Background
Refugees, asylum-seekers and torture claimants in Hong Kong
Refugees and mental health
Methods
Social determinants of health framework
Study design, setting and participants
Survey instrument
Consisting of 5 items, the scale assessed frequencies of different day-to-day mistreatment; with a Cronbach alpha of 0.77. Participants were asked to rate the frequency of the following items: |
1. You are treated with less courtesy or respect than other people. |
2. You receive poorer service than other people at restaurants or stores. |
3. People act as if they think you are not smart. |
4. People act as if they are afraid of you. |
5. You are threatened or harassed. |
Responses were rated into: never, less than once a year, a few times a year, a few times a month, at least once a week and multiple times a week |
Everyday discrimination scale
Socio-demographics characteristics | |
Gender | |
Male | 292 (78.1%) |
Female | 82 (21.9%) |
Age Group (Mean: 31.52, SD: ±7.41) | |
18–27years | 107 (28.6%) |
28–37years | 194 (51.9%) |
38–47years | 66 (17.6%) |
48years + | 7 (1.9%) |
Place of origin | |
North Africa | 13 (3.5%) |
East Africa | 131 (35.0%) |
Central Africa | 69 (18.4%) |
South Africa | 10 (2.7%) |
Western Africa | 151 (40.4%) |
Length of Residence in Hong Kong | |
Less than 5 years | 280 (74.9%) |
5 to 10 years | 89 (23.8%) |
11years plus | 5 (1.3%) |
Intermediarydeterminants of health | |
Material/Living Circumstances | |
Problems with Accommodation | |
No | 80 (21.4%) |
Yes | 294 (78.6%) |
Problems with food packages | |
No | 132 (35.3%) |
Yes | 242 (64.7%) |
Problems with case officer | |
No | 174 (46.5%) |
Yes | 200 (53.5%) |
Biological/Behavioural Circumstances | |
Alcohol consumptiona,b
| |
None | 268 (71.7%) |
Infrequently | 57 (15.2%) |
Frequently | 49 (13.1%) |
Smokinga,c
| |
None | 260 (69.5%) |
Light Smoker | 24 (6.4%) |
Heavy Smoker | 90 (24.1%) |
Recreational Drugsa
| |
No | 342 (91.4%) |
Yes | 32 (8.6%) |
Exercisea,d
| |
Little or none | 276 (73.8%) |
Frequent | 98 (26.2%) |
Multiple Sex partnersa
| |
None | 201 (53.7%) |
Only one | 117 (31.3%) |
More than one | 56 (15.0%) |
Illness, Injury, or symptomsa
| |
No | 193 (51.6%) |
Yes | 181 (48.4%) |
Chronic illness | |
No | 223 (59.6%) |
Yes | 151 (40.4%) |
Psychosocial Factors | |
Religion | |
Atheist | 14 (3.7%) |
Christian/Catholic | 211 (56.4%) |
Muslim | 142 (38.0%) |
Other | 7 (1.9%) |
Marital Status | |
Single | 252 (67.4%) |
Married | 71 (19.0%) |
Divorced/Separated/Widowed | 51 (13.6%) |
Living Companion | |
Alone | 286 (76.5%) |
With Family | 65 (17.4%) |
With Others | 23 (6.1%) |
PHQ-2 Score (Cut off at 2) | |
Below 2 | 239 (63.9%) |
Equal or above 2 | 135 (36.1%) |
General healthe
| |
Very Good/Excellent | 72 (19.2%) |
Good | 114 (30.5%) |
Fair/Poor | 188 (50.3%) |
Health vs. locals of same agee
| |
Better or Much Better | 162 (43.3%) |
Same | 133 (35.6%) |
Worse or Much Worse | 79 (21.1%) |
Health vs. prior arrival in HKe
| |
Better or Much Better | 148 (39.6%) |
Same | 110 (29.4%) |
Worse or Much Worse | 116 (31.0%) |
PHQ-2 Score (Cut off at 4) | |
Below 4 | 327 (87.4%) |
Equal or above 4 | 47 (12.6%) |
Health system determinants of health | |
Satisfaction with Medical Services | |
Not used | 87 (23.3%) |
Fair/Poor | 105 (28.1%) |
Good-Excellent | 182 (48.6%) |
Admission to hospitala
| |
Yes | 146 (39.0%) |
No | 228 (61.0%) |
Difficulties Accessing Medical Facilities | |
No | 104 (27.8%) |
Yes | 270 (72.2%) |
Obtained treatment due to illness/injurya
| |
Yes | 217 (58.0%) |
No | 157 (42.0%) |
Structural determinants of health | |
Socio-economic Position | |
ASR Status | |
Refugee | 32 (8.6%) |
Asylum Seeker Claimant | 172 (46.0%) |
Torture Claimant | 115 (30.7%) |
Asylum Seeker & Torture Claimant | 55 (14.7%) |
Education Level in country of origin | |
None | 55 (14.7%) |
Primary | 87 (23.3%) |
High School | 177 (47.3%) |
University or above | 55 (14.7%) |
Occupation in country of origin | |
Professional | 124 (33.1%) |
Supervisory | 57 (15.2%) |
Skilled manual worker | 74 (19.8%) |
Semi/Unskilled manual worker | 44 (11.8%) |
Casual worker or unemployed | 75 (20.1%) |
Discrimination | |
Everyday Discrimination Scale: Mean = 12.87; SD = ±7.01 | |
Treated with less respect than localsa
| |
None | 118 (31.5) |
Not regularly | 96 (25.7) |
Regularly | 160 (42.8) |
Receive Poorer Services than localsa
| |
None | 104 (27.8) |
Not regularly | 83 (22.2) |
Regularly | 187 (50.0) |
Considered Not Smarta
| |
None | 100 (26.8) |
Not regularly | 88 (23.5) |
Regularly | 186 (49.7) |
People Fear youa
| |
None | 117 (31.3) |
Not regularly | 84 (22.4) |
Regularly | 173 (46.3) |
Felt threateneda
| |
None | 169 (45.2) |
Not Regularly | 79 (21.1) |
Regularly | 126 (33.7) |
The patient health questionnaire-2
Data analysis
Results
Socio-demographics and social experiences of African ASRs in Hong Kong
Intermediary determinants of depression
Variable | OR | 95%CI | aOR | 95%CI |
---|---|---|---|---|
Intermediary determinants of health | ||||
Age | 1.05 | (1.01–1.09)* | 1.02 | (0.97–1.07) |
Exercisea,b
| 0.37 | (0.15–0.91)* | 0.42 | (0.15–1.15) |
Illness, Injury, or symptomsa
| 2.55 | (1.33–2.17)* | 1.23 | (0.49–3.06) |
Chronic illness | 2.44 | (1.31–4.56)* | 0.87 | (0.35–2.18) |
Living Companion (Alone) | ||||
With Family | 0.30 | (0.09–0.99)* | 0.25 | (0.07–0.88)* |
Others | 1.29 | (0.41–4.00) | 0.97 | (0.23–4.04) |
General health ‖ (Very Good/Excellent) | ||||
Good | 2.46 | (1.66–9.13) | 3.18 | (0.71–14.19) |
Fair/Poor | 4.90 | (1.45–16.51)* | 5.78 | (1.40–23.81)* |
Health vs. locals of same agec‖ (Better) | ||||
Same | 2.65 | (1.30–5.42)* | 2.22 | (0.90–5.49) |
Worse | 1.49 | (0.60–3.61) | 0.63 | (0.20–1.98) |
Healthsystem determinants of health | ||||
Reported difficulties accessing Med Services (Yes) | 2.92 | (1.20–7.11)* | 3.57 | (0.95–13.44) |
Satisfaction with Medical Services (Not Used) | ||||
Good - Excellent | 1.27 | (0.43–3.71) | 0.75 | (0.16–3.41) |
Fair - Poor | 2.88 | (1.16–7.18)* | 0.92 | (0.23–3.67) |
Obtained treatment due to illness/injuryd
| 2.32 | (1.16–4.64)* | 1.19 | (0.44–3.25) |
Structural determinants of health | ||||
Everyday Discrimination Scaled
| 1.17 | (1.11–1.23)** | 1.17 | (1.10–1.24)** |