Background 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. Methods 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. Results 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. Conclusions 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.

BackgroundMental disorders are associated with an elevated risk for suicide attempt and suicide. Whether the strength of the associations also holds for refugees is unclear.AimsTo examine the relationship between specific mental disorders and suicide attempt and suicide in refugees and Swedish-born individuals.MethodThis longitudinal cohort study included 5 083 447 individuals aged 16–64 years, residing in Sweden in 2004, where 196 757 were refugees. Mental disorders were defined as having a diagnosis in psychiatric care during 2000–2004. Estimates of risk of suicide attempt and suicide were calculated as hazard ratios with 95% confidence intervals. Adjustments were made for important confounding factors, including history of attempt. The reference group comprised Swedish-born individuals without mental disorders.ResultsRates for suicide attempt in individuals with a mental disorder were lower in refugees compared with Swedish-born individuals (480 v. 850 per 100 000 person-years, respectively). This pattern was true for most specific disorders: compared with the reference group, among refugees, multivariable-adjusted hazard ratios for suicide attempt ranged from 3.0 (anxiety) to 7.4 (substance misuse), and among Swedish-born individuals, from 4.9 (stress-related disorder) to 9.3 (substance misuse). For schizophrenia, bipolar disorder and personality disorder, estimates for suicide attempt were comparable between refugees and Swedish-born individuals. Similar patterns were seen for suicide.ConclusionsFor most mental disorders, refugees were less likely to be admitted to hospital for suicide attempt or die by suicide compared with Swedish-born individuals. Further research on risk and protective factors for suicide attempt and suicide among refugees with mental disorders is warranted.Declaration of interestNone.

Background Little is known regarding treatment for common mental disorders (CMDs) in young refugees. We aimed to identify (i) if the risk of treatment for CMDs in young refugees varies by their country of birth, compared with the Swedish-born population and (ii) if time period of resettlement influences these possible associations. Methods All Swedish-born individuals and people who were granted refugee status, aged 16–25 years, living in Sweden on 31 December 1999, 2004 or 2009 (around 1 million people with 3–4% refugees in each cohort), were followed for 4 years for treated CMDs by linking register data. To facilitate stratified analyses by refugees’ country of birth, the 2009 cohort was followed for 7 years with regard to specialized healthcare and antidepressant prescription due to CMDs. Hazard ratios with 95% confidence intervals were computed in crude and adjusted models. Results Refugees in the 2009 cohort with 7-year follow-up had a 25% lower risk for treated CMDs, compared with the Swedish-born. Stratified analysis by country of birth showed a similarly lower risk regarding treated CMDs among refugees from all countries but Iran [hazard ratios (95% confidence intervals): 1.15 (1.05–1.26)] than their Swedish-born peers. No substantial effect of time period of resettlement was observed in the risk for treated CMDs in refugees. Conclusions Treatment for CMDs is lower in young refugees than in the majority population in Sweden, is stable across time, but varies with country of birth. Strategies to improve access to mental healthcare for young refugees are warranted.

Purpose There is a lack of research on whether healthcare use before and after a suicide attempt differs between refugees and the host population. We aimed to investigate if the patterns of specialised (inpatient and specialised outpatient) psychiatric and somatic healthcare use, 3 years before and after a suicide attempt, differ between refugees and the Swedish-born individuals in Sweden. Additionally, we aimed to explore if specialised healthcare use differed among refugee suicide attempters according to their sex, age, education or receipt of disability pension. Methods All refugees and Swedish-born individuals, 20-64 years of age, treated for suicide attempt in specialised healthcare during 2004-2013 (n = 85,771 suicide attempters, of which 4.5% refugees) were followed 3 years before and after (Y − 3 to Y + 3) the index suicide attempt (t0) regarding their specialised healthcare use. Annual adjusted prevalence with 95% confidence intervals (CIs) of specialised healthcare use were assessed by generalized estimating equations (GEE). Additionally, in analyses among the refugees, GEE models were stratified by sex, age, educational level and disability pension. Results Compared to Swedish-born, refugees had lower prevalence rates of psychiatric and somatic healthcare use during the observation period. During Y + 1, 25% (95% CI 23-28%) refugees and 30% (95% CI 29-30%) Swedish-born used inpatient psychiatric healthcare. Among refugees, a higher specialised healthcare use was observed in disability pension recipients than non-recipients. Conclusion Refugees used less specialised healthcare, before and after a suicide attempt, relative to the Swedish-born. Strengthened cultural competence among healthcare professionals and better health literacy among the refugees may improve healthcare access in refugees.

Background Little is known about adolescent mental health problems, including social phobia, as risk factors for future work incapacity. The aim of this study was to investigate the association between social phobia in adolescence and unemployment and sickness absence (SA) in early adulthood, also evaluating the role of familial factors (genetics and shared environment). Methods A sample of 2845 Swedish twins born in 1985–86 in Sweden was followed longitudinally in the population-based and prospective Twin study of CHild and Adolescent Development. Information on twins’ social phobia was collected at ages 13–4, 16–7 and 19–20 years. Logistic regression providing odds ratios (OR) with 95% confidence intervals (95% CI) was used to analyze the associations between social phobia, unemployment and SA during the follow-up 2006–12. The influence of familial factors was evaluated by conditional logistic regression. Results Presence of social phobia during adolescence was associated with increased odds for unemployment and SA in young adulthood. For unemployment, the highest OR was at the age of 13–4 years (1.58 [95% CI: 1.22–2.06]), and the associations became null after adjusting for familial factors. For SA, the highest OR was at the age of 19–20 years (1.73 [95% CI: 1.13–2.65]), and the estimates changed slightly after adjusting for familial factors. Conclusions : Results suggest that social phobia experienced in adolescence contribute to early adulthood unemployment and SA. Familial factors seemed to explain the association between social phobia and unemployment.