Migration can be conceptualized as arising due to 'push' factors like civil war, persecution, and discrimination; these are also determinants of psychiatric disorders [1
]. Migration can also occur due to 'pull' factors like seeking employment, and to live with friends and family. Asylum seekers and refugees are at greater risk of psychiatric disorders because of the risks associated with migration itself [1
], and due to severe traumatic life events, usually in the context of conflict and persecution, before and during asylum journeys [2
]. Contrasting with the hazards before migration and during asylum-seeking journeys, some research is beginning to show that adversities in the country providing asylum may be the more important determinants of psychiatric illness [3
The majority of asylum seekers and refugee migrants in the UK are living in the capital city, London [5
], where there is poor quality housing, significant material and area deprivation which contribute to higher risks of psychiatric disorders [6
]. Asylum seekers may be detained at the port of entry whilst their documents are scrutinized; they may be subjected to interrogation about seeking illegal entry; they may be declined asylum and refugee status on the basis of inconsistent stories even though it is known poor recall occurs more commonly amongst traumatized refugee populations [7
]. While their asylum application is processed they may be held in detention centres for long periods of time or in public housing provided by the authorities. Ultimately, even if they are granted refugee status, they may be re-settled in a city or town which is not of their own choosing, and it may be a long way from friends, relatives, and away from people in whom they can confide and whom they trust [8
]. Stigma and discrimination, known to be associated with psychiatric disorders, is a particularly common experience if the host population perceives asylum seekers and refugees are favoured in receiving jobs and housing. Furthermore, some countries (the UK for example, unlike the US) prohibit employment whilst the asylum application is considered, and do not offer more than minimal financial support whilst awaiting refugee status. People with psychiatric disorders also tend to descend the social ladder, a process called social drift, and end up living in impoverished housing and in poorer neighborhoods as their illness prevents them from securing income and permanent housing.
Although a great deal of literature considers the impact of international migration on psychiatric disorders, especially in asylum seekers and refugee populations, there is little that examines local in-country migration as a determinant of psychiatric disorders. Little has been done to test whether local residential movement is equally or more important than other adverse experiences. This paper presents new findings about local residential mobility and psychiatric disorders among Somali migrants (asylum seekers and refugees) living in East and South London. The study made use of an innovative method to describe different patterns of residential mobility. The frequency and distance travelled during residential moves, the relative deprivation of the neighborhoods between moves, and the role of personal choice (versus forced moves) over changes in accommodation are specifically investigated as risks for psychiatric disorders whilst also taking into account social support, employment, and pre- and post-migration social adversity (discrimination, traumatic events). The majority of refugee migrants do not have psychiatric disorders. So this study also investigates supportive relationships with friends, families and wider networks which are known to offer some protections against emotional problems and ill health in general. Can social support buffer against psychiatric disorders related to residential mobility?
Specifically, the study hypotheses are that
1 Psychiatric disorders are more common among those showing residential movements.
2 Choice over the residential move is associated with a lower prevalence of psychiatric disorders.
3 Social support mitigates the risk of psychiatric disorders, whilst discrimination and traumatic experience increase the risks of psychiatric disorders.