Disability pension and mortality in individuals with specific somatic and mental disorders: examining differences between refugees and Swedish-born individuals

Risk factors for common mental disorders in young refugees from Iran, Somalia and Syria to Sweden

BACKGROUND

Our primary aim was to determine sociodemographic and health-related risk factors for diagnosed common mental disorders (CMDs) among young refugees in Sweden.

METHODS

All young adult refugees from Iran, Somalia and Syria (n = 7192), who were residents in Sweden in 2009, were followed from 2010 to 2013 regarding diagnosed CMDs. Cox regression models were used to compute hazard ratios (HRs) of CMDs with 95% confidence intervals (CIs).

RESULTS

Those arriving as unaccompanied refugee minors had a lower risk of being diagnosed with CMDs (HR: 0.7; 95%CI: 0.6-0.9) than those arriving as accompanied refugee minors. A higher risk of being diagnosed with CMDs was also found in female refugees (HR: 1.3; 95%CI: 1.1-1.5) compared with male refugees. In addition, individuals with a low (HR: 1.7; 95%CI: 1.3-2.3) or a medium (HR: 1.4; 95%CI: 1.1-1.8) educational level were found to have a higher risk of being diagnosed with CMDs compared with individuals with a high educational level. Refugees from Iran (HR: 2.3; 95%CI: 1.8-2.9) had a higher risk of a diagnosis of a CMD than refugees from Somalia. Moreover, refugees with a diagnosis of a mental disorder other than a CMD (HR: 4.2; 95%CI: 2.8-6.1), digestive (HR: 1.5; 95%CI: 1.0-2.2) or musculoskeletal diseases (HR: 1.5; 95%CI: 1.0-2.2) had a higher risk of being diagnosed with subsequent CMDs, compared with those with no such disorders.

CONCLUSIONS

Pre-existing diagnoses of mental disorders other than CMDs, and digestive and musculoskeletal disorders should be carefully considered in clinical assessments to initiate early interventions to prevent CMDs.

Association of common mental disorders and related multimorbidity with subsequent labor market marginalization among refugee and Swedish-born young adults

Background

Common mental disorders (CMDs), multimorbidity, and refugee status are associated with poor labor market outcome. Little is known about how these factors interact in young adults.

Objective

We aimed to i) investigate whether the association of CMDs and multimorbidity with labor market marginalization (LMM) differs between refugee and Swedish-born young adults and ii) identify diagnostic groups with particularly high risk for LMM.

Methods

This longitudinal registry-based study included individuals aged 20–25 years followed from 2012 to 2016 in Sweden (41,516 refugees and 207,729 age and sex-matched Swedish-born individuals). LMM was defined as granted disability pension (DP) or > 180 days of unemployment (UE). A disease co-occurrence network was constructed for all diagnostic groups from 2009 to 2011 to derive a personalized multimorbidity score for LMM. Multivariate logistic regression was used to estimate odds ratios of LMM in refugee and Swedish-born youth as a function of their multimorbidity score. The relative risk (RR, 95% CI) of LMM for refugees with CMDs compared to Swedish-born with CMDs was computed in each diagnostic group.

Results

In total, 5.5% of refugees and 7.2% of Swedish-born with CMDs were granted DP; 22.2 and 9.4%, respectively received UE benefit during follow-up. While both CMDs and multimorbidity independently elevated the risk of DP considerably in Swedish-born, CMDs but not multimorbidity elevated the risk of UE. Regarding UE in refugees, multimorbidity with the presence of CMDs showed stronger estimates. Multimorbidity interacted with refugee status toward UE (p < 0.0001) and with CMDs toward DP (p = 0.0049). Two diagnostic groups that demonstrated particularly high RR of UE were schizophrenia, schizotypal and delusional disorders (RR [95% CI]: 3.46 [1.77, 6.75]), and behavioral syndromes (RR [95% CI]: 3.41 [1.90, 6.10]).

Conclusion

To combat LMM, public health measures and intervention strategies need to be tailored to young adults based on their CMDs, multimorbidity, and refugee status.

Effects of Posttraumatic Stress Disorder and Mental Disorders on the Labor Market Integration of Young Syrian Refugees

Civil war experience in the Syrian home country, insecurity and critical life events during migration, or adverse events in the receiving country might affect refugees' mental health. This paper addresses the effects of psychological distress and mental disorders on refugees' labor market integration in Germany between 2016 and 2021. We employ survey data from about 2700 young Syrians, delivering information on individuals' experience of migration and arrival in Germany in 2016. The survey data were successfully merged with register data, delivering detailed information regarding individuals' process of labor market integration and employment status from 2016 to 2021. Overall, the labor market integration of young refugees improved remarkably over time. In 2021, about 69% of the study population was integrated in a wider sense, and 30% was employed in fulltime contracts in 2021. However, the results indicate long-lasting effects of PTSD and mental disorders on individuals' labor market integration, whilst individuals' characteristics related to migration and arrival lose relevance over time and hardly affect labor market integration around five years after arrival. High PTSD scores in 2016 indicate a significantly reduced full-time employment probability in 2021. Anxiety and depression show significant negative effects on individuals' labor market integration, but with a less severe impact compared to a PTSD diagnosis.

Sustainable Earnings among Immigrants, and the Role of Health Status for Self-Sufficiency: A 10-Year Follow-Up Study of Labour Immigrants and Refugees to Sweden 2000-2006

This study aimed to investigate economic self-sufficiency for immigrants, and how health status affected self-sufficiency. The proportion of self-sufficiency during years 1-10 after receiving a residence permit is presented for all non-European labour immigrants (n = 1259) and refugees (n = 23,859), aged 18-54, who immigrated to Sweden 2000-2006, and compared to a control group of Swedish-born (n = 144,745). The risk of not being self-sufficient in year 10 was analysed with Cox regression models, and the results are presented as hazard ratios (HRs) with 95% confidence intervals (CIs). Moreover, the impact on the self-sufficiency of having a diagnosis from specialised health care during the first five years in Sweden was analysed. The results showed that half of the refugees and three-quarters of the labour immigrants were self-sufficient 10 years after residency. The adjusted risk of not being self-sufficient at year 10 was 80% higher among labour immigrants (HR = 1.8; CI = 1.6-2.0) and more than two-fold among refugees (HR = 2.7; CI = 2.6-2.8) compared to the Swedish-born. Having a diagnosis from specialised health care during the first five years in Sweden had an impact on self-sufficiency in all groups; however, the impact of having a diagnosis did not differ between refugees and Swedish-born. Measures must be taken to increase immigrants' work participation.

The relationship between employment and health for people from refugee and asylum-seeking backgrounds: A systematic review of quantitative studies

Background

For the general population, the positive effects of paid employment on health and wellbeing are well established. However, less is known for people from refugee and asylum-seeking backgrounds. This review aims to systematically summarise the quantitative literature on the relationship between employment and health and wellbeing for refugees and asylum seekers.

Method

A search strategy was conducted in online databases, including MEDLINE, PsychINFO, EMCARE, SCOPUS, CINHAL, ProQuest and Web of Science. Articles were screened against inclusion and exclusion criteria. Studies published in English between 2000 to October 2021 were included if they used quantitative methods to consider the relationship between employment and health for refugees and asylum seekers in resettlement countries. Study quality was assessed using The Joanna Briggs Institute's Critical Appraisal Tools. Findings were synthesised using a narrative approach.

Results

Seventy-two papers were identified. The majority of papers (N = 58, 81%) examined the association between employment and mental health outcomes. Overall, while there were inconsistencies in the findings, employment had a positive effect on mental health particularly in reducing levels of psychological distress and depression. Though more limited in number, the papers examining physical health suggest that people who are employed tend to have better physical health than unemployed persons. There was some evidence to support the bi-directional relationship between employment and health. Poor mental and physical health negatively impacted the odds of employment and occupational status of refugees.

Conclusion

Good quality employment is an essential component of refugee resettlement and this review found that in general employment is also beneficial for refugee health, particularly aspects of mental health. More research regarding the effects of employment on physical health is required. The effects of refugee-specific factors such as gender roles, torture, and trauma on the relationship between employment and health also require further investigation.

Mental and somatic disorders and the subsequent risk of all-cause and cause-specific mortality in refugees, non-refugee migrants and the Swedish-born youth: a population-based cohort study in Sweden

OBJECTIVES

The aims were to investigate the associations between specific mental and somatic disorders and subsequent all-cause and cause-specific mortality (suicide, external and other causes) in young refugees and non-refugee migrants compared with Swedish-born individuals of similar age.

METHODS

In this register-based prospective cohort study, all 1 003 760 individuals (40 305 refugees, 31 687 non-refugee migrants as the exposure groups and the rest as the Swedish-born comparison group), 16-25 years old, residing in Sweden on 31 December 2004 were included. These individuals were followed regarding the outcome of all-cause and cause-specific mortality (suicide and external causes) between 2005 and 2016. The study population was also stratified according to any use of specialised healthcare for mental or somatic diagnoses before baseline (2000-2004). Cox regression models yielding crude and multivariate Hazard Ratios (HR and aHR, respectively) with 95% Confidence Intervals (CI) were used to investigate the afore-mentioned associations.

RESULTS

A lower proportion of both refugees (12%) and non-refugee migrants (10%) had college/university education compared with the Swedish-born individuals (17%). The proportion of unemployed (>180 days) among refugees (2.3%) and non-refugees (2.9%) was higher than the Swedish born (1.4%). Refugees and non-refugee migrants had about a 20% lower risk of all-cause mortality and external causes of mortality compared with Swedish-born individuals. An even greater reduction in suicide risk (aHR 0.51, 95% CI 0.37 to 0.70, and 0.63, 95% CI 0.49 to 0.82 for non-refugees and refugees, respectively) was found. When restricted to those with a mental or somatic disorder, a lower risk of both general and specific mortality was also found among both refugees and non-refugee migrants compared with Swedish-born individuals. Refugees had, however, equal point estimates of all-cause mortality associated with substance misuse disorder and neoplasms as their Swedish-born peers with these disorders.

CONCLUSIONS

With few exceptions, young migrants with specific mental and somatic disorders have a mortality advantage compared with their Swedish-born peers with the same disorders. Further research on protective factors is warranted.

Differences in labour market marginalisation between refugees, non-refugee immigrants and Swedish-born youth: Role of age at arrival and residency duration

AIMS

We investigated if the risk of long-term unemployment (LTU) and disability pension (DP) differs between young refugees and non-refuge immigrants compared to the Swedish-born. The role of age at arrival, duration of residency and morbidity in this association was also investigated.

METHODS

All 19- to 25-year-olds residing in Sweden on 31 December 2004 (1691 refugees who were unaccompanied by a parent at arrival, 24,697 accompanied refugees, 18,762 non-refugee immigrants and 621,455 Swedish-born individuals) were followed from 2005 to 2016 regarding LTU (>180 days annually) and DP using nationwide register data. Cox regression models were used to estimate crude and multivariate-adjusted (adjusted for several socio-demographic, labour market and health-related covariates) hazard ratios (aHRs) with 95% confidence intervals.

RESULTS

Compared to the Swedish-born, all migrant groups had around a 1.8-fold higher risk of LTU (range aHR=1.71-1.83) and around a 30% lower risk of DP (range aHR=0.66-0.76). Older age at arrival was associated with a higher risk of LTU only for non-refugee immigrants. Both older age at arrival and a shorter duration of residency were associated with a lower risk of DP for all migrant groups. Psychiatric morbidity had the strongest effect on subsequent DP, with no significant differences between migrant groups and the Swedish-born (range aHR=5.1-6.1).

CONCLUSIONS

Young immigrants had a higher risk of LTU and a lower risk of DP than their Swedish-born peers. No differences between the different immigrant groups were found. Age at arrival, psychiatric morbidity and duration of residency are strong determinants of being granted DP.

Association between migration status and subsequent labour market marginalisation among individuals with posttraumatic stress disorder: a Swedish nationwide register-based cohort study

PURPOSE

The high prevalence of posttraumatic stress disorder (PTSD) among migrants in Europe is widely reported. Our research aimed to investigate the association between migration status and subsequent labour market marginalisation (LMM) events, i.e., long-term unemployment (LTU), long-term sickness absence (LTSA), and disability pension (DP) among individuals with PTSD, and to elucidate how the sociodemographic factors and the pre-existing health conditions influence such association.

METHODS

We established a cohort of 36,714 individuals born between 1960 and 1995, living in Sweden during 2004-2009, aged 19 years or above, with PTSD diagnosis during 2006-2009. Migration status, categorized as refugees, non-refugees, second-generation migrants, and Swedish-born with Swedish-born parents (reference group) was considered as exposure and LMM events as outcome. The cohort was followed from 01-Jan-2010 until LMM, death, or end of follow-up (31-Dec-2016). Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated by Cox regression with a seven-year follow-up.

RESULTS

Refugees (HR 2.07, 95% CI 1.86-2.30), and non-refugees (HR 1.96, 95% CI 1.85-2.07) had almost doubled relative risk of long-term unemployment, compared with the Swedish-born. The hazards of long-term sickness absence were similar across the groups. Refugees (HR 1.49, 95% CI 1.24-1.77), and non-refugees (HR 1.42, 95% CI 1.30-1.56) also had elevated relative risk of disability pension, whereas second-generation migrants had moderately increased relative risks for all three labour market marginalisation events compared with the Swedish-born.

CONCLUSION

Among the individuals with PTSD, being a migrant increases the risk of LMM, refugees being the foremost among migrants. Further research may benefit from including more recent migrant population, pre-migration information and measuring PTSD clinical severity.