Exploring contextual effects of post-migration housing environment on mental health of asylum seekers and refugees: a cross-sectional, population-based, multi-level analysis in a German federal state

Mohsenpour A, Biddle LR, Bozorgmehr K. Exploring contextual effects of post-migration housing environment on mental health of asylum seekers and refugees: a cross-sectional, population-based, multi-level analysis in a German federal state. bioRxiv. 2022.**Background** Asylum seekers and refugees (ASR) in Germany are dispersed quasi-randomly to state-provided, collective accommodation centres. We aimed to analyse contextual effects of post-migration housing environment on their mental health. **Methods** We drew a balanced random sample of 54 from 1 938 accommodation centres with 70 634 ASR in Germany’s 3rd largest federal state. Individual-level data on depression (PHQ2) and anxiety (GAD2) symptoms as well as sociodemographic- and asylum-related covariates, was collected and linked to contextual geo-referenced data on housing environment (‘Small-area Housing Environment Deterioration’ index, number of residents, remoteness, urbanity and German Index of Multiple Deprivation). We fitted two-level random-intercept models to exploratively estimate adjusted contextual effects. **Results** Of 411 surveyed participants, 45.53% and 44.83%, respectively, reported symptoms of depression or anxiety. 52.8% lived in centres with highest deterioration, 46.2% in centres with >=50 residents, 76.9% in urban, and 56% in deprived districts. 7.4% of centres were remote. The accommodation-level median odds ratio for GAD2 was 2.10 with contextual-level variance of 16%. For odds of reporting GAD2 / PHQ2, the highest degree of deterioration (OR 2.22; 95% CI 0.52-9.59 / 1.99;0.55-7.18), large accommodation size (1.34;0.59-3.06. / 1.12;0.56-2.26), remoteness (2.16;0.32-14.79 / 3.79;0.62-23.18) and district urbanity (3.05;0.98-9.49 / 1.14;0.46-2.79) showed higher, but statistically not significant, point-estimates. District deprivation demonstrated higher odds for GAD2 (1.21;0.51-2.88) and, inversely, lower odds for PHQ2 (0.88;0.41-1.89). **Conclusion** We found tendencies for, but no significant, contextual effects of housing environment on ASR mental health in accommodation centres. Confirmatory analyses with prior power calculations are needed to complement these exploratory estimates