Labour market marginalisation subsequent to suicide attempt in young migrants and native Swedes

T Niederkrotenthaler,M Helgesson,M Wang,E Mittendorfer-Rutz,H Wilcox,M Gould

doi:10.1007/s00127-017-1344-6

Abstract

PurposeThis study aimed to compare young individuals who differed in terms of birth region and history of suicide attempt regarding socio-demographic and healthcare factors, and with regard to their risks of subsequent unemployment, sickness absence and disability pension.MethodsProspective cohort study based on register linkage of 2,801,558 Swedish residents, aged 16–40 years in 2004, without disability pension and with known birth country, followed up 2005–2011. Suicide attempters treated in inpatient care during 2002–2004 (N = 9149) were compared to the general population of the same age without attempt 1987–2011 (N = 2,792,409). Hazard ratios (HR) and 95% confidence intervals (CIs) for long-term unemployment (>180 days), sickness absence (>90 days), and disability pension were calculated with Cox regression, adjusted for several risk markers.ResultsCompared to Swedish natives with suicide attempt, migrants of non-Western origin with attempt received less specialised mental healthcare. Distinct differences between native Swedes and migrants were present for the three labour market outcomes, but differences between migrant subgroups were inconsistent. As compared to native Swedes without attempts, non-European migrants with suicide attempt had adjusted HRs and CIs for subsequent unemployment 2.8 (2.5–3.1), sickness absence 2.0 (1.7–2.3) and disability pension 2.2 (1.8–2.6). Respective estimates for natives with suicide attempt were 2.0 (1.9–2.1); 2.7 (2.6–2.9) and 3.4 (3.2–3.6), respectively.ConclusionsMigrant suicide attempters receive less specialised mental health care before their attempt than native Swedes, and their marginalzation patterns are different. Healthcare and policy makers need to take the differential risk profile for migrant and native populations into account.

Highlights

Suicide attempts represent a considerable public health problem in a number of countries worldwide [1]
Exposure was defined as individuals who were treated in inpatient-care following a suicide attempt during the three years preceding study entry, i.e. 2002, 2003 and 2004 (N = 9149)
Hazard ratios (HR) were calculated for population groups that differed with regard to their region of birth and the presence of a suicide attempt, with native Swedes without suicide attempt as the reference group

Summary

Introduction

Suicide attempts represent a considerable public health problem in a number of countries worldwide [1]. Suicide attempts often have an early onset, are prone to repetition and are a risk factor for suboptimal social and functional outcomes, like poor academic achievements [2, 3]. In spite of these findings, there is a scarcity of research on the long term labour market outcomes associated with youth suicide attempt [4, 5]. Increasing global migration has led to dramatic demographic changes in Sweden, like in many other European countries [7]. While some 50 years ago, predominantly individuals with a European

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