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Wallace M, Hiam L, Aldridge R. Elevated mortality among the second-generation (children of migrants) in Europe: what is going wrong? A review. Br Med Bull 2023; 148:5-21. [PMID: 37933157 PMCID: PMC10724460 DOI: 10.1093/bmb/ldad027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/21/2023] [Accepted: 09/30/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION The 'second-generation' (i.e. the children of migrants) represent one of the fastest growing subpopulations of the child and young adult populations in Europe today. The research so far appears to indicate that their mortality risk is elevated relative to people with non-migrant backgrounds. SOURCES OF DATA Peer-reviewed publications. AREAS OF AGREEMENT Second-generation status is a clear marker of elevated mortality risk in Europe in early life (including stillbirth, perinatal, neonatal and infant mortality) and adulthood, particularly if the parent(s) were born outside of Europe. Socioeconomic inequality plays an important, albeit rarely defining, role in these elevated risks. AREAS OF CONTROVERSY It remains unclear what causes-of-death are driving these elevated mortality risks. The exact influence of (non-socioeconomic) explanatory factors (e.g. health care, racism & discrimination, and factors related to integration) on the elevated mortality risks of the second-generation also remains unclear. GROWING POINTS The second-generation will continue to grow and diversify in Europe; we must intervene to address these inequalities now. AREAS TIMELY FOR DEVELOPING RESEARCH Place more emphasis on the complexity of migration background, specific causes-of-death, and understanding the roles of explanatory factors beyond socioeconomic background.
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Affiliation(s)
- Matthew Wallace
- Sociology Department, Stockholm University, Frescativägen, Stockholm 114 19, Sweden
| | - Lucinda Hiam
- School of Geography and the Environment, Oxford University Centre for the Environment, University of Oxford, South Parks Road, Oxford, OX1 3QY, UK
| | - Robert Aldridge
- Institute of Health Informatics, University College London, 222 Euston Road London, NW1 2DA, UK
- The Institute for Health Metrics and Evaluation, Hans Rosling Center for Population Health, 3980 15th Ave NE, Seattle WA 98195, United States
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Oksuzyan A, Drefahl S, Caputo J, Aradhya S. Is it Better to Intermarry? Immigration Background of Married Couples and Suicide Risk Among Native-Born and Migrant Persons in Sweden. EUROPEAN JOURNAL OF POPULATION = REVUE EUROPEENNE DE DEMOGRAPHIE 2023; 39:8. [PMID: 36890348 PMCID: PMC9995640 DOI: 10.1007/s10680-023-09650-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 12/13/2022] [Indexed: 03/10/2023]
Abstract
Marriage is protective against suicide across most populations, including for persons of different ethnicities and immigrant backgrounds. However, the well-being benefits of marriage are contingent upon marital characteristics-such as conflict and quality-that may vary across spousal dyads with different immigration backgrounds. Leveraging Swedish register data, we compare suicide mortality among married persons on the basis of their and their spouse's immigration backgrounds. We find that relative to those in a native Swede-Swede union, Swedish men married to female immigrants and immigrant women married to native men are at higher risk of death by suicide, while immigrants of both genders who are married to someone from their birth country have a lower risk of suicide mortality. The findings support hypotheses about the strains that may be encountered by those who intermarry, as well as the potential selection of individuals into inter- and intra-ethnic marriages.
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Affiliation(s)
- Anna Oksuzyan
- Chair of Demography and Health, School of Public Health, Bielefeld University, 33615, Bielefeld, Germany.
- Max Planck Institute for Demographic Research, Rostock, Germany.
| | - Sven Drefahl
- Demography Unit, Institute of Sociology, Stockholm University, Stockholm, Sweden
| | - Jennifer Caputo
- Center for Health and the Social Sciences and Department of Sociology, University of Chicago, Chicago, USA
- Westat, Rockville, MD, USA
| | - Siddartha Aradhya
- Demography Unit, Institute of Sociology, Stockholm University, Stockholm, Sweden
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Abstract
OBJECTIVE In recent years, there has been an increase in immigrant populations worldwide. This study aims to present the global prevalence of suicide between immigrants and refugees as well as to report the prevalence of suicide ideation, suicide mortality, suicide attempts, and plan of suicide. METHOD Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA's) rules were used as a guide in the current research path. PubMed and EMBASE were targeted for the study until December 2019. After collecting the data, the number of events and sample size extracted for each study and also pooled odds ratio and confidence interval (CI) were used to investigate the suicide ratio among immigrants and refugees compared to the native population. RESULTS Fifty-one studies were included in the meta-analysis to investigate suicide prevalence or suicide odds ratio. The prevalence of suicidal ideation was 16% (CI: 0.12-0.20, I2 = 99.4%), for attempted suicide was 6% (CI: 0.05-0.08, I2 = 98.0%), and for suicide plan prevalence was 4% (CI: 0.00-0.08, I2 = 96.8%). The prevalence of suicidal ideation was 10% (CI: 0.04-0.17, I2 = 0.0%) in men and 17% (CI: 0.10-0.24, I2 = 96.8%) in women. The prevalence of attempted suicide was 1% (CI: 0.01-0.02, I2 = 0.0%) in men and 7% (CI: 0.03-0.10, I2 = 94.4%) in women. The odds ratio of suicide mortality among immigrants was 0.91 (CI: 0.90-0.93, p < 0.001; I2 = 97.6%) and for attempted suicide was 1.15 (CI: 1.10-1.20, p < 0.001; I2 = 92.0%). Begg's test (p = 0.933) (Egger test; p = 0.936) rejected publication bias. CONCLUSION Given the high prevalence of suicide, especially suicide ideation and suicide attempts in immigrants, increased attention needs to be paid to the mental health of this population.
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López-Cuadrado T, Hernández-Calle D, Martínez-Alés G. Trends in suicide mortality in Spain, 2000-2019: Moderation by foreign-born status. J Affect Disord 2022; 300:532-539. [PMID: 34998806 DOI: 10.1016/j.jad.2022.01.031] [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] [Received: 09/23/2021] [Revised: 12/31/2021] [Accepted: 01/04/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Suicide rates in Spain remained stable during the early 21st century. Suicide rates among specific socially vulnerable groups, however, remain unknown, and there are no data on suicide mortality rates and trends among migrants living in Spain. METHODS We analyzed Spain's 2000-2019 suicide mortality data by migration status (native- vs. foreign-born), examining crude and age-standardized rates and trends overall and by sex, age-group, suicide method, Spanish citizenship status, and country of origin, using joinpoint regression models. RESULTS Annual crude suicide mortality rates were higher among native- than foreign-born individuals (9.2 versus 6.2 por 100.000 inhabitants, respectively). While suicide rates decreased among native-born men and remained roughly stable among native-born women - with slight decreases among older native-born women, they increased after 2010 among foreign-born men aged 15-44 and ≥65 years and foreign-born women aged ≥65 years. Increases in suicide trends among foreign-born residents in Spain were largely driven by increases specific to individuals without Spanish citizenship. LIMITATIONS Suicide mortality data are subject to potential errors due to underreporting of suicide in death certificates CONCLUSIONS: Between 2010-2019, suicide in Spain increased only among foreign-born residents. These findings should enhance our understanding of the dynamics and potential actionable causes of suicide among migrants living in Spain.
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Affiliation(s)
| | | | - Gonzalo Martínez-Alés
- La Paz University Hospital, Madrid, Spain; Columbia University Mailman School of Public Health, New York, NY, USA; Network Center for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
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Næss EO, Mehlum L, Qin P. Marital status and suicide risk: Temporal effect of marital breakdown and contextual difference by socioeconomic status. SSM Popul Health 2021; 15:100853. [PMID: 34222610 PMCID: PMC8242039 DOI: 10.1016/j.ssmph.2021.100853] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/03/2021] [Accepted: 06/18/2021] [Indexed: 11/18/2022] Open
Abstract
Research has shown that people who have never been married, divorced, or widowed are at an increased risk of suicide compared with those who are married, but we have little knowledge as to how this elevated risk is modified by socioeconomic factors, and little research has studied the risk among persons enduring a marital separation. This study addressed these issues with individual-level data from Norwegian national registers. All suicide cases in people above 18 years that took place in the period 1992–2012 (n = 11 051) were compared with living controls (185 685) matched on sex and age via a nested case control design, and suicide risk associated with marital status was assessed with conditional logistic regression. The results showed that, compared with a status of being married, suicide risk was highly associated with a status of being never married, separated, divorced, or widowed, even after adjustment for income-level, educational attainment, centrality of residence, and immigration status. The strongest effect was seen for a separated status; compared to the married, separated persons were fully 6.06 times more apt to die by suicide, and the effect was strongest in the 30 days following a separation. The observed significant associations remained but differed in strength by sex and age, and there were significant deviations by personal socioeconomic status. Most notably, the increased risk was higher for never-married persons with low educational attainment or income. However, most interaction effects (10/16) did not yield significant results. In conclusion, suicide risk is strongly associated with a single status of any form with the highest risk during a marital separation, but the increased risk varies in strength according to individual-level factors. The stress and loss of support induced by marital dissolution are important contributing risk factors for suicide, and persons with low income may be especially vulnerable. Single status of any form was associated with increased risk of suicide. The risk was highest during the first month of a marital separation. A separated status had the strongest effect in middle-aged adults of both sexes. The risk for individuals who had never married differed by income and education.
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Affiliation(s)
- Erik Oftedahl Næss
- National Center for Suicide Research and Prevention, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Sognsvannsveien 21, N-0372, Oslo, Norway
| | - Lars Mehlum
- National Center for Suicide Research and Prevention, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Sognsvannsveien 21, N-0372, Oslo, Norway
| | - Ping Qin
- National Center for Suicide Research and Prevention, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Sognsvannsveien 21, N-0372, Oslo, Norway
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Abstract
BACKGROUND Literature shows that migrants-a generic definition for persons who leave their own country of origin-have increased psychopathological vulnerability. Between 2014 and 2017, 976 963 non-European Union (non-EU) people arrived in Italy, of which 30% for humanitarian reasons. This study is aimed at a better understanding of the experience of asylum seekers who transferred to Italy were subjected to the EU Dublin Regulation and most of them suspended in their asylum application. METHODS We elaborate a descriptive study based on a population of refugees and asylum seekers who have suffered from social and personal migratory stressful factors. Clinical data was collected between 2011 and 2013 at the "A. Gemelli" General Hospital IRCCS, Rome, Italy. Minors, elderly people, and patients who are unable to declare a voluntary consensus and economic migrants were excluded from the study. Candidates for the status of refugee or asylum seekers were included. RESULTS The sample consisted of 180 asylum seekers aged 25.52 ± 5.6 years. Most frequently diagnosis was post-traumatic stress disorder (PTSD) (53%), subthreshold PTSD was reported in 22% of subjects. We found phenomenological patterns highly representative of PTSD of the dissociative subtype. Around 20% of the sample suffered from psychotic symptomatology. CONCLUSIONS Loss of the migratory project and the alienation mediated by chronic social defeat paradigm may trigger a psychopathological condition described by the failure to cope with the negative emotional context of social exclusion and solitude. A common and integrated treatment project is needed, with the scope of reintegrating the migrant's personal and narrative identity.
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Amin R, Helgesson M, Runeson B, Tinghög P, Mehlum L, Qin P, Holmes EA, Mittendorfer-Rutz E. Suicide attempt and suicide in refugees in Sweden - a nationwide population-based cohort study. Psychol Med 2021; 51:254-263. [PMID: 31858922 PMCID: PMC7893509 DOI: 10.1017/s0033291719003167] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 08/16/2019] [Accepted: 10/16/2019] [Indexed: 11/05/2022]
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.
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Affiliation(s)
- Ridwanul Amin
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77Stockholm, Sweden
| | - Magnus Helgesson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77Stockholm, Sweden
| | - Bo Runeson
- Department of Clinical Neuroscience, Centre for Psychiatry Research, S.t Göran's Hospital, Karolinska Institutet, Stockholm County Council, SE-112 81Stockholm, Sweden
| | - Petter Tinghög
- Swedish Red Cross University College, Hälsovägen 11, SE-141 57Huddinge, Sweden
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, University of Oslo, Sognsvannsveien 21, NO-0374Oslo, Norway
| | - Ping Qin
- National Centre for Suicide Research and Prevention, University of Oslo, Sognsvannsveien 21, NO-0374Oslo, Norway
| | - Emily A. Holmes
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77Stockholm, Sweden
- Department of Psychology, Uppsala University, Von Kraemers allé 1A and 1C, SE-752 37Uppsala, Sweden
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77Stockholm, Sweden
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Lunde KB, Mehlum L, Melle I, Qin P. Deliberate self-harm and associated risk factors in young adults: the importance of education attainment and sick leave. Soc Psychiatry Psychiatr Epidemiol 2021; 56:153-164. [PMID: 32556378 PMCID: PMC7847451 DOI: 10.1007/s00127-020-01893-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/09/2020] [Indexed: 11/12/2022]
Abstract
PURPOSE The prevalence of deliberate self-harm (DSH) is high in young adults. However, few studies have examined risk in this specific age group. We, therefore, examined the relative influence and interactive nature of a wide range of potential sociodemographic and sick leave related risk factors in young adults, aged 18-35 years, using Norwegian register data. METHODS All subjects with at least one episode of hospital presentation for DSH registered in the Norwegian Patient Register during the period 2008-2013 were compared with age, gender and date matched population controls using a nested case-control design. The relative influence of factors and their interactions were assessed using conditional logistic regression and recursive partitioning models. RESULTS 9 873 study cases were compared to 186 092 controls. Socioeconomic status, marital status, sick leave and several demographic factors influenced risk for DSH. Specifically, low education (OR 7.44, 95% CI 6.82-8.12), current sick leave due to psychiatric disorders (OR 18.25, 95% CI 14.97-22.25) and being previously married (OR 3.83, 95% CI 3.37-4.36) showed the highest effect sizes. Importantly, there was an interaction between education and sick leave, where those with either low education and no sick leave (OR 13.33, 95% CI 11.66-15.23) or high education and sick leave (OR 18. 87, 95% CI 17.41-24.21) were the subgroups at highest risk. CONCLUSION DSH in young adults is associated with multiple sociodemographic and health disadvantages. Importantly, the two high-risk subgroups imply different pathways of risk and a need for differentiated preventative efforts.
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Affiliation(s)
- Ketil Berge Lunde
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Lars Mehlum
- grid.5510.10000 0004 1936 8921National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Melle
- grid.5510.10000 0004 1936 8921NORMENT, K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ping Qin
- grid.5510.10000 0004 1936 8921National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Ohm E, Holvik K, Kjøllesdal MKR, Madsen C. Health care utilisation for treatment of injuries among immigrants in Norway: a nationwide register linkage study. Inj Epidemiol 2020; 7:60. [PMID: 33190634 PMCID: PMC7667780 DOI: 10.1186/s40621-020-00286-7] [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: 07/08/2020] [Accepted: 10/01/2020] [Indexed: 11/25/2022] Open
Abstract
Background Previous research has generally found lower rates of injury incidence in immigrant populations than in native-born populations. Most of this literature relies on mortality statistics or hospital data, and we know less about injuries treated in primary health care. The aim of the present study was to assess use of primary and secondary care for treatment of injuries among immigrants in Norway according to geographic origin and type of injury. Methods We conducted a nationwide register-based cohort study of all individuals aged 25–64 years who resided in Norway as of January 1st 2008. This cohort was followed through 2014 by linking sociodemographic information and injury data from primary and secondary care. We grouped immigrants into six world regions of origin and identified immigrants from the ten most frequently represented countries of origin. Six categories of injury were defined: fractures, superficial injuries, open wounds, dislocations/sprains/strains, burns and poisoning. Poisson regression models were fitted to estimate incidence rate ratios separately for injuries treated in primary and secondary care according to immigrant status, geographic origin and type of injury, with adjustment for sex, age, county of residence, marital status and socioeconomic status. Results Immigrants had a 16% lower incidence of injury in primary care than non-immigrants (adjusted IRR = 0.84, 95% CI 0.83–0.84), and a 10% lower incidence of injury in secondary care (adjusted IRR = 0.90, 95% CI 0.90–0.91). Immigrants from Asia, Africa and European countries outside EU/EEA had lower rates than non-immigrants for injuries treated in both primary and secondary care. Rates were lower in immigrants for most injury types, and in particular for fractures and poisoning. For a subset of injuries treated in secondary care, we found that immigrants had lower rates than non-immigrants for treatment of self-harm, falls, sports injuries and home injuries, but higher rates for treatment of assault, traffic injuries and occupational injuries. Conclusions Health care utilisation for treatment of injuries in primary and secondary care in Norway was lower for immigrants compared to non-immigrants. Incidence rates were especially low for immigrants originating from Asia, Africa and European countries outside EU/EEA, and for treatment of fractures, poisoning, self-harm and sports injuries.
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Affiliation(s)
- Eyvind Ohm
- Norwegian Institute of Public Health, PO Box 222, Skøyen, 0213, Oslo, Norway.
| | - Kristin Holvik
- Norwegian Institute of Public Health, PO Box 222, Skøyen, 0213, Oslo, Norway
| | | | - Christian Madsen
- Norwegian Institute of Public Health, PO Box 222, Skøyen, 0213, Oslo, Norway
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Niederkrotenthaler T, Mittendorfer-Rutz E, Mehlum L, Qin P, Björkenstam E. Previous suicide attempt and subsequent risk of re-attempt and suicide: Are there differences in immigrant subgroups compared to Swedish-born individuals? J Affect Disord 2020; 265:263-271. [PMID: 32090750 DOI: 10.1016/j.jad.2020.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/18/2019] [Accepted: 01/03/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Studies investigating how suicide attempting refugees and non-refugee migrants differ from Swedish-born individuals in terms of re-attempts and suicide are missing. It remains unknown how mental disorders and labour market marginalization (LMM) impact on these associations. METHODS This longitudinal cohort study included Swedish residents aged 20-64 with suicide attempt in 2004-2012. In total, 42,684 individuals including 2017 refugees, and 2544 non-refugee migrants were included and followed until December 31, 2016. Risks of re-attempt and suicide were calculated as hazard ratios (HR) with 95% confidence intervals (CI), and adjusted for important confounders. Stratified analyses were to assess if mental disorders or LMM modified these associations. RESULTS In the adjusted models, refugees had an adjusted HR (aHR) of suicide re-attempt of 0.74 (CI: 0.67-0.81), and an aHR of 0.67 (CI: 0.53-0.86) for suicide death. These estimates were very similar to those of non-refugee migrants. Refugees and non-refugee migrants with suicide attempt had a lower prevalence of specialised health care due to mental disorders compared to Swedish-born attempters (48%, 44% and 61%, respectively). Mental disorders and LMM in terms of long-term sickness absence and disability pension increased the risk of re-attempt and suicide in all three groups. LIMITATIONS Only suicide attempts and mental disorders resulting in specialized in-and outpatient care were registered. CONCLUSION Migrants show considerably lower risks of re-attempt and suicide than Swedish-born individuals, with no differences between migrant groups. Despite vast differences in the prevalence of specific mental disorders, the role of mental disorders in the pathways to re-attempt and suicide does not appear to differ considerably between these groups.
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Affiliation(s)
- Thomas Niederkrotenthaler
- Unit Suicide Research & Mental Health Promotion, Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, A-1090 Vienna, Austria.
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, University of Oslo, Sognsvannsveien 21, NO-0374 Oslo, Norway
| | - Ping Qin
- National Centre for Suicide Research and Prevention, University of Oslo, Sognsvannsveien 21, NO-0374 Oslo, Norway
| | - Emma Björkenstam
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden; Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden; Department of Community Health Sciences, Fielding School of Public Health and California Center for Population Research, University of California Los Angeles, Los Angeles, California, United States
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Saunders NR, Chiu M, Lebenbaum M, Chen S, Kurdyak P, Guttmann A, Vigod S. Suicide and Self-Harm in Recent Immigrants in Ontario, Canada: A Population-Based Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:777-788. [PMID: 31234643 PMCID: PMC6882076 DOI: 10.1177/0706743719856851] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To estimate the rates of suicide and self-harm among recent immigrants and to determine which immigrant-specific risk factors are associated with these outcomes. METHODS Population-based cohort study using linked health administrative data sets (2003 to 2017) in Ontario, Canada which included adults ≥18 years, living in Ontario (N = 9,055,079). The main exposure was immigrant status (long-term resident vs. recent immigrant). Immigrant-specific exposures included visa class and country of origin. Outcome measures were death by suicide or emergency department visit for self-harm. Cox proportional hazards estimated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). RESULTS We included 590,289 recent immigrants and 8,464,790 long-term residents. Suicide rates were lower among immigrants (n = 130 suicides, 3.3/100,000) than long-term residents (n = 6,354 suicides, 11.8/100,000) with aHR 0.3, 95% CI, 0.2 to 0.3. Male-female ratios in suicide rates were attenuated in immigrants. Refugees had 2.1 (95% CI, 1.3 to 3.6; rate 6.1/100,000) and 2.8 (95% CI, 2.5 to 3.2) times the likelihood of suicide and self-harm, respectively, compared with nonrefugee immigrants. Self-harm rate was lower among immigrants (n = 2,256 events, 4.4/10,000) than long-term residents (n = 68,039 events, 9.7/10,000 person-years; aHR 0.3; 95% CI, 0.3 to 0.3). Unlike long-term residents, where low income was associated with high suicide rates, income was not associated with suicide among immigrants and there was an attenuated income gradient for self-harm. Country of origin-specific analyses showed wide ranges in suicide rates (1.4 to 9.9/100,000) and self-harm (1.8 to 14.9/10,000). CONCLUSION Recent immigrants have lower rates of suicide and self-harm and different sociodemographic predictors compared with long-term residents. Analysis of contextual factors including immigrant class, origin, and destination should be considered for all immigrant suicide risk assessment.
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Affiliation(s)
- Natasha Ruth Saunders
- The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada.,These authors contributed equally, acting as co-first authors
| | - Maria Chiu
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada.,These authors contributed equally, acting as co-first authors
| | - Michael Lebenbaum
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada
| | | | - Paul Kurdyak
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Astrid Guttmann
- The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada
| | - Simone Vigod
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
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Øien-Ødegaard C, Reneflot A, Hauge LJ. Use of primary healthcare services prior to suicide in Norway: a descriptive comparison of immigrants and the majority population. BMC Health Serv Res 2019; 19:508. [PMID: 31331323 PMCID: PMC6647119 DOI: 10.1186/s12913-019-4246-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 06/12/2019] [Indexed: 11/16/2022] Open
Abstract
Background There is an increase in studies investigating the use of healthcare services prior to suicide. Although studies generally report high usage, there are no previous studies comparing immigrants’ use of primary healthcare (PHC) prior to suicide with that of majority populations. There is a strong influx of immigrants in Europe, and thus a growing demand for filling this knowledge gap and exploiting unused potential for suicide prevention. Method By linking three national registers, we examine contact with PHC prior to suicide in all suicide cases in Norway from 2007 to 2014 among individuals aged 15 years and over (N = 4341). We report the percentage of individuals in personal contact within the last 6 months, 1 month and 1 week prior to suicide, and use the chi square-test for association. Results Overall, immigrants have less contact with PHC prior to suicide. We find significantly lower rates of contact among immigrants, both 6 months and 1 month prior to suicide, for both sexes. The trend is similar in the last week prior to suicide, but less pronounced. The largest variance in contact with PHC prior to suicide is amongst 30–44 year olds. Young, male immigrant suicide victims have the lowest rates of contact with PHC prior to suicide. Contact rates increase with age for all men and women in the majority population, but not for female immigrant suicide victims. Conclusions There is a clear difference in rates of contact with PHC prior to suicide between the majority and immigrant populations. The rates are especially low among young males, and measures should be made to lower their threshold for consulting PHC for young males in general and young male immigrants in particular. The difference in contact due to immigrant status appears to be of equal importance as the difference due to sex, although, with few significant results, a conclusion is hard to draw.
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Affiliation(s)
- Carine Øien-Ødegaard
- Division of mental and physical health, Norwegian Institute of Public Health, PO Box 222, Skøyen, N-0213, Oslo, Norway.
| | - Anne Reneflot
- Division of mental and physical health, Norwegian Institute of Public Health, PO Box 222, Skøyen, N-0213, Oslo, Norway
| | - Lars Johan Hauge
- Division of mental and physical health, Norwegian Institute of Public Health, PO Box 222, Skøyen, N-0213, Oslo, Norway
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13
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Erlangsen A, Qin P, Mittendorfer-Rutz E. Studies of Suicidal Behavior Using National Registers. CRISIS 2018; 39:153-158. [PMID: 29792362 DOI: 10.1027/0227-5910/a000552] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Annette Erlangsen
- 1 Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Hellerup, Denmark.,2 Department of Mental Health, John Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,3 Centre for Mental Health Research, Australian National University, Canberra, Australia
| | - Ping Qin
- 4 National Center for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway
| | - Ellenor Mittendorfer-Rutz
- 5 Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
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14
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Giammusso I, Casadei F, Catania N, Foddai E, Monti MC, Savoja G, Tosto C. Immigrants Psychopathology: Emerging Phenomena and Adaptation of Mental Health Care Setting by Native Language. Clin Pract Epidemiol Ment Health 2018; 14:312-322. [PMID: 30972131 PMCID: PMC6407656 DOI: 10.2174/1745017901814010312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/18/2018] [Accepted: 10/29/2018] [Indexed: 11/22/2022]
Abstract
Mental health of immigrants is an important social and clinical issue. Immigrants may report higher rates of mental disorders and lower levels of use of mental health service with respect to natives. The aim of the present work is to review recent findings of the psychopathology of immigrants and analyze how to adapt the mental care settings through the use of mother tongues. We searched the literature to individuate and review the most recent scientific articles focused on the psychopathology of immigrants realized in Europe. Moreover, we summarized the guidelines about immigrants mental health care and we focused on the barriers caused by language. We individuated 15 papers reporting data about mental disorders among immigrants and the related risk and protective factors. The articles reported information about psychosis, depression, anxiety, post-traumatic stress disorder, somatization and suicide rates. Risk and protective factors are individuated mainly among social factors (e.g. ethnic density effect, hosting countries' policies). Furthermore, immigrants encounter language barriers in the use of mental care services. The realization of cross-cultural training and the development of a working alliance between clinicians and interpreters resulted to be effective solutions even if these interventions are not frequently implemented. The extent of migratory flows and the related difficulties experienced by immigrants require attention and well-informed interventions. The high rates of incidence of mental disorder and the strict number of services who implement interventions taking into accounts fundamental aspect as language show that there is still a lot to do.
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Affiliation(s)
- Isabella Giammusso
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy.,Associazione PLP, Psicologi Liberi Professionisti, Via Pasteur, 65, 00144, Rome, Italy
| | - Filippo Casadei
- Associazione PLP, Psicologi Liberi Professionisti, Via Pasteur, 65, 00144, Rome, Italy
| | - Nicolay Catania
- Associazione PLP, Psicologi Liberi Professionisti, Via Pasteur, 65, 00144, Rome, Italy
| | - Elena Foddai
- Associazione PLP, Psicologi Liberi Professionisti, Via Pasteur, 65, 00144, Rome, Italy
| | - Maria Chiara Monti
- Associazione PLP, Psicologi Liberi Professionisti, Via Pasteur, 65, 00144, Rome, Italy
| | - Giorgia Savoja
- Associazione PLP, Psicologi Liberi Professionisti, Via Pasteur, 65, 00144, Rome, Italy
| | - Crispino Tosto
- Istituto per le Tecnologie Didattiche, Consiglio Nazionale delle Ricerche, Palermo, Italy
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15
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Puzo Q, Mehlum L, Qin P. Rates and characteristics of suicide by immigration background in Norway. PLoS One 2018; 13:e0205035. [PMID: 30265720 PMCID: PMC6161913 DOI: 10.1371/journal.pone.0205035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/18/2018] [Indexed: 11/30/2022] Open
Abstract
Suicide mortality among immigrant groups is an important health issue, particularly in countries with growing segments of immigrant populations such as Norway. Through linkage of Norwegian national registers we wanted to estimate suicide rates (per 100,000 population) in immigrant groups and to profile characteristics of suicide by immigration background with respect to sex, age, method and seasonality of suicide as well as time since immigrating to Norway. Among all 11,409 suicides during 1992-2012, 1,139 (10%) were individuals with an immigration background. Suicide rate was lower in first-generation immigrants (foreign-born persons to two foreign-born parents) than native Norwegians (9.53 vs 12.22, P < 0.01), with a significant difference confined to male rates only. Foreign-born persons with at least one Norwegian-born parent had significantly higher suicide rates than natives in both sexes (22.42 vs 18.03 in males, 11.67 vs 6.54 in females, P < 0.01). The most frequently used suicide method in all the population groups was hanging; this method accounted for 44.0% of all suicides of first-generation immigrants, 45.2% of all suicides of foreign-born persons with at least one Norwegian-born parent, and 35.4% of all suicides of natives. Suicide by firearms accounted for a much smaller proportion of cases of first-generation immigrants (6.7%) and foreign-born persons with at least one Norwegian-born parent (6.8%) than cases of native Norwegians (20.7%). In terms of monthly distribution, suicides of first-generation immigrants displayed two peaks, in May and in November (P = 0.01). More than 25% of all first-generation immigrant suicides occurred in the first five years after immigration; but differences in time since immigration were observed by sex and country group of origin, in particular among those aged 35 years or less when moving to Norway. In conclusion, there are notable differences in characteristics of suicides by immigration background. Knowledge of immigrant mortality according to suicide method, seasonality of suicide, and time since immigration may be useful when planning suicide preventive measures.
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Affiliation(s)
- Quirino Puzo
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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16
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Puzo Q, Mehlum L, Qin P. Socio-economic status and risk for suicide by immigration background in Norway: A register-based national study. J Psychiatr Res 2018; 100:99-106. [PMID: 29501935 DOI: 10.1016/j.jpsychires.2018.02.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 02/19/2018] [Accepted: 02/22/2018] [Indexed: 10/18/2022]
Abstract
The relative importance of socio-economic factors on risk for suicide in the immigrant population may differ from that for the native population; however, few studies have addressed this issue on a national basis. With a nested case-control design and data from Norwegian population registers we identified 11,409 suicide cases in the years 1992-2012 and 191,785 sex-birthdate-matched controls. The influence of socio-economic factors on the risk for completed suicide was assessed through conditional logistic regression. Among 11,409 suicides, 1139 (10%) were individuals with an immigration background of either themselves or their parent(s). Suicide cases, as well as the controls, with an immigration background differed in several aspects of their socio-economic status from those without such a background. Being single or separated, divorced or widowed, was, however, associated with an increased risk of suicide regardless to the subjects' immigration background. Low level of education and low annual income significantly increased the risk for suicide in almost all the study subgroups. Living in the capital area was associated with a reduced risk of suicide in first-generation immigrants but an increased risk in native Norwegians. In conclusion, persons with an immigration background, as well as native Norwegians, shared most common risk factors for suicide, but the strength of associations between socio-economic factors and risk for suicide can differ by immigration background.
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Affiliation(s)
- Quirino Puzo
- National Centre for Suicide Research and Prevention, Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Sognsvannsveien 21, N-0372, Oslo, Norway.
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Sognsvannsveien 21, N-0372, Oslo, Norway.
| | - Ping Qin
- National Centre for Suicide Research and Prevention, Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Sognsvannsveien 21, N-0372, Oslo, Norway.
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