Migrant status and risk of compulsory admission at first diagnosis of psychotic disorder: a population-based cohort study in Sweden
Year: 2020
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Minority ethnic and migrant groups face an elevated risk of compulsory admission for mental illness. There are overlapping cultural, socio-demographic, and structural explanations for this risk that require further investigation. METHODS: By linking Swedish national register data, we established a cohort of persons first diagnosed with a psychotic disorder between 2001 and 2016. We used multilevel mixed-effects logistic modelling to investigate variation in compulsory admission at first diagnosis of psychosis across migrant and Swedish-born groups with individual and neighbourhood-level covariates. RESULTS: Our cohort included 12 000 individuals, with 1298 (10.8%) admitted compulsorily. In an unadjusted model, being a migrant [odds ratio (OR) 1.48; 95% confidence interval (CI) 1.26-1.73] or child of a migrant (OR 1.27; 95% CI 1.10-1.47) increased risk of compulsory admission. However after multivariable modelling, region-of-origin provided a better fit to the data than migrant status; excess risk of compulsory admission was elevated for individuals from sub-Saharan African (OR 1.94; 95% CI 1.51-2.49), Middle Eastern and North African (OR 1.46; 95% CI 1.17-1.81), non-Nordic European (OR 1.27; 95% CI 1.01-1.61), and mixed Swedish-Nordic backgrounds (OR 1.33; 95% CI 1.03-1.72). Risk of compulsory admission was greater in more densely populated neighbourhoods [OR per standard deviation (s.d.) increase in the exposure: 1.12, 95% CI 1.06-1.18], an effect that appeared to be driven by own-region migrant density (OR per s.d. increase in exposure: 1.12; 95% CI 1.02-1.24). CONCLUSIONS: Inequalities in the risk of compulsory admission by migrant status, region-of-origin, urban living and own-region migrant density highlight discernible factors which raise barriers to equitable care and provide potential targets for intervention.
Source: Psychological Medicine
Authors: J. Terhune, J. Dykxhoorn, E. Mackay, A.-C. Hollander, J. B. Kirkbride, C. Dalman
Institutions: University College London, Karolinska Institutet
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: hybrid
Estimated APC paid: $3,160
Awards: G158726132, Psychosis risk over the life course: A multilevel, longitudinal investigation of social, economic and physical environmental risk factors at different stages in life., G210416921, Psychiatric care among migrants, descendants of migrants, and Swedish born,–what are the differences, and why does it differ?, Causation in a complex social system: understanding schizophrenia, bipolar disorder, self-harm, and suicide in socially excluded groups, G3625587306, G457166169, Psychosis risk over the life course: A multilevel, longitudinal investigation of social, economic and physical environmental risk factors at different stages in life.
OpenAlex ID: W3037833599