Hostname: page-component-848d4c4894-2xdlg Total loading time: 0 Render date: 2024-06-21T09:26:44.209Z Has data issue: false hasContentIssue false
  • English
  • Français

Differences in psychiatric care utilization between refugees, non-refugee migrants and Swedish-born youth

Published online by Cambridge University Press:  11 September 2020

Emma Björkenstam Open the ORCID record for Emma Björkenstam [Opens in a new window] ,
Magnus Helgesson ,
Marie Norredam ,
Marit Sijbrandij ,
Christopher Jamil de Montgomery  and
Ellenor Mittendorfer-Rutz
Emma Björkenstam*
Affiliation:
Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden Department of Neuroscience, Uppsala University, Uppsala, Sweden
Magnus Helgesson
Affiliation:
Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden
Marie Norredam
Affiliation:
Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health (MESU), Section for Health Services Research, University of Copenhagen, Copenhagen K, Denmark Section of Immigrant Medicine, Department of Infectious Diseases, University Hospital Hvidovre, Copenhagen, Denmark
Marit Sijbrandij
Affiliation:
Department of Clinical, Neuro- and Developmental Psychology, World Health Organization Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit, Amsterdam, The Netherlands
Christopher Jamil de Montgomery
Affiliation:
Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health (MESU), Section for Health Services Research, University of Copenhagen, Copenhagen K, Denmark
Ellenor Mittendorfer-Rutz
Affiliation:
Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden
*
Author for correspondence: Emma Björkenstam, E-mail: emma.bjorkenstam@ki.se
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The study aimed to examine differences in, and characteristics of psychiatric care utilization in young refugees who came to Sweden as unaccompanied or accompanied minors, compared with that of their non-refugee immigrant and Swedish-born peers.

Methods

This register-linkage cohort study included 746 688 individuals between 19 and 25 years of age in 2009, whereof 32 481 were refugees (2896 unaccompanied and 29 585 accompanied) and 32 151 non-refugee immigrants. Crude and multivariate Cox regression models yielding hazard ratios (HR) and 95% confidence intervals (CI) were conducted to investigate subsequent psychiatric care utilization for specific disorders, duration of residence and age at migration.

Results

The adjusted HRs for psychiatric care utilization due to any mental disorder was significantly lower in both non-refugee and refugee immigrants when compared to Swedish-born [aHR: 0.78 (95% CI 0.76–0.81) and 0.75 (95% CI 0.72–0.77, respectively)]. Within the refugee group, unaccompanied had slightly lower adjusted risk estimates than accompanied. This pattern was similar for all specific mental disorders except for higher rates in schizophrenia, reaction to severe stress/adjustment disorders and post-traumatic stress disorder. Psychiatric health care utilization was also higher in immigrants with more than 10 years of residency in Sweden entering the country being younger than 6 years of age.

Conclusions

For most mental disorders, psychiatric health care utilization in young refugees and non-refugee immigrants was lower than in their Swedish-born peers; exceptions are schizophrenia and stress-related disorders. Arrival in Sweden before the age of 6 years was associated with higher rates of overall psychiatric care utilization.

Keywords

Cohorthealth care utilizationmental disordersmigrationyoung refugees
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 7 , May 2022 , pp. 1365 - 1375
Check for updates
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abubakar, I., Aldridge, R. W., Devakumar, D., Orcutt, M., Burns, R., Barreto, M. L., … Zimmerman, C. (2018). The UCL-lancet commission on migration and health: The health of a world on the move. Lancet (London, England), 392, 2606–2654.CrossRefGoogle ScholarPubMed
Barghadouch, A., Carlsson, J., & Norredam, M. (2018). Psychiatric disorders and predictors hereof among refugee children in early adulthood: A register-based cohort study. The Journal of Nervous and Mental Disease, 206, 3–10.CrossRefGoogle ScholarPubMed
Barghadouch, A., Kristiansen, M., Jervelund, S. S., Hjern, A., Montgomery, E., & Norredam, M. (2016). Refugee children have fewer contacts to psychiatric healthcare services: An analysis of a subset of refugee children compared to Danish-born peers. Social Psychiatry and Psychiatric Epidemiology, 51, 1125–1136.CrossRefGoogle ScholarPubMed
Bean, T., Derluyn, I., Eurelings-Bontekoe, E., Broekaert, E., & Spinhoven, P. (2007). Comparing psychological distress, traumatic stress reactions, and experiences of unaccompanied refugee minors with experiences of adolescents accompanied by parents. The Journal of Nervous and Mental Disease, 195, 288–297.CrossRefGoogle ScholarPubMed
Bean, T., Eurelings-Bontekoe, E., Mooijaart, A., & Spinhoven, P. (2006). Factors associated with mental health service need and utilization among unaccompanied refugee adolescents. Administration and Policy in Mental Health and Mental Health Services Research, 33, 342–355.CrossRefGoogle ScholarPubMed
Björkenstam, E., Helgesson, M., Norredam, M., Sijbrandij, M., de Montgomery, C. J., & Mittendorfer-Rutz, E. (2020). Common mental disorders among young refugees in Sweden: The role of education and duration of residency. Journal of Affective Disorders, 266, 563–571.CrossRefGoogle Scholar
Brendler-Lindqvist, M., Norredam, M., & Hjern, A. (2014). Duration of residence and psychotropic drug use in recently settled refugees in Sweden – a register-based study. International Journal for Equity in Health, 13, 122.CrossRefGoogle ScholarPubMed
Buhmann, C. B. (2014). Traumatized refugees: Morbidity, treatment and predictors of outcome. Danish Medical Journal, 61, 1–29.Google ScholarPubMed
de Montgomery, C. J., Petersen, J. H., & Jervelund, S. S. (2020). Psychiatric healthcare utilisation among refugee adolescents and their peers in Denmark. Social Psychiatry and Psychiatric Epidemiology, 1–12. doi: 10.1007/s00127-020-01878-w.Google ScholarPubMed
Fazel, M. (2018). Psychological and psychosocial interventions for refugee children resettled in high-income countries. Epidemiology and Psychiatric Sciences, 27, 117–123.CrossRefGoogle ScholarPubMed
Fazel, M., Reed, R. V., Panter-Brick, C., & Stein, A. (2012). Mental health of displaced and refugee children resettled in high-income countries: Risk and protective factors. Lancet (London, England), 379, 266–282.CrossRefGoogle ScholarPubMed
Gadeberg, A. K., Montgomery, E., Frederiksen, H. W., & Norredam, M. (2017). Assessing trauma and mental health in refugee children and youth: A systematic review of validated screening and measurement tools. European Journal of Public Health, 27, 439–446.CrossRefGoogle ScholarPubMed
Giacco, D., Laxhman, N., & Priebe, S. (2018). Prevalence of and risk factors for mental disorders in refugees. Seminars in Cell and Developmental Biology, 77, 144–152.CrossRefGoogle ScholarPubMed
Harris, S., Dykxhoorn, J., Hollander, A. C., Dalman, C., & Kirkbride, J. (2019). Substance use disorders in refugee and migrant groups in Sweden: A nationwide cohort study of 1.2 million people. PLoS Medicine, 16, 1–19. doi: 10.1371/journal.pmed.1002944.CrossRefGoogle ScholarPubMed
Hollander, A. C., Bruce, D., Burström, B., & Ekblad, S. (2013). The association between immigrant subgroup and poor mental health: A population-based register study. Journal of Nervous and Mental Disease, 201, 645–652.CrossRefGoogle ScholarPubMed
Hollander, A. C., Dal, H., Lewis, G., Magnusson, C., Kirkbride, J. B., & Dalman, C. (2016). Refugee migration and risk of schizophrenia and other non-affective psychoses: Cohort study of 1.3 million people in Sweden. BMJ, 352, 1–8. doi: 10.1136/bmj.i1030.Google ScholarPubMed
Huemer, J., Karnik, N. S., Voelkl-Kernstock, S., Granditsch, E., Dervic, K., Friedrich, M. H., & Steiner, H. (2009). Mental health issues in unaccompanied refugee minors. Child and Adolescent Mental Health, 3, 13. doi: 10.1186/1753-2000-3-13CrossRefGoogle ScholarPubMed
Jung, H., Cho, Y. J., Rhee, M. K., & Jang, Y. (2020). Stigmatizing beliefs about depression in diverse ethnic groups of Asian Americans. Community Mental Health Journal, 56, 79–87.CrossRefGoogle ScholarPubMed
Kien, C., Sommer, I., Faustmann, A., Gibson, L., Schneider, M., Krczal, E., … Gartlehner, G. (2018). Prevalence of mental disorders in young refugees and asylum seekers in European Countries: A systematic review. European Child & Adolescent Psychiatry, 10, 1295–1310. doi: 10.1007/s00787-018-1215-z.Google Scholar
Kirkbride, J, & Jones, P. (2011). Epidemiological aspects of migration and mental illness. In Bhugra, D., & Gupta, S. (Eds.), Migration and mental health (pp. 15–43). Cambridge, UK: Cambridge University Press.Google Scholar
Manhica, H., Almquist, Y., Rostila, M., & Hjern, A. (2017). The use of psychiatric services by young adults who came to Sweden as teenage refugees: A national cohort study. Epidemiology and Psychiatric Sciences, 26, 526–534.CrossRefGoogle ScholarPubMed
Montgomery, E. (2011). Trauma, exile and mental health in young refugees. Acta Psychiatrica Scandinavia Supplementum, 146, 1–46. doi: 10.1111/j.1600-0447.2011.01740.x.Google Scholar
Myers, D., Gao, X., & Emeka, A. (2009). The gradient of immigrant age-at-arrival effects on socioeconomic outcomes in the U. S. International Migration Review, 43, 209–229.CrossRefGoogle Scholar
Na, S., Ryder, A. G., & Kirmayer, L. J. (2016). Toward a culturally responsive model of mental health literacy: Facilitating help-seeking among East Asian immigrants to North America. American Journal of Community Psychology, 58, 211–225.CrossRefGoogle Scholar
Niederkrotenthaler, T., Floderus, B., Alexanderson, K., Rasmussen, F., & Mittendorfer-Rutz, E. (2012). Exposure to parental mortality and markers of morbidity, and the risks of attempted and completed suicide in offspring: An analysis of sensitive life periods. Journal of Epidemiology and Community Health, 66, 233–239.CrossRefGoogle ScholarPubMed
Niederkrotenthaler, T., Mittendorfer-Rutz, E., Mehlum, L., Qin, P., & Björkenstam, E. (2020). Previous suicide attempt and subsequent risk of re-attempt and suicide: Are there differences in immigrant subgroups compared to Swedish-born individuals? Journal of Affective Disorders, 265, 263–271.CrossRefGoogle ScholarPubMed
Norredam, M., Nellums, L., Nielsen, R. S., Byberg, S., & Petersen, J. H. (2018). Incidence of psychiatric disorders among accompanied and unaccompanied asylum-seeking children in Denmark: A nation-wide register-based cohort study. European Child & Adolescent Psychiatry, 27, 439–446.CrossRefGoogle ScholarPubMed
Satinsky, E., Fuhr, D. C., Woodward, A., Sondorp, E., & Roberts, B. (2019). Mental health care utilisation and access among refugees and asylum seekers in Europe: A systematic review. Health Policy, 123, 851–863.CrossRefGoogle ScholarPubMed
Saunders, N. R., Lebenbaum, M., Stukel, T. A., Lu, H., Urquia, M. L., Kurdyak, P., & Guttmann, A. (2017). Suicide and self-harm trends in recent immigrant youth in Ontario, 1996–2012: A population-based longitudinal cohort study. BMJ Open, 7, e014863. doi: 10.1136/bmjopen-2016-014863CrossRefGoogle ScholarPubMed
UNHCR (2019). Guidelines on policies and procedures in dealing with unaccompanied children seeking asylum. Retrieved from https://www.unhcr.org/3d4f91cf4.pdf.Google Scholar
United Nations, D. o. E. a. S. A., Population Division. (2017). International migration report 2017: Highlights (ST/ESA/SER.A/404). New York. Retrieved from http://www.un.org/en/development/desa/population/migration/publications/migrationreport/docs/MigrationReport2017_Highlights.pdf.Google Scholar
World Health Organization (2018). Health of refugee and migrant children. Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0011/388361/tc-health-children-eng.pdf?ua=1.Google Scholar
Supplementary material: File

Björkenstam et al. supplementary material

Björkenstam et al. supplementary material

Download Björkenstam et al. supplementary material(File)
File 33.8 KB