Pre-migration socioeconomic status and post-migration health satisfaction among Syrian refugees in Germany: A cross-sectional analysis.

BACKGROUND: The large increase in numbers of refugees and asylum seekers in Germany and most of Europe has put the issue of migration itself, the integration of migrants, and also their health at the top of the political agenda. However, the dynamics of refugee health are not yet well understood. From a life-course perspective, migration experience is associated with various risks and changes, which might differ depending on the socioeconomic status (SES) of refugees in their home country. The aim of this paper was to analyze the relationship between pre-migration SES and self-reported health indicators after migration among Syrian refugees. Specifically, we wanted to find out how their SES affects the change in health satisfaction from pre- to post-migration. METHODS AND FINDINGS: We used data from the 2016 refugee survey, which was part of the German Socio-Economic Panel (GSOEP). Although cross-sectional by design, this survey collected information referring to the current situation as a refugee in Germany as well as to their situation before migration. Using a sample of 2,209 adult Syrian refugees who had entered Germany between 2013 and 2016, we conducted a cross-sectional and a quasi-longitudinal (retrospective) analysis. The mean ± SD age was 35 ± 11 years, with 64% of the participants being male. Our results showed a positive association between pre-migration self-reported SES and several subjective health indicators (e.g., health satisfaction, self-reported health, mental health) in the cross-sectional analysis. However, the quasi-longitudinal analysis revealed that the socioeconomic gradient in health satisfaction before migration was strongly attenuated after migration (SES-by-time interaction: -0.48, 95% CI -0.61 to -0.35, p < 0.001; unstandardized regression coefficients, 5-point SES scale and 11-point health outcome scale). Similar results were produced after controlling for sociodemographic characteristics, experiences during the migration passage, and the current situation in Germany. A sex-stratified analysis showed that while there was some improvement in health satisfaction among men from the lowest SES over time, no improvement was found among women. A limitation of this study is that it considers only the first months or years after migration. Thus, we cannot preclude that the socioeconomic gradient regains importance in the longer run. CONCLUSIONS: Our findings suggest that the pre-migration socioeconomic gradient in health satisfaction is strongly attenuated in the first years after migration among Syrian refugees. Hence, a high SES before crisis and migration provides limited protection against the adverse health effects of migration passage.

The paradox of falling job satisfaction with rising job stickiness in the German nursing workforce between 1990 and 2013.

BACKGROUND: Literature reports a direct relation between nurses' job satisfaction and their job retention (stickiness). The proper planning and management of the nursing labor market necessitates the understanding of job satisfaction and retention trends. The objectives of the study are to identify trends in, and the interrelation between, the job satisfaction and job stickiness of German nurses in the 1990-2013 period using a flexible specification for job satisfaction that includes different time periods and to also identify the main determinants of nurse job stickiness in Germany and test whether these determinants have changed over the last two decades. METHODS: The development of job stickiness in Germany is depicted by a subset of data from the German Socio-Economic Panel (1990-2013), with each survey respondent assigned a unique identifier used to calculate the year-to-year transition probability of remaining in the current position. The changing association between job satisfaction and job stickiness is measured using job satisfaction data and multivariate regressions assessing whether certain job stickiness determinants have changed over the study period. RESULTS: Between 1990 and 2013, the job stickiness of German nurses increased from 83 to 91%, while their job satisfaction underwent a steady and gradual decline, dropping by 7.5%. We attribute this paradoxical result to the changing association between job satisfaction and job stickiness; that is, for a given level of job (dis)satisfaction, nurses show a higher stickiness rate in more recent years than in the past, which might be partially explained by the rise in part-time employment during this period. The main determinants of stickiness, whose importance has not changed in the past two decades, are wages, tenure, personal health, and household structure. CONCLUSIONS: The paradoxical relation between job satisfaction and job stickiness in the German nursing context could be explained by historical downsizing trends in hospitals, an East-West German nurse compensation gap, and an increase in the proportion of nurses employed on a part-time basis. A clearer analysis of each of these trends is thus essential for the development of evidence-based policies that enhance the job satisfaction and efficiency of the German nursing workforce.

Trends in job satisfaction among German nurses from 1990 to 2012.

OBJECTIVE: Improving the job satisfaction of nurses is essential to enhance their productivity and retention and to improve patient care. Our aim was to analyse trends in German nurses' job satisfaction to enhance understanding of the nursing labour market and inform future policies. METHODS: We used 1990-2012 German Socioeconomic Panel data for trends in nurses' job satisfaction. Comparisons were drawn with doctors, other health care workers, and employees in other sectors of employment. Analysis explored associations between job satisfaction trends and other aspects of employment, such as whether full time or part time and pay. To account for fluctuations across the period of analysis, linear trends were generated using ordinary least squares. RESULTS: Over 23 years, job satisfaction of German nurses underwent a steady and gradual decline, dropping by an average 7.5%, whereas that of doctors and other health care workers increased by 14.4% and 1%, respectively. The decline for part-time nurses (13%) was more pronounced than that for full-time nurses (3%). At the same time, nurses' pay rose by only 3.8% compared to a 23.8% increase for doctors. CONCLUSIONS: The steady decline in nurses' job satisfaction over the last two decades may be attributable to the multiple reforms and associated policy changes that generally disadvantaged nurses. Contributing factors to job satisfaction decline include lower pay and the demanding and strenuous work environment. Irrespective of the reason, health services researchers, leaders, and policy makers should investigate the reasons for this decline given the forecast growth in work load and complexity of care. Supportive policies for nurses would help enhance the quality and sustainability of German health care.