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Initiation of antipsychotic medication among refugees, non-refugee migrants, second-generation migrants, and Swedish-born adults with incident non-affective psychotic disorders

Year: 2025

Type: article

Abstract: BACKGROUND: It is not known if there are differences in antipsychotic initiation between migrants and native-born individuals diagnosed with non-affective psychotic disorder. This study aimed to determine (1) potential differences in initiation rate and type of first antipsychotic medication between refugees, non-refugee migrants, second-generation migrants, and Swedish-born young adults with incident non-affective psychosis and (2) which sociodemographic and clinical factors are associated with initiation. METHODS: This register-based cohort included 12,960 adults aged 18-35 years, residing in Sweden during 2007-2018, with an incident diagnosis of a non-affective psychotic disorder in inpatient or specialised outpatient care. Sociodemographic and clinical factors associated with antipsychotic initiation were determined using modified Poisson regression models yielding Relative Risk, RRs, and 95% Confidence Intervals, CI. RESULTS: Initiation of antipsychotic use was slightly less common among refugees (65.6%) compared to non-refugee migrants (70.2%), second-generation migrants (71.0%), and Swedish-born individuals (71.1%). However, after adjustment for sociodemographic and clinical factors, there was no difference in initiation rates between refugees and Swedish-born individuals (adjusted RR 0.96; 95% CI 0.92-1.00). Olanzapine was most common initial antipsychotic in all groups. However, compared to the Swedish-born, refugees (1.47; 1.10-1.97), non-refugee migrants (1.70; 1.26-2.27) and second-generation migrants (1.43; 1.05-1.97) were more likely to initiate the use with long-acting injectable antipsychotics, and also with first-generation antipsychotics, particularly haloperidol. Sociodemographic factors associated with initiation were similar among refugees and Swedish-born individuals, including younger age, higher education and inpatient care. CONCLUSION: Our finding that migrants were more likely to initiate long-acting antipsychotics suggests that clinical teams anticipate medication non-adherence among migrants.

Source: Social Psychiatry and Psychiatric Epidemiology

DOI: 10.1007/s00127-025-02887-3

Authors: Daniela Mellin, Ellenor Mittendorfer-Rutz, Christopher J. de Montgomery, Alexis E. Cullen, Heidi Taipale

Institutions: Karolinska Institutet, University of Copenhagen, University of Eastern Finland, Niuvanniemi Hospital

Language: English

Topic: Migration, Health and Trauma

Subfield: Clinical Psychology

Field: Psychology

Domain: Social Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $4,390