Migrant status and risk of compulsory admission at first diagnosis of psychotic disorder: a population-based cohort study in Sweden.

J Terhune,J Dykxhoorn,A.-C Hollander,C Dalman,E Mackay,J B Kirkbride

doi:10.1017/s0033291720002068

Abstract

Minority ethnic and migrant groups face an elevated risk of compulsory admission for mental illness. There are overlapping cultural, socio-demographic, and structural explanations for this risk that require further investigation. By linking Swedish national register data, we established a cohort of persons first diagnosed with a psychotic disorder between 2001 and 2016. We used multilevel mixed-effects logistic modelling to investigate variation in compulsory admission at first diagnosis of psychosis across migrant and Swedish-born groups with individual and neighbourhood-level covariates. Our cohort included 12 000 individuals, with 1298 (10.8%) admitted compulsorily. In an unadjusted model, being a migrant [odds ratio (OR) 1.48; 95% confidence interval (CI) 1.26-1.73] or child of a migrant (OR 1.27; 95% CI 1.10-1.47) increased risk of compulsory admission. However after multivariable modelling, region-of-origin provided a better fit to the data than migrant status; excess risk of compulsory admission was elevated for individuals from sub-Saharan African (OR 1.94; 95% CI 1.51-2.49), Middle Eastern and North African (OR 1.46; 95% CI 1.17-1.81), non-Nordic European (OR 1.27; 95% CI 1.01-1.61), and mixed Swedish-Nordic backgrounds (OR 1.33; 95% CI 1.03-1.72). Risk of compulsory admission was greater in more densely populated neighbourhoods [OR per standard deviation (s.d.) increase in the exposure: 1.12, 95% CI 1.06-1.18], an effect that appeared to be driven by own-region migrant density (OR per s.d. increase in exposure: 1.12; 95% CI 1.02-1.24). Inequalities in the risk of compulsory admission by migrant status, region-of-origin, urban living and own-region migrant density highlight discernible factors which raise barriers to equitable care and provide potential targets for intervention.

Highlights

There is strong evidence that risk of compulsory psychiatric care is greater for certain ethnic minority groups than majority white populations (Anderson, Flora, Archie, Morgan, & Mckenzie, 2014; Barnett et al, 2019; Weich et al, 2017)
Population-based nationwide sample of people experiencing their first admission for psychosis in Sweden, we found evidence that migrants and children of migrants were more likely to be compulsorily admitted at first admission for psychotic
Neighbourhood own-region migrant density (z-standardised) Intraclass correlation coefficient (%)b aAdjusted for sex, age group at diagnosis, region of origin and population density

Summary

Introduction

There is strong evidence that risk of compulsory psychiatric care is greater for certain ethnic minority groups than majority white populations (Anderson, Flora, Archie, Morgan, & Mckenzie, 2014; Barnett et al, 2019; Weich et al, 2017). Migrants were 1.5 times more likely than nonmigrants to experience compulsory detention for psychiatric care This issue is pervasive with respect to psychotic disorders, where several migrants and minority ethnic groups across international contexts face elevated incidence (Selten, Van Der Ven, & Termorshuizen, 2020), including in Sweden (Dykxhoorn et al, 2018), and increased risk of compulsory admission (Fassaert et al, 2016; Halvorsrud, Nazroo, Otis, Brown Hajdukova, & Bhui, 2018; Mulder, Koopmans, & Selten, 2006; Rodrigues et al, 2020; Rotenberg, Tuck, Ptashny, & McKenzie, 2017). People from many migrant and minority ethnic backgrounds may face the compound effects of inequalities in both risk of psychotic disorder and pathways to care. Inequalities in the risk of compulsory admission by migrant status, region-oforigin, urban living and own-region migrant density highlight discernible factors which raise barriers to equitable care and provide potential targets for intervention

Methods

Results

Conclusion