Assessment of Suicide Risk and Cultural Considerations in Forcibly Displaced Migrant Youth

Migrant youth who face forced displacement from their home countries have an emergent mental health burden, placing them at increased suicide risk. As such, it is crucial for pediatric providers to include suicide screening and assessment in their care for this population. Migrant families seek safety but, in many cases, encounter adverse events and psychosocial inequities in the migration journey and in the host community. Factors such as trauma, acculturative stress, and intersectionality influence suicide risk in migrants. Summative traumatic events contribute to the mental health load and worsen suicidal outcomes in migrant youth. Acculturative stress can lead to social marginalization in the host country, further adding to the existing mental health burden. Finally, intersectionality encompasses complex sociocultural influences, which shape the development of cultural identity in migrant youth and influence suicide risk. By examining these factors, the author advances cultural considerations in screening and assessment for suicide risk in migrant youth through evidence-based tools in pediatric clinical practice. Barriers to access to mental health services, stigma, and distrust of the health care system within the host community are also addressed. The author establishes recommendations for early suicide screening and prevention within this population through trauma-informed care, active advocacy, and cultural sensitivity.

Meta-Analysis of Acculturation and Suicide-Related Outcomes: A Test of the Immigrant Paradox

OBJECTIVE

This meta-analysis aimed to systematically test the relation between acculturation and suicide-related outcomes among immigrants, with attention to key methodological (i.e., measure of suicide-related outcome, measure of acculturation) and demographic (i.e., race, gender, age, geographic region, publication year) moderators.

METHOD

We conducted a meta-analysis of 72 independent samples from 50 studies (38 peer-reviewed articles, 12 dissertations) representing more than 1.4 million immigrants. Participants' age ranged from 11.20 to 74.70 years (M = 29.96, SD = 15.07). Random effects models were used for both main and moderation analyses.

RESULTS

We found significant positive associations between acculturation and suicidal ideation, but not suicide attempts and deaths. We also found a significant and positive effect of acculturation on suicide-related outcomes when acculturation was measured by psychological scales, but not by generation status, length of residence in the host country, and proficiency in the host country's language. More acculturated Latinx immigrants were at higher risk for suicide-related outcomes, whereas a reverse pattern was found among Asian immigrants. Meta-regressions revealed that the moderating effects of participants' age and publication year were also significant.

CONCLUSION

Our results show partial support for the immigrant paradox but suggest that the relation between acculturation and suicide-related outcomes is complex and multifaceted. We discuss the implications of our findings and recommendations for research and prevention.

Children's bullying victimization and maternal suicidal ideation among multicultural families in South Korea: Heterogeneity by family socioeconomic status

RATIONALE

Children from multicultural families in Korea are vulnerable to bullying victimization. Despite growing evidence on the mental health consequences of bullying victimization for victims, little is known about the spillover effects on their immigrant mothers.

OBJECTIVE

This study examined the association between children's bullying victimization and their immigrant mothers' suicidal ideation. The potential moderating role of family socioeconomic status was also investigated.

METHODS

Using nine waves of the Multicultural Adolescents Panel Study spanning from 2011 to 2019 (N = 1466), this study estimated individual fixed effects models to control for unobserved individual-level heterogeneity. Interaction models were used to investigate potential heterogeneity by family socioeconomic status, including maternal education, household income, and maternal occupational status.

RESULTS

Fixed effects estimates revealed that children's bullying victimization is associated with an increased likelihood of suicidal ideation among marriage migrant mothers (b = 0.012, p < 0.05), even after controlling for unobserved time-invariant confounders as well as a set of time-varying covariates. Family socioeconomic status moderated this association. The association between children's bullying victimization and immigrant mothers' suicidal ideation was stronger for those with low levels of education and household income. No such moderating effects were observed for maternal occupation.

CONCLUSIONS

The findings of this study suggest that efforts to address the mental health consequences of bullying victimization among multicultural family children should extend beyond the victim to their immigrant mothers. When developing interventions to reduce suicidal ideation among immigrant mothers whose children have been victimized, policymakers may wish to consider the moderating role of family socioeconomic status.

Suicide in first-generation Australian migrants, 2006-2019: a retrospective mortality study

Background

This study addressed the limited understanding of suicide risk and patterns among migrants in Australia. It examined national-level suicide rates and trends in the Australian population to identify migrant groups which are disproportionately affected by suicide.

Methods

The National Coronial Information System was used to identify suicide cases from 2006 to 2019. Incident rate ratios (IRR) with 95% confidence intervals (CI) evaluated suicide risk for migrant groups compared to Australian-born and migrants from English-speaking countries. Age-standardised suicide rates (ASR) per 100,000 and average annual percentage change (AAPC) were calculated to compare suicide rates and trends.

Findings

Compared to the Australian-born population, all migrant males and females had significantly lower suicide risk, except females from Oceania countries. Females from European (IRR 1.28, 95% CI 1.13, 1.14) and Oceanian countries (IRR 1.25; 95% CI 0.95, 1.66) had an elevated suicide risk compared to female migrants from English-speaking countries. Male migrants from Oceania (ASR 20.4, AAPC 1.0 (-3.6, 5.8)) and Africa (ASR 18.0, AAPC -0.4 (-5.5, 4.9)) have high ASR with no significant changes in trend over the study duration. Female African migrants had an ASR of 5.3 per 100,000, which increased by 8% (95% CI 1.4, 15.0) between 2006 and 2019.

Interpretation

Migrants from Oceania and African countries are disproportionately affected by suicide mortality compared to other migrant groups in Australia. Further research is needed to identify the risk factors and develop suicide prevention strategies for these groups.

Funding

Suicide Prevention Australia, Australian Research Council.

Double stigma in mental health service use: Experience from ethnic minorities in Hong Kong

BACKGROUND

Ethnic minorities (EMs) typically underutilise mental health services (EMs) with issues that are not shared by the local population. Understanding the underlying perceived factors could help reduce their mental health disparities.

AIMS

This is a qualitative study aiming to examine the barriers that prevent EMs from seeking mental health services in Hong Kong.

METHODS

Six semistructured focus groups with 31 EMs who resided in Hong Kong were conducted from May 31 to June 26, 2021. The outcome measures were the themes and subthemes of perspectives on mental health service use.

RESULTS

Among 31 adults (20 [64.5%] women, 11 [35.5%] men; 17 [54.8%] aged 25-39 years) who participated, most participants self-identified as Indian (13 [41.95]) or Pakistani (10 [32.3]). There were 16 individuals (51.6%) who reported severe or higher levels of anxiety or depressive symptoms, while 12 individuals (38.7%) reported moderate levels. Three emerging themes identified for the barriers to help-seeking for psychiatric intervention were (1) preexisting problems, (2) psychaitric service lacks cultural sensitivity and (3) personal or family limitation, while that for the recommendations to improve help-seeking had six themes: (1) improve cultural sensitivity, (2) make EM mental health practitioners available, (3) improve professional conduct, (4) improve on-site support, (5) improve financial support and (6) improve mental health promotion in schools.

CONCLUSION

This study found that EMs in Hong Kong experience double stigma, which keeps them away from seeking professional mental health care. There were also disparities in the use of mental health services by ethnicity. The study also made recommendations for promoting EM help-seeking at the individual, governmental and community levels.

Patterns of Suicide and Suicidal Ideation in Relation to Social Isolation and Loneliness in Newcomer Populations: A Review

The purpose of this systematic review was to locate and synthesise existing peer-reviewed quantitative and qualitative evidence regarding the relationship between social connection and suicide among newcomers, immigrants, and asylum seekers. Systematic searches were conducted according to PRISMA guidelines using Web of Science and Pubmed. Search terms included those related to (1) social isolation and loneliness, (2) suicide and suicidal ideation, and (3) newcomer, immigrant, and asylum-seeking populations. Inclusion was limited to studies that were published in English and conducted between January 2001 and July 2021 in core anglosphere countries (Canada, United States, Australia, United Kingdom, Scotland, Wales, and Ireland). All potentially eligible articles were screened at two stages: First, we reviewed title and abstracts to omit obviously irrelevant studies and second, we reviewed the full text of each candidate article. Our initial search yielded 136 results. A total of 108 unique results were included for screening; 12 of which were eligible for inclusion in this review. Studies were categorized into 2 themes based on the methodologies of the articles found: qualitative perspectives of immigrants and newcomers; quantitative assessment of the risk of suicide burden and impact of social support and engagement on health and wellbeing of newcomers. Both types of studies highlight a social (dis)connection as an important determinant of mental health and suicide risk among immigrant populations in core anglo-sphere countries, highlighting the continued importance of community programs and funding to support inclusion and community-development among newcomer, immigrant, and asylum-seeking populations.

Depression, Alcohol Misuse, and Suicide Attempt Among North Korean Refugee Women Exposed to Gender-Based Violence

North Korean (NK) refugee women report a disproportionately high rate of suicide compared to the general South Korean (SK) population. NK refugee women's exposure to gender-based violence (GBV) is a risk factor for adverse mental health symptoms. However, the association between GBV exposure and mental health has received less scholarly attention. This study examined NK refugee women's exposure to GBV (i.e., sexual violence, human trafficking, and forced sex work) and explored whether it is associated with an increased risk of depression, alcohol misuse, and suicide attempts. A three-way interaction between depression, alcohol misuse, and suicide attempts among GBV-exposed NK refugee women was examined. Data from a snowball sample of 180NK refugee women were analyzed for this study. Findings show that 47.8% experienced GBV in either NK or intermediary countries. Multivariate analyses revealed that depression (OR = 1.13, p < .05) and alcohol misuse (OR = 3.01, p < .01) was significantly associated with suicide attempts in GBV-exposed groups. Results from the three-way interaction (GBV victimization × Depression × Alcohol misuse) suggest that GBV exposure and higher levels of depression were significantly associated with suicide attempts among NK refugee women with greater severity of alcohol misuse (OR = 1.75, p < .05). The findings indicate that NK refugee women with GBV exposure, depression, and alcohol misuse are at increased risk for suicide attempts. Study limitations included the use of snowball sampling and cross-sectional data. This study discusses implications for future research and targeted, trauma-informed treatments focused on GBV and mental health symptoms among NK refugee women.

The Impact of Religion and Spirituality on Suicide Risk in Veterans and Refugees With Posttraumatic Stress Disorder

ABSTRACT

It has been suggested that religion and spirituality have a protective impact on suicide risk in populations living with posttraumatic stress disorder (PTSD). This review sought to examine the association between suicide risk among veterans and refugees with PTSD and religion or spirituality as a modifying factor. Two databases, PubMed and Embase, were searched and 10 publications were identified and included. Seven publications found that religion or spirituality was associated with lower suicide risk. The findings in this study suggest that religion and spirituality contain social as well as psychological domains, which should be considered in future interventions and in strategies of prevention of suicide in populations with PTSD. Further high-quality research with well-defined terms of religion and spirituality that investigates the connection to suicide risk of veterans and refugees with PTSD is recommended.

Suicidal Behaviour, including Ideation and Self-Harm, in Young Migrants: A Systematic Review

Young people experience high rates of suicidal ideation, self-harm, suicide attempt and death due to suicide. As a result of increasing globalisation, young people are increasingly mobile and can migrate from one country to another seeking educational and employment opportunities. With a growing number of young migrants, it is important to understand the prevalence of suicidal behaviour among this population group. We systematically searched Medline, Embase, and PsycINFO from inception until 31 March 2022. Eligible studies were those providing data on suicidal ideation, self-harm, suicide attempt, and death due to suicide. Seventeen studies were included in the review, some of which provided data on multiple outcomes of interest. Twelve studies provided data on suicidal ideation, five provided data on self-harm, eight provided data on suicide attempt, and one study had data on suicide death among young migrants. The quality of the included studies was varied and limited. The studies included in this review commonly reported that young migrants experience higher rates of self-harm and suicide attempt, but no major differences in suicidal ideation and suicide death compared to non-migrant young people. However, the limited number of studies focused on suicidal behaviour among young migrants highlights the need for further high-quality studies to capture accurate information. This will enable the development of policies and interventions that reduce the risk of suicidal behaviour among young migrants.

Prevalence of suicidal ideation and suicide attempts among refugees: a meta-analysis

BACKGROUND

Suicidal ideation and attempts are one of the most serious mental health problems affecting refugees. Risk factors such as mental disorders, low socio-economic status, and stressful life events all contribute to making refugees a high-risk group. For this reason, this meta-analysis aims to investigate the prevalence of suicidal ideation and attempts among refugees in non-clinical populations.

METHOD

We searched PubMed, Web of Science, PubPsych, and PsycInfo for articles reporting (period) prevalence rates of suicidal ideation and attempts. Inclusion criteria were the population of refugees or asylum seekers (aged 16 years and older), assessment of the prevalence of suicidal ideation and attempts in empirical studies in cross-sectional or longitudinal settings, written in English, and published by August 2020. Exclusion criteria were defined as a population of immigrants who have lived in the host country for a long time, studies that examined children and adolescents younger than 16 years, and research in clinical samples. Overall prevalence rates were calculated using Rstudio.

RESULTS

Of 294 matches, 11 publications met the inclusion criteria. The overall period prevalence of suicidal ideation was 20.5% (CI: 0.11-0.32, I2 = 98%, n = 8), 22.3% (CI: 0.10-0.38, I2 = 97%, n = 5) for women, and 27.7% for men (CI: 0.14-0.45, I2 = 93%, n = 3). Suicide attempts had an overall prevalence of 0.57% (CI: 0.00-0.02, I2 = 81%, n = 4).

CONCLUSION

There is a great lack of epidemiological studies on suicidal ideation and attempts among refugees. The high prevalence of suicidal ideation indicates the existence of heavy psychological burden among this population. The prevalence of suicide attempts is similar to that in non-refugee populations. Because of the large heterogeneity between studies, the pooled prevalence estimates must be interpreted with caution. The results underline the need for systematic and standardized assessment and treatment of suicidal ideation and attempts.

An age-period-cohort study of completed suicides in Greece: Patterns and implications for suicide prevention

Suicide is a dynamic phenomenon. Psychiatric medication intake, illicit drug and alcohol use or the preference for particular suicide methods shift continuously over time. To capture such variations -and their potential implications for suicide prevention-, we researched the forensic records of suicide cases for the period 1992-2016 at a large department of forensic medicine and conducted age-period-cohort (APC) analyses of our sample (1162 suicides, 77.45% males, 22.25% females). We primarily investigated socio-demographic and toxicological parameters. Benzodiazepine, alcohol and illicit drug use increased considerably towards the younger cohorts. The segment of individuals of foreign nationality raised significantly too; likewise, the proportion of prison suicides. Hanging appears increasingly preferred by the younger APCs (the opposite is true for jumping). Hanging seems more popular among males, prisoners, and those under the influence of illicit drugs; jumping by females and those less likely to have consumed alcohol or illicit drugs. Given that the method of a prior attempt, if a highly lethal one, usually gets repeated in the completed suicide, a history of an attempt by hanging should never be underestimated. The mental health needs of immigrants and prisoners look inadequately addressed. Young-middle aged immigrant prisoners appear a group at high suicide risk.

Suicidal Ideation and Attempt among North Korean Refugee Women in South Korea: Factors that Distinguish Suicide Attempt from Suicidal Ideation

BACKGROUND

North Korean Refugee Women (NKRW) are at a high risk for suicide. However, few studies have examined risk factors for suicide among NKRW in South Korea. This study aimed to examine factors increasing risk for suicidal ideation and to identify factors differentiating suicide attempt from ideation among NKRW in South Korea.

METHODS

A sample of 140 NKRW was analyzed; multinomial logistic regression was conducted to identify factors distinguishing respondents with (1) no suicidal ideation, (2) isolated suicidal ideation (without attempts), and (3) ideation with attempts.

RESULTS

About 46% of the sample reported suicidal ideation, and about 18% attempted suicide during the past year. NKRW without any suicidal risk had significantly lower levels of social isolation (OR = 0.86, p = 0.02) and less exposure to traumatic events (OR = 0.89, p = 0.02) than those with suicidal ideation. NKRW who attempted suicide were more likely to have higher levels of stress than those with only suicidal ideation (OR = 1.40, p = 0.03).

CONCLUSION

This study provides insights into suicide prevention among refugees and emphasized that post-migration life stress significantly differentiates suicidal ideation from attempt among NKRW. Intervening to address current life stress, traumatic experiences, and social isolation may help prevent refugee suicidal ideation and further attempt.

Academic Achievement and Psychosocial Adjustment in Child Refugees: A Systematic Review

Child refugees are at high risk for problems with academic achievement and psychosocial well-being. We aimed to review the literature concerning these outcomes in primary school-aged child refugees. This study was a systematic review and included studies that reported on outcomes of interest in child refugees between 5 and 12 years of age. Our search generated 3,172 articles; we selected 313 for review and included 45. Child refugees are diverse in their educational performance, and early deficits often resolve with time spent in the host country. These children are at an increased risk of emotional and behavioral difficulties, and multiple factors are associated with these outcomes. Although educational difficulties of primary school-aged child refugees in high-income countries tend to resolve, the risks for psychosocial problems persist. This review provides a deepened understanding of the diverse educational and psychosocial experiences of these children and highlights the need for developing health and educational programs to support this population.

Negotiating Identity and Belonging in a New Space: Opportunities and Experiences of African Youths in South Australia

This paper was part of a large study that aimed to explore determinants of increased suicides among African youths in South Australia. As part of this larger study, narratives from participants indicated that identity crisis could be a potential determinant of suicide. This paper reports on how African youths negotiate and form identity in Australia. A qualitative inquiry was undertaken with 31 African youths using a focus group and individual interviews. Data analysis was guided by a framework for qualitative research. These youths negotiated multiple identities, including those of race, gender, ethnicity and their origin. ‘Freedom and opportunity’, ‘family relationships’, ‘neither belonging here nor there’ and ‘the ability to cope against the paradox of resourcefulness in Australia’ appeared to be important themes in negotiating individual identities. An opportunity was used to acknowledge privileges available in Australia relative to Africa. However, the extent to which individuals acted on these opportunities varied, affecting a person’s sense of purpose, identity formation and belonging in Australia. The loss of social networks following migration, and cultural differences between African and Australian societies, shaped the experience of belonging and identity formation. These findings are crucial as they indicate the need for policies and practices that consider experiences of youths as they form their identity in Australia. Further studies with large numbers of participants are needed to explore these issues further among African youths in Australia.

Rates and characteristics of suicide by immigration background in Norway

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.

[Suicidal thoughts and suicide attempts in adolescence among migrants]

Migration is an experience with a creative and dynamic potential, but it can also serve to further isolate people. Migrant adolescents and ethnic minorities with a migrant background are particularly vulnerable to suicidal ideation and suicidal behaviour. International studies show a significant prevalence of suicide attempts among migrants and their children. Intergenerational conflicts and the family environment, for example poor communication and lack of parental support, are risk factors for suicidal behaviour in migrant adolescents. The valorisation of the culture of origin could contribute to the feeling of 'cultural continuity' which is a protective factor of the suicidal risk.

Challenges of Combining Perspectives

Abstract.Background: Asylum seekers have increased risk of suicide and suicidal behavior, with differences related to origin, gender, and age. There are barriers to communication in clinical encounters between asylum seekers and clinicians. There is insufficient knowledge about how communication in the clinical encounter affects the suicide risk in female asylum seekers. Aims: To explore the documented communication between female asylum-seeking suicide attempters and clinicians and how it affects treatment. Method: The medical records of 18 asylum-seeking women who had attempted suicide were analyzed with content analysis. Results: Communication between patients and clinicians was affected by: the unbearable realities of the women; difficulties for clinicians in decoding languages of distress, and understanding trauma and subjective meanings of suicide; challenges of combining patients' and clinicians' perspectives; and a sense of shared powerlessness. Limitations: The medical records did not give direct access to the patient's experience, only to the patient as documented by the clinician. Conclusion: The results suggest that clinicians working with asylum seekers who have attempted suicide need to develop an understanding of social and cultural factors and of trauma issues. A question for further study is how an enhanced integration of context and subjectivity in psychiatric practice would equip clinicians for the specific challenges encountered.

ISSOP position statement on migrant child health

Greater numbers of children are on the move than ever before. In 2015, the number of forcibly displaced people across the globe reached 65.3 million. Of the more than 1 million migrants, asylum seekers, and refugees who arrived in Europe in 2015, nearly one third were children, and 90,000 of these children were unaccompanied. Child migrants are among the most vulnerable, even after arriving at their destination. The health of migrant children is related to their health status before their journey, the conditions during their journey and at their destination, and the physical and mental health of their caregivers. These children may have experienced numerous forms of trauma including war, violence, separation from family, and exploitation. They may suffer from malnutrition and communicable diseases including vaccine-preventable diseases. Pregnant women, newborns, and unaccompanied minors are particularly vulnerable groups. Social isolation is a major risk factor for all migrant children that compound other health risks even after settlement in their new home. Lack of health information, language, and cultural differences serve as major barriers to adequate, timely, and appropriate healthcare. In spite the challenges they face, migrant children demonstrate remarkable resilience that can be nurtured to promote good mental and physical health. Migrant children, irrespective of their legal status, are entitled to healthcare of the same standard provided to children in the resident population, as stated in the UN Convention on the Rights of the Child. It is imperative that the health sector includes informed health workers who are able to identify the health risks and needs of these children and provide culturally competent care. In order to achieve this and promote the rights of migrant children to optimal health and well-being, ISSOP recommends that Programmes and activities designed to promote and protect migrant child health and well-being must be designed in collaboration with all sectors involved, including the education and social sectors, and should always include the voices of migrant children and their families. Health services should be readily available and easily accessible for preventive, maintenance, and curative care regardless of the child's legal status. Care should be of the same standard as care provided to the local population. Health information should be provided that is culturally sensitive and readily available in a language that migrant children and families can understand. Medical interpreters and cultural mediators should be available during healthcare encounters, and personnel working with migrants should receive training in cultural competence. Health professionals should not participate in age determination until methods with acceptable scientific and ethical standards have been developed. Professionals working with migrant children and families should have access to emotional support services. Evidence-based best practices in the care of migrant children should be identified and made widely available to health workers. An observatory should be established to study the factors leading to poor psychosocial and mental health in migrant children and youth. Paediatricians and paediatric societies should work to improve the sensitivity of their respective populations towards migrants, asylum seekers, and refugees.

A suicide research agenda for people from immigrant and refugee backgrounds

The aim of this study was to establish mental health and suicide research priorities for people from immigrant and refugee background in Australia. This article focuses on the data relevant to the development of the suicide research agenda. This study was conducted using Delphi consensus method with two rounds of online questionnaires. A total of 138 and 86 participants, respectively, completed the first and second rounds of survey. Participants were policy makers, service providers, academics, service users, and carer advocates in Australia with expertise in mental health and/or suicide among people from immigrant and refugee backgrounds. Of the total 268 research questions included in the questionnaires, 70 questions about suicide were ranked as essential by over 50% respondents (i.e., the set level of consensus). In particular, research questions regarded as the greatest priority related to access and engagement with suicide prevention services, suicide protective and risk factors compared to populations not from immigrant and refugee backgrounds, and culturally appropriate assessment of suicide risk.

Suicide among immigrant population in Norway: a national register-based study

OBJECTIVE

To investigate differences in suicide risk among immigrant population in Norway compared with native Norwegians, with respect to associated country group of origin.

METHODS

Based on the entire national population, a nested case-control design was adopted using Norwegian national longitudinal registers to obtain 23 073 suicide cases having occurred in 1969-2012 and 373 178 controls. Odds ratios (ORs) for suicide were estimated using conditional logistic regression analysis adjusting for socio-economic factors.

RESULTS

Compared with native Norwegians, suicide risk was significantly lower in first- and second-generation immigrants but higher in Norwegian-born with one foreign-born parent and foreign-born individuals with at least one Norwegian-born parent. When stratifying data by country group of origin, first-generation immigrants had lower ORs in most of the strata. Subjects born in Asia and in Central and South America with at least one Norwegian-born parent had a significantly higher risk of suicide. The observed results remained mostly unchanged in the analyses controlled for socio-economic status.

CONCLUSIONS

Suicide risk is lower in first- and second-generation immigrants but higher in subjects born in Norway with one foreign-born parent and those born abroad with at least one Norwegian-born parent, with notable differences by country group of origin.

Assessing the risk for suicide in schizophrenia according to migration, ethnicity and geographical ancestry

BACKGROUND

Suicide is a leading cause of mortality among those afflicted by schizophrenia. Previous studies demonstrated that the stressors associated with immigration may lead to an onset of schizophrenia and suicide separately in susceptible individuals. However, no studies have shown whether immigration may lead to suicidal behaviour for individuals with schizophrenia. Our study proposes that an individual's geographical ancestry, ethnicity or migration status may be predictive of suicide risk in schizophrenia.

METHODS

In a sample of 276 participants with schizophrenia spectrum disorders, we conducted cross-sectional assessments to collect clinical information. Self-identified ethnicity and suicide history were collected through self-report questionnaires and interview-based scales. Ancestry was identified using 292 genetic markers from HapMap. Migrants were classified as those who immigrated to Canada during their lifetime. Using a regression analysis, we tested whether a history of migration, ethnicity or geographical ancestry were predictive of a history of suicide attempts.

RESULTS

Our analysis failed to demonstrate a significant relationship between suicide history and migration, ethnicity or ancestry. However, ethnicity appears to be significantly associated with the number of psychiatric hospitalizations in our sample.

CONCLUSION

Ethnicity and migration history are not predictive of previous suicide attempts. Ethnicity may be an important demographic factor affecting access to mental health resources and frequency of hospitalizations.

Association between Suicide Ideation and Attempts and Being an Immigrant among Adolescents, and the Role of Socioeconomic Factors and School, Behavior, and Health-Related Difficulties

The risk of suicide behaviors in immigrant adolescents varies across countries and remains partly understood. We conducted a study in France to examine immigrant adolescents' likelihood of experiencing suicide ideation in the last 12 months (SI) and lifetime suicide attempts (SA) compared with their native counterparts, and the contribution of socioeconomic factors and school, behavior, and health-related difficulties. Questionnaires were completed by 1559 middle-school adolescents from north-eastern France including various risk factors, SI, SA, and their first occurrence over adolescent's life course (except SI). Data were analyzed using logistic regression models for SI and Cox regression models for SA (retaining only school, behavior, and health-related difficulties that started before SA). Immigrant adolescents had a two-time higher risk of SI and SA than their native counterparts. Using nested models, the excess SI risk was highly explained by socioeconomic factors (27%) and additional school, behavior, and health-related difficulties (24%) but remained significant. The excess SA risk was more highly explained by these issues (40% and 85%, respectively) and became non-significant. These findings demonstrate the risk patterns of SI and SA and the prominent confounding roles of socioeconomic factors and school, behavior, and health-related difficulties. They may be provided to policy makers, schools, carers, and various organizations interested in immigrant, adolescent, and suicide-behavior problems.

Suicide among immigrants in Europe--a systematic literature review

BACKGROUND

Concerns about increased suicide risk among immigrants to European countries have been raised. We review the scientific literature on differences in suicide among immigrants compared with the majority populations in Europe's major immigration countries.

METHODS

We searched the databases PubMed and PsycINFO for peer-reviewed epidemiological studies published in 1990-2011, which compared suicide risks of adult immigrant groups with the risks of the majority population in European countries. Hits were screened by two researchers.

RESULTS

We included 24 studies in the review. No generalizable pattern of suicide among immigrants was found. Immigrants from countries in which suicide risks are particularly high, i.e. countries in Northern and Eastern Europe, experienced higher suicide rates relative to groups without migration background. Gender and age differences were observed. Young female immigrants from Turkey, East Africa and South Asia are a risk group.

CONCLUSION

Immigrants 'bring along' their suicide risk, at least for the initial period they spend in the immigration country. Health-care planners and providers need to be aware of this 'imported risks'. However, most immigrant groups do not have an increased suicide risk relative to the local-born population; some may even experience substantially lower risks.