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Leiler, Bjärtå, Ekdahl & Wasteson, 2019 🔗

Mental health and quality of life among asylum seekers and refugees living in refugee housing facilities in Sweden

Year: 2019

Type of text: Academic article

Published by:  Social Psychiatry and Psychiatric Epidemiology (2019) 54:543–551 

Language: English

Author: Anna Leiler,  Anna Bjärtå, Johanna Ekdahl, & Elisabet Wasteson

Pages: 9

Available at:

Short description of text 

The study is about self-reported mental health and quality of life of a total of 510 respondents (367 were asylum seekers and 143 had received a residence permit) residing in or nearby refugee housing facilities in Jämtland. The period studied is November 2016 to April 2017. The authors claim that this is “one of the first to report on the mental health status among refugees after the crisis in 2015 and to compare the level of clinically significant symptoms among individuals with RP and asylum seekers” (548) and that it is “one of the largest existing studies including not resettled refugees” (549).

Most important results

“importance of residence status for mental health” (547)

“Of the total sample, 56–58.4% reported clinically significant levels of symptoms of depression, anxiety and risk of having PTSD. Prevalence estimates were higher among asylum seekers than among those who had received their residence permit. Quality of life was generally rated below population norms and correlated negatively with mental health outcomes.” (abstract)

“However, the broader community of refugees arriving to Europe in 2015 and forward has not yet been thoroughly studied. Moreover, only a few studies have highlighted the importance of residence status. Nevertheless, those studies indicate poorer mental health among asylum seekers compared to resettled refugees [19, 20]. The group of refugees arriving in the aftermath of the refugee crisis in 2015 was a heterogeneous group, but they shared the conditions they were met with in the host countries. In order to meet the needs of incoming asylum seekers and support transition into a new society, there is a need for extended knowledge on this group of refugees.” (544)

“Quality of life was rated below the population norms established by Skevington, Lofty and O’Connell [24] in all domains, with the lowest ratings found in the domain of environmental quality of life.” (546)

“No differences in ratings of quality of life were found between asylum seekers and individuals with RP, neither in the domain scores nor in general ratings of quality of life or overall satisfaction with health.” (546)

“All health outcome measures were negatively correlated with self-assessed quality of life (see Table 4). The strongest association was found between degree of depression and perceived physical health.

“ (546)

“Prevalence of depressive symptoms was five times higher in this sample than in the Swedish general population, and prevalence of anxiety was four times higher [10]. Levels of PTSD symptoms were about twice as high as compared to levels found in other populations [28, 30].” (548)

“In addition, the levels of reported symptom of mental illhealth in the current study diverged from numbers reported in previous reviews regarding refugee mental health [eg. 2, 3] and of recent studies on mental health of resettled Syrian refugees [12, 15]. This indicates that the refugees under examination in the current study were worse off than what has previously been described within the field of refugee mental health. Explanations to these results might be found looking at the context of refugee reception from 2015 and forward, and the consequences this had for the asylum process and for the individuals caught in it.” (547)

“High levels of anxiety are comprehensible considering the justified fear of repatriation, but PTSD can also be explained by this factor. In facing a risk of being sent back to the country they have fled from, the trauma could be described as still ongoing (see Nickerson, Bryant, Silove and Steel [37] for further elaboration on this).” (547-548)

“Due to a lack of permanent housing solutions, large groups of refugees had received their residence permit but were still not resettled. The results of this study indicate that although they were better off than those still seeking asylum, their mental health status was still lower than that of the resettled refugees more often studied [2–5].” (548)

Environmental quality of life rated lower in this study of refugees in reception facilities than of refugees in camps in Iraqi Kurdistan, hosting Syrian refugees! (548)


“Data, based on 510 individuals, were obtained by means of a questionnaire at open screenings conducted at or nearby refugee housing facilities. Of the participating refugees, 367 were asylum seekers and 143 had received a residence permit but were still awaiting a more permanent housing solution. The questionnaire included measures of depressive symptoms (PHQ-9), symptoms of anxiety (GAD-7), risk of having post-traumatic stress disorder (PC-PTSD), and quality of life (WHOQOL-BREF).” (abstract)

“a cross-sectional study was conducted in the region Jämtland Härjedalen, Sweden” (544)

“ period of November 2016 to April 2017” (544)

“The majority were men and most participants were in the ages of 18–35” (545)

“The final sample was compared to the statistics on the entire population of asylum seekers in Sweden. Based on age, gender and nationality, we can see that our sample in a number of aspects resembles the target population of refugees in housing facilities in Sweden. However, it does diverge in some aspect, indicating that generalizability of the results might be limited.” (548)

“Steel et al. [5] showed that the use of self-report questionnaires resulted in prevalence rates ten percentage units higher than when using diagnostic interviews. Even while considering this, estimates of mental health problems were alarmingly high in the present sample.” (549)

Policy suggestions

“These results are troublesome since the wait time for asylum decisions has lengthened considerably after 2015. The results of the present study calls for the urgency of societal actions to shorten the asylum process and improve conditions at the housing facilities.” (abstract)

Suggestions for further research

“Based on the results from the current study, a recommendation for future studies on refugee mental health is to describe the legal status of the participants and the psychosocial context in which the study takes place. These factors might greatly affect both the symptom levels and the quality of life of refugees. “ (549)

Summarised by: Josefin Åström