Non-refugee Migrants Research Articles

Differences in psychiatric care utilization between refugees, non-refugee migrants and Swedish-born youth.

The study aimed to examine differences in, and characteristics of psychiatric care utilization in young refugees who came to Sweden as unaccompanied or accompanied minors, compared with that of their non-refugee immigrant and Swedish-born peers. This register-linkage cohort study included 746 688 individuals between 19 and 25 years of age in 2009, whereof 32 481 were refugees (2896 unaccompanied and 29 585 accompanied) and 32 151 non-refugee immigrants. Crude and multivariate Cox regression models yielding hazard ratios (HR) and 95% confidence intervals (CI) were conducted to investigate subsequent psychiatric care utilization for specific disorders, duration of residence and age at migration. The adjusted HRs for psychiatric care utilization due to any mental disorder was significantly lower in both non-refugee and refugee immigrants when compared to Swedish-born [aHR: 0.78 (95% CI 0.76-0.81) and 0.75 (95% CI 0.72-0.77, respectively)]. Within the refugee group, unaccompanied had slightly lower adjusted risk estimates than accompanied. This pattern was similar for all specific mental disorders except for higher rates in schizophrenia, reaction to severe stress/adjustment disorders and post-traumatic stress disorder. Psychiatric health care utilization was also higher in immigrants with more than 10 years of residency in Sweden entering the country being younger than 6 years of age. For most mental disorders, psychiatric health care utilization in young refugees and non-refugee immigrants was lower than in their Swedish-born peers; exceptions are schizophrenia and stress-related disorders. Arrival in Sweden before the age of 6 years was associated with higher rates of overall psychiatric care utilization.

Do refugee women have increased risk of perinatal psychiatric dirsorders: a registered-based study?

Abstract Perinatal mental health (PMD) disorders affect up to 15% of women and have negative, long-lasting impact on mothers and children. This is recognized by the WHO as major public health issue. Studies show that migrant women are at increased risk of experiencing perinatal depression and anxiety compared to non-migrants. Knowledge about risk of other mental health disorders is limited and studies in Europe have not examined differences among women with different migrant status. This registered based study examines whether refugee (R) women and different groups of family-reunified (FR) migrants in Denmark have higher risk of PMD compared to native Danes (D) and, how migration related factors are associated with differences in risk of PMD among migrants. We use data from the Danish Adult Refugee Cohort, which includes all refugee and family-reunified individuals who received residence permission in Denmark from 1998-2014 matched 1:6 to Danish born (D) individuals. We identified 274,920 women that gave birth to a live child, without prior psychiatric history and compared risk for PMD from pregnancy to 1 years postpartum between R, FR to R, FR to migrants, FR to Danes, and D women. Differences in types of diagnose (affective, psychotic, neurotic, or any other psychiatric disorder) were examined in sub-analyses. Within migrant women, we examined differences in psychiatric contact by region of origin, time since migration, refugee status, sociodemographic, and birth characteristics. Compared to Danish born women, refugee women were more likely to have a PMD (aOR 1.23, 95% CI 1.01-1.49) and a higher burden of psychotic and neurotic-stress related disorders, while FR to migrants were less likely to have a PMD (aOR=0.37, 95% CI; 0.22-0.64) adjusting covariates. No differences in PMD emerged between FR to refugees, FR to Danes and Danes. Findings will have implications for perinatal mental health service delivery targeting certain immigrant groups and particularly refugees. Key messages Refugee women are at increased risk of experiencing psychiatric disorders during the perinatal period and efforts should be made to offer psychosocial support during pregnancy and after birth. Certain groups of non-refugee migrants may benefit from a ‘healthy migrant effect’ in regards to their risk of experiencing psychiatric disorders during the perinatal period.

General Practitioners' Experiences of Clinical Consultations With Refugees Suffering From Mental Health Problems.

Refugees suffer from higher rates of certain mental health problems than non-refugee migrants and the native population of their host country. General practitioners (GPs) in Norway and many other European countries are the first contact person for settled refugees in need of non-emergency medical support. This includes psychiatric support, although GPs are not typically specialists in psychiatry. The aim of this study is to investigate how GPs experience working with refugees suffering from mental health problems, with a specific focus on perceived challenges and facilitators. We conducted semi-structured interviews with 15 GPs working in Norway (7 females). Participants ages ranged from 29 to 67 (M = 41.7 years, SD = 11.1) with work experience ranging from 2 to 39 years (M = 13.6 years, SD = 12.1). Interviews were analysed thematically using the qualitative data analysis computer software package NVivo 12. The main challenges presented by GPs relate to language barriers, mismatched expectations, different understandings of health and illness, and the GP feeling unprepared to work with this patient group. The main facilitating themes related to establishing trust and finding the work meaningful. The themes presented in this study highlight areas of interest for future research, and should inform training programmes to improve health care for both clinicians and refugee patients.

Previous suicide attempt and subsequent risk of re-attempt and suicide: Are there differences in immigrant subgroups compared to Swedish-born individuals?

BackgroundStudies investigating how suicide attempting refugees and non-refugee migrants differ from Swedish-born individuals in terms of re-attempts and suicide are missing. It remains unknown how mental disorders and labour market marginalization (LMM) impact on these associations. MethodsThis longitudinal cohort study included Swedish residents aged 20–64 with suicide attempt in 2004–2012. In total, 42,684 individuals including 2017 refugees, and 2544 non-refugee migrants were included and followed until December 31, 2016. Risks of re-attempt and suicide were calculated as hazard ratios (HR) with 95% confidence intervals (CI), and adjusted for important confounders. Stratified analyses were to assess if mental disorders or LMM modified these associations. ResultsIn the adjusted models, refugees had an adjusted HR (aHR) of suicide re-attempt of 0.74 (CI: 0.67–0.81), and an aHR of 0.67 (CI: 0.53–0.86) for suicide death. These estimates were very similar to those of non-refugee migrants. Refugees and non-refugee migrants with suicide attempt had a lower prevalence of specialised health care due to mental disorders compared to Swedish-born attempters (48%, 44% and 61%, respectively). Mental disorders and LMM in terms of long-term sickness absence and disability pension increased the risk of re-attempt and suicide in all three groups. LimitationsOnly suicide attempts and mental disorders resulting in specialized in-and outpatient care were registered. ConclusionMigrants show considerably lower risks of re-attempt and suicide than Swedish-born individuals, with no differences between migrant groups. Despite vast differences in the prevalence of specific mental disorders, the role of mental disorders in the pathways to re-attempt and suicide does not appear to differ considerably between these groups.

Lift the Ban? Initial Employment Restrictions and Refugee Labour Market Outcomes

This article investigates the medium to long-term effects on refugee labour market outcomes of the temporary employment bans being imposed in many countries on recently arrived asylum seekers. Using a newly collected dataset covering almost 30 years of employment restrictions together with individual data for refugees entering European countries between 1985 and 2012, our empirical strategy exploits the geographical and temporal variation in employment bans generated by staggered introduction and removal coupled with frequent changes at the intensive margin. We find that exposure to a ban at arrival reduces refugee employment probability in post-ban years by 15%, an impact driven primarily by lower labour market participation. These effects are not mechanical, since we exclude refugees who may still be subject to employment restrictions, are non-linear in ban length, confirming that the very first months following arrival play a key role in shaping integration prospects, and last up to 10 years post arrival. We further demonstrate that the detrimental effects of employment bans are concentrated among less educated refugees, translate into lower occupational quality, and seem not to be driven by selective migration. Our causal estimates are robust to several identification tests accounting for the potential endogeneity of employment ban policies, including placebo analysis of non-refugee migrants and an instrumental variable strategy. To illustrate the costs of these employment restrictions, we estimate a EUR 37.6 billion output loss from the bans imposed on asylum seekers who arrived in Europe during the so-called 2015 refugee crisis.

Substance use disorders in refugee and migrant groups in Sweden: Anationwide cohort study of 1.2 million people.

Refugees are at higher risk of some psychiatric disorders, including post-traumatic stress disorder (PTSD) and psychosis, compared with other non-refugee migrants and the majority population. However, it is unclear whether this also applies to substance use disorders, which we investigated in a national register cohort study in Sweden. We also investigated whether risk varied by region of origin, age at migration, time in Sweden, and diagnosis of PTSD. Using linked Swedish register data, we followed a cohort born between 1984 and 1997 from their 14th birthday or arrival in Sweden, if later, until an International Classification of Diseases, 10th revision (ICD-10), diagnosis of substance use disorder (codes F10.X-19.X), emigration, death, or end of follow-up (31 December 2016). Refugee and non-refugee migrants were restricted to those from regions with at least 1,000 refugees in the Swedish registers. We used Cox proportional hazards regression to estimate unadjusted and adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) in refugee and non-refugee migrants, compared with Swedish-born individuals, for all substance use disorders (F10.X-19.X), alcohol use disorders (F10.X), cannabis use disorders (F12.X), and polydrug use disorders (F19.X). In adjusted analyses, we controlled for age, sex, birth year, family income, family employment status, population density, and PTSD diagnosis. Our sample of 1,241,901 participants included 17,783 (1.4%) refugee and 104,250 (8.4%) non-refugee migrants. Refugees' regions of origin were represented in proportions ranging from 6.0% (Eastern Europe and Russia) to 41.4% (Middle East and North Africa); proportions of non-refugee migrants' regions of origin ranged from 11.8% (sub-Saharan Africa) to 33.7% (Middle East and North Africa). These groups were more economically disadvantaged at cohort entry (p < 0.001) than the Swedish-born population. Refugee (aHR: 0.52; 95% CI 0.46-0.60) and non-refugee (aHR: 0.46; 95% CI 0.43-0.49) migrants had similarly lower rates of all substance use disorders compared with Swedish-born individuals (crude incidence: 290.2 cases per 100,000 person-years; 95% CI 287.3-293.1). Rates of substance use disorders in migrants converged to the Swedish-born rate over time, indicated by both earlier age at migration and longer time in Sweden. We observed similar patterns for alcohol and polydrug use disorders, separately, although differences in cannabis use were less marked; findings did not differ substantially by migrants' region of origin. Finally, while a PTSD diagnosis was over 5 times more common in refugees than the Swedish-born population, it was more strongly associated with increased rates of substance use disorders in the Swedish-born population (aHR: 7.36; 95% CI 6.79-7.96) than non-refugee migrants (HR: 4.88; 95% CI 3.71-6.41; likelihood ratio test [LRT]: p = 0.01). The main limitations of our study were possible non-differential or differential under-ascertainment (by migrant status) of those only seen via primary care and that our findings may not generalize to undocumented migrants, who were not part of this study. Our findings suggest that lower rates of substance use disorders in migrants and refugees may reflect prevalent behaviors with respect to substance use in migrants' countries of origin, although this effect appeared to diminish over time in Sweden, with rates converging towards the substantial burden of substance use morbidity we observed in the Swedish-born population.

Suicide risk among refugees compared with non-refugee migrants and the Swedish-born majority population.

It has been hypothesised that refugees have an increased risk of suicide. To investigate whether risk of suicide is higher among refugees compared with non-refugee migrants from the same areas of origin and with the Swedish-born population, and to examine whether suicide rates among migrants converge to the Swedish-born population over time. A population-based cohort design using linked national registers to follow 1 457 898 people born between 1 January 1970 and 31 December 1984, classified by migrant status as refugees, non-refugee migrants or Swedish-born. Participants were followed from their 16th birthday or date of arrival in Sweden until death, emigration or 31 December 2015, whichever came first. Cox regression models estimated adjusted hazard ratios for suicide by migrant status, controlling for age, gender, region of origin and income. There were no significant differences in suicide risk between refugee and non-refugee migrants (hazard ratio 1.28, 95% CI 0.93-1.76) and both groups had a lower risk of suicide than Swedish born. During their first 5 years in Sweden no migrants died by suicide; however, after 21-31 years their suicide risk was equivalent to the Swedish-born population (hazard ratio 0.94, 95% CI 0.79-1.22). After adjustment for income this risk was significantly lower for migrants than the Swedish-born population. Being a refugee was not an additional risk factor for suicide. Our findings regarding temporal changes in suicide risk suggest that acculturation and socioeconomic deprivation may account for a convergence of suicide risk between migrants and the host population over time. None.

Risk of Psychosis Among Refugees

This systematic review and meta-analysis is, to date, the first and most comprehensive to focus on the incidence of nonaffective psychoses among refugees. To assess the relative risk (RR) of incidence of nonaffective psychosis in refugees compared with the RR in the native population and nonrefugee migrants. PubMed, PsycINFO, and Embase databases were searched for studies from January 1, 1977, to March 8, 2018, with no language restrictions (PROSPERO registration No. CRD42018106740). Studies conducted in Denmark, Sweden, Norway, and Canada were selected by multiple independent reviewers. Inclusion criteria were (1) observation of refugee history in participants, (2) assessment of effect size and spread, (3) adjustment for sex, (4) definition of nonaffective psychosis according to standardized operationalized criteria, and (5) comparators were either nonrefugee migrants or the native population. Studies observing ethnic background only, with no explicit definition of refugee status, were excluded. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines were followed for extracting data and assessing data quality and validity as well as risk of bias of included studies. A random-effects model was created to pool the effect sizes of included studies. The primary outcome, formulated before data collection, was the pooled RR in refugees compared with the nonrefugee population. Of the 4358 screened articles, 9 studies (0.2%) involving 540 000 refugees in Denmark, Sweden, Norway, and Canada were included in the analyses. The RR for nonaffective psychoses in refugees was 1.43 (95% CI, 1.00-2.05; I2 = 96.3%) compared with nonrefugee migrants. Analyses that were restricted to studies with low risk of bias had an RR of 1.39 (95% CI, 1.23-1.58; I2 = 0.0%) for refugees compared with nonrefugee migrants, 2.41 (95% CI, 1.51-3.85; I2 = 96.3%) for refugees compared with the native population, and 1.92 (95% CI, 1.02-3.62; I2 = 97.0%) for nonrefugee migrants compared with the native group. Exclusion of studies that defined refugee status not individually but only by country of origin resulted in an RR of 2.24 (95% CI, 1.12-4.49; I2 = 96.8%) for refugees compared with nonrefugee migrants and an RR of 3.26 (95% CI, 1.87-5.70; I2 = 97.6%) for refugees compared with the native group. In general, the RR of nonaffective psychosis was increased in refugees and nonrefugee migrants compared with the native population. Refugee experience appeared to be an independent risk factor in developing nonaffective psychosis among refugees in Denmark, Sweden, Norway, and Canada. These findings suggest that applying the conclusions to non-Scandinavian countries should include a consideration of the characteristics of the native society and its specific interaction with the refugee population.

Labour market marginalisation among refugees from different countries of birth: a prospective cohort study on refugees to Sweden

BackgroundThe aim was to elucidate if the risk of labour market marginalisation (LMM), measured as long-term unemployment, long-term sickness absence, disability pension and a combined measure of these three measures,...

Global research output in the health of international Arab migrants (1988\u20132017)

BackgroundIn the past few decades Arab countries had witnessed several intra-regional conflicts and civil wars that led to the creation of millions of refugees and migrants. Assessment of research activity is an indicator of national and international efforts to improve the health of those millions of war victims. Therefore, the aim of this study was to analyze published literature in international Arab migrants.MethodsLiterature in international Arab migrants published during the past three decades (1988–2017) was retrieved using Scopus database. A bibliometric analysis methodology was implemented on the retrieved data. Author keywords were mapped using VOSviewer program.ResultsIn total, 1186 documents were retrieved. More than half (658; 55.5%) were published in the last five years (2013–2017). Retrieved documents received an average of 8.6 citations per document and an h-index of 45. The most frequently encountered author keywords were refugees and mental health–related terms. Three countries in the Middle East; Jordan, Lebanon, and Turkey, were among the most active countries. In total, 765 (63.7%) documents were about refugees, 421 (35.5%) were about migrant workers, 30 (2.5%) were about asylum seekers, and 7 (0.6%) were about trafficked and smuggled people. When data were analyzed for the nationality of migrants being investigated, 288 (24.3%) documents were about Syrians, 214 (18.0%) were about Somali, 222 (18.7%) were about Arab or Middle Eastern in general, and 147 (12.4%) were about Palestinians. The American University of Beirut ranked first with 45 (2.4%) publications. The most active journal in publishing research in this field was Journal of Immigrant and Minority Health (35; 3.0%) followed by Journal of Refugee Studies (23, 1.9%), The Lancet (19, 1.6%) and BMC Public Health (16, 1.3%). Publications from Jordan and Lebanon had the highest percentage of international research collaboration.ConclusionResearch in international Arab migrants showed a dramatic increase in the last few years mostly due to the Syrian war. Both mental health and Syrian refugees dominated the literature of international Arab migrants. Research in infectious diseases was relatively low. Research on non-refugee migrants such as workers, trafficked victims, and asylum seekers was also relatively low.

Being a refugee or having a refugee status? Birthweight and gestational age outcomes among offspring of immigrant mothers in Sweden.

Aims: to evaluate whether the information on refugee status based on the residence permit is a useful source of information for perinatal health surveillance. Methods: Using the Swedish population registers (1997-2012), we use multinomial regression models to assess the associations between migration status (refugee and non-refugee) and birth outcomes derived from birthweight and gestational age: low birthweight (LBW) (<2500 g), macrosomia (≥4000 g); preterm: (<37 w) and post-term (≥42 w). The Swedish-born population was used as a reference group. Results: Compared to the Swedish-born population, an increased OR (odds ratio) of LBW and post-term was found among migrants with and without refugee status (respectively: OR for refugees: 1.47 [95% CI: 1.33-1.63] and non-refugees:1.27 [95% CI: 1.18-1.38], for refugees: 1.41 [95% CI: 1.35-1.49] and non-refugees:1.04 [95% CI: 1.00-1.08]) with statistically significant differences between these two migrant categories. However, when looking at specific regions of origin, few regions show differences by refugee status. Compared to Swedes, lower or equal ORs of preterm and macrosomia are observed regardless of migratory status. Conclusions: Small or no differences were observed in birth outcomes among offspring of women coming from the same origin with different migratory status, compared to their Swedish counterparts. This suggests that information on migration status is not a relevant piece of information to identify immigrant women at higher risk of experiencing adverse reproductive outcomes. Our results however might be explained by the large proportion of women coming to Sweden for family reunification who are classified as non-refugee migrants.

Are refugees at increased risk of suicide compared with non-refugee migrants and the host population

Are refugees at increased risk of suicide compared with non-refugee migrants and the host population

Depression and Low Labour Market and Social Expectations among Resettled Syrian Refugees in Sweden

Background Large numbers of refugees have come to Europe in search of safety. For non-refugee migrants, expectations and the extent to which they are met are shown to be integral components of adap ...

Refugee migration and risk of schizophrenia and other non-affective psychoses: cohort study of 1.3 million people in Sweden

Objective To determine whether refugees are at elevated risk of schizophrenia and other non-affective psychotic disorders, relative to non-refugee migrants from similar regions of origin and the Swedish-born population. Design...

Explaining the Refugee Gap: Economic Outcomes of Refugees versus Other Immigrants

It is often assumed that refugees in the US are at an economic disadvantage compared to other immigrants. A number of hypotheses have been postulated to explain this ‘refugee gap’. Refugees, on average, have less English language ability, less educational experience, different forms of family support, poorer mental and physical health, and generally reside in more disadvantaged neighbourhoods than other immigrants. Although these factors are well supported by evidence for specific refugee groups, a lack of representative data for both refugee and non-refugee migrants has made the testing of this refugee gap challenging. Using the first wave of the New Immigrant Survey, these hypotheses are tested on employment, occupation, and earnings outcomes using multivariate modelling techniques among recent immigrants in the United States. Findings demonstrate that accounting for each of the aforementioned explanatory factors minimizes the earnings and occupational differences between refugees and all other immigrants. Despite the inclusion of these factors within the model, however, a refugee disparity in earnings and occupational attainment continues to exist.