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Chen J, Mittendorfer-Rutz E, Taipale H, Rahman S, Niederkrotenthaler T, Klimek P. Association of medication clusters and subsequent labor market marginalization in refugee and Swedish-born young adults with common mental disorders in Sweden. Eur Child Adolesc Psychiatry 2024; 33:897-907. [PMID: 37115278 PMCID: PMC10894142 DOI: 10.1007/s00787-023-02214-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/11/2023] [Indexed: 04/29/2023]
Abstract
Little is known about the association between common mental disorders (CMD) and labor market integration among refugee and Swedish-born young adults. Socially disadvantaged patients such as refugees are more likely to discontinue their medication use prematurely. This study aimed to identify clusters of individuals with similar psychotropic medication patterns; and examine the relationship between cluster membership with labor market marginalization (LMM) in refugee and Swedish-born young adults with CMD. The study uses a longitudinal matched cohort aged 18-24 years with CMD diagnoses from Swedish registers covering 2006-2016. Dispensed psychotropic medications (antidepressants, antipsychotics, anxiolytics, sedative-hypnotics, mood stabilizers) were collected one year before and after CMD diagnosis. Clusters of patients with similar time courses of prescribed dosages were algorithmically identified. The association of cluster membership with subsequent LMM, (long-term sickness absence, SA, disability pension, DP, or long-term unemployment, UE) was assessed using Cox regression. Among 12,472 young adults with CMD, there were 13.9% with SA, 11.9% with DP, and 13.0% with UE during a mean follow-up of 4.1 years (SD 2.3 years). Six clusters of individuals were identified. A cluster with a sustained increase in all medication types yielded the highest hazard ratio (HR [95% CI]) 1.69 [1.34, 2.13] for SA and 2.63 [2.05, 3.38] for DP. The highest HRs of UE give a cluster with a concentrated peak in antidepressants at CMD diagnosis (HR 1.61[1.18, 2.18]). Refugees and Swedish-born showed similar associations between clusters and LMM. To prevent LMM, targeted support and early assessment of CMD treatment are needed for individuals with a sustained increase in psychotropic medication after CMD diagnosis and for refugees in high-risk clusters for UE characterized by a rapid lowering of treatment dosages, which could be an indicator for premature medication discontinuation.
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Affiliation(s)
- J Chen
- Section for Science of Complex Systems, CeDAS, Medical University of Vienna, Vienna, Austria
- Complexity Science Hub Vienna, Vienna, Austria
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - E Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - H Taipale
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
- Niuvanniemi Hospital, Kuopio, Finland
- University of Eastern Finland, School of Pharmacy, Kuopio, Finland
| | - S Rahman
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - T Niederkrotenthaler
- Unit Suicide Research and Mental Health Promotion, Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria
- Wiener Werkstätte for Suicide Research, Vienna, Austria
| | - P Klimek
- Section for Science of Complex Systems, CeDAS, Medical University of Vienna, Vienna, Austria.
- Complexity Science Hub Vienna, Vienna, Austria.
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Gémes K, Taipale H, Björkenstam E, Rahman S, Gustafsson K, Tanskanen A, Ekselius L, Mittendorfer-Rutz E, Helgesson M. The role of sociodemographic and clinical factors in the initiation and discontinuation of attention deficit hyperactivity disorder medication among young adults in Sweden. Front Psychiatry 2023; 14:1152286. [PMID: 37168083 PMCID: PMC10165120 DOI: 10.3389/fpsyt.2023.1152286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/03/2023] [Indexed: 05/13/2023] Open
Abstract
Introduction Long-term medication use is a recommended treatment for attention-deficit/hyperactivity disorder (ADHD), however, discontinuation is common. Non-medical factors which might influence initiation and discontinuation are understudied. Therefore, we investigated how different sociodemographic factors and comorbidities were associated with the initiation and discontinuation of ADHD medication use among young adults. Methods and results We conducted a population-based prospective cohort study using individually linked administrative register data, in which we included all individuals residing in Sweden, between the age of 19 and 29 who were first diagnosed with ADHD between January 2006 and December 2016 (n = 59224). ADHD medication initiation was defined as the first prescription of ADHD medication in the period from 3 months before to 6 months after the cohort entry date. Those who initiated ADHD medication were followed up for medication use until discontinuation, death/emigration, or until 2019. Logistic and Cox regression models were used to investigate the associations between sociodemographics, health-related predictors and initiation, as well as discontinuation. Overall, 48.7% of the 41399 individuals initiated ADHD medication, most often methylphenidate (87%). Among the initiators, 15462 (77%) discontinued medication use during the follow-up (median time: 150 days). After mutually adjusting all other predictors, initiation was positively associated with older age, male sex, higher level of education, and negatively associated with living at home with parents, immigrant status, being unemployed during the year before inclusion, being on disability pension, having autism, substance use, schizophrenia-spectrum disorders, other mental disability/developmental disorders, cardiovascular diseases or previous accidents. Discontinuation was positively associated with being born abroad, living in big cities, being unemployed during the year before inclusion, having cancer, and negatively associated with a higher educational level, having depression, anxiety or stress-related disorder, autism spectrum disorder or diabetes. Conclusion Besides medical factors, sociodemographics, such as educational attainment and immigrant status might also play a role in the initiation and discontinuation of ADHD medication use among young adults newly diagnosed with ADHD.
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Affiliation(s)
- Katalin Gémes
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
- *Correspondence: Katalin Gémes,
| | - Heidi Taipale
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
- Niuvanniemi Hospital, Kuopio, Finland
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Emma Björkenstam
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Syed Rahman
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Klas Gustafsson
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Antti Tanskanen
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
- Niuvanniemi Hospital, Kuopio, Finland
| | - Lisa Ekselius
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Ellenor Mittendorfer-Rutz
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Magnus Helgesson
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Health Equity and Working Life, Uppsala University, Uppsala, Sweden
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Kieseppä V, Markkula N, Taipale H, Holm M, Jokela M, Suvisaari J, Tanskanen A, Gissler M, Lehti V. Antidepressant use among immigrants with depressive disorder living in Finland: A register-based study. J Affect Disord 2022; 299:528-535. [PMID: 34953922 DOI: 10.1016/j.jad.2021.12.071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/08/2021] [Accepted: 12/18/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was to examine differences in the initiation and discontinuation of antidepressants between immigrants and the Finnish-born population diagnosed with depression in specialized health care. METHODS The study utilized register-based data, which includes all immigrants living in Finland at the end of 2010 and matched Finnish-born controls. For this study, we selected individuals who had received a diagnosis of depression during 2011-2014 (immigrants n = 2244, Finnish-born n = 2773). Their antidepressant use was studied for a one-year period from initiation. A logistic regression was used to predict initiation and a Cox regression was used to predict discontinuation. RESULTS Immigrants were more likely to initiate the use of antidepressants than the Finnish-born controls (adjusted OR = 1.25, 95% CI = 1.07-1.46), but they also discontinued the medication earlier than the Finnish-born controls (adjusted HR = 1.48, 95% CI = 1.31-1.68). Immigrants from Sub Saharan Africa, the Middle East and Northern Africa were most likely to discontinue antidepressants earlier. More severe depression, a longer length of residence in Finland and more intensive psychiatric treatment were associated with decreased risk of discontinuation. LIMITATIONS The registers do not provide information on the perceived reasons for the discontinuation. CONCLUSIONS Immigrants with depression initiate antidepressants more often than the Finnish-born population, but they also discontinue them earlier. Early discontinuation may be a sign of insufficient treatment suggesting that there could be a need for improvement in mental health care for immigrants in Finland.
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Affiliation(s)
- Valentina Kieseppä
- Finnish Institute for Health and Welfare, Finland, Equality Unit, Helsinki.
| | - Niina Markkula
- University of Helsinki and Helsinki University Hospital, Finland, Department of Psychiatry, Helsinki; Clínica Alemana Universidad del Desarrollo, Chile, Faculty of Medicine, Santiago
| | - Heidi Taipale
- Karolinska Institutet, Sweden, Department of Clinical Neuroscience, Stockholm; Niuvanniemi Hospital, Finland, Kuopio; University of Eastern Finland, Finland, School of Pharmacy, Kuopio
| | - Minna Holm
- Finnish Institute for Health and Welfare, Finland, Equality Unit, Helsinki
| | - Markus Jokela
- University of Helsinki, Finland, Medicum, Department of Psychology and Logopedics, Helsinki
| | - Jaana Suvisaari
- Finnish Institute for Health and Welfare, Finland, Equality Unit, Helsinki
| | - Antti Tanskanen
- Niuvanniemi Hospital, Finland, Kuopio; University of Eastern Finland, Finland, School of Pharmacy, Kuopio
| | - Mika Gissler
- Finnish Institute for Health and Welfare, Finland, Information Services Department, Helsinki; University of Turku, Finland, Research Centre for Child Psychiatry, Turku; Region Stockholm, Sweden, Academic Primary Health Care Centre, Stockholm, and Karolinska Institute, Sweden, Department of Molecular Medicine and Surgery, Stockholm
| | - Venla Lehti
- Finnish Institute for Health and Welfare, Finland, Equality Unit, Helsinki; University of Helsinki and Helsinki University Hospital, Finland, Department of Psychiatry, Helsinki
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Rahman S, Filatova S, Chen L, Björkenstam E, Taipale H, Mittendorfer-Rutz E. Trajectories of antidepressant use and characteristics associated with trajectory groups among young refugees and their Swedish-born peers with diagnosed common mental disorders-findings from the REMAIN study. Soc Psychiatry Psychiatr Epidemiol 2022; 57:305-317. [PMID: 34297179 PMCID: PMC8784494 DOI: 10.1007/s00127-021-02139-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 07/09/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aimed to (1) identify the trajectories of prescribed antidepressants in refugee youth and matched Swedish-born peers diagnosed with common mental disorder (CMD) and (2) characterize the trajectories according to sociodemographic and medical factors. METHODS The study population comprised 2,198 refugees and 12,199 Swedish-born individuals with both Swedish-born parents, aged 16-25 years in 2011, residing in Sweden and treated in specialised healthcare for CMD 2009-11. Group-based trajectory modelling was used to identify different trajectory groups of antidepressant use-based on annual defined daily dosages (DDDs). Multinomial logistic regression was applied to investigate the association of sociodemographic and medical characteristics with the identified trajectories. Nagelkerke pseudo-R2 values were estimated to evaluate the strength of these associations. RESULTS Four trajectory groups of antidepressant use among young refugees were identified with following proportions and DDD levels in 2011: 'low constant' (88%, < 100), 'low increasing' (2%, ≈710), 'medium decreasing' (8%, ≈170) and 'high increasing' (2%, ≈860). Similar trajectories, however, with different proportions were identified in Swedish-born: 67%, 7%, 21% and 5%, respectively. The most influential factors discriminating the trajectory groups among refugees were 'duration of stay in Sweden' (R2 = 0.013), comorbid 'other mental disorders' (R2 = 0.009) and 'disability pension' (R2 = 0.007), while 'disability pension' (R2 = 0.017), comorbid 'other mental disorders' (R2 = 0.008) and 'educational level' (R2 = 0.008) were the most important determinants discriminating trajectory groups among Swedish-born youth. CONCLUSION The lower use of antidepressants in refugees with CMDs compared to their Swedish-born counterparts warrants health literacy programs for refugees and training in transcultural psychiatry for healthcare professionals.
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Affiliation(s)
- S. Rahman
- Epidemiology of Psychiatric Conditions, Substance Use and Social Environment (EPICSS), Department of Global Public Health, Karolinska Institutet, SE-113 65Solnavägen 1E, Stockholm, Sweden ,Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - S. Filatova
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - L. Chen
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - E. Björkenstam
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - H. Taipale
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden ,Niuvanniemi Hospital, Kuopio, Finland
| | - E. Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Liu C, Butwick A, Sand A, Wikström AK, Snowden JM, Stephansson O. The association between postpartum hemorrhage and postpartum depression: A Swedish national register-based study. PLoS One 2021; 16:e0255938. [PMID: 34379698 PMCID: PMC8357098 DOI: 10.1371/journal.pone.0255938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 07/27/2021] [Indexed: 11/30/2022] Open
Abstract
Background Postpartum hemorrhage is an important cause of maternal death and morbidity. However, it is unclear whether women who experience postpartum hemorrhage are at an increased risk of postpartum depression. Objectives To examine whether postpartum hemorrhage is associated with postpartum depression. Methods We conducted a national register-based cohort study of 486,476 Swedish-born women who had a singleton livebirth between 2007 and 2014. We excluded women with pre-existing depression or who filled a prescription for an antidepressant before childbirth. We classified postpartum depression up to 12 months after giving birth by the presence of an International Classification of Diseases, version 10 (ICD-10) diagnosis code for depression or a filled outpatient prescription for an antidepressant. We used Cox proportional hazard models, adjusting for maternal sociodemographic and obstetric factors. Results Postpartum depression was identified in 2.0% (630/31,663) of women with postpartum hemorrhage and 1.9% (8601/455,059) of women without postpartum hemorrhage. In our unadjusted analysis, postpartum hemorrhage was not associated with postpartum depression (unadjusted hazard ratio (HR) = 1.06, 95% confidence interval (CI) 0.97–1.15). After adjusting for maternal age, parity, education, cohabitation status, maternal smoking status, and early pregnancy maternal BMI, gestational age, and birthweight, the association did not appreciably change, with confidence intervals overlapping the null (adjusted HR = 1.08, 95% CI 0.99, 1.17). Conclusions Within a population-based cohort of singleton women in Sweden with no prior history of depression, postpartum hemorrhage was not associated with postpartum depression.
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Affiliation(s)
- Can Liu
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- * E-mail:
| | - Alexander Butwick
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Anna Sand
- Department of Women’s Health, Karolinska University Hospital, Stockholm, Sweden
| | - Anna-Karin Wikström
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Jonathan M. Snowden
- School of Public Health, Oregon Health & Science University–Portland State University, Portland, Oregon, United States of America
| | - Olof Stephansson
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Women’s Health, Karolinska University Hospital, Stockholm, Sweden
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Helgesson M, Rahman S, Saboonchi F, Mittendorfer Rutz E. Disability pension and mortality in individuals with specific somatic and mental disorders: examining differences between refugees and Swedish-born individuals. J Epidemiol Community Health 2021; 75:721-728. [PMID: 33472869 PMCID: PMC8292560 DOI: 10.1136/jech-2019-213436] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 10/15/2020] [Accepted: 01/04/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND More than half a million refugees have arrived to Sweden during the last decade. The aim was to investigate differences between refugees and Swedish-born individuals regarding different specific somatic and mental disorders, and subsequent disability pension and mortality. METHODS All refugees (n=239 742) and Swedish-born individuals (n=4 133 898), aged 19-60 years, resident in Sweden on 31st of December in 2009 were included in this population-based prospective cohort study. Data from six nationwide Swedish registers were linked by the unique anonymised identification number. HRs with 95% CIs were computed for disability pension and mortality 2010-2013 by Cox regression models. RESULTS Compared with their Swedish-born counterparts with mental or somatic diagnoses, refugees with these diagnoses had a higher risk of subsequent disability pension and a lower risk of mortality. Highest estimates for disability pension were seen for refugees with neoplasm (HR: 1.72; 95% CI: 1.56 to 1.91), musculoskeletal disorders (HR: 1.57; 95% CI: 1.47 to 1.67), diseases of the circulatory system (HR: 1.33; 95% CI: 1.22 to 1.45), depressive disorders (HR: 1.31; 95% CI: 1.21 to 1.41) and diabetes mellitus (HR: 1.30; 95% CI: 1.15 to 1.47). The risk of mortality was lowest for refugees with regard to bipolar disorders (HR: 0.37; 95% CI: 0.16 to 0.82), post-traumatic stress disorder (HR: 0.37; 95% CI: 0.25 to 0.54) and least pronounced in regard to neoplasm (HR: 0.69; 95% CI: 0.61 to 0.77) compared with Swedish-born with similar disorders. CONCLUSION Refugees have a generally higher risk of disability pension compared with Swedish-born with specific somatic and mental disorders. Despite this, refugees with all specific disorders have lower risk estimates of mortality, probably due to a healthy selection. The higher risk of disability pension might therefore be due to other causes besides poor health.
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Affiliation(s)
- Magnus Helgesson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Syed Rahman
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Fredrik Saboonchi
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
- Department of Health Sciences, The Swedish Red Cross University, College, SE-102 15 Stockholm, Sweden
| | - Ellenor Mittendorfer Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
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Trajectories of antidepressant use before and after a suicide attempt among refugees and Swedish-born individuals: a cohort study. Int J Equity Health 2021; 20:131. [PMID: 34078375 PMCID: PMC8170815 DOI: 10.1186/s12939-021-01460-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/29/2021] [Indexed: 11/10/2022] Open
Abstract
Background To identify key information regarding potential treatment differences in refugees and the host population, we aimed to investigate patterns (trajectories) of antidepressant use during 3 years before and after a suicide attempt in refugees, compared with Swedish-born. Association of the identified trajectory groups with individual characteristics were also investigated. Methods All 20–64-years-old refugees and Swedish-born individuals having specialised healthcare for suicide attempt during 2009–2015 (n = 62,442, 5.6% refugees) were followed 3 years before and after the index attempt. Trajectories of annual defined daily doses (DDDs) of antidepressants were analysed using group-based trajectory models. Associations between the identified trajectory groups and different covariates were estimated by chi2-tests and multinomial logistic regression. Results Among the four identified trajectory groups, antidepressant use was constantly low (≤15 DDDs) for 64.9% of refugees. A ‘low increasing’ group comprised 5.9% of refugees (60–260 annual DDDs before and 510–685 DDDs after index attempt). Two other trajectory groups had constant use at medium (110–190 DDDs) and high (630–765 DDDs) levels (22.5 and 6.6% of refugees, respectively). Method of suicide attempt and any use of psychotropic drugs during the year before index attempt discriminated between refugees’ trajectory groups. The patterns and composition of the trajectory groups and their association, discriminated with different covariates, were fairly similar among refugees and Swedish-born, with the exception of previous hypnotic and sedative drug use being more important in refugees. Conclusions Despite previous reports on refugees being undertreated regarding psychiatric healthcare, no major differences in antidepressant treatment between refugees and Swedish-born suicide attempters were found. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-021-01460-z.
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