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Mental health, substance misuse and labour market participation in teenage refugees in Sweden – A longitudinal perspective
Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: To fill the knowledge gap about the importance of contextual factors after resettlement on mental health, substance misuse and labour market participation among young refugees who immigrate to Sweden as teenagers. Methods: Register studies in national registers of national cohorts of young refugees, unaccompanied and accompanied, who settled in Sweden as teenagers. Studies 1-4 used Cox regression models to study the risks of psychiatric care consumption and substance misuse, while Study 5 used multinomial regression to study position on the labour. These findings were compared with peers from the same birth cohorts in the general Swedish population and non-European intercountry adoptees (Studies 2 and 5). Results: The overall results suggest that young accompanied and unaccompanied refugees were more likely to be admitted to psychiatric inpatient and compulsory hospital care, but not outpatient care, with refugees born in the Horn of Africa and Iran having the highest risk (Study 1). Young accompanied and unaccompanied refugees also had higher risk of hospitalization and criminal conviction associated with substance misuse (Study 3). Longer duration of residence in Sweden was associated with increased risks of outpatient care (Study 1) and hospitalization related to substance misuse (studies 3 and 4). These increase risks of young refugees were associated with their socioeconomic living conditions (Studies 3 and 4), but risk factors associated with the country of origin of the refugee population and the intercountry adoptees were more important determinants of schizophrenia than socioeconomic conditions in Sweden (Study 2). Young accompanied and unaccompanied refugees and intercountry adoptees had a lower likelihood of being in full employment than native Swedes with comparable levels of education. Secondary education, however, increased employment chances and reduced the risk of being neither employed nor in education or training (Study 5). Conclusion: Evidence suggests that several groups of young refugees are at higher risk of mental health problems and substance misuse. They also face employment disadvantages and barriers to psychiatric care in the early stages of developing a psychiatric disorder.

Abstract [sv]

Syfte: Att undersöka betydelsen av kontextuella faktorer för psykisk hälsa, alkohol- och narkotikamissbruk samt sysselsättning bland unga flyktingar som invandrat till Sverige som tonåringar.Metod: Avhandlingen baseras i sin helhet på studier i nationella register av nationella kohorter av flyktingar som anlände till Sverige i åldern 13-19 år och var folkbokförda i Sverige 2005, jämförda med övrig svensk befolkning och utlandsadopterade (Studier 2 och 5) i samma åldrar. Studierna 1-4 använder sig av Cox regressionsmodeller för att undersöka psykiatrisk vårdkonsumtion inklusive vård relaterad till alkohol- och narkotikamissbruk. Studie 5 undersöker position på arbets-marknaden bland unga ensamkommande och icke-ensamkommande flyktingar med hjälp av multinominal regression. Resultat: Unga ensamkommande och icke-ensamkommande flykting-ungdomar vårdas i större utsträckning i psykiatrisk sluten- och tvångs-vård, men ej öppenvård, med störst risk för flyktingar födda på Afrikas Horn och i Iran (Studie 1). Unga ensamkommande och icke-ensamkommande flyktingungdomar hade också högre risk för sjukhusvård och att dömas för brott i samband med alkohol- och narkotikamissbruk (Studie 3). Denna ökade vårdkonsumtion förklaras till en del av de unga flyk-tingarnas socioekonomiska levnadsförhållanden (Studier 3 och 4). Konsumtionen av psykiatrisk öppenvård ökade med tiden efter ankomsten till Sverige (Studie 1), liksom sjukhusvård till följd av alkohol- och narkotikamissbruk (Studier 3 och 4). Sjukhusvård och kriminalitet i sam-band med missbruk av alkohol och narkotika är vanligare bland unga manliga flyktingar än för kvinnliga. Faktorer associerade med flyktingars och utlandsadopterades ursprungsland var mer betydande riskfaktorer för schizofreni än de socioekonomiska förhållandena i Sverige (Studie 2). Unga ensamkommande och icke-ensamkommande flyktingar hade en högre risk att varken arbeta eller delta i en utbildning och hade också sämre utsikter till anställning än inhemska svenskar med jämförbar utbildningsnivå. Gymnasiekompetens ökade chanserna för inträde på arbetsmarknaden (Studie 5). Slutsats: Resultaten tyder på att flera grupper av unga flyktingar har en högre risk för problem med psykisk ohälsa och substansmissbruk. De konfronteras även i högre grad med arbetslöshet och olika hinder för att få psykiatrisk vård i tidiga stadier av psykisk ohälsa.

Place, publisher, year, edition, pages
Stockholm: Centre for Health Equity Studies (CHESS), Stockholm University , 2017. , 83 p.
Series
Health Equity Studies, ISSN 1651-5390 ; 22
Keyword [en]
Young refugees, mental health, substance misuse, care consumption, labour market
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public Health Sciences
Identifiers
URN: urn:nbn:se:su:diva-143219ISBN: 978-91-7649-864-4 (print)ISBN: 978-91-7649-865-1 (electronic)OAI: oai:DiVA.org:su-143219DiVA: diva2:1096694
Public defence
2017-08-25, Aula Svea, Socialhögskolan, Sveavägen 160, Stockholm, 10:00 (English)
Opponent
Supervisors
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 1453203
Note

At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 4: Manuscript. Paper 5: Manuscript.

Available from: 2017-06-07 Created: 2017-05-18 Last updated: 2017-09-20Bibliographically approved
List of papers
1. The use of psychiatric services by young adults who came to Sweden as teenage refugees: a national cohort study
Open this publication in new window or tab >>The use of psychiatric services by young adults who came to Sweden as teenage refugees: a national cohort study
2016 (English)In: Epidemiology and Psychiatric Sciences, ISSN 2045-7960, E-ISSN 1827-4331Article in journal (Refereed) Epub ahead of print
Abstract [en]

Aims. To investigate the patterns of use of different forms of psychiatric care in refugees who settled in Sweden as teenagers.

Method. Cox proportional hazards models were used to estimate the use of different forms of psychiatric care from 2009 to 2012 in a population of 35 457 refugees, aged from 20 to 36, who had settled in Sweden as teenagers between 1989 and 2004. These findings were compared with 1.26 million peers from the same birth cohorts in the general Swedish population.

Results. Unaccompanied and accompanied refugees were more likely to experience compulsory admission to a psychiatric hospital compared with the native Swedish population, with hazard ratios (HRs) of 2.76 (1.86–4.10) and 1.89 (1.53–2.34), respectively, as well as psychiatric inpatient care, with HRs of 1.62 (1.34–1.94) and 1.37 (1.25–1.50). Outpatient care visits by the young refugees were similar to the native Swedish population. The longer the refugees had residency in Sweden, the more they used outpatient psychiatric care. Refugees born in the Horn of Africa and Iran were most likely to undergo compulsory admission, with HRs of 3.98 (2.12–7.46) and 3.07 (1.52–6.19), respectively. They were also the groups who were most likely to receive inpatient care, with HRs of 1.55 (1.17–2.06) and 1.84 (1.37–2.47), respectively. Our results also indicated that the use of psychiatric care services increased with the level of education in the refugee population, while the opposite was true for the native Swedish population. In fact, the risks of compulsory admissions were particularly higher among refugees who had received a secondary education, compared with native Swedish residents, with HRs of 4.72 (3.06–7.29) for unaccompanied refugees and 2.04 (1.51–2.73) for accompanied refugees.

Conclusions. Young refugees received more psychiatric inpatient care than the native Swedish population, with the highest rates seen in refugees who were not accompanied by their parents. The discrepancy between the use of inpatient and outpatient care by young refugees suggests that there are barriers to outpatient care, but we did note that living in Sweden longer increased the use of outpatient services. Further research is needed to clarify the role that education levels among Sweden's refugee populations have on their mental health and health-seeking behaviour.

Keyword
adolescents, discrimination, mental health, primary care, psychiatric services
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public Health Sciences
Identifiers
urn:nbn:se:su:diva-131094 (URN)10.1017/S2045796016000445 (DOI)
Available from: 2016-06-13 Created: 2016-06-13 Last updated: 2017-09-20
2. Origin and schizophrenia in young refugees and inter-country adoptees from Latin America and East Africa in Sweden: a comparative study
Open this publication in new window or tab >>Origin and schizophrenia in young refugees and inter-country adoptees from Latin America and East Africa in Sweden: a comparative study
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2016 (English)In: British Journal of Psychiatry, ISSN 0007-1250, E-ISSN 1472-1465, Vol. 2, no 1, 6-9 p.Article in journal (Refereed) Published
Abstract [en]

Background Migrants’ socioeconomic adversity has been linked to schizophrenia.

Aims To investigate whether the more favourable socioeconomic situation of adoptees prevents them from the high risk of schizophrenia found in other migrants.

Method Register study in a cohort of refugees and inter-country adoptees aged 16–40 years, born in East Africa (n=8389), Latin America (n=11 572) and 1.2 million native Swedes. Cox-regression models estimated hazard ratios (HRs) of schizophrenia in data from psychiatric care.

Results Despite diverse income levels, HRs for schizophrenia were similar for refugees and adoptees, with East Africans having the highest HRs: 5.83 (3.30–10.27) and 5.80 (5.03–6.70), followed by Latin Americans: HRs 3.09 (2.49–3.83) and 2.31 (1.79–2.97), compared with native Swedes. Adjustment for income decreased these risks slightly for refugees, but not for adoptees.

Conclusions This study suggests that risk factors associated with origin are more important determinants of schizophrenia than socioeconomic adversity in the country of settlement.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public Health Sciences
Identifiers
urn:nbn:se:su:diva-127117 (URN)10.1192/bjpo.bp.115.002048 (DOI)000408509800003 ()
Available from: 2016-02-25 Created: 2016-02-25 Last updated: 2017-09-20Bibliographically approved
3. Hospital admission and criminality associated with substance misuse in young refugees – a Swedish national cohort study
Open this publication in new window or tab >>Hospital admission and criminality associated with substance misuse in young refugees – a Swedish national cohort study
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2016 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 11, e0166066Article in journal (Refereed) Published
Abstract [en]

Background

High rates of mental health problems have been described in young refugees, but few studies have been conducted on substance misuse. This study aimed to investigate the patterns of hospital care and criminality associated with substance misuse in refugees who settled in Sweden as teenagers.

Methods

Gender stratified Cox regression models were used to estimate the risks of criminal convictions and hospital care associated with substance misuse from national Swedish data for 2005–2012. We focused on 22,992 accompanied and 5,686 unaccompanied refugees who were aged 13–19 years when they settled in Sweden and compared them with 1 million native Swedish youths from the same birth cohort.

Results

The risks of criminal conviction associated with substance misuse increased with the length of residency in male refugees, after adjustment for age and domicile. The hazard ratios (HRs) were 5.21 (4.39–6.19) for unaccompanied and 3.85 (3.42–4.18) for accompanied refugees after more than 10 years of residency, compared with the native population. The risks were slightly lower for hospital care, at 2.88 (2.18–3.79) and 2.52(2.01–3.01) respectively. Risks were particularly pronounced for male refugees from the Horn of Africa and Iran. The risks for all male refugees decreased substantially when income was adjusted for. Young female refugees had similar risks to the general population.

Conclusion

The risks of criminality and hospital care associated with substance misuse in young male refugees increased with time of residency in Sweden and were associated with a low level of income compared with the native Swedish population. Risks were similar in accompanied and unaccompanied refugees.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public Health Sciences
Identifiers
urn:nbn:se:su:diva-136461 (URN)10.1371/journal.pone.0166066 (DOI)000389474100010 ()
Available from: 2016-12-07 Created: 2016-12-07 Last updated: 2017-09-20Bibliographically approved
4. Alcohol related disorders among young adult refugees who arrived in Sweden asteenagers - a national cohort study
Open this publication in new window or tab >>Alcohol related disorders among young adult refugees who arrived in Sweden asteenagers - a national cohort study
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(English)Manuscript (preprint) (Other academic)
Keyword
Young adult refugees, hospital care, alcohol related disorders, migration, culture
National Category
Public Health, Global Health, Social Medicine and Epidemiology Substance Abuse
Research subject
Public Health Sciences
Identifiers
urn:nbn:se:su:diva-143208 (URN)
Available from: 2017-05-18 Created: 2017-05-18 Last updated: 2017-09-20Bibliographically approved
5. Labour market participation among young refugees in Sweden and the potential of education: a national cohort study
Open this publication in new window or tab >>Labour market participation among young refugees in Sweden and the potential of education: a national cohort study
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(English)Manuscript (preprint) (Other academic)
National Category
International Migration and Ethnic Relations
Research subject
Public Health Sciences
Identifiers
urn:nbn:se:su:diva-143218 (URN)
Available from: 2017-05-18 Created: 2017-05-18 Last updated: 2017-09-20Bibliographically approved

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