Suicide attempt and suicide in refugees in Sweden – a nationwide population-based cohort study

Abstract

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.

Recruitment and Baseline Characteristics of Participants in the “Sanadak” Trial: A Self-Help App for Syrian Refugees with Post-traumatic Stress

“…The number of individuals with acute suicidal tendencies in our sample was low. This is contrary to other studies that reported higher suicidality in refugees, including a population-based cohort [ 32 ] and compared to the general population [ 33 , 34 , 35 ]. However, as already stated before, the concept of suicidality may have lead to misunderstandings in our sample due to cultural differences.…”

Mental disorders and suicidal behavior in refugees and Swedish-born individuals: is the association affected by work disability?

“…In general, refugees had a lower risk of both suicide attempt and suicide when compared to the Swedish-born population. Associations between refugee status and suicide attempt and suicide have rarely been investigated [8,9]. Hence, our study is one of the first to examine associations between mental disorders and suicide attempt and suicide in refugees.…”

“…Given these higher levels of psychiatric morbidity, it has further been hypothesized that refugees have an elevated risk of suicidal behavior, in terms of suicide attempt and suicide. However, there are hardly any studies examining this association [7][8][9]. One Danish study that investigated differences in injury mortality in refugees and immigrants reported lower rates of suicide [7] in refugees in comparison with the host Danish population.…”

Healthcare use before and after suicide attempt in refugees and Swedish-born individuals

“…In turn, these disorders are among the main risk factors for suicidal behaviour [4,5]. However, there is knowledge gap regarding whether risk of suicide attempt, compared with a country's host population, is different for refugees [6,7]. A recent cohort study in Sweden reported a lower risk of suicide attempt in refugees, compared with the Swedish-born population [7].…”

“…However, there is knowledge gap regarding whether risk of suicide attempt, compared with a country's host population, is different for refugees [6,7]. A recent cohort study in Sweden reported a lower risk of suicide attempt in refugees, compared with the Swedish-born population [7]. The knowledge gap in this field seems even more prominent in light of the increase in global migration in the recent decades.…”