Abstract
Despite a reported high rate of mental disorders in refugees, scientific knowledge on their risk of suicide attempt and suicide is scarce. We aimed to investigate (1) the risk of suicide attempt and suicide in refugees in Sweden, according to their country of birth, compared with Swedish-born individuals and (2) to what extent time period effects, socio-demographics, labour market marginalisation (LMM) and morbidity explain these associations. Three cohorts comprising the entire population of Sweden, 16-64 years at 31 December 1999, 2004 and 2009 (around 5 million each, of which 3.3-5.0% refugees), were followed for 4 years each through register linkage. Additionally, the 2004 cohort was followed for 9 years, to allow analyses by refugees' country of birth. Crude and multivariate hazard ratios (HRs) with 95% confidence intervals (CIs) were computed. The multivariate models were adjusted for socio-demographic, LMM and morbidity factors. In multivariate analyses, HRs regarding suicide attempt and suicide in refugees, compared with Swedish-born, ranged from 0.38-1.25 and 0.16-1.20 according to country of birth, respectively. Results were either non-significant or showed lower risks for refugees. Exceptions were refugees from Iran (HR 1.25; 95% CI 1.14-1.41) for suicide attempt. The risk for suicide attempt in refugees compared with the Swedish-born diminished slightly across time periods. Refugees seem to be protected from suicide attempt and suicide relative to Swedish-born, which calls for more studies to disentangle underlying risk and protective factors.
Highlights
Despite a reported high rate of mental disorders in refugees, scientific knowledge on their risk of suicide attempt and suicide is scarce
Refugees have been reported to have a high prevalence of common mental disorders, post-traumatic stress disorder (Bogic et al, 2015; Tinghög et al, 2017), which in turn can lead to suicidal behaviour (Ferrada‐Noli et al, 1998; van Heeringen, 2012)
Higher proportions with history of inpatient healthcare and almost the same distribution of history of suicide attempt were observed among the refugees and the Swedish-born population in all the cohorts
Summary
Despite a reported high rate of mental disorders in refugees, scientific knowledge on their risk of suicide attempt and suicide is scarce. We aimed to investigate (1) the risk of suicide attempt and suicide in refugees in Sweden, according to their country of birth, compared with Swedish-born individuals and (2) to what extent time period effects, socio-demographics, labour market marginalisation (LMM) and morbidity explain these associations. HRs regarding suicide attempt and suicide in refugees, compared with Swedish-born, ranged from 0.38–1.25 and 0.16–1.20 according to country of birth, respectively. The risk for suicide attempt in refugees compared with the Swedish-born diminished slightly across time periods. Refugees have been reported to have a high prevalence of common mental disorders, post-traumatic stress disorder (Bogic et al, 2015; Tinghög et al, 2017), which in turn can lead to suicidal behaviour (suicide attempt and suicide) (Ferrada‐Noli et al, 1998; van Heeringen, 2012). Post-migration difficulties including psychosocial acculturation problems and ethnical discrimination may adversely affect mental health and increase the risk of suicidal behaviour (Berry et al, 2002; Tinghög, 2009)
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