title: Inequalities by immigrant status in depressive symptoms in Europe: the role of integration policy regimes.
abstract: We aimed to study whether country integration policy models were related to inequalities by immigrant status in depressive symptoms in Europe.
  
  
  
  This is a cross-sectional study using data from 17 countries in the sixth wave of the European Social Survey (2012), comparing subjects born either in the country of residence (non-immigrants, N = 28,333) or in a country not classified as "advanced economy" by the IMF (immigrants, N = 2041). Depressive symptoms were assessed with the eight-item version of the Center for Epidemiologic Studies Depression scale. Countries were grouped into three integration policy regimes (inclusive, assimilationist, and exclusionist). Linear regressions were fitted adjusting first by age, sex, and education level, then sequentially by citizenship, perceived discrimination, and socio-economic variables.
  
  
  
  In all integration regimes, immigrants report significantly more depressive symptoms than non-immigrants. The gap is the largest in exclusionist countries (immigrants score 1.16, 95% CI 0.65-1.68, points higher than non-immigrants in the depression scale), followed by assimilationist countries (0.85 and 0.57-1.13) and inclusive countries (0.60 and 0.36-0.84). Financial strain explains all the associations in inclusive countries, most of it in assimilationist countries, but only a small part in exclusionist countries.
  
  
  
  Across most European countries, immigrants seem to experience more depressive symptoms than the population born in the country, mostly reflecting their poorer socio-economic situation. Inequalities are larger in countries with more restrictive policies. Despite some limitations, this study adds new evidence to suggest that immigrants' health is shaped by integration policies in their host country.
authors.affiliation: Agència de Salut Pública de Barcelona, IIB-Sant Pau, Plaça Lesseps, 1, 08023, Barcelona, Spain. dmalmusi@gmail.com.|Ciber de Epidemiología y Salud Pública, Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0, 28029, Madrid, Spain. dmalmusi@gmail.com.
authors.forename: Davide
authors.identifier: 0000-0003-1877-3581
authors.initials: D
authors.lastname: Malmusi
authors.affiliation: Agència de Salut Pública de Barcelona, IIB-Sant Pau, Plaça Lesseps, 1, 08023, Barcelona, Spain.|Ciber de Epidemiología y Salud Pública, Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0, 28029, Madrid, Spain.
authors.forename: Laia
authors.initials: L
authors.lastname: Palència
authors.affiliation: Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
authors.forename: Umar Z
authors.initials: UZ
authors.lastname: Ikram
authors.affiliation: Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
authors.forename: Anton E
authors.initials: AE
authors.lastname: Kunst
authors.affiliation: Agència de Salut Pública de Barcelona, IIB-Sant Pau, Plaça Lesseps, 1, 08023, Barcelona, Spain.|Ciber de Epidemiología y Salud Pública, Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0, 28029, Madrid, Spain.|Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Doctor Aiguader, 88, 08003, Barcelona, Spain.
authors.forename: Carme
authors.identifier: 0000-0003-1877-3581
authors.initials: C
authors.lastname: Borrell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003863:Depression / Q000208:ethnology*; D054242:Emigrants and Immigrants / Q000523:psychology*; D005060:Europe / Q000208:ethnology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011640:Public Policy; D055815:Young Adult
keywords: Depression; Europe; Immigrant status; Integration policy; Social determinants