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Gubi E, Hollander AC, Bäärnhielm S. "I had no idea there were psychiatric clinics for children": A qualitative study of how migrant parents reach Swedish mental health services for their children. Transcult Psychiatry 2024:13634615241250203. [PMID: 38780532 DOI: 10.1177/13634615241250203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Migrant children have repeatedly been shown to underutilize psychiatric services and to face barriers to care, yet few studies have examined the experience of migrant parents who are successful in their help-seeking efforts for their children's mental health. The aim of this study was to gain a deeper understanding of facilitators and obstacles to reaching care among migrant parents in contact with child psychiatric services. We explored how migrant parents in Stockholm, Sweden, experienced the process of reaching child mental health services. Participants were recruited from out-patient mental health clinics. Ten in-depth interviews were conducted; qualitative analysis of transcripts was undertaken using thematic content analysis. Parents described a desire to reach services but difficulties doing so on their own. We identified a strong dependence on referring agents, such as schools and child health centers, for parents to gain contact. Informants expressed a high degree of trust toward these agents. Contrary to previous studies, stigma was not described as an obstacle to help-seeking but was recognized by informants as a potential barrier to care had they not emigrated. Although participants in our study had differing educational backgrounds and residency times in Sweden, a common experience of reliance on others for reaching services was evident in the data. Our findings highlight the role of referring agents as bridging contacts between different welfare services. Understanding the specific local resources and services that are available to migrant parents, and strengthening these across different sectors, could potentially help reduce barriers to care.
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Affiliation(s)
- Ester Gubi
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Sofie Bäärnhielm
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet (KI) and Transcultural Centre, Stockholm Health Care Services, Stockholm, Sweden
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Mattelin E, Söderlind N, Korhonen L. "You cannot just stop life for just that": a qualitative study on children's experiences on refugee journey to Sweden. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02387-w. [PMID: 38360923 DOI: 10.1007/s00787-024-02387-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 01/22/2024] [Indexed: 02/17/2024]
Abstract
Children with refugee backgrounds are often exposed to violence and other adverse experiences with well-known detrimental consequences on mental health. However, the current group of approximately 40 million child refugees is heterogeneous, stressing the importance of first-person perspectives in understanding children's unique experiences and needs related to the migration process. Identifying contextual factors promoting health and resilience is also essential. For instance, the roles children play as active agents in constructing their own lives and adapting to different environments are poorly described in contemporary research on child refugees and their mental health. To address these knowledge gaps, we conducted qualitative interviews with a reflexive thematic analysis with eighteen children with refugee backgrounds in Sweden. This resulted in two main themes: Longing for a good life that cannot be taken for granted and Challenged agency and changing rights. The narratives indicate that children, although exposed to different challenges in different migration phases and based on gender and asylum status, have experiences of ordinary childhood with a desire for a good life with prospects. The results also show that children execute active and adaptable agency that is impacted by various factors. Reaching the full age appears to be a confusing and ambivalent transition due to changes in rights. The results pinpoint several possibilities to address factors that pose a risk to health and restrictions of rights among child refugees.
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Affiliation(s)
- Erica Mattelin
- Barnafrid, Swedish National Center On Violence Against Children, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Center for Social and Affective Neuroscience and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Save the Children, Stockholm, Sweden
| | - Natalie Söderlind
- Barnafrid, Swedish National Center On Violence Against Children, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Laura Korhonen
- Barnafrid, Swedish National Center On Violence Against Children, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
- Center for Social and Affective Neuroscience and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
- Department of Child and Adolescent Psychiatry and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
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Demetry Y, Wasteson E, Lindegaard T, Abuleil A, Geranmayeh A, Andersson G, Shahnavaz S. Individually Tailored and Culturally Adapted Internet-Based Cognitive Behavioral Therapy for Arabic-Speaking Youths With Mental Health Problems in Sweden: Qualitative Feasibility Study. JMIR Form Res 2023; 7:e46253. [PMID: 37999955 DOI: 10.2196/46253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 08/28/2023] [Accepted: 09/21/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Most forcibly displaced refugees in Sweden originate from the Arab Republic of Syria and Iraq. Approximately half of all refugees are aged between 15 and 26 years. This particular group of youths is at a higher risk for developing various mental disorders. However, low use of mental health services across Europe has been reported. Previous research indicates that culturally adapted psychological interventions may be suitable for refugee youths. However, little is known about the feasibility, acceptability, and efficacy of such psychological interventions. OBJECTIVE This study aimed to explore the feasibility, acceptability, and preliminary efficacy of an individually tailored and culturally adapted internet-based cognitive behavioral therapy for Arabic-speaking refugees and immigrant youths in Sweden. METHODS A total of 17 participants were included to participate in an open trial study of an individually tailored and culturally adapted internet-based cognitive behavioral therapy targeting common mental health problems. To assess the intervention outcome, the Hopkins Symptom Checklist was used. To explore the acceptability of the intervention, in-depth interviews were conducted with 12 participants using thematic analysis. Feasibility was assessed by measuring treatment adherence and by calculating recruitment and retention rates. RESULTS The intervention had a high dropout rate and low feasibility. Quantitative analyses of the treatment efficacy were not possible because of the high dropout rate. The qualitative analysis resulted in 3 overarching categories: experiences with SahaUng (the treatment), attitudes toward psychological interventions, and personal factors important for adherence. CONCLUSIONS The findings from this study indicate that the feasibility and acceptability of the current intervention were low and, based on the qualitative analysis, could be increased by a refinement of recruitment strategies, further simplification of the treatment content, and modifications to the cultural adaptation.
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Affiliation(s)
- Youstina Demetry
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Elisabet Wasteson
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
| | - Tomas Lindegaard
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Amjad Abuleil
- Competence Team for migration health, Region Jämtland Härjedalen, Östersund, Sweden
| | - Anahita Geranmayeh
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Gerhard Andersson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Shervin Shahnavaz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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Moseholm E, Ameri S, Storgaard M, Pedersen G, Johansen IS, Katzenstein TL, Weis N. Psychiatric Diagnoses Among HIV-Exposed and HIV-Unexposed Uninfected Children: A Danish Nationwide Cohort Study. AIDS Patient Care STDS 2023; 37:469-479. [PMID: 37862077 DOI: 10.1089/apc.2023.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
This nationwide registry-based cohort study aimed to compare the risk of psychiatric diagnoses among HIV-exposed uninfected (HEU) children with a matched comparison group of HIV-unexposed uninfected (HUU) children, born in Denmark. We hypothesized that HEU children had an increased risk of psychiatric diagnoses and that this increased risk may differ by sex and age. All HEU children born in Denmark between year 2000 and 2020 were included. Each HEU child was matched by year of birth, maternal age at birth, and maternal immigration status to 10 HUU children. The primary outcome was risk of any psychiatric diagnosis (International Classification of Diseases, 10th Revision F00-F99). Incidence rate ratios (IRRs) were estimated using Poisson regression. Analyses stratifying by sex and age were also conducted. In total, 550 HEU children and 5500 HUU children were included. HEU children had an increased risk of any psychiatric disorder [IRR 1.45; 95% confidence interval (CI): 1.04-2.04] in the unadjusted analysis, but in the adjusted analysis, the risk was only significant for children aged 6-11 years [adjusted incidence rate ratio (aIRR) 1.93; 95% CI: 1.14-3.28]. Stratifying by sex, girls aged 6-11 years had an increased risk of any psychiatric disorder (aIRR 3.04; 95% CI: 1.27-7.28), while boys had an increased risk at age 12-20 years (aIRR 2.47; 95% CI: 1.18-5.17). In conclusion, HEU girls aged 6-11 years and HEU boys aged 12-20 years had an increased risk of any psychiatric disorder compared with HUU girls and boys, respectively. These findings highlight the importance of addressing the mental health needs of HEU children/adolescents.
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Affiliation(s)
- Ellen Moseholm
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sammy Ameri
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark
| | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark
| | - Gitte Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Isik S Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Terese L Katzenstein
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Nina Weis
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Manhica H, Yacamán-Méndez D, Sjöqvist H, Lundin A, Danielsson AK. Early substance use disorders and subsequent NEET-not in education, employment or training-a national cohort study. Eur J Public Health 2023; 33:633-639. [PMID: 37527830 PMCID: PMC10393475 DOI: 10.1093/eurpub/ckad105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Substance use problems have been associated with poor labour market outcomes. This study investigated whether substance use disorders (SUD) in emerging adulthood increase the likelihood of later being not in employment, education or training (NEET). METHODS A national cohort study of 23 5295 males and 227 792 females born between 1981 and 1987. SUD was assessed between ages 17 and 24 years. Logistic regression models were used to estimate the odds ratios (ORs) of NEET, between ages 25-34. Sibling-comparison analysis was performed to account for potential shared genetic and environmental factors. RESULTS Having been diagnosed with a SUD was associated with the likelihood of being NEET among males [OR = 1.37, 95% confidence interval (CI), 1.25-1.49] and females (1.19, 1.13-1.27) after adjusting for domicile, origin, psychiatric diagnosis and parental psychiatric diagnosis. Early SUD was also associated with a gradual increase in the ORs of accumulation of years being NEET. This was more evident among females. In the sibling-comparison analysis, we found a higher OR of NEET among same-sex sibling males 1.39 (1.06-1.82) and females 1.28 (0.99-1.66) with SUD. These risks were fully attenuated when another psychiatric diagnosis was adjusted for. CONCLUSION Early SUD was associated with an increased likelihood of being NEET in both males and females. Neither origin, domicile, psychiatric diagnoses nor parental psychiatric diagnoses did fully explain the association. The combination of unmeasured familial factors and having other psychiatric disorders largely explained these associations.
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Affiliation(s)
- Hélio Manhica
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Diego Yacamán-Méndez
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm, Sweden
| | - Hugo Sjöqvist
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Lundin
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm, Sweden
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Stewart SL, Dimos T, Poss JW. Treatment Seeking Children and Youth who have Experienced Warzone Trauma: Examining the Mental Health Care Planning Needs. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01570-5. [PMID: 37428420 DOI: 10.1007/s10578-023-01570-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2023] [Indexed: 07/11/2023]
Abstract
This study compares mental health treatment-seeking children and youth who have experienced warzone-related trauma to other treatment-seeking children and youth to determine similarities and differences and aid in care planning. Data from 53 agencies across Ontario from 2015-2022 were analysed, resulting in a sample of 25,843 individuals, 188 of which met the warzone and immigration criteria. Individuals who experienced warzone-related trauma were less likely to: (a) have a psychiatric diagnosis; (b) speak English, and; (c) have close friends. Collaborative Action Plans (CAPS) related to traumatic life events, parenting, and informal support were triggered at a higher rate for those who experienced warzone-related trauma compared to those who did not. This study highlights areas where children and youth who have experienced warzone-related trauma require improved access to services. Findings also highlight issues related to a needs-based approach to service delivery to facilitate improved outcomes for these vulnerable children and their families.
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Affiliation(s)
- Shannon L Stewart
- Faculty of Education, University of Western Ontario, London, ON, Canada
| | - Tatiana Dimos
- Faculty of Education, University of Western Ontario, London, ON, Canada.
| | - Jeffrey W Poss
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
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Chen J, Mittendorfer-Rutz E, Berg L, Nørredam M, Sijbrandij M, Klimek P. Association of common mental disorders and related multimorbidity with subsequent labor market marginalization among refugee and Swedish-born young adults. Front Public Health 2023; 11:1054261. [PMID: 37006549 PMCID: PMC10060531 DOI: 10.3389/fpubh.2023.1054261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 02/24/2023] [Indexed: 03/18/2023] Open
Abstract
BackgroundCommon mental disorders (CMDs), multimorbidity, and refugee status are associated with poor labor market outcome. Little is known about how these factors interact in young adults.ObjectiveWe aimed to i) investigate whether the association of CMDs and multimorbidity with labor market marginalization (LMM) differs between refugee and Swedish-born young adults and ii) identify diagnostic groups with particularly high risk for LMM.MethodsThis longitudinal registry-based study included individuals aged 20–25 years followed from 2012 to 2016 in Sweden (41,516 refugees and 207,729 age and sex-matched Swedish-born individuals). LMM was defined as granted disability pension (DP) or > 180 days of unemployment (UE). A disease co-occurrence network was constructed for all diagnostic groups from 2009 to 2011 to derive a personalized multimorbidity score for LMM. Multivariate logistic regression was used to estimate odds ratios of LMM in refugee and Swedish-born youth as a function of their multimorbidity score. The relative risk (RR, 95% CI) of LMM for refugees with CMDs compared to Swedish-born with CMDs was computed in each diagnostic group.ResultsIn total, 5.5% of refugees and 7.2% of Swedish-born with CMDs were granted DP; 22.2 and 9.4%, respectively received UE benefit during follow-up. While both CMDs and multimorbidity independently elevated the risk of DP considerably in Swedish-born, CMDs but not multimorbidity elevated the risk of UE. Regarding UE in refugees, multimorbidity with the presence of CMDs showed stronger estimates. Multimorbidity interacted with refugee status toward UE (p < 0.0001) and with CMDs toward DP (p = 0.0049). Two diagnostic groups that demonstrated particularly high RR of UE were schizophrenia, schizotypal and delusional disorders (RR [95% CI]: 3.46 [1.77, 6.75]), and behavioral syndromes (RR [95% CI]: 3.41 [1.90, 6.10]).ConclusionTo combat LMM, public health measures and intervention strategies need to be tailored to young adults based on their CMDs, multimorbidity, and refugee status.
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Affiliation(s)
- Jiaying 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, Stockholm, Sweden
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Lisa Berg
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Centre for Health Equity Studies, Karolinska Institutet, Stockholm University, Stockholm, Sweden
| | - Marie Nørredam
- Danish Research Centre for Migration, Ethnicity, and Health (MESU), Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Section of Immigrant Medicine, Department of Infectious Diseases, University Hospital Hvidovre, Copenhagen, Denmark
| | - Marit Sijbrandij
- Department of Clinical, Neuro-and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Peter Klimek
- Section for Science of Complex Systems, CeDAS, Medical University of Vienna, Vienna, Austria
- Complexity Science Hub Vienna, Vienna, Austria
- *Correspondence: Peter Klimek
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Zheng M, Chen F, Pan Y, Kong D, Renzaho AMN, Sahle BW, Mahumud RA, Ling L, Chen W. Trends and Impact Factors of Mental Health Service Utilization among Resettled Humanitarian Migrants in Australia: Findings from the BNLA Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10119. [PMID: 36011758 PMCID: PMC9408151 DOI: 10.3390/ijerph191610119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/14/2022] [Accepted: 08/14/2022] [Indexed: 06/15/2023]
Abstract
Resettled humanitarian migrants (HMs) have high levels of mental disorders, but factors associated with the utilization of mental health services (MHS) are poorly understood. We aimed to explore trends and impact factors of MHS utilization among HMs in the process of resettlement in Australia. A total of 2311 HMs from the 1st (2013), 3rd, and 5th (2018) waves of a national cohort study were included. MHS utilization in the past year was assessed by two indicators: having MHS contacts and the frequency of MHS contacts. Trends were identified by Cochran-Armitage tests, and generalized linear mixed models and ordered logistic models were fitted to explore impact factors of MHS utilization. The proportion of having MHS contacts significantly rose from 13.0% to 29.4% over the five years. MHS utilization was mainly driven by perceived needs, such as post-traumatic stress disorders and the degree of post-migration stress. Unemployment and strong belongingness to the local community were also associated with having MHS contacts. No significant gender difference was found in having MHS contacts but females tended to contact MHS more frequently. Resettled HMs have a persistent dilemma of high mental illness prevalence and MHS underutilization. Sustainable mental health education and long-term resettlement services targeted at social integration that consider gender difference are urgently needed in host countries.
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Affiliation(s)
- Meng Zheng
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Zhongshan Road 2, Guangzhou 510080, China
- Center for Migrant Health Policy, Sun Yat-sen University, Zhongshan Road 2, Guangzhou 510080, China
| | - Feng Chen
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Zhongshan Road 2, Guangzhou 510080, China
- Center for Migrant Health Policy, Sun Yat-sen University, Zhongshan Road 2, Guangzhou 510080, China
| | - Yan Pan
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Zhongshan Road 2, Guangzhou 510080, China
- Center for Migrant Health Policy, Sun Yat-sen University, Zhongshan Road 2, Guangzhou 510080, China
| | - Di Kong
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Zhongshan Road 2, Guangzhou 510080, China
- Center for Migrant Health Policy, Sun Yat-sen University, Zhongshan Road 2, Guangzhou 510080, China
| | - Andre M. N. Renzaho
- School of Medicine, Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2751, Australia
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC 3004, Australia
| | - Berhe W. Sahle
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Melbourne, VIC 3125, Australia
- Centre for Quality and Patient Safety Research, Alfred Health Partnership, Institute for Health Transformation, Melbourne, VIC 3125, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3125, Australia
| | - Rashidul Alam Mahumud
- NHMRC Clinical Trials Centre Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, QLD 4350, Australia
| | - Li Ling
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Zhongshan Road 2, Guangzhou 510080, China
- Center for Migrant Health Policy, Sun Yat-sen University, Zhongshan Road 2, Guangzhou 510080, China
| | - Wen Chen
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Zhongshan Road 2, Guangzhou 510080, China
- Center for Migrant Health Policy, Sun Yat-sen University, Zhongshan Road 2, Guangzhou 510080, China
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Are all children treated equally? Psychiatric care and treatment receipt among migrant, descendant and majority Swedish children: a register-based study. Epidemiol Psychiatr Sci 2022; 31:e20. [PMID: 35438074 PMCID: PMC9069577 DOI: 10.1017/s2045796022000142] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Underutilisation of mental health services among migrant youth has been demonstrated repeatedly, but little is known about potential discrepancies in terms of treatment receipt for those who do reach services. This study examines the type and level of care received among migrant children and descendants of migrants, particularly investigating disparities in treatment receipt given a specific diagnosis. METHODS We used register data of the total population aged 6-17 years in Stockholm, followed from 2006 to 2015, comprising 444 196 individuals, categorised as refugees, non-refugee migrants, descendants of migrants and Swedish-born. To identify recommended treatments for specific diagnoses we used official clinical guidelines. We report logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) of diagnosis receipt, treatment provision and level of care where a diagnosis was first registered. RESULTS Migrant children had a lower likelihood of receiving a wide range of psychiatric diagnoses, including mood disorder (OR 0.58; 95% CI 0.52-0.64), anxiety disorder (OR 0.62; 95% CI 0.57-69) and neurodevelopmental disorder (OR 0.59; 95% CI 0.55-0.63). Moreover, when these diagnoses were set, migrant children had a lower likelihood of receiving the recommended treatments for these conditions compared to the majority individuals with the same diagnosis (OR of receiving psychotherapy for anxiety disorder and depression: 0.71; 95% CI 0.62-0.95 and 0.50; 95% CI 0.33-0.75, respectively; OR for receiving ADHD-medication: 0.49; 95% CI 0.43-0.54). CONCLUSIONS Migrant children risk underdiagnosis of various mental health conditions, and, when reaching mental health services, risk not receiving the optimal care available.
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