Abstract
PurposeMigrant children underutilize mental health services (MHS), but differences according to age, reason for migration, type of problem, and time have not been thoroughly analyzed. We aimed to explore utilization of MHS among migrant children and youth and to study if the hypothesized lower utilization could be explained by fewer neurodevelopmental assessments.MethodsA cohort of the population aged 0–24 years in Stockholm, comprising 472,129 individuals were followed for maximum 10 years, between January 1, 2006 and December 31, 2015. We categorized individuals as accompanied refugee migrants, unaccompanied refugee migrants and non-refugee migrants, or Swedish-born. We used survival and logistic analyses to estimate rates of utilization of MHS.ResultsMigrant children and youth utilized less MHS than the majority population, with hazard ratios ranging from 0.62 (95% CI: 0.57; 0.67) to 0.72 (95% CI: 0.69; 0.76). Refugee and non-refugee children utilized less mental health care than their Swedish peers, apart from the youngest refugees (0–10 years) who had similar utilization as Swedish-born. The lower rates were partly explained by all migrant youths’ lower risk of being diagnosed with a neurodevelopmental condition. Time in Sweden had a major impact, such that unaccompanied refugee minors had a higher utilization in their first 2 years in Sweden (OR: 3.39, 95% CI: 2.96; 3.85).ConclusionMigrant youth use less MHS compared with native-born peers, and this is partly explained by fewer neurodevelopmental diagnoses. Strengthening the awareness about unmet needs, and the referring capacity by professionals in contact with migrant children could help reduce barriers to care.
Highlights
IntroductionUntil 2015, Sweden had one of the most generous asylum policies in Europe, and currently, 20% of the population is foreign-born [1]
The number of migrants in the world is at an all-time high
Using an outcome measure that includes visits to primary care, specialist psychiatric care, and specialist child and youth clinics, we aim to investigate the hypothesis that migrant children utilize less mental health services than Swedish-born, and that reason for migration, parental presence, time in Sweden, and country of origin explain some of the differences we expect to see
Summary
Until 2015, Sweden had one of the most generous asylum policies in Europe, and currently, 20% of the population is foreign-born [1]. Stockholm, Sweden historically has been labor-related, migration from outside of Europe has consisted mainly of asylum seekers—including many children and youth refugees, whose mental health needs have drawn increased attention. Less attention has been directed at the mental health needs of non-refugee migrant youths [2]. Despite extensive evidence that refugee children are at increased risk of poor mental health compared to their majority peers [3,4,5], there has only recently been intensified efforts to study utilization of mental health services among migrant and refugee children. Studies investigating utilization have not consistently distinguished non-refugee from refugee sub-groups
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