Exploring the effects of the COVID-19 pandemic on mental health and well-being of migrant populations in europe: an equity-focused scoping review
Abstract
The pandemic is aggravating health inequalities, particularly mental health inequalities, while revealing the social determinants of these inequalities, including migration as a social determinant that mediates the interaction of social, economic, cultural, institutional, and structural factors with health indicators. Therefore, it is of most relevance to identify the multiple interconnected factors that influence the mental health and well-being of migrant populations. A scoping review was developed to map the research performed in this area and to identify any gaps in knowledge, following the PRISMA extension for scoping reviews. MEDLINE, Scopus, and WHO Global Health research databases on COVID-19 were searched from January 2020 to October 2021. The review followed the inclusion criteria Population/Concept/Context (PCC): Population-Adult International migrants (including refugees, asylum seekers, and undocumented migrants); Concept-determinants of (and factors influencing) mental health and well-being; Context-COVID-19 anywhere in the world. Of the sixty-five selected studies, eleven were from European countries and were the focus of this review with special attention to health inequalities experienced by migrants in Europe. The results cover a diversity of themes related to the effects of COVID-19 on the mental health of migrants (country-level environmental factors, social determinants of mental health, mental health indicators and outcomes), responses (such as solidarity and resilience), populations, and study methods. The evidence found can inform recommendations and interventions focused on health promotion and mitigation of the inequalities accentuated by the pandemic.
Full text
Behav.Sci.2022,12,393.https://doi.org/10.3390/bs12100393www.mdpi.com/journal/behavsci Review ExploringtheEffectsoftheCOVID‐19PandemiconMental HealthandWell‐BeingofMigrantPopulationsinEurope:An Equity‐FocusedScopingReview VioletaAlarcão 1,2, *,AnaVirgolino 2 ,MiodragaStefanovska‐Petkovska 2 andJúliaNeves 1,2 1 CentrodeInvestigaçãoeEstudosdeSociologia,Iscte—InstitutoUniversitáriodeLisboa,AvenidadasFor‐ çasArmadas,1649‐026Lisboa,Portugal 2 InstitutodeSaúdeAmbiental,FaculdadedeMedicina,UniversidadedeLisboa,AvenidaProfessorEgas Moniz,1649‐028Lisboa,Portugal *Correspondence:violeta_sabina_alarcao@iscte‐iul.pt Abstract:Thepandemicisaggravatinghealthinequalities,particularlymentalhealthinequalities, whilerevealingthesocialdeterminantsoftheseinequalities,includingmigrationasasocialdeter‐ minantthatmediatestheinteractionofsocial,economic,cultural,institutional,andstructuralfac‐ torswithhealthindicators.Therefore,itisofmostrelevancetoidentifythemultipleinterconnected factorsthatinfluencethementalhealthandwell‐beingofmigrantpopulations.Ascopingreview wasdevelopedtomaptheresearchperformedinthisareaandtoidentifyanygapsinknowledge, followingthePRISMAextensionforscopingreviews.MEDLINE,Scopus,andWHOGlobalHealth researchdatabasesonCOVID‐19weresearchedfromJanuary2020toOctober2021.Thereview followedtheinclusioncriteriaPopulation/Concept/Context(PCC):Population‐AdultInternational migrants(includingrefugees,asylumseekers,andundocumentedmigrants);Concept‐determi‐ nantsof(andfactorsinfluencing)mentalhealthandwell‐being;Context‐COVID‐19anywherein theworld.Ofthesixty‐fiveselectedstudies,elevenwerefromEuropeancountriesandwerethe focusofthisreviewwithspecialattentiontohealthinequalitiesexperiencedbymigrantsinEurope. TheresultscoveradiversityofthemesrelatedtotheeffectsofCOVID‐19onthementalhealthof migrants(country‐levelenvironmentalfactors,socialdeterminantsofmentalhealth,mentalhealth indicatorsandoutcomes),responses(suchassolidarityandresilience),populations,andstudy methods.Theevidencefoundcaninformrecommendationsandinterventionsfocusedonhealth promotionandmitigationoftheinequalitiesaccentuatedbythepandemic. Keywords:coronavirusdisease2019;mentalhealthandwell‐being;socialdeterminantsofhealth; migration 1.Introduction AsrapidastheCOVID‐19pandemicemerged,itgaverisetoaseriesofdisruptivecon‐ sequencesintheeconomic,health,andeducationalsectorsthatcontributedtoascenarioof disproportionaleconomicandsocialvulnerability.Theseeffectsofthepandemicseemtobe greaterinsociallyvulnerableandmarginalizedgroups,morespecificallymigrantpopula‐ tions.WhilethesegroupsareoverrepresentedinCOVID‐19casesintermsoflaboratory diagnosis,hospitaladmissions,intensivecare,anddeathstatisticsinallcountriesaccording totheavailabledata[1–4],theycontinuetofacestructuralbarrierstoCOVID‐19control efforts,suchastestingandvaccination[5,6].Asaresult,inadditiontotheadverseeffects ontheirphysicalhealth,theyarepronetothedevelopmentofmentalhealthandwell‐being ill‐effects,thuspositioningthemasoneofthemostvulnerableandneglectedgroupsinthe COVID‐19pandemic[7–9]. Citation:Alarcão,V.;Virgolino,A.; Stefanovska‐Petkovska,M.;Neves,J. ExploringtheEffectsofthe COVID‐19PandemiconMental HealthandWell‐BeingofMigrant PopulationsinEurope:An Equity‐FocusedScopingReview. Behav.Sci.2022,12,393. https://doi.org/10.3390/bs12100393 AcademicEditor:AndrewSoundy Received:17September2022 Accepted:13October2022 Published:14October2022 Publisher’sNote:MDPIstaysneu‐ tralwithregardtojurisdictional claimsinpublishedmapsandinstitu‐ tionalaffiliations. Copyright:©2022bytheauthors.Li‐ censeeMDPI,Basel,Switzerland. Thisarticleisanopenaccessarticle distributedunderthetermsandcon‐ ditionsoftheCreativeCommonsAt‐ tribution(CCBY)license(http://crea‐ tivecommons.org/licenses/by/4.0/).
Behav.Sci.2022,12,3932of15 Thisresearchcentralizesaroundthepremisethatthepandemicisaggravatinghealth inequalities,particularlymentalhealthinequalities,whilerevealingthesocialdetermi‐ nantsoftheseinequalities,includingmigrationasadeterminantthatmediatestheinter‐ actionofsocial,economic,cultural,institutional,andstructuralfactorswithhealthindi‐ cators,affectingthedifferentspheresoflife[10–13].Therefore,itisrelevantandnecessary toidentifythemultiplefactorsthatinterconnectandinfluencementalhealthandwell‐ beingtounderstandtheinterdependenciesbetweenmentalhealthandglobalchallenges, suchasthecurrentcontextandimpactsattheindividualandsocietallevels. Intersectionalapproachesareneededtoanalyzethecomplexityofthepandemicsit‐ uationandadaptthepoliticalresponsestodealwiththiscomplexity.Intersectionalityis atheoretical‐methodologicalpowerfultooltorevealprocessesofinteractionbetween powerrelationsandcategories—suchasgender,class,race,andethnicity—inindividual, collective,andcultural/institutionalcontexts,yetstillwithlimiteduseinmentalhealth. Usinganintersectionallensofanalysiscanhelptoidentifydifferentialsinthemental healtheffectsofthepandemicbetweenindividualsandsocialgroups,facilitatingtheelab‐ orationofpoliticalresponsestailoredtopeopleatthemostmarginalizedintersections(ra‐ cial/ethnicminorities,women,andundocumentedworkers)withafocusonequity[14– 17]. Thisscopingreviewaimstoidentifyandsummarizetheexistingresearchontheef‐ fectsoftheCOVID‐19pandemiconthementalhealthofmigrantswithreflectiononthe Europeancontext(anunder‐researchedregionneedingafocusedanalysis)toinform suitedrecommendationsformigrant‐sensitiveandmigrant‐inclusivehealthcare.The overarchingresearchquestionwastopinpointthemultiplefactorsinfluencingthe COVID‐19pandemic’seffectsonthementalhealthofinternationaladultmigrants(in‐ cludingrefugees,asylumseekers,andirregularmigrants). 2.Methods 2.1.StudyDesign InearlyOctober2021,weconductedapreliminarysearchontheJoannaBriggsInsti‐ tute(JBI)DatabaseofSystematicReviewsandImplementationReportsandtheCochrane DatabaseofSystematicReviewsforidentifyingexistingscopingandsystematicreviews onthetopic.NostudiesontheintersectionsbetweenCOVID‐19,mentalhealth,andmi‐ grantswerefound.Therefore,ascopingreviewwasdevelopedtomaptheresearchcar‐ riedoutinthisareaandtoidentifyexistingknowledgegaps,sincescopingreviewspro‐ videacomprehensiveoverviewtoaddressbroaderreviewquestionsthantraditionally morespecificsystematicreviewsofeffectivenessorqualitativeevidence[18]. TheprotocolwasregisteredwiththeOpenScienceFrameworkon5November2021. ThereviewwasundertakenfollowingthePreferredReportingItemsforSystematicRe‐ viewsandMeta‐Analysesextensionforscopingreviews—PRISMA‐ScR[19]andtherec‐ ommendationsmadebytheJBI,whichisaglobalorganizationpromotingandsupporting evidence‐baseddecisionsthatimprovehealthandhealthservicedelivery[18]. 2.2.SearchStrategy Asystematicliteraturesearchwasperformedusingthefollowingelectronicdata‐ bases:MEDLINE(viaPubMed),Scopus,andWHOGlobalHealthresearchdatabaseon COVID‐19,usingcombinationsofthesearchterms,tailoredtothesyntax,andfunction‐ alityofeachdatabase.Allsearcheswereconductedon13October2021andtailoredto eachelectronicdatabase(SeetheexamplesearchforMEDLINEinAppendixA).Adate rangelimitationof‘2020—current’wasdefined,andonlyEnglish‐writtendocuments wereconsideredeligibleforinclusion. 2.3.InclusionandExclusionCriteria
Behav.Sci.2022,12,3933of15 TheInternationalOrganizationforMigration(IOM)definesamigrantas“anyperson whoismovingorhasmovedacrossaninternationalborderorwithinaStateawayfrom his/herhabitualplaceofresidence,regardlessof(1)theperson’slegalstatus;(2)whether themovementisvoluntaryorinvoluntary;(3)whatthecausesforthemovementare;or (4)whatthelengthofthestayis”)wasconsidered[20].So,articlesinwhichthepopulation ofinterestdidnotmeetthecriteriastatedinthisdefinitionwereexcluded. ThePCCmethod(Population(orparticipants)/Concept/Context)recommendedby theJBItoidentifythemainconceptsintheprimaryreviewquestionswasusedforthe searchstrategyandthedefinitionofinclusioncriteria[18]:P(Population=International migrant,Refugee,Asylumseeker,Undocumentedmigrant,age18andabove),C(Concept =empiricaldataonindividual,social,cultural,institutional,andstructuralfactorsinflu‐ encingmentalhealthandwell‐beingoutcomes),C(Context=Studiesonanycountryin theworldreportinginternationalmigrants’mentalhealthandwell‐beingduringthe COVID‐19pandemic).Onlyempiricalstudieswereincluded,regardlessofresearchde‐ sign,samplesize,andmethodsused.Anexceptionwasinterventionstudies,whichwere excluded,becauseoftheirdistinguishedfeaturescomparedtoobservationalstudies.Book reviews,bookchapters,conferenceproceedings,editorials,commentaries,guidelines, studyprotocols,andvignettestudieswerealsoexcluded.Eachrelevantrecordwasre‐ viewedindependentlybytwoauthors,whichscreenedtitlesandabstracts,andwhen needed,fulltexts.Afinaldecisionwasobtainedforeachrecord,withuncertaintiesand disagreementsresolvedinconsultationwithathirdauthor. 2.4.DataExtractionandAnalysis Forallthearticlesincludedinthefinalanalysis,datawereextractedbytwoofthe authorsandincludedthefollowingvariables:(1)Author(s)andyearofpublication,(2) country,(3)population(samplesize,typeofmigrant,countryoforigin,age,gender),(4) aim,(5)design,(6)mentalhealthoutcome(s),(7)socialdeterminantsofhealth,(8)overall results,(9)overalllimitations,(10)andoverallrecommendations.Bibliometricdatare‐ gardingthejournal’stitle,publicationquartile,anddomain/areaofwork(i.e.,thearea withthehighestquartileintheyearofthestudypublicationaccordingtotheScimago JournalandCountryRank)werealsocollected.Methodologicalqualityorriskofbiasof theincludedarticleswasnotappraisedbecauseitwasnotrelevanttothescopingreview objectives,whichisconsistentwithguidanceonscopingreviewconduct[18].Results weresynthesizedusingathematicapproachfocusingontheidentificationofrelevant themesrelatedtoindividual,social,cultural,institutional,andstructuralfactorsinfluenc‐ ingmentalhealthoutcomes. 3.Results Atotalof1938publicationswereidentifiedfromthethreesearcheddatabases.Once duplicateswereremoved,1291articlesremainedforscreening.Ofthese,1226wereex‐ cludedbecausetheywerenotempiricalstudies,didnotfocusonmentalhealthoutcomes, orwerenotconductedamongmigrantpopulations.Asaresult,65studiescouldbein‐ cluded.Elevenarticles(17%)wereconductedinEuropeancountriesandwerespecifically selectedtobeincludedinthisreviewpaperformappingtheresearchontheeffectsofthe COVID‐19pandemiconthementalhealthofmigrantsaswellastoidentifyknowledge gapsinEurope.Aflowdiagramdetailingthenumberofstudiesincludedandexcluded ateachstageforthisreviewisprovidedinFigure1.
Behav.Sci.2022,12,3934of15 Figure1.PRISMA2020flowdiagram. 3.1.CharacteristicsofSelectedArticles Alloftheselectedstudieswerepublishedinjournalswithimpactfactor,mainlyin journalsrankedinthefirstquartile(7/11).Threestudieswerepublishedinjournalsinthe secondquartile,andonestudyinthethirdquartile.Intermsofthesubjectarea,fourarti‐ cleswerepublishedinthePublichealth,EnvironmentalandOccupationalHealthdo‐ main,twoinPsychiatryandmentalhealth,twoinGeography,PlanningandDevelop‐ ment,andoneinClinicalpsychology,inLeadershipandManagement,andHealth,Toxi‐ cologyandMutagenesis. ThestudieswereconductedineightEuropeancountriesandonepublicationwas fromaEuropeanConsortium,theApartTogetherConsortium,ledbytheGhentUniver‐ sityinBelgiumandtheUniversityofCopenhageninDenmark,andtheMigrationand HealthprogramoftheWHORegionalOfficeforEurope[21]. TwooftheelevenstudieswereconductedinItalywithmigrantpatientsinmental healthoutpatientdepartments,onepublishedin2020aimingtoevaluatetheimpactofthe COVID‐19–relatedlockdownonthedifficultiesintheutilizationofmentalhealthservices andfollow‐upadherence[22],andtheotherpublishedin2022toinvestigatetheeffects onthementalhealthoutcomes[23]. TwootherstudieswereconductedintheUnitedKingdom(UK),onewithBlack, Asian,andMinorityEthnicitygroup(BAME)healthcareworkers[24],andanotherwith datafromtheUKHouseholdLongitudinalSurveyandthefirsttwowaves(AprilandMay 2020)oftheCOVID‐19surveyviaweb‐basedquestionnairesappliedtoUK‐bornandfor‐ eign‐bornmen[25]. Additionally,twostudieswererelatedtotheNetherlands—morespecificallyan onlinesurveyamongChineseimmigrantslivingintheNetherlands[26]andaPolish studyofthreepopulationgroups:non‐immigrantslivinginPoland,Dutchcitizens,and PolishimmigrantslivingintheNetherlands[27].
Behav.Sci.2022,12,3935of15 Finally,fourcountries(Spain,Switzerland,France,andGermany)hadonepublica‐ tioneach,withdifferentpopulationsandapproaches.ResearchconductedinSpainwas centeredontheroleofresilienceformentalhealthintimesofCOVID‐19acrossgroupsof migrationandnon‐migrationindividuals[28].ThestudyinSwitzerlandwasconducted duringtheCOVID‐19lockdowninApril–May2020withundocumentedandrecentlyreg‐ ularizedmigrants[29],whiletheresearchinFrancefocusedonthechangesinmental healthamongdisadvantagedimmigrantsfromSub‐SaharanAfricainthegreaterParis areawithdatacollectedbeforeandduringthefirstCOVID‐19‐relatedlockdown[30].The investigationyieldinGermanyreliesonacohortofoutpatientsatapsychiatricoutpatient clinicwithahighpercentageofpatientswithamigrationbackground[31]. Thestudiesusedaquantitativeapproach,withonlineand/ortelephonesurveys. Thereisadiversityinthementalhealthoutcomesanalyzed,fromdepression,anxiety, andstress,tosleepingproblemsandsubstanceuse,satisfactionwithlife,andresponses (resilience,andsolidarity,amongotherstrategies). Table1presentsmoredetailsonthecharacteristicsofthestudies. Table1.Characteristicsofthestudies. Author, DateJournal,QuartileDomain/Areaof WorkCountry(ies)Populationand SampleMethods MentalHealthOut‐ comesandInstru‐ ments Aragonaet al.,2022[23] TheInternational journalofsocial psychiatryQ1 Psychiatryand mentalhealthItaly Migrantsintreat‐ mentinaMental HealthUnitatan outpatientdepart‐ ment(n=81) Telephonesurvey to casuallyselected adultsintreatment beforetheperiod oflockdownbythe clinicians ‐Post‐traumaticintru‐ sivethoughtsand nightmares(PTSD Scale) ‐Irritablebehaviorand angryoutbursts,and sleepdisturbances ‐Depressedmoodand psychicanxiety(Ham‐ iltonDepressionRat‐ ingScale) Aragonaet al.,2020[22]PublichealthQ2 Publichealth,En‐ vironmentaland Occupational Health Italy Patientsfromamen‐ talhealthoutpatient serviceinRome(n= 286);mainprove‐ nanceAfrica Retrospective cross‐sectional studywithdata routinelyinmedi‐ calrecords Trendsinthenumber ofpatientsandpsychi‐ atriccategoriesusing theInternationalClas‐ sificationofDiseases (ICD)‐9 Bujek‐Ku‐ basand Mojs,2021 [27] Internationaljour‐ nalofoccupational medicineandenvi‐ ronmentalhealth Q3 Publichealth,En‐ vironmentaland Occupational Health Polandandthe Netherlands Adults(n=168) Non‐immigrantsin Poland(n=50); Dutchcitizens(n= 56); Polishimmigrantsin theNetherlands(n= 62) Onlinesurvey(via Facebook) 1ststudybefore thepandemicin January2020and 2ndstudyin April–May2020 withthesamesur‐ veyset ‐PositiveandNegative ExperienceScale ‐PerceivedStress Scale,and ‐SatisfactionWithLife Scalepandemic Burton‐ J eangroset al.,2020[29] FrontiersinPublic HealthQ2 Publichealth,En‐ vironmentaland Occupational Health Switzerland Undocumentedand recentlyregularized migrants(n=117for theonlinequestion‐ naireandn=17for theinterviews) Cross‐sectional mixedmethods studynestedwith acohortstudy; onlinequestion‐ nairefollowedby phoneinterviews inasubsample Satisfactionwithlife, livingconditionsin Geneva,andsocialiso‐ lation
Behav.Sci.2022,12,3936of15 Gosselinet al.,2021[30] Journalofpsycho‐ somaticresearch Q1 Clinicalpsychol‐ ogyFrance n=100immigrants fromsub‐Saharan Africain theGreaterParis area Community‐based cohortbeforethe COVID‐19pan‐ demic,withbase‐ linedataontheliv‐ ingconditionsand mentalhealth,and follow‐uptele‐ phoneinterviews betweenApriland June2020 Depressionseverity— PatientHealthQues‐ tionnaire(PHQ9) Mingand DeJong, 2021[26] SustainabilityQ1 Geography,Plan‐ ningandDevel‐ opment Netherlands Chineseimmigrants livingintheNether‐ lands(n=268) Onlinesurveydur‐ ingthesecond waveofthepan‐ demic(November– December2020) Participantscompare theirwell‐beingwith thetimebefore COVID‐19usingan adaptedversionofthe ShortDepression‐ HappinessScale (SDHS); Moorthy andSankar, 2020[24] Journalofpublic healthQ1 Publichealth,En‐ vironmentaland Occupational health UnitedKingdom Black,Asian,and MinorityEthnicity group(BAME) healthcareworkers inLeicestershire(n= 200); 78%bornoutsideof theUK Cross‐sectional surveyusing20 questionsinan electronicformat from2May to17May2020 ImpactofCOVID‐19 onmentalhealth‐ Singlequestion Moranet al.,2021[31] FrontiersinPsychi‐ atryQ1 Psychiatryand mentalhealthGermany n=294psychiatric patientsinanoutpa‐ tient clinicinBerlin,with ahighpercentageof patientswithami‐ grationbackground Multimodesurvey (telephoneinter‐ viewbyclinical staffandself‐ad‐ ministeredbypa‐ tients)between AprilandJune 2020 ‐Lockdown‐related distress: fearforlovedones; sleep;physicalcom‐ plaints;anxiety;wors‐ eningsymptoms; drugconsumption; fearofcontagion; ‐Family‐relateddis‐ tress:morehousehold tension,morework, moredomesticvio‐ lence Shenand Bartram, 2021[25] EuropeanSocieties Q1 Geography,Plan‐ ningandDevel‐ opment UnitedKingdom n=3778male,of which3337areUK‐ bornand441arefor‐ eign‐born COVID‐19survey viaweb‐based questionnaires; datafromUnder‐ standingSociety— theUKHousehold LongitudinalSur‐ veyandthefirst twowaves(April andMay2020)of the Mentalwell‐being, (GeneralHealthQues‐ tionnaire—GHQ) Solà‐Saleset al.,2021[28]HealthcareQ2Leadershipand ManagementSpain n=245Spanishnon‐ migrants,Spanish migrants, non‐Spanishmi‐ grantsandrefugees Face‐to‐faceor videocallinter‐ views betweenJanuary andMay2021, ‐Spanish adaptationoftheDe‐ pression,Anxietyand StressScale(DASS‐21);
Behav.Sci.2022,12,3937of15 throughasnowball sampling ‐Spanishadaptationof theBriefResilient CopingScale(BRCS), ‐Attitudestowardthe COVID‐19outbreak Spiritus‐ Beerdenet al.,2021[21] InternationalJour‐ nalofEnvironmen‐ talResearchand PublicHealthQ1 Health,Toxicol‐ ogyandMuta‐ genesis Europeanconsor‐ tium* n=20,742refugees andmigrantpartici‐ pantsolderthan16 yearsold(surveyre‐ spondentslivedin 170countriesand originatedfrom159 countries) Quantitativeonline globalstudy,as partofthe ApartTogether study,fromApril 2020untilNovem‐ ber2020in37lan‐ guages 11mental‐health‐re‐ lateditemsscale:feel‐ ingsofdepression, anxiety,worries,feel‐ ingsofloneliness,an‐ ger,unpleasantre‐ mindersofpasttrau‐ maticexperiences, physicalreactionsto stress,feelingsofirri‐ tation,hopelessness, sleepingproblems, andsubstanceuse *TheApartTogetherConsortiumincludesBelgium,Denmark,Ireland,UnitedStatesofAmerica, Sweden,UnitedKingdomofGreatBritain,andNorthernIreland,Portugal,Spain,Greece,Italy, andtheNetherlands. 3.2.Country‐LevelEnvironment TheCOVID‐19pandemichasposednewchallengestosocietiesandtheirhealthsys‐ tems.Theincludedpapersmentionaseriesofunprecedentedinterventionsimplemented, fromminor(maskwearingandhandhygiene)tomajorreadjustmentstoeverydaylife, suchasthe“lockdown”periodsthatfirsttookplaceinmanycountriesbetweenMarch andJune2020toreducethespreadofSARS‐CoV‐2infection[31],withItalybeingthefirst Europeancountrytobebrutallyimpacted[23]. Preventiveactionsinvolvedaseriesofescalatingrestrictionsoneverydaylife,includ‐ inglimitationsongatherings,travelrestrictions,andminimizationofmovementoutside ofthehouse,withseveralservicesclosedandsocialactivitiessuspended.Inadditionto thetremendousconsequencestotheeconomy,socio‐economicinequalitieswereexacer‐ batedduringthelockdown.TheUnitedKingdomisamongthecountrieswherepre‐ex‐ istingsocioeconomicinequalitieshavebecomeworsethanbeforethepandemicduetothe adoptedmeasures[25]. Switzerlandwasamongthecountriesmostrapidlyandseverelyaffectedrelativeto itssize,withapeakincidenceofnewpositivetestson30March2020,inGeneva,where undocumentedmigrantsrepresentabout2.5%ofthe500,000residents.Thedurationof thepublichealthlockdownmeasuresputmigrants,especiallyundocumentedmigrants, atincreasedriskofnotbeingabletomeettheirbasicneeds[29].Whilestronglyexposed tothedisease,somemigrantsdidnothavesufficientinformationaboutthepandemicand policymeasures.ThiswasthecaseinFrance,evenwithinformationcampaignslaunched toaddressthespecificneedsofthispopulation[30].DatafromtheFrenchNationalInsti‐ tuteofStatisticsrevealedthatthemortalityratewastwiceashighamongimmigrantsas amongnativesduringthefirstwaveoftheCOVID‐19pandemicinAprilandMarch,and amongimmigrantsfromsub‐SaharanAfrica,excessmortalitywasestimatedat+114% [30]. Inadditiontosocialisolation,COVID‐19hasdemandedpeopleadapttonovelsitu‐ ationsandfutureuncertainty,whichrepresentedagreatpsychologicalburden.Astudy conductedinPolandandtheNetherlandstoexploreenvironmentalstressandthequality oflifeconnectedwithCOVID‐19hasshownculturaldifferencesbetweenthetwocoun‐ tries,thatcanbelinkedtothegovernment’scrisismanagementinthesecountries[27]. AnxietydecreasedinthegroupofnativeDutchcitizensduringthepandemic,possibly duetotheDutchgovernment’spositivereinforcement(e.g.,thepolicepraisedcitizensfor
Behav.Sci.2022,12,3938of15 keepingadistanceof1.5m,andfewerbans).Moreover,thesenseofthequalityoflife increasedduringthepandemicamongPolishimmigrants,eventhoughtheyhadthehigh‐ estintensityoffearandnegativefeelings.Onthecontrary,anxietyincreasedamongPoles livinginPoland,whichmayresultfrommorerigidrestrictions(e.g.,wearingmasks,in‐ troducingvariousbans,orhighfinesfornon‐compliancewiththerules).Anotherexpla‐ nationcanbetheefficiencyofhealthcareintheNetherlands,whileplannedvisitstospe‐ cialistsweresuspendedinPoland[27]. 3.3.SocialDeterminantsofMentalHealth Economicstability(employment,income,housing,foodsecurity) Ofthe11articlesselected,sixpresentedfindingsoneconomicandlaborinstability inmigrantpopulationsduringCOVID‐19[21,23–25,29,30]. Socioeconomicissueslinkedtounemploymentandimmigrationstatusuncertainty increasedtheriskofmentalsufferingduetothepandemic[23].COVID‐19hasbeenim‐ pactingdisproportionallythemostsociallyvulnerablegroups,whoareathigherriskof experiencingnegativementalhealthoutcomes.Migrantsreportingmostchallengesinse‐ curingmaterialandmedicaldailyneeds,suchashousing,work,food,andclothesalso reportedmorenegativementalhealthoutcomes,includingmorefeelingsofanxietyand depression[21,30]. Mostmigrantsworkinjobs(domesticorconstructionwork)requiringtheirpresence, whichaddedtotheirdensehousingconditions,putsthemathigherriskofinfectionthan thegeneralpopulation,acrossseveralsettings[24,29,30].FindingsfromtheUKUnder‐ standingSocietyCOVID‐19longitudinalsurveyshowedthatmigrantworkingmenwere moreeconomicallyaffectedthantheirnative‐borncounterparts,namelyintermsoflosing workhours,andthatthiswideningofthesocialandeconomicdivisionswasfollowedby anincreasinggapinmentalwell‐being[25]. Socio‐demographiccharacteristicsofthemigrantpopulations(gender,age,ethnicity, education) GenderdifferencesinhealthoutcomesinthecontextofCOVID‐19wereobservedin theselectedstudies.Moranandcollaboratorsconcludedthatwhilemenhaveahigherrisk ofCOVID‐19mortalityandseverity,theindirectconsequencesofthevirustendtoimpact morewomen,duetotheirgreatersocioeconomicvulnerability.Impactsrangefromjob andincomelossestoincreasinggender‐basedviolenceandmentalhealth.However,men whoaremarginalizedorindisadvantagedpositionsarealsoparticularlyvulnerable[31]. Aragonaetal.presentedthenegativeimpactsoftheCOVID‐19lockdownonaccess tomentalhealthservicesandillustratedhowthepre‐pandemicsituationofvulnerability putsomesubgroupsofthepopulationmoreatrisk,includingpeoplewithlowereconomic status,homelessness,migrants,andpatientswithmentalhealthdisorders.Additionally, someindividualsfallintoseveralofthesesubgroups,thusfacingasignificantlyhigher riskofnegativementalhealthconsequences.InItaly,thereareincreasingcasesofasylum seekerswhoseclaimhasbeenrejectedthatarewithoutdocuments,withoutjobs,home‐ less,andlivinginpoverty.Thosemostvulnerablemigrantsalsooftenhavesymptomsof post‐traumaticstressdisorder(PTSD)duetotheirmigratoryexperience,aswellasde‐ pressiveandadjustmentdisorders[22]. IntheApartTogetheronlineglobalsurveyofrefugeesandmigrants,individualswith citizenshipreportedtheleasteffectofCOVID‐19ontheirmentalhealth,comparedtothe mostvulnerablegroupsofmigrants(i.e.,thoselivinginasylumcentersoronthestreet, thosewithoutdocumentsorwithtemporarydocuments).Youngerparticipantsalsore‐ portedalessnegativeeffectofCOVID‐19ontheiranxietyanddepression,indicatingan ageeffect[21].
Behav.Sci.2022,12,3939of15 Healthcareaccessandtreatmentcompliance Migrantsmorefrequentlyfacelimitedaccesstomedicalcare,diminishingtheodds ofseekingmedicaltreatmentearlyenoughtoreducethenumberofundetectedcasesand self‐isolateathome,whichmayacceleratethetransmissionofthedisease.Inaddition, duringtheCOVID‐19pandemic,accesstopublichospitalshasbeencontrolledbysecurity staff,withthelikelyconsequencetorepelundocumentedmigrants.Datasincethebegin‐ ningoftheCOVID‐19crisisindicatesthatundocumentedmigrantshavelowerutilization ofhealthcare,comparedtoregularizedmigrants.Additionally,poormentalhealthwas relatedtotheavoidanceofhealthcare[22]. Duringthelockdown,patientsreportedbarrierstomentalhealthcareaccess(alt‐ houghpsychiatriccareremainedavailableonline).Thisperceivedunavailabilityofser‐ vicesduetotheCOVID‐19emergencyisnotonlyrelatedtoareductioninthenumberof patientsandfollow‐upvisitsbutalsoinfluencedtreatmentdiscontinuation[22,23]. Aragonaetal.,intheirstudyofmigrantsintreatmentatanoutpatientdepartment,re‐ porteda32%discontinuationrateinthepsychopharmacologicaltreatmentand52%in psychotherapytreatment[23]. Additionally,thestudyinFrancehasshownthatthespecificpolicymeasuresimple‐ mentedbytheFrenchgovernment,suchasthevalidityofallresidencepermitsandthe StateMedicalAid(healthinsuranceforundocumentedpersons),wereonlyacknowl‐ edgedbyafewmigrants.However,regardingstrategiestopreserveone’shealth,ama‐ joritymentionedusingbarriermeasures(masks,handwashing,physicaldistancing)[30]. 3.4.MentalHealthIndicatorsandOutcomes Mentalandfamily‐relateddistress Amongindividualsalreadyintreatmentbeforethepandemic,therewasanincrease inthefrequencyofpsychicanxiety,depressivesymptoms,feelingsoftension/nervous‐ ness,andsleepdisorders,rangingbetween74%and91%,andincludinganxietyspecifi‐ callyrelatedtothecoronavirus(e.g.,fearofcontamination).Intermsoftheeffectsofthe lockdown,mentalsymptomswereunchangedorimprovedinmanypatients.However, anxietyandnervousnesswerereportedasthemostfrequentlyworsenedsymptoms,but neverabove50%[23]. Astudyofminorityethnichealthcareworkershasshownfeelingsofanxietyabout theworkingconditionandaboutfamily,particularlylivinginsocialisolationduring COVID‐19,withasignificantimpactontheirmentalhealth[24]. Astudywithfemalepsychiatricpatientsalsohasfoundgreaterfamily‐relateddis‐ tress,includingmorehouseholdtension,morehousework,andmoredomesticviolence, especiallyamongthosewithamigrationbackground[31]. Stigmatizationanddiscriminationofvulnerablegroups SincetheearliestcaseswerereportedinChina,severalstudieshavedrawnattention totheriseofstigmatizationandracismagainstChineseandAsianimmigrants.Asthe studyconductedamongChineseimmigrantsintheNetherlandshasshown,thepandemic anditssocietaldynamicsharmedmigrants’viewsoftheirhostcountry.Besidesfeelings offearofCOVID‐19,financialconsequences,socialisolation,feelingsoflosttime,missing China,andperceivedtravelrestrictionstoChina,moreexperiencesofracismwerefre‐ quentlyreported[26]. Otherresultshaveshownthatrefugeesandmigrantswithhigherperceiveddiscrim‐ inationlevelssincethepandemicalsoreportedworsementalhealthoutcomes[21]. 3.5.CopingBehaviors TheGermanstudyevaluatingtheexperienceofthepandemicamongacohortofout‐ patientsatalargepsychiatricoutpatientinstitutionmeasuredthelevelofdistresscon‐ cerningCOVID‐19lockdownandfoundincreasedconcernaboutrelatives,anxiety,worse sleep,andmorephysicalsymptoms,withasmallgroupalsoreportingincreaseddrug