Subjective social status mobility and mental health of asylum seekers and refugees: population-based, cross-sectional study in a German federal state

Background: Asylum seekers and refugees (ASR) experience substantial changes in subjective social status (SSS), pre and post migration, which may affect their mental health. However, the effect of SSS mobility on mental health among ASR has been underexplored so far. Methods: Population-based cross-sectional study among a random sample of 560 adult ASR living in 64 collective accommodation centres in Baden-Wurttemberg, Germany. SSS in the country of origin before emigration and in Germany was assessed with a multi-lingual, adapted version of the MacArthur social ladder. Health-related quality of life (HRQoL), anxiety and depressive symptoms were measured as mental health outcomes. Generalized linear regression models were fitted to estimate associations between changes in SSS and each outcome. Results: A perceived loss of three or more steps in SSS from origin to Germany (compared to no change) was associated with poorer scores in HRQoL (B, standardized coefficient = -2.679, standard error, se = 1.351, p = 0.047), with more depressive symptoms (B = 1.156, se = 0.389, p = 0.003) and anxiety (B = 0.971, se = 0.432, p = 0.025), in models adjusted for SSS in country of origin. The strength and direction of associations remained after adjusting for sex, age, education and time since arrival (HRQoL: B = -2.494, se = 1.351, p = 0.066; depression: B = 1.048, se = 0.393, p = 0.008; anxiety: B = 1.006, se = 0.438, p = 0.022). Conclusion: ASR experiencing downward SSS mobility present poorer mental health compared to those experiencing no change in SSS. Early integration efforts and intersectoral measures to counter social downward mobility could prevent poor mental health among ASR.