Does country of resettlement influence the risk of suicide in refugees? A case-control study in Sweden and Norway

Abstract

Aims Little is known regarding how the risk of suicide in refugees relates to their host country. Specifically, to what extent inter-country differences in structural factors between the host countries may explain the association between refugee status and subsequent suicide is lacking in previous literature. We aimed to investigate (1) the risk of suicide in refugees resident in Sweden and Norway, in general, and according to their sex, age, region/country of birth and duration of residence, compared with the risk of suicide in the respective majority host population; (2) if factors related to socio-demographics, labour market marginalisation (LMM) and healthcare use might explain the risk of suicide in refugees differently in host countries. Methods Using a nested case-control design, each case who died by suicide between the age of 18 and 64 years during 1998 and 2018 (17 572 and 9443 cases in Sweden and Norway, respectively) was matched with up to 20 controls from the general population, by sex and age. Multivariate-adjusted conditional logistic regression models yielding adjusted odds ratios (aORs) with 95% confidence intervals (95% CI) were used to test the association between refugee status and suicide. Separate models were controlled for factors related to socio-demographics, previous LMM and healthcare use. Analyses were also stratified by sex and age groups, by refugees' region/country of birth and duration of residence in the host country. Results The aORs for suicide in refugees in Sweden and Norway were 0.5 (95% CI 0.5–0.6) and 0.3 (95% CI 0.3–0.4), compared with the Swedish-born and Norwegian-born individuals, respectively. Stratification by region/country of birth showed similar statistically significant lower odds for most refugee groups in both host countries except for refugees from Eritrea (aOR 1.0, 95% CI 0.7–1.6) in Sweden. The risk of suicide did not vary much across refugee groups by their duration of residence, sex and age except for younger refugees aged 18–24 who did not have a statistically significant relative difference in suicide risk than their respective host country peers. Factors related to socio-demographics, LMM and healthcare use had only a marginal influence on the studied associations in both countries. Conclusions Refugees in Sweden and Norway had almost similar suicide mortality advantages compared with the Swedish-born and Norwegian-born population, respectively. These findings may suggest that resiliency and culture/religion-bound attitudes towards suicidal behaviour in refugees could be more influential for their suicide risk after resettlement than other post-migration environmental and structural factors in the host country.

Prevention of suicide and suicide attempts in the Nordic countries

“…Refugees are likely to experience traumatizing events both in their home country, during their migration, and after arrival (Khan Amiri, et al, 2021). Nevertheless, refugees were in general not found to have higher suicide rates when compared to the general population in Denmark, Norway and Sweden (Khan Amiri, et al, 2021, Geirsdottir, et al, 2021, Amin, et al, 2021a, Amin, et al, 2021b). An exception is unaccompanied minors who seek asylum; this group was found to have higher suicide rates when compared to youth in Sweden (Mittendorfer -Rutz, et al, 2020).…”

Does country of resettlement influence the risk of labor market marginalization among refugees? A cohort study in Sweden and Norway

“…Between 2004 and 2021, around 353 000 and 110 000 refugees resettled in Sweden and Norway, respectively ( 3 , 4 ). In 2020, 6.5 and 4.4% of the population of Sweden and Norway, respectively, were immigrants with a refugee background ( 5 ).…”

“…Several non-structural factors related to the heterogeneity among refugees seem to predict patterns of labor market marginalization ( 16 , 19 ), such as socioeconomic status, health condition, language skills post resettlement ( 20 ), and traumatic experiences faced prior to and during migration ( 6 ). Structural factors in the host country, including social insurance policies, healthcare systems, migration policies, and unemployment rates, may further affect refugees’ integration and risk of labor market marginalization ( 5 ). Comparing the risk of labor market marginalization among refugees from the same birth country who resettled in different host countries will, to some extent, account for the within-group heterogeneity among refugees and may provide insight into how host-country-specific structural factors influence labor market marginalization risk.…”