Differences in psychiatric care utilisation among unaccompanied refugee minors, accompanied migrant minors, and Swedish-
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ORIGINAL PAPER
Differences in psychiatric care utilisation among unaccompanied refugee minors, accompanied migrant minors, and Swedish‑born minors Lovisa Axelsson1 · Sofie Bäärnhielm2,3 · Christina Dalman4,5 · Anna‑Clara Hollander4 Received: 10 April 2019 / Accepted: 2 May 2020 © The Author(s) 2020
Abstract Purpose To better understand underutilisation of psychiatric care among migrant children, we compared utilisation of psychiatric care among unaccompanied refugee minors and accompanied migrant minors, with Swedish-born minors. Methods Using a large longitudinal database of linked national registers, we established a retrospective cohort of 1,328,397 people born 1984–1988 comparing minors born in Sweden to 2 Swedish-born parents (95.4%) to minors who had been arriving in Sweden between 2002 and 2011 with a permanent resident permit and were either unaccompanied refugee minors (0.4%), or accompanied migrant minors (4.0%). The outcome measures were different measures of psychiatric care including in- and outpatient care, and prescribed psychotropic medication. Result Compared with the Swedish-born minors the unaccompanied refugee minors had a higher likelihood of utilisation of all psychiatric care except ADHD medication. However, compared with accompanied migrant minors, the Swedish-born minors had a higher likelihood of having utilised psychiatric care. Conclusion Our study shows that during the first years of living in Sweden, there seems to be fewer barriers to psychiatric care for unaccompanied refugee minors compared to the accompanied migrant minors. There are a number of possible reasons for this including stronger ties with the Swedish society. Keywords Refugee · Unaccompanied refugee minor · Utilisation of psychiatric care · Population study
Background The United Nations High Commissioner for Refugees (UNHCR) has documented the highest ever number of people who are forced to leave their homes at over 70.8 million people [1, 2]. Of these, about 25.9 million are classified as * Anna‑Clara Hollander anna‑[email protected] 1
Stockholm, Sweden
2
Center for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet (KI), Stockholm, Sweden
3
Transcultural Centre, Region Stockholm, Stockholm, Sweden
4
Epidemiology of Psychiatric Conditions, Substance Use and Social Environment (EPiCSS), Department of Global Public Health Sciences, KI, Solnavägen 1E, 171 77 Stockholm, Sweden
5
Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
refugees in accordance with the United Nations Refugee Convention. Conferring to the UN Conventions, all persons under 18 years are considered to be children, and approximately half of the world’s refugees are children. Significant portions of these children have fled without parents, guardians or other relatives [2] and are known as unaccompanied refugee minors. Refugee children who migrate in the company of at least one parent or guardian, or who have at least one parent or guardian who is already
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