this epidemiologic shift in the demographic profile of IBD, which was traditionally a disease of Caucasians in industrialized countries, strongly implicates non-genetic factors and gene-environment interactions in the pathophysiology of IBD among immigrants from LTHICs. The primary objectives of this Viewpoint are to [1] provide a focused overview of IBD epidemiology among immigrants from countries at differential IBD risk; [2] emphasize the potential to advance our understanding of IBD pathogenesis via targeted research efforts to delineate risk and protective determinants in this cohort; and [3] highlight disparities and barriers in IBD care, as well as the economic implications of the rising, yet underappreciated, disease burden among immigrants from LTHICs.
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Affiliation(s)
- Manasi Agrawal
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York NY, USA
| | - Johan Burisch
- Gastrounit, Medical Division, Hvidovre Hospital, Copenhagen, Denmark
| | - Jean-Frederic Colombel
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York NY, USA
| | - Shailja C Shah
- Division of Gastroenterology, Vanderbilt University, Nashville TN, USA
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de Graaff AM, Cuijpers P, Acarturk C, Bryant R, Burchert S, Fuhr DC, Huizink AC, de Jong J, Kieft B, Knaevelsrud C, McDaid D, Morina N, Park AL, Uppendahl J, Ventevogel P, Whitney C, Wiedemann N, Woodward A, Sijbrandij M. Effectiveness of a peer-refugee delivered psychological intervention to reduce psychological distress among adult Syrian refugees in the Netherlands: study protocol. Eur J Psychotraumatol 2020; 11:1694347. [PMID: 32082506 PMCID: PMC7006761 DOI: 10.1080/20008198.2019.1694347] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 09/09/2019] [Accepted: 09/14/2019] [Indexed: 11/03/2022] Open
Abstract
Background: Syrian refugees face multiple hardships and adversities which put them at risk for the development of mental health problems. However, access to adequate mental health care in host countries is limited. The WHO has developed Problem Management Plus (PM+), a brief, scalable psychological intervention, delivered by non-specialist helpers, that addresses common mental disorders in people affected by adversity. This study is part of the STRENGTHS project, that aims to evaluate peer-refugee delivered psychological interventions for Syrian refugees in Europe and the Middle East. Objective: To evaluate the effectiveness and cost-effectiveness of the peer-refugee delivered PM+ intervention among Syrian refugees with elevated levels of psychological distress in the Netherlands. Methods: PM+ will be tested in a randomized controlled trial (RCT) among Arabic-speaking Syrian refugees in the Netherlands aged 18 years and above with self-reported psychological distress (Kessler Psychological Distress Scale; K10 >15) and impaired daily functioning (WHO Disability Assessment Schedule; WHODAS 2.0 >16). Participants (N = 380) will be randomized into care as usual with PM+ (CAU/PM+, n = 190) or CAU only (CAU, n = 190). Baseline, 1-week post-intervention, and 3-month and 12-month follow-up assessments will be conducted. Primary outcomes are symptoms of depression and anxiety. Secondary outcomes are functional impairment, posttraumatic stress disorder symptoms, self-identified problems, anger, health and productivity costs, and hair cortisol concentrations. A process evaluation will be carried out to evaluate treatment dose, protocol fidelity and stakeholder views on barriers and facilitators to implementing PM+. Results and Conclusions: PM+ has proved effectiveness in other populations and settings. After positive evaluation, the adapted manual and training materials for individual PM+ will be made available through the WHO to encourage further replication and scaling up. Trial registration: Trial registration Dutch Trial Registry, NL7552, registered prospectively on March 1, 2019. Medical Ethics Review Committee VU Medical Center Protocol ID 2017.320, 7 September 2017.
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Affiliation(s)
- Anne M. de Graaff
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ceren Acarturk
- Department of Psychology, Koç University, Sariyer/Istanbul, Turkey
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Sebastian Burchert
- Division of Clinical-Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Daniela C. Fuhr
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Anja C. Huizink
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | | | - Christine Knaevelsrud
- Division of Clinical-Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Naser Morina
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - A-La Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Jana Uppendahl
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Peter Ventevogel
- Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | | | - Nana Wiedemann
- International Federation of Red Cross and Red Crescent Societies Reference Centre for Psychosocial Support, Copenhagen, Denmark
| | - Aniek Woodward
- KIT Health, KIT Royal Tropical Institute, Amsterdam, The Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Gover AR, Harper SB, Langton L. Anti-Asian Hate Crime During the COVID-19 Pandemic: Exploring the Reproduction of Inequality. AMERICAN JOURNAL OF CRIMINAL JUSTICE : AJCJ 2020; 45:647-667. [PMID: 32837171 PMCID: PMC7364747 DOI: 10.1007/s12103-020-09545-1] [Citation(s) in RCA: 204] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 06/11/2020] [Indexed: 05/12/2023]
Abstract
Coronavirus Disease 2019 (COVID-19) is believed to have emerged in Wuhan, China in late December 2019 and began rapidly spreading around the globe throughout the spring months of 2020. As COVID-19 proliferated across the United States, Asian Americans reported a surge in racially motivated hate crimes involving physical violence and harassment. Throughout history, pandemic-related health crises have been associated with the stigmatization and "othering" of people of Asian descent. Asian Americans have experienced verbal and physical violence motivated by individual-level racism and xenophobia from the time they arrived in America in the late 1700s up until the present day. At the institutional level, the state has often implicitly reinforced, encouraged, and perpetuated this violence through bigoted rhetoric and exclusionary policies. COVID-19 has enabled the spread of racism and created national insecurity, fear of foreigners, and general xenophobia, which may be related to the increase in anti-Asian hate crimes during the pandemic. We examine how these crimes - situated in historically entrenched and intersecting individual-level and institutional-level racism and xenophobia - have operated to "other" Asian Americans and reproduce inequality.
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Affiliation(s)
- Angela R. Gover
- School of Public Affairs, University of Colorado Denver, 1380 Lawrence Street, Suite 500, Denver, CO 80204 USA
| | - Shannon B. Harper
- Department of Sociology, Iowa State University, 510 Farm House Lane, Ames, IA 50011 USA
| | - Lynn Langton
- RTI International, 701 13th St NW, Suite 750, Washington, DC 20005 USA
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[Reduce obstacles, promote health-healthcare access for undocumented migrants within a pilot project in Lower Saxony, Germany (2016-2018)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:927-934. [PMID: 31201447 DOI: 10.1007/s00103-019-02972-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND In 2014, the parliament of the federal state of Lower Saxony (Germany) implemented a three-year pilot project to reduce barriers to healthcare for undocumented migrants. For this purpose, two counselling centres (CCs) were established (Hanover and Goettingen), where undocumented migrants receive treatment vouchers for the medical treatment of acute medical issues, check-ups, and vaccination. OBJECTIVE We assessed which medical services were used in order to identify needs and recommend specific improvements to policymakers. METHODS We analysed CC data from the first two years after starting the project (1 February 2016-31 January 2018). We described demographic characteristics of attendees, reasons for attendance, and medical diagnoses. Additionally, we carried out explorative interviews on the subject of vaccination in one CC (February-May 2018). RESULTS In total, 236 undocumented migrants received 698 vouchers. The number of vouchers issued increased over time: from 17/month (February-July 2016) to 44/month (August 2017-January 2018); 56% were female and 16% were younger than 18 years. Half of the women (66/132) attended for prenatal care. In 4% (9/236) of attendees vaccinations were given. Of 25 people approached for explorative interviews, 18 participated. All of them were generally open about vaccinations; 12 (67%) had already received vaccinations at some point. CONCLUSIONS The increasing use of CCs shows the need for low-threshold healthcare access, particularly for vulnerable groups (children, pregnant women). Vaccinations were rarely performed. Strengthening vaccination literacy by providing more information to both physicians and attendees can increase vaccination uptake.
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Winters M, Rechel B, de Jong L, Pavlova M. A systematic review on the use of healthcare services by undocumented migrants in Europe. BMC Health Serv Res 2018; 18:30. [PMID: 29347933 PMCID: PMC5774156 DOI: 10.1186/s12913-018-2838-y] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 01/11/2018] [Indexed: 11/17/2022] Open
Abstract
Background Undocumented migrants face particular challenges in accessing healthcare services in many European countries. The aim of this study was to systematically review the academic literature on the utilization of healthcare services by undocumented migrants in Europe. Methods The databases Embase, Medline, Global Health and Cinahl Plus were searched systematically to identify quantitative, qualitative and mixed methods studies published in 2007–2017. Results A total of 908 articles were retrieved. Deletion of duplicates left 531. After screening titles, abstracts and full texts according to pre-defined inclusion and exclusion criteria, 29 articles were included in the review. Overall, quantitative studies showed an underutilization of different types of healthcare services by undocumented migrants. Qualitative studies reported that, even when care was received, it was often inadequate or insufficient, and that many undocumented migrants were unfamiliar with their entitlements and faced barriers in utilizing healthcare services. Conclusions Although it is difficult to generalize findings from the included studies due to methodological differences, they provide further evidence that undocumented migrants in Europe face particular problems in utilizing healthcare services. Electronic supplementary material The online version of this article (10.1186/s12913-018-2838-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marjolein Winters
- Department of Health Services Research, Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands.
| | - Bernd Rechel
- European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, England
| | - Lea de Jong
- Department of Health Services Research, Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands
| | - Milena Pavlova
- Department of Health Services Research, CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands
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Access to Preventive Health Care for Undocumented Migrants: A Comparative Study of Germany, The Netherlands and Spain from a Human Rights Perspective. LAWS 2016. [DOI: 10.3390/laws5010009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Population movements, whether voluntary or forced, are an integral part of an increasingly globalized society and, while the health needs of migrant populations cannot be generalized, some migrants can have worse oral health outcomes compared with their host-country counterparts, with their first dental contact typically being for emergency care. Failure to provide immediately necessary treatment may be unlawful under the Human Rights Act 1998. CPD/Clinical Relevance: NHS dental services need to evolve and address the challenges inherent in caring for vulnerable migrants. Education and appropriate training needs to be developed for the dental profession in order to enable new ways of promoting intersectoral care and community engagement.
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Hacker K, Anies M, Folb BL, Zallman L. Barriers to health care for undocumented immigrants: a literature review. Risk Manag Healthc Policy 2015; 8:175-83. [PMID: 26586971 PMCID: PMC4634824 DOI: 10.2147/rmhp.s70173] [Citation(s) in RCA: 280] [Impact Index Per Article: 31.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
With the unprecedented international migration seen in recent years, policies that limit health care access have become prevalent. Barriers to health care for undocumented immigrants go beyond policy and range from financial limitations, to discrimination and fear of deportation. This paper is aimed at reviewing the literature on barriers to health care for undocumented immigrants and identifying strategies that have or could be used to address these barriers. To address study questions, we conducted a literature review of published articles from the last 10 years in PubMed using three main concepts: immigrants, undocumented, and access to health care. The search yielded 341 articles of which 66 met study criteria. With regard to barriers, we identified barriers in the policy arena focused on issues related to law and policy including limitations to access and type of health care. These varied widely across countries but ultimately impacted the type and amount of health care any undocumented immigrant could receive. Within the health system, barriers included bureaucratic obstacles including paperwork and registration systems. The alternative care available (safety net) was generally limited and overwhelmed. Finally, there was evidence of widespread discriminatory practices within the health care system itself. The individual level focused on the immigrant’s fear of deportation, stigma, and lack of capital (both social and financial) to obtain services. Recommendations identified in the papers reviewed included advocating for policy change to increase access to health care for undocumented immigrants, providing novel insurance options, expanding safety net services, training providers to better care for immigrant populations, and educating undocumented immigrants on navigating the system. There are numerous barriers to health care for undocumented immigrants. These vary by country and frequently change. Despite concerns that access to health care attracts immigrants, data demonstrates that people generally do not migrate to obtain health care. Solutions are needed that provide for noncitizens’ health care.
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Affiliation(s)
- Karen Hacker
- Allegheny County Health Department, Pittsburgh, PA, USA ; Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Maria Anies
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Barbara L Folb
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA ; Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA, USA
| | - Leah Zallman
- Institute for Community Health, Cambridge, MA, USA ; Cambridge Health Alliance, Cambridge, MA, USA ; Harvard School of Medicine, Boston, MA, USA
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Teunissen E, Van Bavel E, Van Den Driessen Mareeuw F, Macfarlane A, Van Weel-Baumgarten E, Van Den Muijsenbergh M, Van Weel C. Mental health problems of undocumented migrants in the Netherlands: A qualitative exploration of recognition, recording, and treatment by general practitioners. Scand J Prim Health Care 2015; 33:82-90. [PMID: 25961462 PMCID: PMC4834507 DOI: 10.3109/02813432.2015.1041830] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To explore the views and experiences of general practitioners (GPs) in relation to recognition, recording, and treatment of mental health problems of undocumented migrants (UMs), and to gain insight in the reasons for under-registration of mental health problems in the electronic medical records. DESIGN Qualitative study design with semi-structured interviews using a topic guide. SUBJECTS AND SETTING Sixteen GPs in the Netherlands with clinical expertise in the care of UMs. RESULTS GPs recognized many mental health problems in UMs. Barriers that prevented them from recording these problems and from delivering appropriate care were their low consultation rates, physical presentation of mental health problems, high number of other problems, the UM's lack of trust towards health care professionals, and cultural differences in health beliefs and language barriers. Referrals to mental health care organizations were often seen as problematic by GPs. To overcome these barriers, GPs provided personalized care as far as possible, referred to other primary care professionals such as social workers or mental health care nurses in their practice, and were a little less restrictive in prescribing psychotropics than guidelines recommended. CONCLUSIONS GPs experienced a variety of barriers in engaging with UMs when identifying or suspecting mental health problems. This explains why there is a gap between the high recognition of mental health problems and the low recording of these problems in general practice files. It is recommended that GPs address mental health problems more actively, strive for continuity of care in order to gain trust of the UMs, and look for opportunities to provide mental care that is accessible and acceptable for UMs.
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Affiliation(s)
- Erik Teunissen
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
- Correspondence: Erik Teunissen, Department of Primary and Community Care, Radboud University Medical Center, Geert Grooteplein 21, Nijmegen, 6525 EZ, the Netherlands. E-mail:
| | - Eric Van Bavel
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Anne Macfarlane
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
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Teunissen E, Sherally J, van den Muijsenbergh M, Dowrick C, van Weel-Baumgarten E, van Weel C. Mental health problems of undocumented migrants (UMs) in The Netherlands: a qualitative exploration of help-seeking behaviour and experiences with primary care. BMJ Open 2014; 4:e005738. [PMID: 25416057 PMCID: PMC4244440 DOI: 10.1136/bmjopen-2014-005738] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To explore health-seeking behaviour and experiences of undocumented migrants (UMs) in general practice in relation to mental health problems. DESIGN Qualitative study using semistructured interviews and thematic analysis. PARTICIPANTS 15 UMs in The Netherlands, varying in age, gender, country of origin and education; inclusion until theoretical saturation was reached. SETTING 4 cities in The Netherlands. RESULTS UMs consider mental health problems to be directly related to their precarious living conditions. For support, they refer to friends and religion first, the general practitioner (GP) is their last resort. Barriers for seeking help include taboo on mental health problems, lack of knowledge of and trust in GPs competencies regarding mental health and general barriers in accessing healthcare as an UM (lack of knowledge of the right to access healthcare, fear of prosecution, financial constraints and practical difficulties). Once access has been gained, satisfaction with care is high. This is primarily due to the attitude of the GPs and the effectiveness of the treatment. Reasons for dissatisfaction with GP care are an experienced lack of time, lack of personal attention and absence of physical examination. Expectations of the GP vary, medication for mental health problems is not necessarily seen as a good practice. CONCLUSIONS UMs often see their precarious living conditions as an important determinant of their mental health; they do not easily seek help for mental health problems and various barriers hamper access to healthcare for them. Rather than for medication, UMs are looking for encouragement and support from their GP. We recommend that barriers experienced in seeking professional care are tackled at an institutional level as well as at the level of GP.
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Affiliation(s)
- Erik Teunissen
- Department of Primary and Community Care (Radboudumc), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jamilah Sherally
- Department of Primary and Community Care (Radboudumc), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maria van den Muijsenbergh
- Department of Primary and Community Care (Radboudumc), Radboud University Medical Center, Nijmegen, The Netherlands Centre of Expertise on Health Disparities, Pharos Utrecht, Utrecht, The Netherlands
| | - Chris Dowrick
- Department of Psychological Sciences, B121 Waterhouse Buildings University of Liverpool, Liverpool, UK
| | - Evelyn van Weel-Baumgarten
- Department of Primary and Community Care (Radboudumc), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Chris van Weel
- Department of Primary and Community Care (Radboudumc), Radboud University Medical Center, Nijmegen, The Netherlands Australian Primary Health Care Research Institute, Australian National University, Canberra, Australia
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Woodward A, Howard N, Wolffers I. Health and access to care for undocumented migrants living in the European Union: a scoping review. Health Policy Plan 2014; 29:818-30. [PMID: 23955607 PMCID: PMC4186209 DOI: 10.1093/heapol/czt061] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Literature on health and access to care of undocumented migrants in the European Union (EU) is limited and heterogeneous in focus and quality. Authors conducted a scoping review to identify the extent, nature and distribution of existing primary research (1990-2012), thus clarifying what is known, key gaps, and potential next steps. METHODS Authors used Arksey and O'Malley's six-stage scoping framework, with Levac, Colquhoun and O'Brien's revisions, to review identified sources. Findings were summarized thematically: (i) physical, mental and social health issues, (ii) access and barriers to care, (iii) vulnerable groups and (iv) policy and rights. RESULTS Fifty-four sources were included of 598 identified, with 93% (50/54) published during 2005-2012. EU member states from Eastern Europe were under-represented, particularly in single-country studies. Most study designs (52%) were qualitative. Sampling descriptions were generally poor, and sampling purposeful, with only four studies using any randomization. Demographic descriptions were far from uniform and only two studies focused on undocumented children and youth. Most (80%) included findings on health-care access, with obstacles reported at primary, secondary and tertiary levels. Major access barriers included fear, lack of awareness of rights, socioeconomics. Mental disorders appeared widespread, while obstetric needs and injuries were key reasons for seeking care. Pregnant women, children and detainees appeared most vulnerable. While EU policy supports health-care access for undocumented migrants, practices remain haphazard, with studies reporting differing interpretation and implementation of rights at regional, institutional and individual levels. CONCLUSIONS This scoping review is an initial attempt to describe available primary evidence on health and access to care for undocumented migrants in the European Union. It underlines the need for more and better-quality research, increased co-operation between gatekeepers, providers, researchers and policy makers, and reduced ambiguities in health-care rights and obligations for undocumented migrants.
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Affiliation(s)
- Aniek Woodward
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, Tavistock Place, London, WC1H 9SH, UK, King's International Development Institute and King's Centre for Global Health, King's College London, London, WC2R 2LS, UK and Vrije Universiteit Medical Centre, Amsterdam, 1007 MB, the Netherlands Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, Tavistock Place, London, WC1H 9SH, UK, King's International Development Institute and King's Centre for Global Health, King's College London, London, WC2R 2LS, UK and Vrije Universiteit Medical Centre, Amsterdam, 1007 MB, the Netherlands
| | - Natasha Howard
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, Tavistock Place, London, WC1H 9SH, UK, King's International Development Institute and King's Centre for Global Health, King's College London, London, WC2R 2LS, UK and Vrije Universiteit Medical Centre, Amsterdam, 1007 MB, the Netherlands
| | - Ivan Wolffers
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, Tavistock Place, London, WC1H 9SH, UK, King's International Development Institute and King's Centre for Global Health, King's College London, London, WC2R 2LS, UK and Vrije Universiteit Medical Centre, Amsterdam, 1007 MB, the Netherlands
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Dauvrin M, Lorant V, Sandhu S, Devillé W, Dia H, Dias S, Gaddini A, Ioannidis E, Jensen NK, Kluge U, Mertaniemi R, Puigpinós i Riera R, Sárváry A, Straßmayr C, Stankunas M, Soares JJF, Welbel M, Priebe S. Health care for irregular migrants: pragmatism across Europe: a qualitative study. BMC Res Notes 2012; 5:99. [PMID: 22340424 PMCID: PMC3315408 DOI: 10.1186/1756-0500-5-99] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 02/16/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health services in Europe face the challenge of delivering care to a heterogeneous group of irregular migrants (IM). There is little empirical evidence on how health professionals cope with this challenge. This study explores the experiences of health professionals providing care to IM in three types of health care service across 16 European countries. RESULTS Semi-structured interviews were conducted with health professionals in 144 primary care services, 48 mental health services, and 48 Accident & Emergency departments (total n = 240). Although legal health care entitlement for IM varies across countries, health professionals reported facing similar issues when caring for IM. These issues include access problems, limited communication, and associated legal complications. Differences in the experiences with IM across the three types of services were also explored. Respondents from Accident & Emergency departments reported less of a difference between the care for IM patients and patients in a regular situation than did respondents from primary care and mental health services. Primary care services and mental health services were more concerned with language barriers than Accident & Emergency departments. Notifying the authorities was an uncommon practice, even in countries where health professionals are required to do this. CONCLUSIONS The needs of IM patients and the values of the staff appear to be as important as the national legal framework, with staff in different European countries adopting a similar pragmatic approach to delivering health care to IM. While legislation might help to improve health care for IM, more appropriate organisation and local flexibility are equally important, especially for improving access and care pathways.
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Affiliation(s)
- Marie Dauvrin
- Fonds de la Recherche Scientifique-FNRS, rue d'Egmont 5, 1000 Bruxelles, Belgium
- Institute of Health and Society IRSS, Université catholique de Louvain, Clos Chapelle aux Champs 30 B1.30.15, 1200 Bruxelles, Belgium
| | - Vincent Lorant
- Institute of Health and Society IRSS, Université catholique de Louvain, Clos Chapelle aux Champs 30 B1.30.15, 1200 Bruxelles, Belgium
| | - Sima Sandhu
- Unit for Social and Community Psychiatry, London and the Barts School of Medicine and Dentistry, Queen Mary University of London, Newham Centre for Mental Health, London E13 8SP, UK
| | - Walter Devillé
- International and Migrant Health, NIVEL (Netherlands Institute for Health Services Research), Otterstraat 118-124, PO Box 1568, 3500, BN Utrecht, The Netherlands
| | - Hamidou Dia
- Etablissement public de santé Maison Blanche, 3-5 rue Lespagnol, 75020 Paris, France
| | - Sónia Dias
- Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, 96, 1349-008, Lisbon, Portugal
| | - Andrea Gaddini
- Laziosanità ASP Public Health Agency for the Lazio Region, Via S. Costanza 53, 00185 Rome, Italy
| | - Elisabeth Ioannidis
- Department of Sociology, National school of Public Health, 196 Alexandras avenue, Athens 11521, Greece
| | - Natasja K Jensen
- Danish Research Centre for Migration, Ethnicity and Health (MESU), Section for Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, DK-1014 Copenhagen, Denmark
| | - Ulrike Kluge
- Clinic for Psychiatry and Psychotherapy, Charité - University Medicine Berlin, CCM, Charitéplatz 1, 10117 Berlin, Germany
| | - Ritva Mertaniemi
- Department for mental health and substance abuse services, National Institute for Health and Welfare (THL), P.O.B. 30, FIN-00271 Helsinki, Finland
| | | | - Attila Sárváry
- Faculty of Health, University of Debrecen, Sóstói út 2-4, 4400 Nyíregyháza, Hungary
| | - Christa Straßmayr
- Ludwig Boltzmann Institute for Social Psychiatry, Lazarettgasse 14A-912, 1090 Vienna, Austria
| | - Mindaugas Stankunas
- School of Public Health, Griffith University, Gold Coast Campus, Southport, Queensland 4222, Australia
- Department of Health Management, Lithuanian University of Health Sciences, A. Mickeviciaus 9, Kaunas 44307, Lithuania
| | - Joaquim JF Soares
- Department of Public Health Sciences, Section of Social Medicine, Karolinska Institutet, SE- 171 76 Stockholm, Sweden
- Department of Public Health Sciences, Mid Sweden University, SE-851 70 Sundsvall, Sweden
| | - Marta Welbel
- Institute of Psychiatry and Neurology, Ul. Sobieskiego 9, 02-957 Warsaw, Poland
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, London and the Barts School of Medicine and Dentistry, Queen Mary University of London, Newham Centre for Mental Health, London E13 8SP, UK
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