Health Care Services Utilization and Health-Related Quality of Life of Syrian Refugees with Post-Traumatic Stress Symptoms in Germany (the Sanadak Trial)
Abstract
:1. Introduction
2. Materials and Methods
2.1. Sample
2.2. Measures
2.3. Statistical Analysis
3. Results
3.1. Sample Characteristics
3.2. Health Care Services Utilization
3.3. Health Care Costs
3.4. Health-Related Quality of Life
4. Discussion
4.1. Main Findings
4.2. Previous Research and Possible Explanations
4.3. Implications for Health Care Services and Policy
4.4. Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | Total Sample (n = 133) | Without Probable PTSD Diagnosis (PDS-5-Index < 28, n = 92) | With Probable PTSD Diagnosis (PDS-5-Index ≥ 28, n = 41) |
---|---|---|---|
Age: mean years (SE) | 33.34 (0.97) | 33.10 (1.12) | 33.88 (1.92) |
Female sex: n (%) | 51 (38.35) | 33 (35.87) | 18 (43.90) |
Marital status: n (%) | |||
Single/divorced/widowed | 81 (61.08) | 56 (61.30) | 25 (60.59) |
Married/in partnership | 52 (38.92) | 36 (38.70) | 16 (39.41) |
Educational training: n (%) | |||
No graduation | 16 (12.06) | 8 (8.74) * | 8 (19.51) * |
Certificate after grade 9/10 | 18 (13.62) | 8 (8.83) | 10 (24.39) |
Intermediate certificate (after grade 10) | 4 (3.10) | 4 (4.48) | 0 (0.00) |
Higher education entrance qualification (after grade 12/13) | 95 (71.22) | 72 (77.96) | 23 (56.10) |
Professional education: n (%) | |||
No professional qualification | 69 (51.58) | 44 (48.35) | 25 (58.83) |
Professional qualification | 7 (5.32) | 4 (3.87) | 3 (8.59) |
University degree † | 57 (43.10) | 44 (47.78) | 13 (32.59) |
Employment: n (%) | |||
Working ≥35 h/week | 8 (6.02) | 7 (7.61) | 10 (7.44) |
Working <35 h/week | 13 (9.77) | 9 (9.78) | 40 (9.76) |
Marginal employment | 20 (15.04) | 17 (18.48) | 30 (7.32) |
Not employed | 92 (69.17) | 59 (64.13) | 33 (80.49) |
Resident status: n (%) | |||
Asylum entitlement/applicant | 74 (55.64) | 52 (56.52) | 22 (53.66) |
Refugee protection | 28 (21.05) | 17 (18.48) | 11 (26.83) |
Other residence permission ‡ | 31 (23.31) | 23 (25.00) | 8 (19.51) |
Years in Germany: mean (SE) | 3.05 (0.11) | 2.99 (0.12) | 3.17 (0.21) |
PDS-5-Index: mean (SE) | 28.82 (1.01) | 17.29 (0.55) *** | 38.46 (1.23) *** |
Cost Category/Measure of Health Effect | % of the Sample with Utilization | Mean Utilization in Days/Contacts (SE) | Mean Annual Costs/Value | Median Annual Costs/Value | SE of Annual Costs/Value | Annual Cost/Value Range |
---|---|---|---|---|---|---|
Inpatient care | 10.53 | 0.44 (0.19) | €616 | €0 | €261 | €0 to €31,732 |
General hospital | 10.53 | 0.43 (0.19) | €610 | €0 | €261 | €0 to €31,732 |
Psychiatric hospital | 0.75 | 0.01 (0.01) | €6 | €0 | €6 | €0 to €790 |
Outpatient physician services | 83.46 | 5.02 (0.48) | €1257 | €748 | €129 | €0 to €6963 |
Primary care physician | 57.14 | 1.86 (0.23) | €124 | €67 | €15 | €0 to €1005 |
Dentist | 51.88 | 1.42 (0.17) | €244 | €173 | €30 | €0 to €1729 |
Specialists | 48.12 | 1.75 (0.25) | €888 | €436 | €101 | €0 to €5174 |
Outpatient non-physician services | 12.78 | 0.83 (0.27) | €47 | €0 | €14 | €0 to €1330 |
Total | 84.96 | - | €1920 | €975 | €321 | €0 to €36,651 |
EQ-5D-5L-Index | - | - | 0.82 | 0.88 | 0.02 | 0.07 to 1.00 |
EQ-VAS | - | - | 73.61 | 70.00 | 1.64 | 10 to 100 |
Cost Category/Measure of Health Effect | Without Probable PTSD Diagnosis (PDS-5-Index < 28, n = 92) | With Probable PTSD Diagnosis (PDS-5-Index ≥ 28, n = 41) | Difference | ||
---|---|---|---|---|---|
Mean (SE) | Mean (SE) | Mean (SE) | 95% CI | p-Value & | |
Inpatient care | €213 (€309) | €1521 (€463) | €1308 (€557) | €206; €2410 | 0.020 * |
General hospital | €213 (€309) | €1501 (€462) | €1289 (€556) | €188; €2389 | 0.022 * |
Psychiatric hospital | €0 (€0) | €19 (€19) | €19 (€13) | −€6; €45 | 0.135 |
Outpatient physician services | €1249 (€156) | €1275 (€234) | €26 (€281) | −€530; €582 | 0.926 |
Primary care physician | €112 (€18) | €152 (€27) | €40 (€33) | −€25; €105 | 0.226 |
Dentist | €280 (€36) | €164 (€53) | −€116 (€64) | −€243; €12 | 0.075 |
Specialists | €857 (€121) | €958 (€182) | €102 (€219) | −€331; €535 | 0.643 |
Outpatient non-physician services | €29 (€18) | €88 (€26) | €59 (€32) | −€4; €122 | 0.068 |
Total costs | €1491 (€381) | €2883 (€571) | €1393 (€687) | €33; €2752 | 0.045 * |
EQ-5D-5L-Index | 0.88 (0.02) | 0.71 (0.03) | −0.17 (0.03) | −0.23; −0.11 | <0.001 *** |
EQ-VAS | 74.14 (1.99) | 72.32 (2.96) | −1.87 (3.55) | −8.90; 5.15 | 0.609 |
Independent Variables | Dependent Variable | |||||
---|---|---|---|---|---|---|
Sociodemographic Characteristics | Annual Health Care Costs (Model 1) | EQ-5D-5L Disutility Scores ‡ (Model 2) | ||||
Beta (SE) | 95% CI | p-Value | Beta (SE) | 95% CI | p-Value | |
PDS-5 Index | 0.02 (0.02) | −0.01; 0.05 | 0.200 | 0.05 (0.01) | 0.03; 0.06 | <0.001 |
Gender (ref. male) | ||||||
Female | −0.37 (0.35) | −1.05; 0.30 | 0.279 | 0.18 (0.20) | −0.20; 0.56 | 0.353 |
Age category (ref. [18,19,20,21,22,23,24,25,26,27,28,29]) | ||||||
30–39 | −0.24 (0.37) | −0.97; 0.48 | 0.507 | −0.12 (0.22) | −0.55; 0.32 | 0.146 |
40–49 | −0.87 (0.37) | −1.59; −0.14 | 0.019 | −0.70 (0.33) | −1.35; −0.05 | 0.035 |
≥50 | −0.32 (0.49) | −0.64; 1.28 | 0.517 | 0.05 (0.25) | −0.45; 0.55 | 0.839 |
Education (ref. no graduation) | ||||||
Certificate after grade 9/10 | −0.94 (0.53) | −1.97; 0.10 | 0.077 | −0.83 (0.43) | −0.67; 0.01 | 0.054 |
Intermediate certificate (after grade 10) | −0.53 (0.51) | −1.54; 0.47 | 0.300 | −0.65 (0.56) | −0.75; 0.45 | 0.246 |
Higher education entrance qualification (after grade 12/13) | −0.93 (0.25) | −1.41; −0.44 | <0.001 | −0.68 (0.32) | −1.31; 0.04 | 0.037 |
Employment (ref. not employed) | ||||||
Marginal employment | −0.81 (0.32) | −1.43; −0.19 | 0.010 | −0.34 (0.24) | −0.81; 0.12 | 0.150 |
Working <35 h/week | −0.49 (0.40) | −1.28; 0.28 | 0.223 | −0.65 (0.56) | −0.70; 0.21 | 0.296 |
Working ≥35 h/week | −0.58 (0.48) | −1.52; 0.35 | 0.220 | −0.68 (0.32) | −1.10; 0.19 | 0.171 |
Marital status (ref. single/divorced/widowed) | ||||||
Married/in partnership | 0.73 (0.34) | 0.07; 1.39 | 0.031 | −0.23 (0.24) | −0.71; 0.24 | 0.331 |
Resident status (ref. asylum entitlement/applicant) | ||||||
Refugee protection | −0.63 (0.30) | −1.22; −0.04 | 0.037 | −0.48 (0.26) | −0.98; 0.03 | 0.063 |
Other residence permission † | 0.08 (0.32) | −0.71; 0.54 | 0.795 | 0.16 (0.23) | −0.29; 0.61 | 0.493 |
Constant | 7.99 (0.47) | 7.07; 8.91 | <0.001 | −2.18 (0.39) | −2.95; −1.42 | <0.001 |
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Grochtdreis, T.; Röhr, S.; Jung, F.U.; Nagl, M.; Renner, A.; Kersting, A.; Riedel-Heller, S.G.; König, H.-H.; Dams, J. Health Care Services Utilization and Health-Related Quality of Life of Syrian Refugees with Post-Traumatic Stress Symptoms in Germany (the Sanadak Trial). Int. J. Environ. Res. Public Health 2021, 18, 3408. https://doi.org/10.3390/ijerph18073408
Grochtdreis T, Röhr S, Jung FU, Nagl M, Renner A, Kersting A, Riedel-Heller SG, König H-H, Dams J. Health Care Services Utilization and Health-Related Quality of Life of Syrian Refugees with Post-Traumatic Stress Symptoms in Germany (the Sanadak Trial). International Journal of Environmental Research and Public Health. 2021; 18(7):3408. https://doi.org/10.3390/ijerph18073408
Chicago/Turabian StyleGrochtdreis, Thomas, Susanne Röhr, Franziska U. Jung, Michaela Nagl, Anna Renner, Anette Kersting, Steffi G. Riedel-Heller, Hans-Helmut König, and Judith Dams. 2021. "Health Care Services Utilization and Health-Related Quality of Life of Syrian Refugees with Post-Traumatic Stress Symptoms in Germany (the Sanadak Trial)" International Journal of Environmental Research and Public Health 18, no. 7: 3408. https://doi.org/10.3390/ijerph18073408