Suicide risk among refugees compared with non-refugee migrants and the Swedish-born majority population

Abstract

BackgroundIt has been hypothesised that refugees have an increased risk of suicide.AimsTo investigate whether risk of suicide is higher among refugees compared with non-refugee migrants from the same areas of origin and with the Swedish-born population, and to examine whether suicide rates among migrants converge to the Swedish-born population over time.MethodA population-based cohort design using linked national registers to follow 1 457 898 people born between 1 January 1970 and 31 December 1984, classified by migrant status as refugees, non-refugee migrants or Swedish-born. Participants were followed from their 16th birthday or date of arrival in Sweden until death, emigration or 31 December 2015, whichever came first. Cox regression models estimated adjusted hazard ratios for suicide by migrant status, controlling for age, gender, region of origin and income.ResultsThere were no significant differences in suicide risk between refugee and non-refugee migrants (hazard ratio 1.28, 95% CI 0.93–1.76) and both groups had a lower risk of suicide than Swedish born. During their first 5 years in Sweden no migrants died by suicide; however, after 21–31 years their suicide risk was equivalent to the Swedish-born population (hazard ratio 0.94, 95% CI 0.79–1.22). After adjustment for income this risk was significantly lower for migrants than the Swedish-born population.ConclusionsBeing a refugee was not an additional risk factor for suicide. Our findings regarding temporal changes in suicide risk suggest that acculturation and socioeconomic deprivation may account for a convergence of suicide risk between migrants and the host population over time.Declaration of interestNone.

Substance use disorders in refugee and migrant groups in Sweden: A nationwide cohort study of 1.2 million people

“…Interestingly, our results indicated that rates of substance use disorders in migrant groups in Sweden tended to converge (i.e., increase) towards the rate in the Swedish-born population over time in a dose-response fashion, whether inspected via earlier age at migration or time lived in Sweden. These results are in line with similar observations in prevalence data on substance abuse [22] and with respect to suicide risk from a similar longitudinal cohort study in Sweden [8]. One possible interpretation of these findings is that acculturative processes lead some migrant groups to adopt Swedish health behaviors over time, here increasing their risk of being diagnosed with a substance use disorder.…”

“…Refugees experience high rates of certain mental health disorders, including post-traumatic stress disorder (PTSD) [3–6] and psychotic disorders including schizophrenia [7]. Less epidemiological research has focused on the risk of other mental health disorders on refugees, although they appear to have lower risk of suicide than nonmigrant populations [8]. For non-refugee migrants, risk of depression and anxiety may be lower [9–12] or equivocal to autochthonous populations [11,13], but like refugees, they are at elevated risk of psychotic disorders [7,14–16].…”

“…There is also some evidence that the risk of some other psychiatric outcomes in migrant populations, most notably suicide [8], converge to the background Swedish rate with longer residence in Sweden. Moreover, earlier age at migration has been associated with increased risk of psychotic disorders in some [29–31] (but not all [15]) studies, implicating possible cultural adaptation as a mechanism influencing future mental health.…”

Suicide risk in people with post-traumatic stress disorder: A cohort study of 3.1 million people in Sweden

“…The Swedish registers are known to be reliable for psychiatric research because they provide completed records of all psychiatric contacts from inpatient settings (1987 onwards) and outpatient settings (2001 onwards), with strong reliability of suicide classification ( Tøllefsen et al., 2015 ) and the validity of PTSD diagnoses in the national patient register ( A.C. Hollander et al., 2019 ). While our included sample differed on exposure and covariate data from the small proportion (0•5%) of people we excluded due to missing data, the effect of this potential bias on our results would have been minimal.…”

Beginning to hope: Aligning psychiatric care provision to needs of vulnerable children and young people

“…In Sweden, evidence suggests that refugees are also up to three times more likely to experience a psychotic disorder before 30 years old, a risk that is 60% higher than for non‐refugee migrants from the same regions of origin 6 . And while the risks of both substance abuse disorders 7 and suicide 8 are approximately 50% and 30% lower, respectively, for refugees on arrival to Sweden than the background Swedish‐born population, these risks converge towards the Swedish rate over time. This suggests that post‐migratory environmental characteristics—including barriers to timely, appropriate early intervention—affect the future chances of young people seeking to rebuild their lives following a period of trauma exposure.…”