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

瑞典难民利用心理健康服务的障碍和便利因素

• 批准号: 10612585
• 负责人: Diana Rayes
• 金额: $ 4.93万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-16 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10612585
• 关键词: Adult; Affect; Age; Anxiety; Area; Canada; Conflict (Psychology); Country; Cox Proportional Hazards Models; Data; Data Analyses; Dimensions; Distress; Education; Employment; Europe; Fellowship; Funding; Gender; Goals; Health; Health Disparities Research; Health Professional; Health Services Accessibility; Health system; High Prevalence; Income; Individual; Inequality; Inpatients; International; Interview; Language; Logistic Regressions; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Methods; Migrant; Modeling; National Institute of Mental Health; Natural Disasters; Neighborhoods; Outcome; Outpatients; Pattern; Personal Satisfaction; Population; Post-Traumatic Stress Disorders; Poverty; Prospective Studies; Quality of life; Refugees; Registries; Reporting; Research; Research Design; Research Personnel; Research Priority; Safety; Services; Social Well-Being; Societies; Sweden; System; Time; Training; Transportation; Trauma; Trust; Unemployment; United States; Universities; War; contextual factors; data registry; design; disparity reduction; distrust; doctoral student; evidence base; experience; health care service utilization; health economics; health equity; health service use; improved; longitudinal analysis; marginalized population; meetings; migration; population based; service utilization; social integration; social stigma; trend

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.

项目摘要 背景：大约340万难民和寻求庇护者被重新安置在高收入国家，一个 鉴于人们增加了战争，冲突，冲突中的安全性的位移，预计会增加的数字。 和自然灾害。 2011年叙利亚冲突发作之后，人均叙利亚难民数量最多。尽管如此 瑞典的公共精神卫生服务的可用性，有证据表明这些服务不足 由于各种结构性障碍，包括语言，运输，流离失所人口的服务 信任和文化污名。 研究目标：了解难民成年人精神保健利用的障碍和促进者 在瑞典使用国家注册表数据和定性访谈，重点是叙利亚拒绝人士 瑞典例子的人口可以应用于理解障碍和促进者 包括美国在内的其他高收入国家的精神卫生服务利用。 具体目的：1）比较拒绝成年人随着时间的流逝将心理健康服务的利用比较 移民的流行和瑞典的土著人口； 随着时间的流逝，瑞典的垃圾成年人和3） 瑞典叙利亚难民成年人的医疗保健利用。 方法：这项研究利用了一种解释，顺序混合方法方法。 瑞典国家登记册提供的纵向数据的二级数据分析。 比例危害建模，以确定使用国家住院和 门诊注册表。 利用率。 在AIM 1和2中确定了与叙利亚拒绝成年人的深入访谈，他们代表最高 流离失所瑞典的难民人数。 奖学金信息：支撑的研究是为了履行戴安娜女士的博士学位论文 雷斯（Rayes）是约翰·霍普金斯大学（Johns Hopkins University）国际卫生系现任博士生。 研究直接与NIMH的优先事项保持一致，以减少差距并进步心理健康服务 和结果。 还有一位特别贡献者，合并在方法和健康差异研究方面的专业知识 这与受创伤，边缘化的人群的健康有关。 研究和其他机会，准备雷斯女士成为公共心理健康领域的主要研究人员。