Interconnected Challenges: Examining the Impact of Poverty, Disability, and Mental Health on Refugees and Host Communities in Northern Mozambique

Background: The connections between poverty, disability, and mental health are deeply intertwined and mutually reinforcing, potentially leading to poverty traps. Forced displacement can have enduring impacts on both mental health and poverty. Adults with disabilities experience mental distress more frequently than those without disabilities. However, the interplay between poverty, disability, mental health, and forced displacement remains not fully understood due to limited comparable data between displaced and non-displaced populations in the same context. This paper examines the mental health status, disability burden, cognitive bias of pessimism, subjective feeling of loneliness and self-esteem, and socio-economic factors including financial security, of both refugees and host communities in a low-income setting in Northern Mozambique. Methods: Poor adult refugees (n=134) and Mozambican nationals living in the vicinity (n=314) were identified based on a poverty score card employed by the World Bank for the targeting of Government social protection programs. They were administered a survey capturing symptoms of depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), disability (Washington Group on Disability Statistics- Short Set), and socioeconomic characteristics. Results: Both refugees and hosts report high symptom levels of depression (34% and 29% respectively) and anxiety (25%) without significant differences between the groups. Women in both groups report more symptoms. Both refugees and Mozambicans face a high disability burden (25% and 22%). Individuals with disabilities are twice as likely to experience depression and three times as likely to suffer from anxiety. Financial security is inversely related to mental health issues: a one-unit increase in financial security corresponds to a 0.069 unit decrease in anxiety (p< 5%) and a 0.069 unit decrease in depression (p< 1%). Pessimism is positively associated with poor mental health for both refugees and hosts, increasing the prevalence of anxiety and depression more than 2.5 times compared to those who are not pessimistic. Loneliness is not a good predictor of depression or anxiety among the population studied while self-esteem is a good predictor of depression and anxiety with low self-esteem more than doubling the likelihood of the prevalence of GAD and depression. Conclusions: Our findings confirm the link between poverty and mental health, introducing disability as another contributing factor. This underscores the need for enhanced mental health and public health services for both refugees and hosts, with a particular focus on women. Policy actions to improve employment access and social inclusion for persons with disabilities are crucial for better mental health outcomes. Mental health interventions should be integrated into antipoverty measures alongside traditional economic interventions. Additionally, high levels of mental health issues can hinder the economic and social integration of refugees, which is essential for the economic growth and stability needed for long-term solutions.