Mental health and utilization of health care among asylum-seekers and refugees: results from a cross-sectional survey

Purpose Asylum-seekers and refugees (ASR) show a low utilization of mental health care (MHC), despite high prevalence rates for depression and anxiety. Limited eligibility, bureaucratic hurdles and lacking interpretation services may compromise ASRs’ access to health care in Germany and redirect them from ambulatory to emergency care. We analyze how physical and mental health and MHC, GP and ECS utilization interrelate.

Methods We surveyed ASRs from 22 randomly selected accommodation centers in Berlin using a validated questionnaire in nine languages. To compare associations of physical and mental health with GP, ECS and MHC utilization we employed a structural equation model (SEM), as using the different services is neither mutually exclusive nor independent from one another. All analyses were performed in Stata 15.1.

Results N = 319 ASRs (8 % of eligible ASRs) participated in the study. 37 % and 34 % respectively screened positive for anxiety and depression. While less than 25 % accessed any MHC in the prior year, around 37 % used ECS. The SEM results indicate higher utilization of GP (p < 0.01) and ECS (p < 0.05) by ASRs in poor physical health, and higher utilization of MHC by ASRs with anxiety (p < 0.05). We find a positive association between MHC and ECS utilization (p < 0.1), but no association between GP and ECS use.

Conclusions The positive association between MHC and ECS suggests that ASRs who access MHC also use ECS. ASRs with anxiety disorders are more likely to use MHC, but depression is not associated with utilization of any type of healthcare. This result may reflect the need to improve access to care for ASRs with depressive disorders.

Publication History

Article published online:
02 September 2021