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Substance use disorders in refugee and migrant groups in Sweden: A nationwide cohort study of 1.2 million people


Autoři: Samantha Harris aff001;  Jennifer Dykxhoorn aff001;  Anna-Clara Hollander aff003;  Christina Dalman aff003;  James B. Kirkbride aff001
Působiště autorů: Psylife Group, Division of Psychiatry, University College London, London, United Kingdom aff001;  Department of Psychosocial Science, University of Bergen, Bergen, Norway aff002;  Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden aff003
Vyšlo v časopise: Substance use disorders in refugee and migrant groups in Sweden: A nationwide cohort study of 1.2 million people. PLoS Med 16(11): e32767. doi:10.1371/journal.pmed.1002944
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pmed.1002944

Souhrn

Background

Refugees are at higher risk of some psychiatric disorders, including post-traumatic stress disorder (PTSD) and psychosis, compared with other non-refugee migrants and the majority population. However, it is unclear whether this also applies to substance use disorders, which we investigated in a national register cohort study in Sweden. We also investigated whether risk varied by region of origin, age at migration, time in Sweden, and diagnosis of PTSD.

Methods and findings

Using linked Swedish register data, we followed a cohort born between 1984 and 1997 from their 14th birthday or arrival in Sweden, if later, until an International Classification of Diseases, 10th revision (ICD-10), diagnosis of substance use disorder (codes F10.X–19.X), emigration, death, or end of follow-up (31 December 2016). Refugee and non-refugee migrants were restricted to those from regions with at least 1,000 refugees in the Swedish registers. We used Cox proportional hazards regression to estimate unadjusted and adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) in refugee and non-refugee migrants, compared with Swedish-born individuals, for all substance use disorders (F10.X–19.X), alcohol use disorders (F10.X), cannabis use disorders (F12.X), and polydrug use disorders (F19.X). In adjusted analyses, we controlled for age, sex, birth year, family income, family employment status, population density, and PTSD diagnosis. Our sample of 1,241,901 participants included 17,783 (1.4%) refugee and 104,250 (8.4%) non-refugee migrants. Refugees' regions of origin were represented in proportions ranging from 6.0% (Eastern Europe and Russia) to 41.4% (Middle East and North Africa); proportions of non-refugee migrants' regions of origin ranged from 11.8% (sub-Saharan Africa) to 33.7% (Middle East and North Africa). These groups were more economically disadvantaged at cohort entry (p < 0.001) than the Swedish-born population. Refugee (aHR: 0.52; 95% CI 0.46–0.60) and non-refugee (aHR: 0.46; 95% CI 0.43–0.49) migrants had similarly lower rates of all substance use disorders compared with Swedish-born individuals (crude incidence: 290.2 cases per 100,000 person-years; 95% CI 287.3–293.1). Rates of substance use disorders in migrants converged to the Swedish-born rate over time, indicated by both earlier age at migration and longer time in Sweden. We observed similar patterns for alcohol and polydrug use disorders, separately, although differences in cannabis use were less marked; findings did not differ substantially by migrants’ region of origin. Finally, while a PTSD diagnosis was over 5 times more common in refugees than the Swedish-born population, it was more strongly associated with increased rates of substance use disorders in the Swedish-born population (aHR: 7.36; 95% CI 6.79–7.96) than non-refugee migrants (HR: 4.88; 95% CI 3.71–6.41; likelihood ratio test [LRT]: p = 0.01). The main limitations of our study were possible non-differential or differential under-ascertainment (by migrant status) of those only seen via primary care and that our findings may not generalize to undocumented migrants, who were not part of this study.

Conclusions

Our findings suggest that lower rates of substance use disorders in migrants and refugees may reflect prevalent behaviors with respect to substance use in migrants’ countries of origin, although this effect appeared to diminish over time in Sweden, with rates converging towards the substantial burden of substance use morbidity we observed in the Swedish-born population.

Klíčová slova:

Africa – Cannabis – Mental health and psychiatry – Outpatients – Population density – Post-traumatic stress disorder – Sweden – Substance abuse


Zdroje

1. United Nations. International migration report 2017: highlights. 2012.

2. UNHCR. UNHCR - Figures at a Glance [cited 2019 May 28]. Available from: https://www.unhcr.org/figures-at-a-glance.html

3. Richter K, Peter L, Lehfeld H, Zäske H, Brar-Reissinger S, Niklewski G. Prevalence of psychiatric diagnoses in asylum seekers with follow-up. BMC Psychiatry. 2018;18: 206. doi: 10.1186/s12888-018-1783-y 29925338

4. Zipfel S, Huber C, Erim Y, Georgiadou E, Zbidat A, Schmitt GM. Prevalence of mental distress among Syrian refugees with residence permission in Germany: a registry-based study. Front Psychiatry. 2018;1: 393. doi: 10.3389/fpsyt.2018.00393 30210373

5. Georgiadou E, Morawa E, Erim Y. High manifestations of mental distress in Arabic asylum seekers accommodated in collective centers for refugees in Germany. Int J Environ Res Public Heal. 2017;14: 1–13. doi: 10.3390/ijerph14060612 28590438

6. Slewa-Younan S, Mond JM, Bussion E, Melkonian M, Mohammad Y, Dover H, et al. Psychological trauma and help seeking behaviour amongst resettled Iraqi refugees in attending English tuition classes in Australia. Int J Ment Health Syst. 2015;9: 5. doi: 10.1186/1752-4458-9-5 25972917

7. Hollander A-C, Dal H, Lewis G, Magnusson C, Kirkbride JB, Dalman C. Refugee migration and risk of schizophrenia and other non-affective psychoses: cohort study of 1.3 million people in Sweden. BMJ. 2016;352: i1030. doi: 10.1136/bmj.i1030 26979256

8. Hollander A-C, Pitman A, Sjöqvist, Lewis G, Magnusson C, Kirkbride JB, et al. Suicide risk among refugees compared with non-refugee migrants and the Swedish-born majority population. Br J Psychiatry. 2019; 1–7. doi: 10.1192/bjp.2019.220 31608849

9. Kirmayer LJ, Narasiah L, Munoz M, Rashid M, Ryder AG, Guzder J, et al. Common mental health problems in immigrants and refugees: General approach in primary care. CMAJ. 2011;183: E959–E967. doi: 10.1503/cmaj.090292 20603342

10. Aglipay M, Colman I, Chen Y. Does the healthy immigrant effect extend to anxiety disorders? Evidence from a nationally representative study. J Immigr Minor Heal. 2013;15: 851–857. doi: 10.1007/s10903-012-9677-4 22797950

11. Markkula N, Lehti V, Gissler M, Suvisaari J. Incidence and prevalence of mental disorders among immigrants and native Finns: a register-based study. Soc Psychiatry Psychiatr Epidemiol. 2017;52: 1523–1540. doi: 10.1007/s00127-017-1432-7 28856385

12. Salas-Wright CP, Kagotho N, Vaughn MG. Mood, anxiety, and personality disorders among first and second-generation immigrants to the United States. Psychiatry Res. 2014;220: 1028–1036. doi: 10.1016/j.psychres.2014.08.045 25223256

13. Foo S, Tam W, Ho C, Tran B, Nguyen L, McIntyre R, et al. Prevalence of Depression among Migrants: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2018;15: 1986. doi: 10.3390/ijerph15091986 30213071

14. Cantor-Graae E, Pedersen CB. Full spectrum of psychiatric disorders related to foreign migration: a Danish population-based cohort study. JAMA psychiatry. 2013;70: 427–35. doi: 10.1001/jamapsychiatry.2013.441 23446644

15. Dykxhoorn J, Hollander AC, Lewis G, Magnusson C, Dalman C, Kirkbride JB. Risk of schizophrenia, schizoaffective, and bipolar disorders by migrant status, region of origin, and age-at-migration: A national cohort study of 1.8 million people. Psychol Med. 2018; 1–10. doi: 10.1017/S0033291718003227 30514409

16. Manhica H, Hollander A-C, Almquist YB, Rostila M, Hjern A. Origin and schizophrenia in young refugees and inter-country adoptees from Latin America and East Africa in Sweden: a comparative study. BJPsych Open. 2016;2: 6–9. doi: 10.1192/bjpo.bp.115.002048 27703747

17. Horyniak D, Melo JS, Farrell RM, Ojeda VD, Strathdee SA. Epidemiology of substance use among forced migrants: a global systematic review. PLoS ONE. 2016;11: e0159134. doi: 10.1371/journal.pone.0159134 27411086

18. Sundquist K, Frank G. Urbanization and hospital admission rates for alcohol and drug abuse: a follow-up study of 4.5 million women and men in Sweden. Addiction. 2004;99: 1298–1305. doi: 10.1111/j.1360-0443.2004.00810.x 15369568

19. Manhica H, Gauffin K, Almqvist YB, Rostila M, Hjern A. Hospital admission and criminality associated with substance misuse in young refugees—A swedish national cohort study. PLoS ONE. 2016;11. doi: 10.1371/journal.pone.0166066 27902694

20. Luitel NP, Jordans M, Murphy A, Roberts B, McCambridge J. Prevalence and patterns of hazardous and harmful alcohol consumption assessed using the AUDIT among Bhutanese refugees in Nepal. Alcohol Alcohol. 2013;48: 349–55. doi: 10.1093/alcalc/agt009 23443987

21. Salas-Wright CP, Vaughn MG. A “refugee paradox” for substance use disorders? Drug Alcohol Depend. 2014;142: 345–349. doi: 10.1016/j.drugalcdep.2014.06.008 24999058

22. Salas-Wright CP, Vaughn MG, Clark TT, Terzis LD, Córdova D. Substance use disorders among first- and second- generation immigrant adults in the United States: evidence of an immigrant paradox? J Stud Alcohol Drugs. 2014;75: 958–67. doi: 10.15288/jsad.2014.75.958 25343653

23. Hjern A, Allebeck P. Alcohol-related disorders in first- and second-generation immigrants in Sweden: a national cohort study. Addiction. 2004;99: 229–236. doi: 10.1046/j.1360-0443.2003.00562.x 14756715

24. Salama E, Niemelä S, Suvisaari J, Laatikainen T, Koponen P, Castaneda AE. The prevalence of substance use among Russian, Somali and Kurdish migrants in Finland: a population-based study. BMC Public Health. 2018;18: 651. doi: 10.1186/s12889-018-5564-9 29788931

25. Abebe DS, Hafstad GS, Brunborg GS, Kumar BN, Lien L. Binge Drinking, Cannabis and Tobacco Use Among Ethnic Norwegian and Ethnic Minority Adolescents in Oslo, Norway. J Immigr Minor Heal. 2015;17: 992–1001. doi: 10.1007/s10903-014-0077-9 25037580

26. Carrasco-Garrido P, De Miguel AG, Barrera VH, Jiménez-García R. Health profiles, lifestyles and use of health resources by the immigrant population resident in Spain. Eur J Public Health. 2007;17: 503–507. doi: 10.1093/eurpub/ckl279 17251304

27. Qureshi A, Garcia Campayo J, Eiroa-Orosa FJ, Sobradiel N, Collazos F, Febrel Bordejé M, et al. Epidemiology of substance abuse among migrants compared to native born population in primary care. Am J Addict. 2014;23: 337–342. doi: 10.1111/j.1521-0391.2013.12103.x 24961361

28. Rolland B, Geoffroy PA, Pignon B, Benradia I, Font H, Roelandt JL, et al. Alcohol Use Disorders and Immigration up to the Third Generation in France: Findings from a 39,617-Subject Survey in the General Population. Alcohol Clin Exp Res. 2017;41: 1137–1143. doi: 10.1111/acer.13387 28470666

29. Kirkbride JB, Hameed Y, Ioannidis K, Ankireddypalli G, Crane CM, Nasir M, et al. Ethnic Minority Status, Age-at-Immigration and Psychosis Risk in Rural Environments: Evidence From the SEPEA Study. Schizophr Bull. 2017;43: 1251–1261. doi: 10.1093/schbul/sbx010 28521056

30. Veling W, Hoek HW, Selten JP, Susser E. Age at migration and future risk of psychotic disorders among immigrants in the Netherlands: A 7-year incidence study. Am J Psychiatry. 2011;168: 1278–1285. doi: 10.1176/appi.ajp.2011.11010110 22193672

31. Anderson KK, Cheng J, Susser E, McKenzie KJ, Kurdyak P. Incidence of psychotic disorders among first-generation immigrants and refugees in Ontario. CMAJ. 2015;187: E279–E286. doi: 10.1503/cmaj.141420 25964387

32. Jacobsen LK, Southwick SM, Kosten TR. Substance Use Disorders in Patients With Posttraumatic Stress Disorder: A Review of the Literature. Am J Psychiatry. 2001;158: 1184–1190. doi: 10.1176/appi.ajp.158.8.1184 11481147

33. Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995;52: 1048–60. doi: 10.1001/archpsyc.1995.03950240066012 7492257

34. Fazel M, Wheeler J, Danesh J, Fazel M, Wheeler J, Danesh J. Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. Lancet. 2005. doi: 10.1016/S0140-6736(05)61027-6

35. Ludvigsson JF, Andersson E, Ekbom A, Feychting M, Kim JL, Reuterwall C, et al. External review and validation of the Swedish national inpatient register. BMC Public Health. 2011;11: 450. doi: 10.1186/1471-2458-11-450 21658213

36. UN Refugee Agency. Convention and protocol relating to the status of refugees. United Nations Conference of plenipotentiaries on the status of refugees and stateless persons. Geneva, Switzerland; 2018. doi: 10.1093/iclqaj/10.2.255

37. StataCorp. Stata Statistical software. Stata: Release 13. College Station, TX: StataCorp LLC; 2013.

38. Schafer JL. Multiple imputation: a primer. Stat Methods Med Res. 1999;8: 3–15. doi: 10.1177/096228029900800102 10347857

39. Bennett DA. How can I deal with missing data in my study? Aust N Z J Public Health. 2001;25: 464–469. doi: 10.1111/j.1467-842X.2001.tb00294.x 11688629

40. Dong Y, Peng CYJ. Principled missing data methods for researchers. Springerplus. 2013;2: 1–17. doi: 10.1186/2193-1801-2-1

41. Bijl R V., de Graaf R, Ravelli A, Smit F, Vollebergh WAM. Gender and age-specific first incidence of DSM-III-R psychiatric disorders in the general population. Results from the Netherlands mental health survey and incidence study (NEMESIS). Soc Psychiatry Psychiatr Epidemiol. 2002;37: 372–379. doi: 10.1007/s00127-002-0566-3 12195544

42. Grant BF, Goldstein RB, Chou SP, Huang B, Stinson FS, Dawson DA, et al. Sociodemographic and psychopathologic predictors of first incidence of DSM-IV substance use, mood and anxiety disorders: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Mol Psychiatry. 2009;14: 1051–1066. doi: 10.1038/mp.2008.41 18427559

43. Chauvin P, Mestre M-C, Simonnot N. Access to healthcare for vulnerable groups in the EU in 2012: An overview of the condition of persons excluded. Paris, France; 2012 [cited 2019 Sep 6]. Available from: http://www.europarl.europa.eu/document/activities/cont/201302/20130208ATT60776/20130208ATT60776EN.pdf

44. Pagano A, García V, Recarte C, Lee JP. Sociopolitical contexts for addiction recovery: Anexos in U.S. Latino communities. Int J Drug Policy. 2016;37: 52–59. doi: 10.1016/j.drugpo.2016.08.002 27588569

45. Tinghög P, Malm A, Arwidson C, Sigvardsdotter E, Lundin A, Saboonchi F. Prevalence of mental ill health, traumas and post migration stress among refugees from Syria resettled in Sweden after 2011: a population-based survey. BMJ Open. 2017; 1–11. doi: 10.1136/bmjopen-2017-018899 29289940

46. Marshall GN, Schell TL, Elliott MN, Berthold SM, Chun C-A. Mental Health of Cambodian Refugees 2 Decades After Resettlement in the United States. JAMA. 2005;294: 571. doi: 10.1001/jama.294.5.571 16077051

47. Bogic M, Ajdukovic D, Bremner S, Franciskovic T, Galeazzi GM, Kucukalic A, et al. Factors associated with mental disorders in long-settled war refugees: refugees from the former Yugoslavia in Germany, Italy and the UK. Br J Psychiatry. 2012;200: 216–223. doi: 10.1192/bjp.bp.110.084764 22282430

48. Hjern A. Illicit drug abuse in second-generation immigrants: a register study in a national cohort of Swedish residents. Public Health. 2004;32: 40–46. doi: 10.1080/14034940310001677

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Interní lékařství

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