Neighborhood disadvantage is associated with increased risk of psychiatric disorders in refugee children

 1. In a retrospective study of refugee children in Denmark, there was a linear association between increasing risk of psychiatric disorders and increasing neighborhood disadvantage.

2. Increasing neighborhood disadvantage was associated with increased use of psychiatric medications.

Evidence Rating Level: 2 (Good)

Study Rundown: It has been well-documented that adverse childhood events increase the risk of developing future mental health disorders. Refugee children may be particularly vulnerable to psychiatric disorders given their exposure to difficulties associated with geographic displacement. However, there is limited research studying the interaction between neighborhood characteristics following displacement and the risk of psychiatric disorders in refugee children. To address these deficits, this study examined the association between neighborhood disadvantage and risk of psychiatric disorders in a cohort of Denmark refugees who were 0 to 16 years of age at the time of resettlement from 1986 to 1998. Of the approximately 18,000 refugee children followed for a median of 16 years, increasing neighborhood disadvantage was linearly associated with risk of psychiatric disorders and the use of psychiatric medication. Two notable limitations of this study include unmeasured neighborhood factors that may confound results, as well as limiting mental health outcomes solely to psychiatric diagnoses and medication use. Overall, this study has broad implications for refugee health, and suggests that placing refugee children in advantaged neighborhoods may have positive impacts on long-term mental health outcomes.

Link to Article: Click here to read the article in the JAMA Pediatrics

Relevant Reading: Neighbourhood socioeconomic disadvantage and behavioural problems from late childhood into early adolescence

In-Depth [retrospective cohort]: This was a registry-based cohort study including 18,709 refugee children from Denmark aged 0 to 16 years of age at the time of resettlement during the study period of 1986 to 1998. Data were acquired from several longitudinal registers that include the entire Danish population. Psychiatric morbidity was defined as a first-time psychiatric evaluation in any healthcare setting in childhood or early adulthood up to 30 years of age (primary outcome), or first-time redemption of prescribed psychiatric medications (secondary outcome). Neighborhood disadvantage was measured by an index derived from principal component analysis of 4 measures: median family income, educational attainment, unemployment rate, and welfare benefits. For the primary outcome, an increase of 1 standard deviation in neighborhood disadvantage was linearly associated with an 11% increase in risk of psychiatric disorders (hazard ratio [HR] 1.11, 95% CI 1.03- 1.21). Similarly, a linear relationship was described between an increase of 1 standard deviation in neighborhood disadvantage and psychiatric medication use by 8% (HR 1.08; 95% CI 1.03-1.14). There was a trend (p=0.42) towards greater risk of psychiatric disorders in single parent households (HR 1.40; 95% CI, 1.08-1.81) compared to dual parent households HR 1.09; 95% CI, 1.00-1.19, although it was not statistically significant.

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