Suicide attempt and suicide in refugees in Sweden – a nationwide population-based cohort study

• Published in: Psychological medicine 2021-01, Vol.51 (2), p.254-263
• Main Authors: Amin, Ridwanul, Helgesson, Magnus, Runeson, Bo, Tinghög, Petter, Mehlum, Lars, Qin, Ping, Holmes, Emily A., Mittendorfer-Rutz, Ellenor
• Format: Article
• Language: English
• Subjects: Acculturation; Birth; Cohort analysis; Community support; Country of birth; Demography; Disability pensions; Exceptions; Health care policy; Humanitarianism; Labor market; Labour market marginalisation; Marginality; Medicin och hälsovetenskap; Mental disorders; Mental health; Migration; Morbidity; Original; Original Articles; Population; Population studies; Population-based studies; Protective factors; Refugees; Sick leave; Sociodemographics; Suicide; suicide attempt; Suicides & suicide attempts
• ISSN: 0033-2917; 1469-8978; 1469-8978
• DOI: 10.1017/S0033291719003167

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. 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. 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. 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.