Trajectories of antidepressant use and characteristics associated with trajectory groups among young refugees and their Swedish-born peers with diagnosed common mental disorders—findings from the REMAIN study

Abstract

Purpose This study aimed to (1) identify the trajectories of prescribed antidepressants in refugee youth and matched Swedish-born peers diagnosed with common mental disorder (CMD) and (2) characterize the trajectories according to sociodemographic and medical factors. Methods The study population comprised 2,198 refugees and 12,199 Swedish-born individuals with both Swedish-born parents, aged 16–25 years in 2011, residing in Sweden and treated in specialised healthcare for CMD 2009–11. Group-based trajectory modelling was used to identify different trajectory groups of antidepressant use-based on annual defined daily dosages (DDDs). Multinomial logistic regression was applied to investigate the association of sociodemographic and medical characteristics with the identified trajectories. Nagelkerke pseudo-R2 values were estimated to evaluate the strength of these associations. Results Four trajectory groups of antidepressant use among young refugees were identified with following proportions and DDD levels in 2011: ‘low constant’ (88%, < 100), ‘low increasing’ (2%, ≈710), ‘medium decreasing’ (8%, ≈170) and ‘high increasing’ (2%, ≈860). Similar trajectories, however, with different proportions were identified in Swedish-born: 67%, 7%, 21% and 5%, respectively. The most influential factors discriminating the trajectory groups among refugees were ‘duration of stay in Sweden’ (R2 = 0.013), comorbid ‘other mental disorders’ (R2 = 0.009) and ‘disability pension’ (R2 = 0.007), while ‘disability pension’ (R2 = 0.017), comorbid ‘other mental disorders’ (R2 = 0.008) and ‘educational level’ (R2 = 0.008) were the most important determinants discriminating trajectory groups among Swedish-born youth. Conclusion The lower use of antidepressants in refugees with CMDs compared to their Swedish-born counterparts warrants health literacy programs for refugees and training in transcultural psychiatry for healthcare professionals.

Association of medication clusters and subsequent labor market marginalization in refugee and Swedish-born young adults with common mental disorders in Sweden

“…Overall, psychotropic medication use among refugee youths was lower than among their Swedish-born counterparts. This finding is in line with other studies examining the relationship between refugee status and psychotropic medications [ 14 , 16 , 19 – 21 ]. Lower amounts of dispensed psychotropic medications were reported among newly resettled refugees in Sweden, compared to native Swedish-born, based on an analysis of over one million young adults [ 20 , 24 ].…”

“…Moreover, several studies from our research group have found lower initiation, adherence, and usage of antidepressants among young refugee youth with CMD than among their Swedish-born counterparts. [ 14 , 16 , 21 ]…”

The role of sociodemographic and clinical factors in the initiation and discontinuation of attention deficit hyperactivity disorder medication among young adults in Sweden

“…While the two studies cannot be compared directly, both of them suggested a lower initiation of ADHD medication within the immigrant population. Immigrants in general might be prone to underutilizing psychiatric health care (41)(42)(43)(44), but other factors such as cultural beliefs and attitudes toward behavioral symptoms and medication of ADHD (45,46), health literacy (47), language problems, or occupation might also contribute to less frequent medication initiation. A study among children, who were born between 1995 and 2004 in Sweden, found that children who had only foreignborn parents were less likely to use medication compared with children who had at least one Swedish-born parent, suggesting that ADHD medication use might be influenced by cultural factors (46).…”

Thinking about young refugees’ mental health following the Russian invasion of Ukraine in 2022

“…In one study, the group CBT intervention for UASC was provided by trained social workers (Pfeiffer et al, 2018), significant given the shortage of CAMHS practitioners in the UK and many other countries. The more severe disorders such as depression and psychosis may require psychopharmacological management that will follow the appropriate guidelines (Kinzie & Friedman, 2004; Rahman et al, 2022).…”