Differences in psychiatric care utilisation among unaccompanied refugee minors, accompanied migrant minors, and Swedish-born minors

Lovisa Axelsson,Christina Dalman,Sofie Bäärnhielm,Anna-Clara Hollander

doi:10.1007/s00127-020-01883-z

Lovisa Axelsson, Christina Dalman + Show 2 more

Open Access

https://doi.org/10.1007/s00127-020-01883-z

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Abstract

PurposeTo better understand underutilisation of psychiatric care among migrant children, we compared utilisation of psychiatric care among unaccompanied refugee minors and accompanied migrant minors, with Swedish-born minors.MethodsUsing a large longitudinal database of linked national registers, we established a retrospective cohort of 1,328,397 people born 1984–1988 comparing minors born in Sweden to 2 Swedish-born parents (95.4%) to minors who had been arriving in Sweden between 2002 and 2011 with a permanent resident permit and were either unaccompanied refugee minors (0.4%), or accompanied migrant minors (4.0%). The outcome measures were different measures of psychiatric care including in- and outpatient care, and prescribed psychotropic medication.ResultCompared with the Swedish-born minors the unaccompanied refugee minors had a higher likelihood of utilisation of all psychiatric care except ADHD medication. However, compared with accompanied migrant minors, the Swedish-born minors had a higher likelihood of having utilised psychiatric care.ConclusionOur study shows that during the first years of living in Sweden, there seems to be fewer barriers to psychiatric care for unaccompanied refugee minors compared to the accompanied migrant minors. There are a number of possible reasons for this including stronger ties with the Swedish society.

Highlights

The United Nations High Commissioner for Refugees (UNHCR) has documented the highest ever number of people who are forced to leave their homes at over 70.8 million people [1, 2]
The mean age at end of study was highest among the Swedish-born minors, and the unaccompanied refugee minors were older at time of immigration compared accompanied minors
We first hypothesised that due to the elevated risk of mental illness and closer ties with the Swedish social system, unaccompanied refugee minors would be more likely to utilise psychiatric care compared to Swedish-born minors and accompanied minors

Summary

Introduction

The United Nations High Commissioner for Refugees (UNHCR) has documented the highest ever number of people who are forced to leave their homes at over 70.8 million people [1, 2]. Use and Social Environment (EPiCSS), Department of Global Public Health Sciences, KI, Solnavägen 1E, 171 77 Stockholm, Sweden 5 Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden refugees in accordance with the United Nations Refugee Convention. Conferring to the UN Conventions, all persons under 18 years are considered to be children, and approximately half of the world’s refugees are children. Significant portions of these children have fled without parents, guardians or other relatives [2] and are known as unaccompanied refugee minors. Studies of refugee children have shown that exposure to violence is a risk factor for mental illness, whereas stable settlement and social support in the host country has a positive effect on the refugee child’s psychological functioning [3].

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