Oxford Article April 2023

Urban Mental Health
Dinesh Bhugra (contributor) et al.
https://doi.org/10.1093/med/9780198804949.001.0001
Published: 2019 Online ISBN: 9780191843013 Print ISBN: 9780198804949
CHAPTER
6 Why urban environments matter for refugee mental

health 
Peter Schofield
https://doi.org/10.1093/med/9780198804949.003.0006 Pages 73–82
Downloaded from https://academic.oup.com/book/25045/chapter/189133858 by McGill University Libraries user on 26 April 2023

Published: June 2019
Abstract
Refugees are at increased risk of mental disorders. This is increasingly attributed to the post-
migration context in which they live, typically socio-economically deprived urban areas. In general,
neighbourhood factors are relevant to mental health outcomes. There is now research showing that
neighbourhood ethnic density is related to the incidence of psychosis and other mental disorders for
ethnic minorities. One consequence of dispersal policies is that refugees are often placed in urban areas
far from others from their country of origin, which is likely to a ect their mental health. Refugees are
more likely to be exposed to other neighbourhood factors shown to have adverse mental health
consequences, e.g. high levels of social deprivation and low levels of social cohesion. The extent to
which these factors might explain the elevated risk of mental disorders among refugees is still
unknown and further research is needed.
Keywords: refugees, ethnic density, neighbourhood factors, psychosis, socio-economic determinants

Subject: Psychiatry, Public Health
Series: Oxford Cultural Psychiatry
Collection: Oxford Medicine Online
Introduction
A de ning feature of most urban environments is that they are receptive to migrants of one kind or another.
With cities now inextricably linked across vast global networks the refugee experience, at least in the global
north, is largely an urban experience [1]. In this chapter, I outline why the kind of urban environment where
refugees eventually nd themselves can play an important role in their subsequent mental health. This is a
pressing concern as we are in the midst of a global refugee crisis, with the numbers displaced as a result of
con ict or persecution increasing at an unprecedented rate [2]. Across much of Europe, government
agencies are now tasked with accommodating those eeing con ict and persecution, typically adopting
dispersal policies aimed at avoiding their accumulation in particular urban areas and ostensibly ‘spreading
the burden’ across municipalities [3]. The potential consequences of these policies are one of the themes I
address. There is often little we can do about circumstances in those countries from which refugees are
eeing that might impact on their mental health. However, as I show, the neighbourhood environment into
which they are received is one relevant, and potentially modi able, risk factor over which we have some
in uence.
Refugee mental health
So, rstly, what do we know about the mental health of refugees? Often, studies have shown refugees to be
more resilient to mental health problems than might be expected given their exposure to severe trauma [4].
However, research has consistently demonstrated an overall increase in their rate of mental disorders
compared to not only the general population, but also other migrants. Refugee status has long been
associated with an increased risk of depression and anxiety disorders [5, 6], with one review estimating
p. 74 around 9% (99% con dence interval (CI) 8–10%) of refugees su ering from post-traumatic stress
disorder [7]. More recently, studies have also highlighted an increased risk of psychotic illness, such as
schizophrenia and bipolar disorder [8, 9, 10]. One Swedish population cohort study found the rate of
psychotic disorders among refugees was nearly three times that of the Swedish born population (adjusted
hazard ratio (aHR) 2.9, 95% CI 2.3–3.6) and this was also greater than that of other migrants (aHR1.7, 95%
CI 1.3–2.1) [8].

Given the traumatic circumstances from which they are eeing it may, perhaps, not be surprising that
refugees are more likely to su er mental health problems. However, while explanations for these increased
rates have in the past largely focused on trauma pre-migration, it is increasingly argued that post-
migration risk factors play an important, if not equal, role [11, 12, 13]. For example, one wide-ranging review
found a range of post-migration factors made a di erence to refugee mental health equal to or greater than
the experience of war and exposure to violence. This conclusion was arrived at after comparing studies of
refugees with those of similar non-refugee migrant groups who had also been exposed to war and violence
[11]. The authors of this review cite restricted economic opportunities and living in institutional
accommodation as major post-migration risk factors. They conclude that mental ill health is not an
inevitable consequence of trauma pre-migration, but instead re ects contextual factors in the host country
that are, importantly, amenable to intervention.
However, studies of refugee populations are often very limited in what they can tell us about the impact of
these post-migration risk factors. Whereas for migrant groups, in general, there is now a wealth of research
evidence about relevant mental health risk factors, for refugees this is a mostly under-developed eld. This
is, in part, because refugees are a largely hidden population, absent from health records and other
administrative data that is usually made available for research [14]. Whereas ethnic group or country of
origin is now routinely coded in health records in the UK and in many other European countries, it is
unusual for refugee status to be recorded, both because this is administratively burdensome and because
these are often highly sensitive data. Also, where large-scale surveys have been attempted they have been
prone to a very high rate of attrition. For example, the UK Survey of New Refugees, to date the most
comprehensive attempt to survey refugees in the UK, began with 5678 refugees at the rst wave, whereas
only 867 (15%) remained at the fourth wave [15].
What we can learn from the migrant experience
While research on post-migration factors for refugees is limited there is much we can learn from what is
p. 75 already known about the experience of migrants in general that can point to relevant contextual factors
that are likely to be relevant to the mental health of refugees. Migrants have long gured disproportionally
among those diagnosed with severe mental illness, since it was rst shown in the 1930s that Scandinavian
immigrants to the US were more likely to be diagnosed with schizophrenia [16, 17]. The original explanation
was that that this was due to selective migration; that is, those with a predisposition to psychosis were more
likely to migrate, although this has been subsequently discounted in the light of evidence from large-scale
cohort studies [18, 19]. International comparison studies have also failed to show any corresponding
increased incidence in the country of origin, therefore ruling out genetic explanations [20, 21]. More
recently, reviews have highlighted how the elevated risk persists from the rst to the second generation,
which suggests that explanations are likely to be found in the post-migration context [17, 22]. There is now

increasing evidence that the neighbourhood environment itself can play an important role in the mental
health of migrant and minority ethnic groups. For example, an ethnic density e ect has been consistently
shown where psychosis incidence is reduced for members of minority ethnic groups living in areas where
their ethnic group is well represented [23, 24, 25, 26]. While this e ect is clearest for psychotic disorders,
such as schizophrenia, a similar e ect has also been demonstrated for other, more common mental
disorders [27, 28, 29]. Although the underlying mechanism behind the ethnic density e ect is still unclear,
it is thought likely that those living in high co-ethnic density neighbourhoods bene t from improved social
support and access to social capital in a way that is protective against mental illness [24, 28]. There is also
evidence that these factors, in turn, can act as a bu er against discrimination which might otherwise be a
signi cant risk factor [30].
Neighbourhood ethnic density and refugee dispersal
This is likely to be particularly relevant to refugees, who are often allocated housing in widely dispersed
locations far from neighbourhoods where migrants from their country of origin have previously settled [3,
31, 32]. International comparison studies have demonstrated how this can lead to a reduction in social
capital and social networks and a corresponding weakening of refugees’ own cultural identity [33, 34].
Dispersal is also a problem because dispersal areas typically lack a history of migration and therefore do not
have relevant services available to cater for refugees [35]. Furthermore, it is now recognized that hostility to
immigration is more likely in areas with little experience of diverse ethnic groups [36]. It has also been
p. 76 shown that accommodating refugees in low co-ethnic density neighbourhoods can have the e ect of
severely reducing opportunities for employment [37, 38]. This has been demonstrated in a series of Danish
studies that take advantage of the way that refugees are, in e ect, randomly assigned to di erent types of
neighbourhood, thus creating a natural experiment. The study authors argue that the lower employment
rates in low ethnic density neighbourhoods is a consequence of restricted access to social networks that
would otherwise be relied on for employment opportunities. Paradoxically, the resulting lack of economic
activity serves to hinder integration into the host society, one of the primary aims of the Danish dispersal
policy. In this way, they argue, living in an ‘ethnic enclave’ can ultimately lead to better integration into the
wider community [39]. While the overall mental health consequences of this are still unclear, the authors of
a recent large-scale cohort study of refugee psychosis in Sweden cite neighbourhood ethnic density as one,
possibly key, explanatory factor for their increased psychosis risk [13]. However, to date, only one study has
explicitly examined the e ect of neighbourhood ethnic density on the mental health of refugees. This large
[2, 28] survey of South East Asian refugees in California found that areas of greater ethnic density served as
a bu er against demoralization for some of the refugee groups they looked at [40]. Interestingly, one group,
refugees from Cambodia, showed the opposite e ect: living in an ethnically dense area served to reinforce
feelings of demoralization.
There is, however, a paucity of research looking at the mental health consequences of dispersal policies in
Europe. What we do know, from recent studies, is that one of the more obvious consequences of ‘no choice’
dispersal has been a steady stream of onward migration to other urban areas with established ethnic
minority communities [3, 33, 34, 41]. One example is Denmark, where the adverse e ects of a rigorously
applied dispersal policy have been well documented [33, 42]. As a result, large numbers of Somali refugees
have left Danish cities to move to urban areas in the UK, claiming they feel more at home, despite moving to
relatively deprived neighbourhoods with often poorer-quality housing [3]. A similar process has also been
clearly observed in the Netherlands, where Somali refugees who were originally dispersed and isolated also
moved to areas in the UK with large Somali communities [34]. However, that is not to say that the UK itself
is immune to this phenomenon, with onward migration also well-documented in the UK [33]. While we
know that onward migration is common, little is known of the mental health consequences for those who
remain behind and there remains a large gap in the research evidence on the mental health impact of
refugee dispersal.
p. 77
Other neighbourhood factors
Other neighbourhood factors are also important. Migrants, in general, and refugees, in particular, are
mostly concentrated in deprived urban areas that have long been associated with increased rates of mental
disorder, even when individual socio-economic circumstances are taken into account [43, 44, 45]. Urban

environments themselves are also associated with a greater risk of psychosis, with increasing levels of
urbanicity related to increased incidence in a dose–response fashion [46]. Furthermore, refugees are often
settled in urban neighbourhoods typi ed by low levels of social cohesion, comprising transient and often
fragmented populations with little sense of involvement in the local community. Studies have found a high
correlation between low levels of neighbourhood social cohesion and rates of psychosis independent of area
deprivation and urbanicity [47, 48, 49].
Neighbourhood and refugee mental health studies
While these neighbourhood studies are relevant it is still unclear exactly how these risk factors might apply
to refugees. There are, however, a few refugee studies that look directly at the mental health impact of
neighbourhood factors. Warfa et al. [50] set out to address the lack of research evidence for the role of the
post-migration environment using a cross-national comparison design. They compared a similar
population of refugees from Somalia in two contrasting areas, London and Minneapolis, with the same data
collection methods in both sites, combining in-depth qualitative data from focus groups with larger-scale
surveys. They found that access to labour markets was a key contextual factor, contributing to an increased
risk of mental disorders, including major depression.
Research on the mental health of migrant groups has bene ted from studies using large cohort designs.
However, this is relatively rare in research looking speci cally at refugees. One exception is a large cohort
study conducted in Ontario, Canada that looked at both refugees and rst-generation migrants [9]. This
followed a retrospective design using health records over a 10-year period covering just over 95,000
refugees. The results showed a higher rate of psychosis among refugees and the study authors point to the
protective e ect of neighbourhood income levels as one relevant contributory factor. Unfortunately, much
of the report con ates refugees and other migrants when presenting the study results.
Another large-scale refugee study in the USA used a survey approach to examine mental health outcomes,
covering a nationally representative sample of 656 Latino and Asian refugees [51]. This found that
p. 78 experience of pre-resettlement trauma failed to make a statistically signi cant di erence to post-
migration mental health outcomes. However, having a good perception of the neighbourhood environment,
based on items covering levels of social cohesion and physical safety, was strongly associated with positive
self-rated mental health. The authors conclude that the resettlement environment can play a central role in
the mental health of refugee populations.
Neighbourhood environment and residential instability
As well as the type of neighbourhood environment, residential instability itself can also be an important risk
factor. A UK study investigated the accommodation histories of a large (n = 142) group of Somali refugees in
London over a 5-year period using in-depth and semi-structured interviews [52]. Once again, the authors
failed to nd a relation between past experiences of traumatic events and current psychiatric disorders.
However, they did show that number of moves post-migration was a risk factor with this depending on
whether moves were by choice and also the existence of a strong friendship network whether moves were by
choice and also existence of a strong friendship network. They conclude that choosing to move to areas
where there is better social support is associated with better mental health outcomes for refugees.
Future research priorities

What we currently know about the mental health impact of the neighbourhood environment from studies of
refugee populations is therefore relatively limited. However, what we know from the wider migrant mental
health literature, and neighbourhood studies in general, suggests that these factors are likely to play an
important role in the mental health of refugees. Further research is now needed to better determine the
extent to which these factors are relevant and how they might a ect di erent groups in di erent contexts.
Ideally, studies would look at both a broad population level while also examining speci c groups in a local
context using more in-depth qualitative approaches. For example, the kind of population register data
available for research in Scandinavian countries could be used to assess the impact of dispersal policies on
subsequent mental health outcomes for refugees. As we have seen, one by-product of a rigorously applied
dispersal policy is that neighbourhood can, under certain conditions, be considered randomly allocated.
This has already been successfully utilized in quasi-experimental study designs in refugee research and this
approach could equally well be used in a mental health context [37, 38]. Where relevant administrative data
p. 79 are lacking, for example in the UK, survey approaches could be adopted. Future surveys should
incorporate information about the neighbourhood in which refugees are living at a detailed area level,
including area deprivation indices and census ethnicity pro les. At a micro-level, further qualitative
research could address the speci c priorities of di erent refugee groups in di erent local contexts to gain a
deeper understanding of contextual factors perceived to be important and the mechanisms through which
these impact on mental health.
Conclusions
The refugee experience is one of involuntary displacement and as a result the urban spaces in which
refugees eventually nd themselves are typically not of their choosing and may contribute to poor mental
health. What we understand of migrants, in general, is that the post-migration context is central to
explanations for increased rates of mental disorder. Some neighbourhood-level factors, such as ethnic
density, may be particularly salient for refugees, subject to ‘no-choice’ dispersal policies and therefore
potentially isolated and vulnerable to mental ill health. To conclude, we have a responsibility to ensure that
the urban environments in which refugees live allow them to thrive and not be detrimental to their mental
health and future research is therefore needed to better inform these decisions.
References
1. Darling J. Forced migration and the city: irregularity, informality, and the politics of presence. Progress in Human
Geography 2016; 41: 178–198. 10.1177/0309132516629004
Google Scholar WorldCat Crossref
2. UN Refugee Agency (UNHCR). Forced Displacement in 2015. Available at:

http://www.unhcr.org/uk/statistics/unhcrstats/576408cd7/unhcr-global-trends-2015.html (accessed 12 November 2018).
WorldCat
3. Wren K. Refugee dispersal in Denmark: from macro- to micro-scale analysis. International Journal of Population Geography
2003; 9: 57–75. 10.1002/ijpg.273
4. Simich L, Andermann L (eds). Refuge and Resilience: Promoting Resilience and Mental Health Among Resettled Refugees and

Forced Migrants. Cham: Springer Nature, 2014.
Google Scholar Google Preview WorldCat COPAC
5. Bogic M, Njoku A, Priebe S. Long-term mental health of war-refugees: a systematic literature review. BMC Int Health Hum
Rights 2015; 15: 29. 10.1186/s12914-015-0064-9
Google Scholar WorldCat Crossref Web of Science
6. Lindert J, Ehrenstein OS von, Priebe S, Mielck A, Brähler E. Depression and anxiety in labor migrants and refugees—a
systematic review and meta-analysis. Social Science & Medicine 2009; 69: 246–257. 10.1016/j.socscimed.2009.04.032
Google Scholar WorldCat Crossref PubMed Web of Science
7. Fazel M, Wheeler J, Danesh J. Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a
systematic review. The Lancet 2005; 365: 1309–1314. 10.1016/S0140-6736(05)61027-6
Google Scholar WorldCat Crossref PubMed
8. Hollander A-C, Dal H, Lewis G, Magnusson C, Kirkbride JB, Dalman C. Refugee migration and risk of schizophrenia and
other non-a ective psychoses: cohort study of 1.3 million people in Sweden. BMJ 2016; 352: i1030. 10.1136/bmj.i1030
p. 80 9. Anderson KK, Cheng J, Susser E, McKenzie KJ, Kurdyak P. Incidence of psychotic disorders among first-generation
immigrants and refugees in Ontario. Canadian Medical Association Journal 2015; 187: E279–E286. 10.1503/cmaj.141420
10. Parrett NS, Mason OJ. Refugees and psychosis: a review of the literature. Psychosis 2010; 2: 111–
121. 10.1080/17522430903219196
11. Porter M, Haslam N. Predisplacement and postdisplacement factors associated with mental health of refugees and
internally displaced persons: a meta-analysis. JAMA 2005; 294: 602–612. 10.1001/jama.294.5.602
12. Anderson KK, Flora N, Archie S, Morgan C, McKenzie K. A meta-analysis of ethnic di erences in pathways to care at the first
episode of psychosis. Acta Psychiatrica Scandinavica 2014; 130: 257–268. 10.1111/acps.12254
13. Norredam M, Garcia-Lopez A, Keiding N, Krasnik A. Risk of mental disorders in refugees and native Danes: a register-based
retrospective cohort study. Social Psychiatry and Psychiatric Epidemiology 2009; 44: 1023–1029. 10.1007/s00127-009-0024-6
14. Enticott JC, Shawyer F, Vasi S, Buck K, Cheng I-H, Russell G, et al. A systematic review of studies with a representative
sample of refugees and asylum seekers living in the community for participation in mental health research. BMC Medical
Research Methodology 2017; 17: 37. 10.1186/s12874-017-0312-x
15. Cebulla A, Daniel M, Zurawan A. Spotlight on refugee integration: findings from the Survey of New Refugees in the United
Kingdom. Available at:
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/116062/horr37-report.pdf
(accessed 12 November 2018).
WorldCat
16. Ødegård Ø. Emigration and Insanity: A Study of Mental Disease Among the Norwegian Born Population of Minnesota.
Copenhagen: Levin & Munksgaard.
17. Cantor-Graae E, Selten JP. Schizophrenia and migration: a meta-analysis and review. American Journal of Psychiatry
2005; 162: 12–24. 10.1176/appi.ajp.162.1.12
18. van der Ven E, Dalman C, Wicks S, Allebeck P, Magnusson C, van Os J, et al. Testing Ødegaardʼs selective migration
hypothesis: a longitudinal cohort study of risk factors for non-a ective psychotic disorders among prospective emigrants.
Psychological Medicine 2015; 45: 727–734. 10.1017/S0033291714001780

19. Pedersen CB, Mortensen PB, Cantor-Graae E. Do risk factors for schizophrenia predispose to emigration? Schizophrenia
Research 2011; 127: 229–234. 10.1016/j.schres.2011.01.013
20. Jablensky A, Sartorius N, Ernberg G, Anker M, Korten A, Cooper JE, et al. Schizophrenia: manifestations, incidence and
course in di erent cultures. A World Health Organization ten-country study. Psychological Medicine Monograph Supplement
1992; 20: 1–97. 10.1017/S0264180100000904
21. Bhugra D, Hilwig M, Hossein B, Marceau H, Neehall J, Le J, et al. First-contact incidence rates of schizophrenia in Trinidad
and one-year follow-up. British Journal of Psychiatry 1996; 169: 587–592. 10.1192/bjp.169.5.587
22. Bourque F, van der Ven E, Malla A. A meta-analysis of the risk for psychotic disorders among first- and second-generation
immigrants. Psychological Medicine 2010; 41: 897–910. 10.1017/S0033291710001406
23. Boydell J, van Os J, McKenzie K, Allardyce J, Goel R, McCreadie RG, et al. Incidence of schizophrenia in ethnic minorities in
London: ecological study into interactions with environment. BMJ 2001; 323: 1336–1338. 10.1136/bmj.323.7325.1336
p. 81 24. Kirkbride JB, Morgan C, Fearon P, Dazzan P, Murray R, Jones PB. Neighbourhood-level e ects on psychoses: re-examining
the role of context. Psychological Medicine 2007; 37: 12. 10.1017/S0033291707000499
25. Veling W, Susser E, van Os J, Mackenbach JP, Selten J-P, Hoek HW. Ethnic density of neighborhoods and incidence of
psychotic disorders among immigrants. American Journal of Psychiatry 2008; 165: 66–73. 10.1176/appi.ajp.2007.07030423
26. Schofield P, Thygesen M, Das-Munshi J, Becares L, Cantor-Graae E, Pedersen C, et al. Ethnic density, urbanicity and
psychosis risk for migrant groups—a population cohort study. Schizophrenia Research 2017; 190: 82–
87. 10.1016/j.schres.2017.03.032
27. Das-Munshi J, Becares L, Dewey ME, Stansfeld SA, Prince MJ. Understanding the e ect of ethnic density on mental health:
multi-level investigation of survey data from England. BMJ 2010; 341: c5367–c5367. 10.1136/bmj.c5367
28. Shaw RJ, Atkin K, Bécares L, Albor C, Sta ord M, Kiernan KE, et al. Impact of ethnic density on adult mental disorders:
narrative review. British Journal of Psychiatry 2012; 201: 11–19. 10.1192/bjp.bp.110.083675
29. Schofield P, Das-Munshi J, Mathur R, Congdon P, Hull S. Does depression diagnosis and antidepressant prescribing vary
by location? Analysis of ethnic density associations using a large primary-care dataset. Psychological Medicine 2016; 46: 1–
9. 10.1017/S0033291715002913
30. Becares L, Das-Munshi J. Ethnic density, health care seeking behaviour and expected discrimination from health services
among ethnic minority people in England. Health Place 2013; 22: 48–55. 10.1016/j.healthplace.2013.03.005
31. Stewart ES. UK dispersal policy and onward migration: mapping the current state of knowledge. Journal of Refugee
Studies 2012; 25: 25–49. 10.1093/jrs/fer039
32. McColl H, McKenzie K, Bhui K. Mental healthcare of asylum-seekers and refugees. Advances in Psychiatric Treatment 2008;
14: 452–459. 10.1192/apt.bp.107.005041
33. Valentine G, Sporton D, Nielsen KB. Identities and belonging: a study of Somali refugee and asylum seekers living in the
UK and Denmark. Environment and Planning D: Society and Space 2009; 27: 234–250. 10.1068/d3407
34. van Liempt I. From Dutch dispersal to ethnic enclaves in the UK: the relationship between segregation and integration

examined through the eyes of Somalis Urban Studies 2011; 48: 3385–3398.
35. Boswell C. Burden-sharing in the European Union: lessons from the German and UK experience. Journal of Refugee
Studies 2003; 16: 316–335. 10.1093/jrs/16.3.316
36. Kaufmann E, Harris G. Changing Places: Mapping the White British Response to Ethnic Change. London: Demos.
37. Damm AP. Neighborhood quality and labor market outcomes: evidence from quasi-random neighborhood assignment of
immigrants. Journal of Urban Economics 2014; 79: 139–166. 10.1016/j.jue.2013.08.004
38. Damm AP, Rosholm M. Employment e ects of spatial dispersal of refugees. Review of Economics of the Household 2009;
8: 105–146. 10.1007/s11150-009-9067-4
39. Damm AP. Ethnic enclaves and immigrant labor market outcomes: quasi-experimental evidence. Journal of Labor
Economics 2009; 27: 281–314. 10.1086/599336
40. Ying Y, Akutsu PD. Psychological adjustment of Southeast Asian refugees: the contribution of sense of coherence. Journal
of Community Psychology 1997; 25: 125–139. 10.1002/(SICI)1520-6629(199703)25:2<125::AID-JCOP2>3.0.CO;2-X
p. 82 41. Hammar T. The ʻSweden-wide strategyʼ of refugee dispersal. In: Black R, Robinson V (eds) Geography and Refugees:
Patterns and Processes of Change. London: Belhaven Press, 1993, pp. 104–117.
42. Larsen BR. Becoming part of welfare scandinavia: Integration through the spatial dispersal of newly arrived refugees in
Denmark. Journal of Ethnic Migration Studies 2011; 37: 333–350. 10.1080/1369183X.2011.521337
43. Kirkbride JB, Jones PB, Ullrich S, Coid JW. Social deprivation, inequality, and the neighborhood-level incidence of
psychotic syndromes in East london. Schizophrenia Bulletin 2014; 40: 169–180. 10.1093/schbul/sbs151
44. Werner S, Malaspina D, Rabinowitz J. Socioeconomic status at birth is associated with risk of schizophrenia: population-
based multilevel study. Schizophrenia Bulletin 2007; 33: 1373–1378. 10.1093/schbul/sbm032
45. Harrison GL, Gunnell D, Glazebrook C, Page K, Kwiecinski R. Association between schizophrenia and social inequality at
birth: case-control study. British Journal of Psychiatry 2001; 179: 346–350. 10.1192/bjp.179.4.346
46. Pedersen CB. Evidence of a dose-response relationship between urbanicity during upbringing and schizophrenia risk.
Archives of General Psychiatry 2001; 58: 1039–1046. 10.1001/archpsyc.58.11.1039
47. Allardyce J, Gilmour H, Atkinson J, Rapson T, Bishop J, McCreadie RG. Social fragmentation, deprivation and urbanicity:
relation to first-admission rates for psychoses. British Journal of Psychiatry 2005; 187: 401–406. 10.1192/bjp.187.5.401
48. Newbury J, Arseneault L, Caspi A, Mo itt TE, Odgers CL, Fisher HL. Why are children in urban neighborhoods at increased
risk for psychotic symptoms? Findings from a UK longitudinal cohort study. Schizophrenia Bulletin 2016; 42: 1372–
1383. 10.1093/schbul/sbw052
49. Kirkbride JB, Fearon P, Morgan C, Dazzan P, Morgan K, Murray RM, et al. Neighbourhood variation in the incidence of
psychotic disorders in Southeast London. Social Psychiatry and Psychiatric Epidemiology 2007; 42: 438–445. 10.1007/s00127-
007-0193-0
50. Warfa N, Curtis S, Watters C, Carswell K, Ingleby D, Bhui K. Migration experiences, employment status and psychological

distress among Somali immigrants: a mixed-method international study. BMC Public Health 2012; 12: 749. 10.1186/1471-2458-
12-749
51. Kim I. Beyond trauma: post-resettlement factors and mental health outcomes among Latino and Asian refugees in the
United States. Journal of Immigrant and Minority Health 2016; 18: 740–748. 10.1007/s10903-015-0251-8
52. Bhui K, Mohamud S, Warfa N, Curtis S, Stansfeld S, Craig T. Forced residential mobility and social support: Impacts on
psychiatric disorders among Somali migrants. BMC International Health and Human Rights 2012; 12: 4. 10.1186/1472-698X-12-4
© Oxford University Press

Oxford Article April 2023

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Oxford Article April 2023

Uploaded by

Copyright:

Available Formats

Urban Mental Health

Dinesh Bhugra (contributor) et al.

6 Why urban environments matter for refugee mental

https://doi.org/10.1093/med/9780198804949.003.0006 Pages 73–82

Downloaded from https://academic.oup.com/book/25045/chapter/189133858 by McGill University Libraries user on 26 April 2023

Keywords: refugees, ethnic density, neighbourhood factors, psychosis, socio-economic determinants

Downloaded from https://academic.oup.com/book/25045/chapter/189133858 by McGill University Libraries user on 26 April 2023

Downloaded from https://academic.oup.com/book/25045/chapter/189133858 by McGill University Libraries user on 26 April 2023

Neighbourhood ethnic density and refugee dispersal

Downloaded from https://academic.oup.com/book/25045/chapter/189133858 by McGill University Libraries user on 26 April 2023

Neighbourhood and refugee mental health studies

Future research priorities

Downloaded from https://academic.oup.com/book/25045/chapter/189133858 by McGill University Libraries user on 26 April 2023

2. UN Refugee Agency (UNHCR). Forced Displacement in 2015. Available at:

Downloaded from https://academic.oup.com/book/25045/chapter/189133858 by McGill University Libraries user on 26 April 2023

Downloaded from https://academic.oup.com/book/25045/chapter/189133858 by McGill University Libraries user on 26 April 2023

Downloaded from https://academic.oup.com/book/25045/chapter/189133858 by McGill University Libraries user on 26 April 2023

Downloaded from https://academic.oup.com/book/25045/chapter/189133858 by McGill University Libraries user on 26 April 2023

© Oxford University Press

You might also like