Employment Satisfaction and Health Outcomes among Professional Iraqi refugees as compared to Immigrants

Abstract

This study investigates employment and health outcomes in Iraqi refugees compared to Iraqi immigrants. We surveyed 148 Iraqi professional refugees and 111 Iraqi professional immigrants residing in the U.S. We hypothesized that Iraqi refugees would report lower employment and worse self-rated health as compared to Iraqi immigrants. Logistic Regression was used to test various models. Results showed that more immigrants were employed, as well as employed in their original profession as compared to refugees. Regardless of immigration status, participants' age and the way they rated their job played a larger role in health. The study is the first to demonstrate that, controlling for professional, ethnic and cultural background, there are unknown mechanisms resulting in lower employment and skilled employment in refugees as compared to matched immigrant controls. Furthermore, satisfaction with the new work appears more important than employment per se.

The refugee process is characterized by a host of complex stressors that affects mental and somatic health, and ultimately the quality of life worldwide. Refugees carry the hardships of their previous life as well as their new one due to lasting psychological effects from traumatic experiences (Keller et al., 2006). Refugee health has been shown to fare worse in comparison to immigrants of similar background (Jamil et al., 2010, Sundquist et al., 2003). However, such studies focus on post displacement stressors that affect health and neglect employment as a major factor in shaping the integration process in the United States; especially for professional refugees who come equipped with degrees from their home country.

Unemployment and underemployment affects refugees worldwide (Bloch, 2002a; Bloch, 2000b; Tabeka, 2000; Owen et al., 2000; Twomey, 2001). Although research focuses on post-displacement factors in refugee integration, little investigates post-displacement employment outcomes and its implication for health and well being. Health is an important factor in the scope of refugee employment since refugees are exposed to direct or indirect violence that results in high level of distress and psychological disorders, which is exacerbated by the immigration process (Ventevogel, 2008). However, examining employment in refugees is a critical factor since prior studies have demonstrated a clear association between unemployment and worse somatic and mental health (Langens & Mose, 2006; Arnetz, et al., 1987).

Most studies of refugee unemployment focus on rather low-to-medium-skilled individuals. A major rationalization for their unemployment might be a lack of sufficient education and practical skills. However, there has been less work on refugees with professional skills and credentials from their country of origin and their ability to secure employment at or below their skills level in their new country. Specifically, there is limited research on professional refugees as compared to professional immigrants, examining how they fair in comparison to immigrations of similar background. Interestingly, professionals seem to be the hardest hit group as compared to native-born professionals, as they earn lower wages, even with higher education levels when entering the new country (Alboim, et al., 2005; Chan, 2001; Reitz, 2001b; Reitz, 2006).

Educational backgrounds of professional refugees set them apart from other refugee groups. Professional refugees come to the new country equipped with degrees, credentials, and experience; yet find it particularly difficult obtaining employment. Interestingly, prior research shows that refugees with postgraduate educational degree fare worse in securing employment than those with undergraduate degrees (Takeda, 2000).

In this research, we wanted to explore employment success and health among professional refugees with credentials from their country of origin, in comparison to professional immigrants of similar ethnic and cultural background. The study adds unique new information about the importance of post-displacement employment and level of employment among professional refugees and its implication for health and job satisfaction.

There are few newcomer groups available to study this. We decided to study Iraqi refugee professionals as compared to Iraqi immigrant professionals, since they are one of the few groups that immigrate in sufficient numbers to new host country to allow for meaningful comparisons. There are more than 60,000 Iraqi refugees and 100,000 Iraqi immigrants residing in the United States (Arab American Institute, 2010), many of which live in Michigan. With the onset of wars in the Middle East the last several decades, Iraqi refugees have disbursed worldwide. Our research takes advantage of the unique opportunity of exploring refugee employment success and health outcomes, comparing it to immigrant professionals of similar cultural background. The two groups have the same culture, values, speak the same language, and have been through the same educational system in Iraq. These factors make investigating differences in employment and health outcomes in Iraqi immigrant and refugee professionals more valid. The significance of such study goes beyond Iraqi professionals; results will further our understanding of immigration status on employment success and health outcomes.

We hypothesized that Iraqi refugees have a lower employment rate compared to Iraqi immigrants due to an overall higher level of prior trauma exposure and institutional discrimination from employers. If employed, Iraqi refugees would be in jobs in which their professional skills were underutilized. Further, we hypothesized that employed refugees and immigrants have higher self-rated health status compared to unemployed, as employment plays a role in somatic and mental health. Finally, we hypothesized that employment per se would be more important for health as compared to whether a person was satisfied with their job or not.

Method

We collaborated with the International Society of Iraqi Scientists (ISIS), located in Michigan, to survey Iraqi professionals holding Bachelor's degrees or higher (postgraduate degrees) and who emigrated from Iraq after the Gulf War in 1991. The study was announced on the ISIS website as well as other Iraqi websites and the questionnaires were distributed to the member's email addresses. The announcement included an information sheet (part of WSU/HIC), inquiring individuals' interested in participating, with an electronic link leading to the Survey Monkey. Within a three-month period (July to October, 2009), 1068 Iraqis, from 61 countries, responded to the Monkey Survey study.

For this study, we selected 259 participants who were residents of the U.S. We excluded 20 participants (13 who entered the U.S. before 1991, 3 who entered the U.S. with student visa, 1 was retired, and 3 participants were in a training course). The participants were classified according to their immigration status (refugees vs. immigrant). There were 148 refugees and 111 immigrants in our final sample. They were further divided into three categories: employed as professionals, employed in non-professional jobs, and unemployed.

A Chi-Square Test of Independence was performed to examine the relation between immigrants and refugees in relation to different discrete demographical variables. Logistic Regression Analysis was used to predict employment status, using sociodemographic, educational status, and refugee/immigration status as independent predictors. Logistic Regression Analysis was used to predict self-rated health using age and job satisfaction and job ratings Overall statistical significance was set to a two-tailed p value of p<.05.

Wayne State University Human investigation Committee approved the study and all participants provided their informed consent by ticking a special question following the information sheet presented on line prior to continuing with the survey.

Results

Table 1 depicts the prevalence rate for refugees and immigrant group characteristics. Results show that there were statistically significant differences between refugees and immigrants in terms of age, marital status, education level, job status, and numbers of years residing in the U.S., but not for gender or ethnicity. Furthermore more immigrants as compared to refugees were employed in professional field.

Table 1.

Characteristics of Iraqi who emigrated to U.S. after 1991 and residents in U.S. by legal status.

Mean (SD)	Refugees (=148)	Immigrants (n=111)	Total (n=259)
Age***	41.9 (10.84)	46.8 (11.57)	44.0 (11.40)
Years in U.S.***	5.7 (5.57)	9.9 (5.16)	7.5 (5.76)
	No. (%)	No. (%)	No. (%)
Gender
Male	104 (70.3)	77 (69.4)	181 (69.9)
Female	44 (29.7)	34 (30.6)	78 (30.1)
Marital Status**
Married/Other	115 (77.7)	99 (89.2)	214 (82.6)
Single	33 (22.3)	12 (10.8)	45 (17.4)
Education**
Bachelors + Diploma	92 (62.2)	51 (45.9)	143 (55.2)
MS + PhD	56 (37.8)	60 (54.1)	116 (44.8)
Job Status***
Professional	30 (21.6)	63 (58.6)	93 (37.5)
Non-professional job	60 (39.9)	25 (21.6)	85 (32)
Unemployed	58 (38.5)	23 (19.8)	81 (30.5)
Ethnicity
Arab	87 (58.8)	59 (53.2)	146 (56.4)
Other Ethnicity	61 (41.2)	52 (46.8)	113 (43.6)
Self Rated Health (SRH)*
Excellent/Very good	82 (76.6)	57 (80.3)	139 (78.1)
Fair/Poor	25 (23.4)	14 (19.7)	39 (21.9)

Note: Total of each character depend on numbers of respondents.

^*P < 0.05;

^**P < 0.01;

^***P < 0.001

Chi Square Analysis was done to examine ratings of job placement and work enjoyment between professionals who were employed in their professional field versus professionals employed below their professional field. Seventy percent of participants who are employed in their professional field rated their job as being “poor”, while 56.3% of those employed in non-professional employment rated their job as “good.” Further, 88% of those employed in their professional field reported that they did not enjoy their job, while 66.9% of those employed in non-professional work reported that they enjoyed their employment (Table 2).

Table 2.

Professional Vs. Non Professional Participants Self-Rating on Quality of Job Placement and Work Enjoyment

Self-Rated to question	Non Professional work	Professional work
	No (%)	No (%)
Rate Your Job placement (P < 0.024)
Poor	6 (30.0)	14 (70.0)
Good	80 (56.3)	62 (43.7)
Rate your work Enjoyment (P < 0.001)
No work enjoyment	4 (11.1)	32 (88.9)
Enjoying the work	83 (66.9)	41 (33.1)

Logistic Regression Analysis was used to predict employment outcome by group, Results indicate that skilled males in our sample [OR= 2.8 (95% CI 1.5–5.3)] were likely to be employed in general than women. Further, individuals in our sample who have been in the United States more than three years [OR=5.4 (CI 95% 2.8–10.40)] were more likely to be employed than individuals who have only been in the United States less than three years (Table 3).

Table 3.

Predictor of Employment in Professional Skilled Iraqi Immigrant and Refugees

likelihood Employed	Sig.	Odds Ratio	95% C.I. for Odds Ratio
			Lower	Upper
Female [Reference]	.001	2.807	1.488	5.298
< 3 Years in USA [Reference]	.000	5.401	2.792	10.447

Adjusted for age, marital status, education and legal status

Taking into account those who were employed in our sample, Logistic Regression was done to predict being employed in the individual's professional field. Results indicate that employed immigrants [OR=3.4 (CI 95% 1.69–6.93)] are more likely to be employed in their professional fields than refugees. Individuals who have been in the United States for three or more years exhibited an OR of 0.184 (CI 95% .07–.48) to being employed in their professional field, indicating that individuals who have been in the United States for three or more years are 81.6% more likely to being employed in their professional areas (Table 4).

Table 4.

Predictor of having professional employment in skilled Iraqi Refugees and Immigrant

Likelihood Professional employment	Sig.	Odds Ratio	95% C.I. for Odds Ratio
			Lower	Upper
Refugees [Reference]	.001	3.417	1.685	6.933
< 3 Years in USA [[Reference]	.001	.184	.071	.478

Adjusted for age, gender, marital status education

Note: Participants who were employed were included

Refugees did not differ from immigrants in self-rated health after controlling for gender, marital status, education, and time in the United States. Further, employment status did not play a role. However, age and how the participants rated their work played a significant role. Younger individuals [OR=−.09 (CI 95% 0.84–0.98) are more likely to report better health. Further, those who rated their jobs in a favorable light are more likely to report better health OR=38.67 (CI 95% 4.44–342.35) (Table 5).

Table 5.

Predictors of Good Self Rated Health among Skilled Iraqi Refugees and Immigrants

Likelihood of Good SRH	Sig.	Odds Ratio	95% C.I. for OR
			Lower	Upper
Age [Continuous]	.016	0.91	0.84	0.98
Job Rating [poor=reference]	.001	38.98	4.44	342.35

Adjusted for gender, marital status, education, immigration status and professional status

Discussion

In the current study, we found that professional refugees have lower employment rates than professional immigrants of similar background. Our research is consistent with previous findings that suggest refugees fare worse when it comes to employability in the host country irrespective of their professional skills (Tabeka, 2000; Bloch, 2002b). Although prior studies have reported similar findings, they have used appropriate comparison groups in their research design such as comparing the refugees with a group similar in culture, language, and country of origin. Rather, comparisons are made to native born workers or ethnically different immigrants. Furthermore, such comparative studies do not account for professional background. The lack of representative data for an adequate refugee comparable group has made researching refugee employment integration difficult.

Our findings indicate that professional refugees are more likely to be underemployed than immigrant of a similar background. Prior studies suggest that refugees' capacity is generally underutilized, where their earnings is not compatible with their educational level compared to their ethnic minority immigrants (Bloch, 2002a; Bloch, 2002b; Owen et al, 2000; Twomey, 2001). These studies focus on diverse groups of refugee, investigating their integration process as one in the same in the European Union. Consequently, the studies don't take into account pre displacement factors that may contribute to refugee groups integrating differently into the new country. We have taken into consideration the importance of investigating a homogenous group of refugees. During the last decade, Iraqi refugees have made up a large proportion of refugees that escape to the Western world, including Europe and the United States. Since there are appropriate control groups available for Iraqi refugees, such as, immigrants from Iraq as well as from other Arab countries, the current study was able to dwell deeper into the employment outcomes of Iraqi refugees as compared to similar groups of non-war exposed immigrants. Iraqi refugees usually arrive with high levels of education; yet still find it difficult obtaining entry-level employment in the United States (United States Government Accountability Office, 2010). Furthermore, Iraqi refugees arriving to the United States between 2007 and 2008 reported that 63% have a college education (RefugeeWorks, 2008).

Prior studies have indicated that lack of English proficiency could explain the difficulty in refugees' employment (Bloch, 2002b; Bloch and Atfield, 2002; DeSilva,1997; Beiser and Hou, 2000). However, once again, these studies do not compare the outcome of similarly educated and skilled persons that voluntary immigrate to the country of interest. Instead the previous studies weakness lies in the fact that they consider ethnically diverse refuges as a homogenous group. Also, refugees are usually compared to either to immigrants or native born workers. It is difficult to develop a comprehensive picture from such comparison. These studies did not take into account the educational levels of the refugees. When comparing our professional refugees with immigrants of similar backgrounds, results indicate that language skills did not explain the difference in employment outcomes. This is possibly due to comparing two groups with similar educational backgrounds, suggesting that their English professioncy is similar. However, it seems that the relationship between refugee status and employment is far more complex than relying strictly on language skills, which is in need of a more in-depth study.

Regardless of immigration status, more males were employed in general than females, which is consistent with prior research (Bloch, 1999; Bloch & Atfield, 2002). These studies investigated gender differences in employment of refugees, however, samples were made up of diverse refugee group, not a comparable group. They also did not take educational background into consideration in the comparisons. Dissecting the issue further, prior research suggests that women's situations are more complex. In addition, individual factors may shape their employment prospects, with some women choosing not to enter the workforce, due to child care or family situations (Bloch, 2002b). However, Takeda (2000) shows that Iraqi males, in particular, were struggling to adapt economically in their new country. Also, results showed that younger age is associated with the likelihood being employed, consistent with prior studies that suggest refugees under the age of 35 are more likely to be in the labor market compared to refugees of the same population (Bloch, 2002b; Chan and Lam, 1987 in Bloch, 2002b). However, in these studies, educational level of the age group wasn't taken into consideration when comparing them.

The length of residency was a predictive factor in being employed. Participants who have been in the United States for three or more years were more likely to gain employment for both groups. This finding is in line with previous findings that suggest the longer the refugee resides in the new country; the more likely they are engaged in employment (Bloch, 2002b). Also, other studies (Simich et al., 2004, Bloch, 1999) reports that the longer the refugee has time to establish themselves in the host country, the more likely they are engaging in networking with friends, relatives, or religious organizations, all of which contributes to a greater chance of securing employment.

Regardless of immigration status (refugees or immigrants), professional individual were less satisfied with their employment than their underemployed counterparts. This finding is novel and unique to the refugee literature; in contrast to literature reviewed our results indicate that it's not necessarily enough to be professionally employed to be satisfied with one's employment. Other factors need to be considered, such as cognitive skills of refugees in their post-displacement efforts toward employment, it is possible that professional jobs require the use of high levels of cognitive skills which may be more taxing for refugees and immigrants considering the multiple factors of being employed in a foreign country. However, little research has been done on refugee or immigrant professional groups and the role cognitive skills play in employment.

Emotional and cognitive demands of the professional fields may cause individuals to encounter further difficulties in post-displacement state (Hochschild, 1983). Jobs that require high emotional labor may create emotional dissonance or inconsistent feelings between employees' jobs performance in high demand jobs and their internal state, creating negative consequences such as being unsatisfied with one's employment, work fatigue and exhaustion, and withdrawing from the work organization (Grandey, 2000; Hochschild, 1983, Morris & Feldman, 1996, Wharton, 1993).

In terms of health, refugee health has been shown to fare worse in comparison to immigrants of similar background (Jamil et al., 2010, Sundquist et al., 2003). However, our hypothesis was rejected that being employed played a significant role for health. Better health was found to be more prevalent in younger individuals in our sample. It appears that research is inconsistent on health and employment. While previous findings state that employment plays a positive role in health, our findings is in disagreement with much of the traditional unemployment research that report unemployment adversely affects a person's self-rated health (Arnetz 1987; Langens & Mose, 2006). This is possibly due to poor health may be affecting the groups, regardless of employment status, as possible migration stressors maybe more profound than employment.

Our findings indicate that better self-rated health was associated with rating one's job more favorably, regardless of immigration status (refugee or immigrants). This finding is interesting because individuals who are less satisfied with their employment have the potential of developing numerous health ailments (Langens & Mose, 2006; Arnetz, et al., 1987). Having negative emotions regarding work is associated with higher levels of emotional exhaustions (Mahoney et al., 2011). These negative emotions are a primary component of burnout, which is associated with poor health such as cardiovascular disease, depression, pain, and insomnia (Honokonen et al., 2006; Peterson et al., 2008;, Shirom, Melamed, Toker, Berlinker, & Shapira, 2005). Professionals reported that they were unsatisfied with their work, which can ultimately affect their long term well- being.

Limitations

There are a few limitations in our study. This is a cross sectional study, making it difficult to determine the true cause-and-effect relationship in employment and health in refugees. Further, our sample was small, nonrandom, and was a convenient sample from a professional group association (the Iraqi Society), possibly affecting external validity. Comparing refugees and immigrants, using native-born professionals as a control group might establish a more comprehensive understanding in employment success in both groups, since immigrants might also fair worse as to employment in general and skilled employment in specific (Jong & Madamba, 2001; Chan, 2001) versus natively born.

Conclusion

This study is an important first step in beginning to understand the differences between immigrants' and refugees' integration process in terms of employment success and health outcomes. Professional refugees are overall more likely to be underemployed or unemployed compared to a similar immigrant group. Beyond immigration status, professionals employed within their domain of expertise are more dissatisfied than those who were underemployed. Predictors of good self-rated health include being a young and rating one's job favorably. We believe our results are generalizable to other refugee groups in terms of employment. With staggering numbers of skilled refugees being forcibly displaced around the world, these findings can play a significant role in enhancing the likelihood of successful integration and employment of refugees worldwide.