Psychiatric and somatic health of homeless individuals in the context of their migration history

Abstract Background Descriptions of homeless individuals’ somatic and psychiatric health status remain scarce. The heterogenicity of the population is increasing, with more people migrating within the European Union. Migration history has been described as a determinant of health and healthcare access. Methods A multicenter cross-sectional study design included homeless individuals in Germany. Using interview-based questionnaires, the prevalence of mental and somatic illnesses, as well as healthcare use and access, were determined. Multinominal logistic regression analysis was performed to examine the influence of the homeless migration history on health status. Results 306/635 (48.2%) of the homeless individuals were born outside Germany; 213/306 (69.6%) came from another EU country. Homeless people from EU countries frequently reported economic reasons for leaving their home country (51.0%) and entering Germany (64.4%). Compared to homeless individuals of German origin and homeless non-EU migrants, they stated to live rough (48.2% p = 0,03), not hold health insurance (62.4% p < 0,0001), and not receive state funds (82.6% p < 0,0001) more often. Prevalences of psychiatric and somatic illnesses among homeless people were high compared to the general German population. There were no differences observed between the prevalence of chronic diseases if stratified by the origin of the homeless individuals. Conclusions Homeless individuals report higher prevalences of psychiatric and somatic illnesses than the general population. Compared to homeless people of other origins, homeless EU migrants may be disadvantaged in their housing situation and integration into the German social security system. Key messages • Programs aiming to integrate homeless people into mainstream health care should focus on homeless EU migrants. • Our data underline the need for specific care services for homeless individuals.


Background:
National identities are socially constructed and imaginary groups with real-life consequences. Migrants are in a heightened risk to be treated as 'others' who do not belong to society. It remains unclear, to what extent national belonging is experienced among Finnish migrants and what consequences on health this has. We study migrants' sense of belonging to Finns, how it's manifested in sociodemographic groups and whether it's associated with psychological strain.

Methods:
We used nationally representative data from the crosssectional Survey on Well-Being among Foreign-Born Population (FinMonik, n = 6836). National belonging was assessed by the item ''Finns'' in question ''which of the following areas or groups you feel you belong to?''. Response options fully and quite a lot were coded to indicate sense of belonging. Logistic regression was used to test the association between belonging, sociodemographic factors and psychological strain (MHI-5). Weights were used to correct the sample. Results: 51% reported sense of belonging to Finns. 46% of those aged 30-44 reported sense of belonging to Finns, whereas the youngest and oldest age groups yielded highest prevalences (18-29 = 53% and 45-64 = 58%, p<.001). Married persons reported sense of belonging to Finns more than those who weren't (55% vs. 48%, p<.01). Country group accounted for the variation in Finnish identification with a p-value of less than 0.001. Only 27 percent of those born in East Asia reported sense of belonging to Finns, whereas almost 60% of those born in Middle East and North Africa sensed belonging to Finns. Those with sense of belonging to Finns were twice as likely to report lack of psychological strain than those with no sense of belonging to Finns (p<.001).

Conclusions:
Achieving national belonging to the receiving society seems to be more difficult or non-appealing for some migrant populations than others. Lack of national belonging poses risk of deterioration of mental health.

Key messages:
The socially constructed boundaries of national belonging can be exclusionary and have negative consequences for the health of migrant populations. Experiencing a sense of national belonging to the country of residence has positive associations with mental wellbeing.

Background:
Descriptions of homeless individuals' somatic and psychiatric health status remain scarce. The heterogenicity of the population is increasing, with more people migrating within the European Union. Migration history has been described as a determinant of health and healthcare access.

Methods:
A multicenter cross-sectional study design included homeless individuals in Germany. Using interview-based questionnaires, the prevalence of mental and somatic illnesses, as well as healthcare use and access, were determined. Multinominal logistic regression analysis was performed to examine the influence of the homeless migration history on health status. Results: 306/635 (48.2%) of the homeless individuals were born outside Germany; 213/306 (69.6%) came from another EU country. Homeless people from EU countries frequently reported economic reasons for leaving their home country (51.0%) and entering Germany (64.4%). Compared to homeless individuals of German origin and homeless non-EU migrants, they stated to live rough (48.2% p = 0,03), not hold health insurance (62.4% p < 0,0001), and not receive state funds (82.6% p < 0,0001) more often. Prevalences of psychiatric and somatic illnesses among homeless people were high compared to the general German population. There were no differences observed between the prevalence of chronic diseases if stratified by the origin of the homeless individuals.

Conclusions:
Homeless individuals report higher prevalences of psychiatric and somatic illnesses than the general population. Compared to homeless people of other origins, homeless EU migrants may be disadvantaged in their housing situation and integration into the German social security system. Key messages: Programs aiming to integrate homeless people into mainstream health care should focus on homeless EU migrants. Our data underline the need for specific care services for homeless individuals.