Limited organizational support and cultural competences makes PPD screening among immigrant women not feasible for maternal health visitors. Abstract citation ID: ckac129.456 The protective effect of reserves on mental health: a cohort study among undocumented migrants

citation ID: ckac129.456 The protective effect of reserves on mental health: a cohort study among undocumented migrants


Background:
Resources are essential for mental health. In temporary stressful situations throughout life, people need to use a particular type of resources, their ''reserves'', to handle the stress. We do not know whether ''reserves'' (economic, cognitive, and relational) are more protective of mental health than ''conventional'' resources. Using a cohort of undocumented migrants experiencing a stressful transition in their life course (in the process of regularisation with local authorities), we will determine which resources, or reserves, and which types, better protect their mental health.

Methods:
A two-wave cohort study followed 362 undocumented migrants from 2017 to 2020, half of whom (48%) were involved in a regularisation process with the local authorities. Depressive symptoms were measured with the Patient Health Questionnaire, anxiety with the Generalized Anxiety Disorder. Economic reserves were measured at baseline and follow-up, cognitive and relational reserves at baseline only. Conventional economic and relational resources were assessed at both time points. The association between reserves and resources and mental health were examined using generalised estimated equations adjusted for age, sex and working hours per week, as well as the interactions between reserves/resources and regularisation status.

Results:
The indicators of economic and relational reserves were consistently and strongly associated with lower levels of anxiety and depressive symptoms. On the other hand, we found that mental health outcomes were marginally associated with conventional economic resources but independent of the relational resources indicators. We did not find strong evidence of interactions between reserves/resources and regularisation status.

Conclusions:
In a vulnerable population experiencing a stressful transition, reserves are more protective than resources. More research is needed in other vulnerable groups experiencing other stressful events. Key messages: Undocumented migrants' economic and relational reserves protect their mental health. More research on the protective effect of reserves is needed in other vulnerable groups experiencing other stressful events.

Background:
The Makasi community-based research project offered an innovative health-related empowerment intervention to immigrants from sub-Saharan Africa living in precarious situations in the greater Paris area, to reduce their social vulnerability and their exposure to HIV. Our objective is to evaluate the impact of the intervention on access to health coverage in this population.

Methods:
Participants were recruited based on precariousness criteria in public places in Ile-de-France (squares, railway stations, markets, etc.) by mobile teams of social workers and health mediators. Following a stepped-wedge design, participants were randomised into two groups receiving the intervention sequentially (immediately in one group and 3 months later in the other). We evaluated the impact of the Makasi intervention on access to health coverage among 821 individuals observed at 0, 3, and 6 months, between 2018 and 2021. We implemented random-effects panel models -allowing for unobserved heterogeneity -using a Heckman selection approach to correct for attrition. Finally, we used seemingly unrelated regressions (SUR) to examine the extent to which the effect of the intervention was mediated by health-related empowerment.

Results:
Participants -77% of which were men -had been living in France for 4 years on average. 44% of them had no health coverage at the time of inclusion. Our results provided evidence for a significant impact of the Makasi intervention on participants' access to health coverage, with an 18 percentage-point increase in the probability of accessing health coverage 6 months after having received the intervention (p < 0.01). The mediation analysis revealed that this effect operated partly through an empowerment process in terms of knowledge of social and health resources.

Conclusions:
We showed that a health empowerment intervention provided by social workers and health mediators largely favours access to health rights for immigrants in precarious situations.

Background:
This study investigates mortality differences by income among first-and second-generation immigrants and the native ancestral population in Sweden. Despite immigrants' various vulnerabilities and the exhaustive evidence for a persistent inverse relationship between income and mortality in general Western populations, previous studies from outside Sweden demonstrated surprisingly weak income gradients in mortality among first-generation immigrants. Examining these associations among second-generation immigrants may help to understand this paradox.

Methods:
Swedish register data from 2002 to 2016 were used to study the association between individual income rank positions and all-cause mortality. The study population was restricted to ages 25-64 years. Based on 'relative indices of inequality' (RII) derived from Poisson regressions, we measured mortality differentials between the least and most deprived income rank positions stratified by nativity group and sex. Correspondingly, we assessed absolute differences in mortality between the most and least deprived by using 'slope indices of inequality' (SII).

Results:
Largest inequalities in mortality by relative income rank positions (based on RII) were found for the Swedish native ancestral population that showed on average a nearly doubled mortality risk for least compared to most deprived rank position. Immigrants disclosed weak or even nullified associations between relative income rank and all-cause mortality. Mortality inequalities by income among second-generation immigrants were substantially higher relative to first-generation immigrants but somewhat lower compared to the native ancestral population. These patterns were consistent between males and females, and confirmed by the use of SII.

Conclusions:
Distinct exposures to inequality structures but also firstgeneration immigrants' 'mortality advantage' likely contribute to the considerable mortality differences by income between the studied nativity groups.
Key messages: Despite their social and economic vulnerabilities, firstgeneration immigrants in Sweden disclose weak associations between relative income rank and all-cause mortality. Second-generation immigrants in Sweden show notably higher magnitudes in income-related mortality compared with first-generation immigrants.