Waiting for family reunification and the risk of mental disorders among refugee fathers: a 24-year longitudinal cohort study from Denmark.

PURPOSE: To examine whether family separation caused by prolonged waiting for family reunification is associated with the risk of mental disorders among refugee fathers. METHOD: Based on full-population Danish registry data covering 1995-2015, we mapped arrival patterns among nuclear refugee family members resettled in Denmark (n = 76,776) and established a cohort of refugee fathers (n = 6176) who all arrived alone and later obtained family reunification with their wife and children. The fathers were followed for up to 24 years, from the day their residence permit was issued until their first psychiatric diagnosis, emigration, death, or study end, whichever came first. Using Cox proportional hazard regression, we estimated hazard ratios (HRs) of being diagnosed with a mental disorder (i) for the period while the fathers were still separated from their family and (ii) across varying lengths of family separation. RESULTS: The HR of any mental disorder was 2.10 (95% confidence interval (CI): 1.57-2.81) for fathers still separated from their family compared with those who had obtained family reunification. The HR increased with longer family separation. Compared with fathers separated for < 9 months, the HR of any mental disorder was 1.43 (95% CI 1.08-1.89) for 9-11 months' separation, increasing to 2.02 (95% CI 1.52-2.68) for 18-23 months' separation. Results were driven by post-traumatic stress disorder. CONCLUSION: Fathers waiting for their wives and children face an increased risk of mental disorders. Countries receiving refugees should be aware that delaying family reunification can lead to adverse mental health effects.

Prolonged periods of waiting for an asylum decision and the risk of psychiatric diagnoses: a 22-year longitudinal cohort study from Denmark.

BACKGROUND: The high prevalence of psychiatric disorders among resettled refugees necessitates identification of factors that reduce the risk of mental illness. In this 22-year longitudinal cohort study, we assessed whether the length of asylum-decision waiting periods is associated with resettled refugees' risk of being diagnosed with a psychiatric disorder. METHODS: We used full-population data from the Danish Civil Registration System to establish a cohort of 46 104 refugees resettled in Denmark during 1995-2016. Hazard ratios (HRs) for first-time psychiatric hospital contact (ICD-10) after residence permit issuance across varying lengths of asylum-decision waiting periods were estimated by cross-linkage with the Danish National Patient Register. RESULTS: Long asylum-decision waiting periods were associated with an increased risk of psychiatric disorders. Compared with refugees who waited 0-6 months for their asylum decision, the HRs of any psychiatric diagnosis were 1.22 [95% confidence interval (CI): 1.12-1.33] for those who waited 13-24 months and 1.46 (95% CI: 1.27-1.69) for those who waited 25-71 months. Associations varied across diagnoses and length of follow-up: whereas the risk of nervous disorders increased with longer asylum-decision waiting periods in the follow-ups of 0-2.9, 3-5.9 and 6-11.9 years, the risk of psychotic disorders was associated with longer asylum-decision procedures only in the 0-2.9-year follow-up. CONCLUSION: Resettled refugees who waited longer than 1 year for an asylum decision face an increased risk of psychiatric disorders. Host countries should consider that long asylum-decision waiting periods could lead to mental illness among refugees.

An estimate of the effect of waiting time in the Danish asylum system on post-resettlement employment among refugees: Separating the pure delay effect from the effects of the conditions under which refugees are waiting.

We provide an estimate of the effect of refugees' length of waiting time in the Danish asylum system on their subsequent employment using administrative data. In contrast to previous studies, we take into account that refugees' labor market integration is delayed since their labor market access is restricted during the asylum-seeking phase. We find that an additional year of waiting time decreases subsequent employment by 3.2 percentage points on average. This effect is mostly driven by the delay in the labor market engagement among refugees. Waiting time may have an effect on subsequent employment that is additional to the delay effect, and this could be either positive or negative depending on the nature of the conditions under which asylum seekers live while waiting for their cases to be processed. We find that this additional effect is positive and statistically significant until observable individual characteristics are included, at which point it becomes small in magnitude and no longer significant.