Experience of discrimination during COVID-19 pandemic: the impact of public health measures and psychological distress among refugees and other migrants in Europe

Abstract

Background The COVID-19 pandemic has had a disproportionately hard impact on refugees and other migrants who are often exposed to the virus with limited means to protect themselves. We tested the hypothesis that during the COVID-19 pandemic, refugees and other migrants have suffered a negative impact on mental health and have been unjustly discriminated for spreading the disease in Europe (data collection from April to November 2020). Methods Participants in the ApartTogether Survey (N = 8297, after listwise deletion of missing items final N = 3940) provided data regarding to their difficulties to adhere to preventive recommendations against COVID-19 infection (CARE), self-perceived stigmatization (SS), and psychological distress (PD). Structural Equation Modeling was used to investigate PD as a mediator in the pathway linking CARE to SS, while adjusting for the housing and residence status. To improve confidence in the findings, single hold-out sample cross-validation was performed using a train/test split ratio of 0.8/0.2. Results In the exploratory set (N = 3159) SS was associated with both CARE (B = 0.200, p < 0.001) and PD (B = 0.455, p < 0.001). Moreover, PD was also associated with CARE (B = 0.094, p = 0.001) and mediated the effect of CARE on SS (proportion mediated = 17.7%, p = 0.001). The results were successfully replicated in the confirmation set (N = 781; total effect = 0.417, p < 0.001; proportion mediated = 29.7%, p < 0.001). Follow-up analyses also found evidence for an opposite effect (i.e., from SS to CARE, B = 0.132; p < 0.001), suggesting that there might be a vicious circle between the self-perceived stigmatization and the access to health care and the use of preventive measures against COVID-19 infection. Conclusions Refugees and other migrants who had more difficulties in accessing health care and preventive measures against COVID-19 infection experienced worse mental health and increased discrimination. These negative effects appeared to be stronger for those with more insecure housing and residence status, highlighting from one side the specific risk of insecure housing in the impact of COVID-19 upon mental health and infection protection, and for another side the need to proper housing as a strategy to prevent both COVID-19 and mental distress.

Exploring the Effects of the COVID-19 Pandemic on Mental Health and Well-Being of Migrant Populations in Europe: An Equity-Focused Scoping Review

“…During the first wave of the COVID-19 pandemic, a total of 168 countries closed their borders, and resettlement movements were suspended, hence aggravating the need for international protection of migrants and refugees [ 28 ]. The pandemic harmed the mental health of the global population, including those in the European region, with a disproportionately severe impact on refugees and other migrants [ 32 ].…”

“…Global studies such as the ApartTogether survey [ 21 ] and comparative studies as the study conducted in Poland and the Netherlands among citizens of the above countries as well as among immigrants residing in the Netherlands [ 27 ], should be considered in the future with improved sampling procedures to analyze the contextual factors that might impact mental health inequities. Additionally, future research should focus on protective factors and coping strategies that might mitigate the effect of the risk factors known to negatively impact mental health, in particular among the most disadvantaged populations, such as migrants, homeless people, or with difficult living conditions, people with previous experience of severe traumatic events and mental distress [ 32 ].…”

“…Finally, findings serve to highlight the need for proper housing as a strategy to prevent both COVID-19 and mental distress by revealing that people who have more difficulties in accessing health care and preventive measures against the infection experience deterioration of their mental health and increased discrimination by the host population [ 32 ].…”

Health inequities and social determinants of health in refugee and immigrant communities.

“…found that unstable housing was a significant obstacle to implementing COVID-19 precautions such as distancing and hand washing (Marchi et al, 2022). While income is certainly an issue in housing selection among undocumented workers, visibility is also a significant factor (Hall & Stringfield, 2014).…”

“…However, again, COVID-19 highlighted the impact of these inequities, as imMigrant workers worldwide experienced increased harm due to COVID-19 exposure in overcrowded housing (such as in Singapore; Koh, 2020) and a lack of access to emergency housing to permit social distancing for survivors of domestic abuse with invisible status (Ng et al, 2020). In addition, a European sample of migrants found that unstable housing was a significant obstacle to implementing COVID-19 precautions such as distancing and hand washing (Marchi et al, 2022).…”