Im/migrants are a highly vulnerable population at risk for significant health disparities. Past research has demonstrated that they have high rates of post-traumatic stress disorder, depressive and anxiety disorders, and chronic diseases that are exacerbated by an inability to access health care while fleeing their natal countries or seeking asylum (1). These individuals face numerous social and political barriers post-migration; for example, asylum seekers must wait a year after filing for asylum before they can officially apply for a work permit (2). More broadly, foreign-born persons often face barriers in accessing social safety net programs due to administrative burdens; language, literacy, or cultural barriers; and climates of fear and mistrust (3). Collectively, these barriers likely contribute to unmet social needs (e.g., food insecurity, housing insecurity), which in turn may increase avoidable health care utilization such as emergency department visits (4).
To help understand and address unmet social needs within vulnerable populations, social determinants of health (SDOH)-focused patient reported outcomes (PROs) and referral systems have been increasingly used in research and clinical practice (5). However, there is little empirical evidence how unmet social needs in im/migrant populations are associated with health care utilization (6). Yet, assessing this population for unmet social needs and factors related to SDOH is important given the legal and systemic barriers that im/migrants may face upon arrival to the US.
To help meet these needs, the Boston Medical Center (BMC) Immigrant and Refugee Health Center (IRHC) provides a full spectrum of medical, mental health, and obstetrics healthcare, along with social services and legal referrals for foreign-born patients who may benefit from assistance navigating and accessing health services in the US. It is housed within BMC—a large, urban safety-net teaching hospital in Boston, MA, and IRHC-associated providers work across many departments including General Internal Medicine, Family Medicine, Obstetrics and Gynecology, and Psychiatry. To measure unmet social needs among patients, BMC uses the THRIVE—a brief, paper-based, SDOH-focused patient reported outcome (PRO) survey that measures eight areas of unmet social need related to housing, food, affording medications, transportation, utilities, caregiving, employment, and education needs, described elsewhere (7). While the majority of patients served by the BMC IRHC are screened via THRIVE during primary care patient visits, little is known about self-reported unmet social needs in im/migrant populations, particularly in health care settings where routine screening is occurring. One exploratory study reporting on health and social needs of a refugee population in the Netherlands found that psychological distress was reported in approximately 67% of respondents whereas social needs such as childcare, money, education, food, and housing were reported in 10-17% of respondents (8). However, these findings were limited to a convenience sample of 30 individuals.
The objectives of this study were to describe types and levels of unmet social needs within a refugee and asylum-seeking cohort and to estimate the relationship between level of unmet social needs and emergency department visit rates within this population.