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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: [email protected]
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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
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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