| 1. |
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| 2. |
- Amin, Ridwanul, et al.
(författare)
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Healthcare use before and after suicide attempt in refugees and Swedish-born individuals
- 2021
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Ingår i: Social Psychiatry and Psychiatric Epidemiology. - : Springer. - 0933-7954 .- 1433-9285. ; 56:2, s. 325-338
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: There is a lack of research on whether healthcare use before and after a suicide attempt differs between refugees and the host population. We aimed to investigate if the patterns of specialised (inpatient and specialised outpatient) psychiatric and somatic healthcare use, 3 years before and after a suicide attempt, differ between refugees and the Swedish-born individuals in Sweden. Additionally, we aimed to explore if specialised healthcare use differed among refugee suicide attempters according to their sex, age, education or receipt of disability pension.METHODS: All refugees and Swedish-born individuals, 20-64 years of age, treated for suicide attempt in specialised healthcare during 2004-2013 (n = 85,771 suicide attempters, of which 4.5% refugees) were followed 3 years before and after (Y - 3 to Y + 3) the index suicide attempt (t0) regarding their specialised healthcare use. Annual adjusted prevalence with 95% confidence intervals (CIs) of specialised healthcare use were assessed by generalized estimating equations (GEE). Additionally, in analyses among the refugees, GEE models were stratified by sex, age, educational level and disability pension.RESULTS: Compared to Swedish-born, refugees had lower prevalence rates of psychiatric and somatic healthcare use during the observation period. During Y + 1, 25% (95% CI 23-28%) refugees and 30% (95% CI 29-30%) Swedish-born used inpatient psychiatric healthcare. Among refugees, a higher specialised healthcare use was observed in disability pension recipients than non-recipients.CONCLUSION: Refugees used less specialised healthcare, before and after a suicide attempt, relative to the Swedish-born. Strengthened cultural competence among healthcare professionals and better health literacy among the refugees may improve healthcare access in refugees.
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| 3. |
- Amin, Ridwanul
(författare)
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Suicidal behaviour and healthcare use among refugees
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Despite higher rates of mental disorders among refugees, there is limited evidence on their risk of suicidal behaviour (suicide attempt and suicide) and how such risk is influenced by differences in country-level structural factors (e.g., the national healthcare and social services, national unemployment rates etc.) in the host countries. Moreover, research on any differences in patterns of healthcare use and trajectories of antidepressant use before and after a suicide attempt between refugees and the host population is lacking. Therefore, this thesis aimed to investigate the risk of suicidal behaviour in resettled refugees compared with the majority host populations in Sweden and Norway. A further aim was to investigate patterns of healthcare use, before and after a suicide attempt, among refugees who resettled in Sweden compared with the Swedish-born population. Methods: In study I, three cohorts comprising the entire population of Sweden, 16-64 years of age on 31 December 1999, 2004, and 2009 (around 5 million each, of which 3.3-5.0% refugees) were followed for four years each through register linkage. Additionally, the 2004 cohort was followed for nine years to allow stratified analyses by refugees’ country of birth. Multivariate-adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) were computed. In study IV, all cases who died by suicide when 18-64-years-old during 1998 and 2018 (17,572 and 9,443 cases in Sweden and Norway, respectively) were matched with 20 sex- and age-matched population controls. Multivariate-adjusted conditional logistic regression models yielding adjusted odds ratios (aORs) with 95% CIs were used to test the association between refugee status and suicide in study IV. The multivariate models in study I and IV were adjusted for socio-demographic, labour market marginalisation (LMM) such as unemployment, sickness absence and disability pension, and morbidity factors. Additionally, in study IV, analyses were stratified by sex and age groups, by refugees’ region/country of birth and duration of residence in the host country. In study II, all refugees and Swedish-born individuals, 20-64 years of age, treated for suicide attempt in specialised healthcare during 2004-2013 (n = 85,771, of which 4.5% refugees) were followed three years before and after (Y-3 to Y+3) the index suicide attempt (t0) regarding their specialised healthcare use. With the same inclusion criteria and study design, another cohort of individuals with suicide attempt during 2009-2015 (n = 62,442, 5.6% refugees) was followed regarding their antidepressant use in study III. Annual adjusted prevalence estimates with 95% CIs of specialised healthcare use were assessed by generalised estimating equations (GEE) in study II. Trajectories of annual defined daily doses (DDDs) of antidepressants were analysed using group-based trajectory models in study III. Associations between the identified trajectory groups and different covariates related to socio-demographics, LMM, and healthcare use were estimated by chi2-tests and multinomial logistic regression. Results: The aHRs of suicide attempt and suicide among refugees vs the Swedish-born ranged from 0.38-1.25 and 0.16-1.20 according to country of birth, respectively, showing either non-significant or lower aHRs for refugees. Exceptions were refugees from Iran with a higher risk for suicide attempt - aHR 1.25; 95% CI 1.12-1.40, compared to individuals born in Sweden. The risk for suicide attempt among refugees diminished slightly across the different cohorts (study I). In study IV, the aORs for suicide among refugees in Sweden and Norway were 0.5 (95% CI: 0.5-0.6) and 0.3 (95% CI: 0.3-0.4), compared with the respective host population. Stratification by region/country of birth showed similar statistically significant lower odds for most refugee groups in both host countries except for refugees from Eritrea (aOR 1.0, 95% CI: 0.7-1.6) in Sweden. The risk of suicide did not vary much across refugee groups by their duration of residence, sex and age except for younger refugees aged 18-24 who did not have a statistically significant relative difference in suicide risk than their respective host country peers. Factors related to socio-demographics, LMM and healthcare use had only a marginal influence on the studied associations in both countries in study IV as well as in study I in Sweden. In study II, among individuals with a suicide attempt, refugees had somewhat lower prevalence rates of psychiatric and somatic healthcare use during the observation period than the Swedish-born. During Y+1, 25% (95% CI 23-28%) of refugees and 30% (95% CI 29-30%) of Swedish-born used inpatient psychiatric healthcare. Among refugees, a higher specialised healthcare use was observed in disability pension recipients than non-recipients. Among the four identified trajectory groups, antidepressant use was constantly low (≤15 DDDs) for 64.9% of refugees in study III. A 'low increasing' group comprised 5.9% of refugees (60-260 annual DDDs before and 510-685 DDDs after index attempt). Two other trajectory groups had constant use at medium (110-190 DDDs) and high (630-765 DDDs) levels (22.5% and 6.6% of refugees, respectively). Method of suicide attempt and any use of psychotropic drugs during the year before index attempt discriminated between refugees’ trajectory groups. The patterns and composition of the trajectory groups, and the associations of the identified trajectory groups with the different covariates, were comparable among refugees and Swedish-born, except for previous sedative/hypnotic drug use, which explained the variability among the trajectory groups more for refugees than for the Swedish-born. Conclusions: Resettled refugees had a lower risk of suicidal behaviour relative to the host population in Sweden and Norway. These findings may suggest that resiliency and culture/religion-bound attitudes towards suicidal behaviour among refugees could be more influential for their suicide risk after resettlement than other post-migration environmental and structural factors in the host country. Specialised healthcare use before and after a suicide attempt was somewhat lower among refugees than among the Swedish-born, and differences in antidepressant treatment were marginal between refugees and the Swedish-born.
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| 4. |
- Amin, Ridwanul, et al.
(författare)
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Suicide attempt and suicide in refugees in Sweden - a nationwide population-based cohort study
- 2021
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Ingår i: Psychological Medicine. - : Cambridge University Press. - 0033-2917 .- 1469-8978. ; 51:2, s. 254-263
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Tidskriftsartikel (refereegranskat)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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| 5. |
- Amin, Ridwanul, et al.
(författare)
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Time period effects in work disability due to common mental disorders among young employees in Sweden-a register-based cohort study across occupational classes and employment sectors
- 2023
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Ingår i: European Journal of Public Health. - : Oxford University Press. - 1101-1262 .- 1464-360X. ; 33:2, s. 272-278
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Tidskriftsartikel (refereegranskat)abstract
- Background We aimed to investigate time period effects in the risk of work disability, defined as long-term sickness absence (LTSA) and disability pension (DP) due to common mental disorders (CMDs), among young employees according to employment sector (private/public) and occupational class (non-manual/manual).Methods Three cohorts, including all employed individuals with complete information on employment sector and occupational class, aged 19-29 years and resident in Sweden on 31 December 2004, 2009 and 2014 (n = 573 516, 665 138 and 600 889, respectively) were followed for 4 years. Multivariate-adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) were estimated to examine the risk of LTSA and DP due to CMDs using Cox regression analyses.Results In all cohorts, public sector employees had higher aHRs for LTSA due to CMDs than private sector employees, irrespective of occupational class, e.g. aHR, 95% CI: 1.24, 1.16-1.33 and 1.15, 1.08-1.23 among non-manual and manual workers in cohort 2004. The rates of DP due to CMDs were much lower in cohorts 2009 and 2014 than 2004 leading to uncertain risk estimates in the later cohorts. Still, public sector manual workers had a higher risk for DP due to CMDs than manual workers in the private sector in cohort 2014 than in 2004 (aHR, 95% CI: 1.54, 1.34-1.76 and 3.64, 2.14-6.18, respectively).Conclusions Manual workers in the public sector seem to have a higher risk of work disability due to CMDs than their counterparts in the private sector calling for the need for early intervention strategies to prevent long-term work disability.
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| 6. |
- Amin, Ridwanul, et al.
(författare)
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Trajectories of antidepressant use before and after a suicide attempt among refugees and Swedish-born individuals : a cohort study
- 2021
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Ingår i: International Journal for Equity in Health. - : BioMed Central. - 1475-9276. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: To identify key information regarding potential treatment differences in refugees and the host population, we aimed to investigate patterns (trajectories) of antidepressant use during 3 years before and after a suicide attempt in refugees, compared with Swedish-born. Association of the identified trajectory groups with individual characteristics were also investigated.METHODS: All 20-64-years-old refugees and Swedish-born individuals having specialised healthcare for suicide attempt during 2009-2015 (n = 62,442, 5.6% refugees) were followed 3 years before and after the index attempt. Trajectories of annual defined daily doses (DDDs) of antidepressants were analysed using group-based trajectory models. Associations between the identified trajectory groups and different covariates were estimated by chi2-tests and multinomial logistic regression.RESULTS: Among the four identified trajectory groups, antidepressant use was constantly low (≤15 DDDs) for 64.9% of refugees. A 'low increasing' group comprised 5.9% of refugees (60-260 annual DDDs before and 510-685 DDDs after index attempt). Two other trajectory groups had constant use at medium (110-190 DDDs) and high (630-765 DDDs) levels (22.5 and 6.6% of refugees, respectively). Method of suicide attempt and any use of psychotropic drugs during the year before index attempt discriminated between refugees' trajectory groups. The patterns and composition of the trajectory groups and their association, discriminated with different covariates, were fairly similar among refugees and Swedish-born, with the exception of previous hypnotic and sedative drug use being more important in refugees.CONCLUSIONS: Despite previous reports on refugees being undertreated regarding psychiatric healthcare, no major differences in antidepressant treatment between refugees and Swedish-born suicide attempters were found.
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| 7. |
- Björkenstam, Emma, et al.
(författare)
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Mental disorders and suicidal behavior in refugees and Swedish-born individuals : is the association affected by work disability?
- 2020
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Ingår i: Social Psychiatry and Psychiatric Epidemiology. - : Springer Nature. - 0933-7954 .- 1433-9285. ; 55:8, s. 1061-1071
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundAmong potential pathways to suicidal behavior in individuals with mental disorders (MD), work disability (WD) may play an important role. We examined the role of WD in the relationship between MD and suicidal behavior in Swedish-born individuals and refugees.MethodsThe study cohort consisted of 4,195,058 individuals aged 16–64, residing in Sweden in 2004–2005, whereof 163,160 refugees were followed during 2006–2013 with respect to suicidal behavior. Risk estimates were calculated as hazard ratios (HR) with 95% confidence intervals (CI). The reference groups comprised individuals with neither MD nor WD. WD factors (sickness absence (SA) and disability pension (DP)) were explored as potential modifiers and mediators.ResultsIn both Swedish-born and refugees, SA and DP were associated with an elevated risk of suicide attempt regardless of MD. In refugees, HRs for suicide attempt in long-term SA ranged from 2.96 (95% CI: 2.14–4.09) (no MD) to 6.23 (95% CI: 3.21–12.08) (MD). Similar associations were observed in Swedish-born. Elevated suicide attempt risks were also observed in DP. In Swedish-born individuals, there was a synergy effect between MD, and SA and DP regarding suicidal behavior. Both SA and DP were found to mediate the studied associations in Swedish-born, but not in refugees.ConclusionThere is an effect modification and a mediating effect between mental disorders and WD for subsequent suicidal behavior in Swedish-born individuals. Also for refugees without MD, WD is a risk factor for subsequent suicidal behavior. Particularly for Swedish-born individuals with MD, information on WD is vital in a clinical suicide risk assessment.
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| 8. |
- Helgesson, Magnus, et al.
(författare)
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Mental and somatic disorders and the subsequent risk of all-cause and cause-specific mortality in refugees, non-refugee migrants and the Swedish-born youth : a population-based cohort study in Sweden
- 2022
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 12:5
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesThe aims were to investigate the associations between specific mental and somatic disorders and subsequent all-cause and cause-specific mortality (suicide, external and other causes) in young refugees and non-refugee migrants compared with Swedish-born individuals of similar age.MethodsIn this register-based prospective cohort study, all 1 003 760 individuals (40 305 refugees, 31 687 non-refugee migrants as the exposure groups and the rest as the Swedish-born comparison group), 16-25 years old, residing in Sweden on 31 December 2004 were included. These individuals were followed regarding the outcome of all-cause and cause-specific mortality (suicide and external causes) between 2005 and 2016. The study population was also stratified according to any use of specialised healthcare for mental or somatic diagnoses before baseline (2000-2004). Cox regression models yielding crude and multivariate Hazard Ratios (HR and aHR, respectively) with 95% Confidence Intervals (CI) were used to investigate the afore-mentioned associations.ResultsA lower proportion of both refugees (12%) and non-refugee migrants (10%) had college/university education compared with the Swedish-born individuals (17%). The proportion of unemployed (>180 days) among refugees (2.3%) and non-refugees (2.9%) was higher than the Swedish born (1.4%). Refugees and non-refugee migrants had about a 20% lower risk of all-cause mortality and external causes of mortality compared with Swedish-born individuals. An even greater reduction in suicide risk (aHR 0.51, 95% CI 0.37 to 0.70, and 0.63, 95% CI 0.49 to 0.82 for non-refugees and refugees, respectively) was found. When restricted to those with a mental or somatic disorder, a lower risk of both general and specific mortality was also found among both refugees and non-refugee migrants compared with Swedish-born individuals. Refugees had, however, equal point estimates of all-cause mortality associated with substance misuse disorder and neoplasms as their Swedish-born peers with these disorders.ConclusionsWith few exceptions, young migrants with specific mental and somatic disorders have a mortality advantage compared with their Swedish-born peers with the same disorders. Further research on protective factors is warranted.
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| 9. |
- Kronsell, Alexander, et al.
(författare)
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The effect of anaesthetic dose on response and remission in electroconvulsive therapy for major depressive disorder : nationwide register-based cohort study
- 2021
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Ingår i: BJPsych Open. - : Royal College of Psychiatrists. - 2056-4724. ; 7:2
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Electroconvulsive therapy (ECT) is a safe and effective treatment for major depressive disorder (MDD). ECT treatment effect relies on induced generalised seizures. Most anaesthetics raise the seizure threshold and shorten seizure duration. There are no conclusive studies on the effect of anaesthetic dose on response and remission rates with ECT for MDD.AIMS: We aimed to examine the effect of different dose intervals of anaesthetics on response and remission after ECT for MDD.METHOD: We conducted a nationwide cohort study, using data from Swedish registers. Low-, medium- and high-dose intervals, adjusted for age and gender, were constructed for each anaesthetic drug. Response and remission were measured with the Clinical Global Impression - Severity and Improvement scales (CGI-I and CGI-S), and a self-rated version of the Montgomery-Åsberg Depression Rating Scale (MADRS-S). Logistic regression models were used to calculate adjusted odds ratios for response and remission rates.RESULTS: The study included 7917 patients who received ECT for MDD during 2012-2018. Patients were given either thiopental (64.1%) or propofol (35.9%). Low-dose intervals of anaesthetics were associated with increased rates of response (CGI-I: odds ratio 1.22, 95% CI 1.07-1.40, P = 0.004; MADRS-S: odds ratio 1.31, 95% CI 1.09-1.56, P = 0.004) and remission (CGI-S: odds ratio 1.37, 95% CI 1.17-1.60, P ≤ 0.001; MADRS-S: odds ratio 1.31, 95% CI 1.10-1.54, P = 0.002).CONCLUSIONS: We found improved treatment outcomes with low- compared with high-dose anaesthetic during ECT for MDD. To enhance treatment effect, deep anaesthesia during ECT for MDD should be avoided.
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