Abstract
BackgroundPsychological distress and lack of family support may explain the mental health problems that are consistently found in young unaccompanied refugees in Western countries. Given the strong relationship between poor mental health and alcohol misuse, this study investigated hospital admissions due to alcohol related disorders among accompanied and unaccompanied young refugees who settled in Sweden as teenagers.MethodsThe dataset used in this study was derived from a combination of different registers. Cox regression models were used to estimate the risks of hospital care due to alcohol related disorders in 15,834 accompanied and 4376 unaccompanied young refugees (2005–2012), aged 13 to 19 years old when settling in Sweden and 19 to 32 years old in December 2004. These young refugees were divided into regions with largely similar attitudes toward alcohol: the former Yugoslavian republics, Somalia, and the Middle East. The findings were compared with one million peers in the native Swedish population.ResultsCompared to native Swedes, hospital admissions due to alcohol related disorders were less common in young refugees, with a hazard ratio (HR) of 0.65 and 95% confidence interval (CI) between 0.56 and 0.77. These risks were particularly lower among young female refugees. However, there were some differences across the refugee population. For example, the risks were higher in unaccompanied (male) refugees than accompanied ones (HR = 1.49, 95% CI = 1.00–2.19), also when adjusted for age, domicile and income. While the risks were lower in young refugees from Former Yugoslavia and the Middle East relative to native Swedes, independent of their length of residence in Sweden, refugees from Somalia who had lived in Sweden for more than ten years showed increased risks (HR = 2.54, 95% CI = 1.71–3.76), after adjustments of age and domicile. These risks decreased considerably when income was adjusted for.ConclusionYoung refugees have lower risks of alcohol disorders compared with native Swedes. The risks were higher in unaccompanied young (male) refugees compared to the accompanied ones. Moreover, Somalian refugees who had lived in Sweden for more than ten years seems to be particularly vulnerable to alcohol related disorders.
Highlights
Psychological distress and lack of family support may explain the mental health problems that are consistently found in young unaccompanied refugees in Western countries
Sweden has a long tradition of national registers, with health and socioeconomic indicators that can be linked to each other through the unique 10-digit personal identification number (PIN) that follows every Swedish resident from birth or immigration to death
The interaction analysis indicated even lower risks of hospital admission in female young refugees compared with male refugees after adjustments of age and domicile in the Model 2a (HR = 0.58, 95% confidence interval (CI) = 0.39–0.87) and income in Model 2b (HR = 0.51, 95% CI = 0.41–0.93)
Summary
Psychological distress and lack of family support may explain the mental health problems that are consistently found in young unaccompanied refugees in Western countries. Epidemiological studies have consistently reported poor mental health among refugees in Western countries [1, 2] This has been applicable to unaccompanied young refugees, who face higher risks of psychological distress and lack the social and emotional support of their friends and family members [3, 4]. The importance of norms or attitudes to alcohol intake in the refugees’ and migrants’ country of origin has attracted considerable interest, as alcohol is culturally prohibited in Muslims, especially women [2, 9, 10]. Their lower consumption rates rather may be a reflection of lack of opportunities to buy alcohol
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