Psychiatric care use among migrants to Sweden compared with Swedish-born residents: a longitudinal cohort study of 5 150 753 people

Hollander, Anna-Clara; MacKay, E. N.; Sjöqvist, Hugo; Kirkbride, James; Bäärnhielm, Sofie; Dalman, Christina

doi:10.1136/bmjgh-2020-002471

Cited by 27 publications

(29 citation statements)

References 35 publications

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“…Several factors may delay treatment-seeking in migrant groups, including unfamiliarity of the legal entitlement to healthcare in Sweden, or other cultural or structural barriers in accessing timely treatment, including language barriers, multiple complex health needs requiring treatment or fear of legal repercussions for refugees. 39 , 40 We suggest that these findings will generalize to other settings where non-refugee and refugee migrants may be at both greater risk of psychosis, 41 and face differential outcomes in their treatment pathways. 42 …”

Section: Discussionmentioning

confidence: 67%

Inequalities in Psychiatric Service Use and Mortality by Migrant Status Following a First Diagnosis of Psychotic Disorder: A Swedish Cohort Study of 1.3M People

Katsampa

Akther

Hollander

et al. 2021

Schizophrenia Bulletin Open

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It is unclear whether inequalities in mental healthcare and mortality following the onset of psychosis exist by migrant status and region-of-origin. We investigated whether (i) mortality (including by major causes of death); (ii) admission type (in- or out-patient), and; (iii) in-patient length of stay at first diagnosis for psychotic disorder presentation, and; (iv) time-to-readmission for psychotic disorder differed for refugees, non-refugee migrants and by region-of-origin. We established a cohort of 1,335,192 people born 1984-1997 and living in Sweden from 1st January 1998, followed from their 14 th birthday or arrival to Sweden, until death, emigration, or 31 December 2016.People with ICD-10 psychotic disorder (F20-33; N=9,399) were 6.7 (95%CI: 5.9-7.6) times more likely to die than the general population, but this did not vary by migrant status (p=0.15) or region-of-origin (p=0.31). This mortality gap was most pronounced for suicide (adjusted hazard ratio [aHR]: 12.2; 95% CI: 10.4-14.4), but persisted for deaths from other external (aHR: 5.1; 95%CI: 4.0-6.4) and natural causes (aHR: 2.3; 95%CI: 1.6-3.3). Non-refugee (adjusted odds ratio [aOR]: 1.4, 95%CI: 1.2-1.6) and refugee migrants (aOR: 1.4, 95%CI: 1.1-1.8) were more likely to receive inpatient care at first diagnosis. No differences in inpatient length of stay at first diagnosis were observed. Sub-Saharan African migrants with psychotic disorder were readmitted more quickly than their Swedish-born counterparts (adjusted sub-HR: 1.2; 95%CI: 1.1-1.4). Our findings highlight the need to understand the drivers of disparities in psychosis treatment and the mortality gap experienced by all people with disorder, irrespective of migrant status or region-of-origin.

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Section: Discussionmentioning

confidence: 67%

Inequalities in Psychiatric Service Use and Mortality by Migrant Status Following a First Diagnosis of Psychotic Disorder: A Swedish Cohort Study of 1.3M People

Katsampa

Akther

Hollander

et al. 2021

Schizophrenia Bulletin Open

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“…► Analysis of register data from multiple registers, including the Psychiatry Sweden database, comparing our target population with non-migrant children Open access (https:// ki. se/ en/ gph/ epidemiology-of-psychiatricconditions-substance-use-and-social-environmentepicss) as done in, [5][6][7] see 'The effect evaluation of the three-component intervention'. ► Focus group interviews, see 'The process evaluation of the three-component intervention'.…”

Section: Evaluation Measures Of Componentmentioning

confidence: 99%

“…In the Scandinavian universal healthcare context, studies indicate that despite higher need of psychiatric care, [1][2][3][4] there is lower psychiatric service utilisation among all migrants, 5 including migrant children and youth, compared with their peers. [6][7][8] The level of psychiatric care utilisation among migrant children is particularly low for primary carebased mental health services 6 and specialist outpatient care when compared with emergency psychiatric care.…”

Section: Introductionmentioning

confidence: 99%

Effect and process evaluation of a multicomponent public health intervention to increase the use of primary care-based mental health services amongst children with a migrant background in Stockholm, Sweden: a protocol for a mixed-methods study

et al. 2021

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IntroductionThe overall aim of the project is to understand how to increase access to, and use of, primary care-based mental health services for children and youth from a migrant background with mild to moderate mental health problems.Methods and analysisThe study will be undertaken in Haninge municipality in Stockholm, Sweden. The study has three intervention components: (1) A health communication intervention targeting parents of children/youth with a migrant background; (2) Training of professionals and volunteers who potentially have contact with parents and children with a migrant background, in order to increase the number of referrals to primary care-based mental health services, and (3) Increasing access to care at a primary care-based mental health service for children, using various strategies to lower barriers to care. The complex multicomponent intervention will be studied with an effect and a process evaluation methodology.Ethics and disseminationAll planned studied are approved by the Swedish Ethical Review Authority dnr 2017-135-31/5, 2019-06275, 2020-03640, 2020-06341, 2020-03642 and 2020-04180. Informed consent, written or verbal, will be obtained from all participants. The results of the project will be published continually in peer-reviewed scientific journals and disseminated to relevant stakeholders nationally and within Haninge municipality.

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“…Despite the likelihood of higher psychopathology among refugee groups, there are European data suggesting that refugees use less mental health services than the native population [ 2 , 3 , 7 , 11 , 14 ]. In Sweden, utilization of psychiatric care among migrants is lower than for the Swedish-born population during the ten first years, apart from compulsory care where care consumption is higher [ 15 , 16 ]. Barriers to mental health care among migrants are seen both on the individual and structural level [ 1 , 2 , 5 , 8 , 11 , 12 , 14 , 15 , 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

“…In Sweden, utilization of psychiatric care among migrants is lower than for the Swedish-born population during the ten first years, apart from compulsory care where care consumption is higher [ 15 , 16 ]. Barriers to mental health care among migrants are seen both on the individual and structural level [ 1 , 2 , 5 , 8 , 11 , 12 , 14 , 15 , 17 , 18 ]. Further, barriers both from the perspective of refugees and asylum seekers, as well as from service providers, may contribute to the lower use of mental health care.…”

Section: Introductionmentioning

confidence: 99%

Cross-cultural training program on mental health care for refugees - a mixed method evaluation

2021

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Background Refugees tend to have a higher risk of mental ill-health and use mental health services less than the native-born population during their first 10 years in Sweden. Intercultural interactions between refugees and mental health professionals have been described as challenging. Cross-cultural training is proposed as one way to improve care for refugees. Evaluations of such training outcomes are sparse. The overall aim of this study was to evaluate Comprehensive Cross-Cultural Training for mental health care professionals in Stockholm, and to assess training outcomes for participants’ perceived knowledge regarding mental health and care for newly arrived refugee patients, asylum seekers and undocumented refugees. In addition, we analysed the dimensionality of the pre- and post-training questionnaires used. Methods An embedded mixed-method design was applied. We used pre-and post-training questionnaires (n = 248) and conducted six focus group discussions (FGDs) with mental health professionals after training. Quantitative data was analysed by t-tests and factor analysis, qualitative data was analysed using thematic content analysis. Results Participants experienced gained knowledge and new perspectives in all aspects covered in the training. Training led to participants restructuring their existing knowledge. Those who had reported experience of refugee patients and working with interpreters pre-training in the past month, had higher ratings of perceived knowledge. Post-training, there were no significant changes in perceived knowledge between those with, and those without, experience of refugee patients and working with interpreters. Factor analysis resulted in 3 factors for the pre-training questionnaire, explaining 71% of the covariance, and 4 factors for the post-training questionnaire, explaining 78% of the covariance. Findings from the post-training FGDs, revealed that refugee patients were described as challenging. Also, that training promoted empathy towards refugees and strengthened participants’ professional role. Conclusions This cross-cultural training contributed to knowledge development and attitude changes. It was valuable regarding care providers’ professional role. Additional outcomes of the training were that participants not only gained knowledge about refugee mental health care but also restructured their existing knowledge.

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Psychiatric care use among migrants to Sweden compared with Swedish-born residents: a longitudinal cohort study of 5 150 753 people

Cited by 27 publications

References 35 publications

Inequalities in Psychiatric Service Use and Mortality by Migrant Status Following a First Diagnosis of Psychotic Disorder: A Swedish Cohort Study of 1.3M People

Inequalities in Psychiatric Service Use and Mortality by Migrant Status Following a First Diagnosis of Psychotic Disorder: A Swedish Cohort Study of 1.3M People

Effect and process evaluation of a multicomponent public health intervention to increase the use of primary care-based mental health services amongst children with a migrant background in Stockholm, Sweden: a protocol for a mixed-methods study

Cross-cultural training program on mental health care for refugees - a mixed method evaluation

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