Inequalities in Psychiatric Service Use and Mortality by Migrant Status Following a First Diagnosis of Psychotic Disorder: A Swedish Cohort Study of 1.3M People.

Dafni Katsampa,Syeda F Akther,Henrik Dal,Christina Dalman,James B Kirkbride,Anna-Clara Hollander

doi:10.1093/schizbullopen/sgab009

Dafni Katsampa, Syeda F Akther + Show 4 more

Open Access

https://doi.org/10.1093/schizbullopen/sgab009

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Abstract

It is unclear whether inequalities in mental healthcare and mortality following the onset of psychosis exist by migrant status and region-of-origin. We investigated whether (1) mortality (including by major causes of death); (2) first admission type (inpatient or outpatient); (3) in-patient length of stay (LOS) at first diagnosis for psychotic disorder presentation, and; (4) time-to-readmission for psychotic disorder differed for refugees, non-refugee migrants, and by region-of-origin. We established a cohort of 1 335 192 people born 1984–1997 and living in Sweden from January 1, 1998, followed from their 14th birthday or arrival to Sweden, until death, emigration, or December 31, 2016. People with ICD-10 psychotic disorder (F20–33; N = 9399) were 6.7 (95% confidence interval [95%CI]: 5.9–7.6) times more likely to die than the general population, but this did not vary by migrant status (P = .15) or region-of-origin (P = .31). This mortality gap was most pronounced for suicide (adjusted hazard ratio [aHR]: 12.2; 95% CI: 10.4–14.4), but persisted for deaths from other external (aHR: 5.1; 95%CI: 4.0–6.4) and natural causes (aHR: 2.3; 95%CI: 1.6–3.3). Non-refugee (adjusted odds ratio [aOR]: 1.4, 95%CI: 1.2–1.6) and refugee migrants (aOR: 1.4, 95%CI: 1.1–1.8) were more likely to receive inpatient care at first diagnosis. No differences in in-patient LOS at first diagnosis were observed by migrant status. Sub-Saharan African migrants with psychotic disorder were readmitted more quickly than their Swedish-born counterparts (adjusted sub-hazard ratio [sHR]: 1.2; 95%CI: 1.1–1.4). Our findings highlight the need to understand the drivers of disparities in psychosis treatment and the mortality gap experienced by all people with disorder, irrespective of migrant status or region-of-origin.

Highlights

Psychotic disorders affect approximately 3.5% of the population,[1] and have been associated with poor physical health outcomes, including weight gain, type II diabetes, cardiometabolic diseases, and coronary heart disease.[2,3,4] These are likely to contribute to premature mortality,[5] culminating in reduced life expectancy of approximately 10 to 25 years compared with the general population.[6,7] This mortality gap appears to be widening.[8]
Our cohort was restricted to people born in Sweden to 2 Swedish-born parents, or refugee and non-refugee migrants who arrived in Sweden from January 1, 1998, from regions of origin (Asia, Eastern Europe including Russia, the Middle East & North Africa, Sub-Saharan Africa) with greater than 1000 refugees in the Register of the Total Population (RTP) to ensure valid comparisons (Supplementary Table 1), consistent with our previous approach.[13,33]
The sample included 9399 people diagnosed for the first time with a psychotic disorder during follow-up (0.7%), which varied by migrant status (0.7% to 1.3%; P < .001) and was highest for refugees

Summary

Introduction

Psychotic disorders affect approximately 3.5% of the population,[1] and have been associated with poor physical health outcomes, including weight gain, type II diabetes, cardiometabolic diseases, and coronary heart disease.[2,3,4] These are likely to contribute to premature mortality,[5] culminating in reduced life expectancy of approximately 10 to 25 years compared with the general population.[6,7] This mortality gap appears to be widening.[8]. Two studies suggest that several ethnic groups,[17] including people of Black ethnic origin[17,18] experienced longer LOS than White participants, and that LOS was longer for people diagnosed with psychosis than other conditions.[17] By contrast, another study reported a reduction in inpatient stays in Black Caribbean compared with White FEP participants receiving intensive community treatment.[19] There is some evidence that people of Black and Asian ethnic origins in the United Kingdom were more and less likely, respectively, to be readmitted following FEP than their White counterparts.[20]

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