Social Psychiatry and Psychiatric Epidemiology

, Volume 51, Issue 8, pp 1125–1136 | Cite as

Refugee children have fewer contacts to psychiatric healthcare services: an analysis of a subset of refugee children compared to Danish-born peers

  • Amina BarghadouchEmail author
  • Maria Kristiansen
  • Signe Smith Jervelund
  • Anders Hjern
  • Edith Montgomery
  • Marie Norredam
Original Paper



Studies show a high level of mental health problems among refugee children. This study examined whether a subset of refugee children living in Denmark accessed psychiatric healthcare services more than those born in the country.


This study compared 24,427 refugee children from Asia, The Middle East, Sub-Saharan Africa and former Yugoslavia, who obtained residency in Denmark between 1 January 1993 and 31 December 2010 with 146,562 Danish-born children, matched 1:6 on age and sex. The study looked at contacts with psychiatric hospitals as well as psychologists and psychiatrists in private practice.


Between 1 January 1996 and 30 June 2012, 3.5 % of the refugee children accessed psychiatric healthcare services compared to 7.7 % of the Danish-born children. The rate ratio of having any first-time psychiatric contact was 0.42 (95 % CI 0.40–0.45) among refugee boys and 0.35 (95 % CI 0.33–0.37) among refugee girls, compared to Danish-born children. Figures were similar for those accessing private psychologists or psychiatrists, emergency room, inpatient and outpatient services.


Refugee children used fewer psychiatric healthcare services than Danish-born children. This may indicate that refugee children experience barriers in accessing psychiatric healthcare systems and do not receive adequate assessment of their mental health and subsequent referral to specialist services.


Psychiatric contacts Refugee children Registry-based Healthcare utilization Migrant 



The study was supported by the Danish foundation TrygFonden, Denmark.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    United Nations High Commissioner for Refugees (2013) Displacement. The new 21st century challenge. UNHCR Global Trends 2012Google Scholar
  2. 2.
    Montgomery E (2011) Trauma, exile and mental health in young refugees. Acta Psychiatr Scand 124:1–46CrossRefGoogle Scholar
  3. 3.
    Montgomery E, Foldspang A (2005) Seeking asylum in Denmark: refugee children’s mental health and exposure to violence. Eur J Public Health 15:233–237CrossRefPubMedGoogle Scholar
  4. 4.
    Hjern A, Angel B (2000) Organized violence and mental health of refugee children in exile: a six-year follow-up. Acta Paediatr 89:722–727CrossRefPubMedGoogle Scholar
  5. 5.
    Hjern A, Angel B, Jeppson O (1998) Political violence, family stress and mental health of refugee children in exile. Scand J Soc Med 26:18–25PubMedGoogle Scholar
  6. 6.
    Fazel M, Reed RV, Panter-Brick C, Stein A (2012) Mental health of displaced and refugee children resettled in high-income countries: risk and protective factors. Lancet 379:266–282CrossRefPubMedGoogle Scholar
  7. 7.
    Goosen S, Stronks K, Kunst A (2013) Frequent relocations between asylum-seeker centres are associated with mental distress in asylum-seeking children: a longitudinal medical record study. Int J Epidemiol 43(1):94–104CrossRefPubMedGoogle Scholar
  8. 8.
    Nielsen SS, Norredam M, Christiansen KL, Obel C, Hilden J, Krasnik A (2008) Mental health among children seeking asylum in Denmark—the effect of length of stay and number of relocations: a cross-sectional study. BMC Public Health 8:293–301CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Ehtholt KA, Yule W (2006) Practitioner review: assessment and treatment of refugee children and adolescents who have experienced trauma. J Child Psychol Psychiatry 47:1197–1210CrossRefGoogle Scholar
  10. 10.
    Ardbo C (2005) Folkhälsorapport 2005 [Public health report 2005]. Socialstyrelsen, StockholmGoogle Scholar
  11. 11.
    Vaage AB, Garløv A, Hauff E, Thomsen PH (2007) Psychiatric symptoms and service utilization among refugee children referred to a Child Psychiatry Department: a retrospective comparative case note study. Transcult Psychiatry 44:440–458CrossRefPubMedGoogle Scholar
  12. 12.
    Mors O, Perto GP, Mortensen PB (2011) The Danish psychiatric central research register. Scand J Public Health 39:54–57CrossRefPubMedGoogle Scholar
  13. 13.
    Andersen JS, de Fine Olicarius N, Krasnik A (2011) The Danish national health service register. Scand J Public Health 39:34–37CrossRefPubMedGoogle Scholar
  14. 14.
    United Nations Statistics Division (2013) Standard country and area codes classifications (M49)Google Scholar
  15. 15.
    Norredam M, Hansen OH, Pedersen JH, Kunst A, Kristiansen M, Krasnik A, Agyemang C (2015) Remigration of severely ill migrants to their countries of origin: myth or reality?–a register-based cohort study. Eur J Public Health 25(1):84–89CrossRefPubMedGoogle Scholar
  16. 16.
    Weitoft GR, Gullberg A, Hjern A, Rosén M (1999) Mortality statistics in immigrant research: method for adjusting underestimation of mortality. Int J Epidemiol 28:756–763CrossRefPubMedGoogle Scholar
  17. 17.
    Lier L, Jansson P, Rich B (2011) Asylbørns psykiske lidelser. In: Vitus K, Nielsen SS (eds) Asylbørn i Danmark. Hans Reitzels Forlag, København, pp 108–124Google Scholar
  18. 18.
    Bodegård G (2005) Pervasive loss of function in asylum-seeking children in Sweden. Acta Paediatr 94:1706–1707CrossRefPubMedGoogle Scholar
  19. 19.
    Ivert A, Merlo J, Svensson R, Levander MT (2013) How are immigrant background and gender associated with the utilisation of psychiatric care among adolescents? Soc Psychiatry Psychiatr Epidemiol 48:693–699CrossRefPubMedGoogle Scholar
  20. 20.
    Bean T, Eurelings-Bontekoe E, Mooijaart A, Spinhoven P (2006) Factors associated with mental health service need and utilization among unaccompanied refugee adolescents. Adm Policy Ment Health Ment Health Serv Res 33:342–355CrossRefGoogle Scholar
  21. 21.
    Garland AF, Lau AS, Yeh M, McCabe KM, Hough RL, Landsverk JA (2005) Racial and ethnic differences in utilization of mental health services among high-risk youths. Am J Psychiatry 162:1336–1343CrossRefPubMedGoogle Scholar
  22. 22.
    Howard M, Hodes M (2000) Psychopathology, adversity, and service utilization of young refugees. J Am Acad Child Adolesc Psychiatry 18:368–377CrossRefGoogle Scholar
  23. 23.
    de Anstiss H, Ziaian T, Procter N, Warland J, Baghurst P (2009) Help-seeking for mental health problems in young refugees: a review of the literature with implications for policy, practice, and research. Transcult Psychiatry 46:584–607CrossRefPubMedGoogle Scholar
  24. 24.
    Cauce AM, Domenech-Rodríguez M, Paradise M, Cochran BN, Shea JM, Srebnik D, Baydar N (2002) Cultural and contextual influences in mental health help seeking: a focus on ethnic minority youth. J Consult Clin Psych 70:44–55CrossRefGoogle Scholar
  25. 25.
    Zwaanswijk M, van der Ende J, Verhaak PFM, Bensing JM, Verhulst FC (2005) Help-seeking for child psychopathology: pathways to informal and professional services in The Netherlands. J Am Acad Child Adolesc Psychiatry 44:1292–1300CrossRefPubMedGoogle Scholar
  26. 26.
    Nørredam M (2008) Migrants’ access to healthcare. Department of Health Services Research, Institute of Public Health, University of Copenhagen, CopenhagenGoogle Scholar
  27. 27.
    Norredam M, Garcia-Lopez A, Keiding N, Krasnik A (2009) Risk of mental disorders in refugees and native Danes: a register-based retrospective cohort study. Soc Psychiat Epidemiol 44:1023–1029CrossRefGoogle Scholar
  28. 28.
    Fazel M, Wheeler J, Danesh J (2005) Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. Lancet 365:1309–1314CrossRefPubMedGoogle Scholar
  29. 29.
    Sayal K (2006) Annotation: pathways to care for children with mental health problems. J Child Psychol Psychiatry 47:649–659CrossRefPubMedGoogle Scholar
  30. 30.
    Pacione L, Measham T, Rousseau C (2013) Refugee children: mental health and effective interventions. Curr Psychiatry Rep 15:341–349CrossRefPubMedGoogle Scholar
  31. 31.
    May S, Rapee RN, Coello M, Momartin S, Aroche J (2013) Mental health literacy among refugee communities: differences between the Australian lay public and the Iraqi and Sudanese refugee communities. Soc Psychiatry Psychiatr Epidemiol 49(5):757–769CrossRefPubMedGoogle Scholar
  32. 32.
    Nørredam M, Krasnik A (2011) Migrants’ access to health services. In: Rechel B, Mladovsky B, Devillé W, Rijks B, Petrova-Benedict R, McKee M (eds) Migration and health in the European Union. Open University Press, McGraw-Hill, Berkshire, pp 67–78Google Scholar
  33. 33.
    Bischoff A, Bovier PA, Isah R, Francoise G, Ariel E, Louis L (2003) Language barriers between nurses and asylum seekers: their impact on symptom reporting and referral. Soc Sci Med 57:503–512CrossRefPubMedGoogle Scholar
  34. 34.
    Norredam M, Mygind A, Nielsen AS, Bagger J, Krasnik A (2007) Motivation and relevance of emergency room visits among immigrants and patients of Danish origin. Eur J Public Health 17:497–502CrossRefPubMedGoogle Scholar
  35. 35.
    Crone MR, Bekkema N, Wiefferink CH, Reijneveld SA (2010) Professional identification of psychological problems among children from ethnic minority groups: room for improvement. J Pediatr 156:277–284CrossRefPubMedGoogle Scholar
  36. 36.
    Kleinman A, Bonson P (2006) Anthropology in the clinic: the problem of cultural competency and how to fix it. PLoS Med 3:1673–1676CrossRefGoogle Scholar
  37. 37.
    Durà-Vilà G, Klasen H, Makatini Z, Rahimi Z, Hodes M (2013) Mental health problems of young refugees: duration of settlement, risk factors and community-based interventions. Clin Child Psychol Psychiatry 18:604–623CrossRefPubMedGoogle Scholar
  38. 38.
    Lægeforeningen (2011) Undersøgelse. Ventetid skader psykiatriske patienter. LægeforeningenGoogle Scholar
  39. 39.
    Nørredam M, Mygind A, Krasnik A (2005) Access to health care for asylum seekers in the European Union—a comparative study of country policies. Eur J Public Health 16:285–289CrossRefGoogle Scholar
  40. 40.
    Sandahl H, Norredam M, Hjern A, Asher H, Nielsen SS (2013) Policies of access to healthcare services for accompanied asylum-seeking children in the Nordic countries. Scand J Public Health 41:630–636CrossRefPubMedGoogle Scholar
  41. 41.
    Gadeberg AK, Norredam M (2016) Urgent need for validated trauma and mental health screening tools for refugee children and youth. Eur Child Adolesc Psychiatry. doi: 10.1007/s00787-016-0837-2

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Amina Barghadouch
    • 1
    Email author
  • Maria Kristiansen
    • 1
  • Signe Smith Jervelund
    • 1
  • Anders Hjern
    • 2
    • 3
  • Edith Montgomery
    • 4
  • Marie Norredam
    • 1
    • 5
  1. 1.Danish Research Centre for Migration, Ethnicity and Health (MESU), Section for Health Services Research, Department of Public HealthUniversity of CopenhagenCopenhagen KDenmark
  2. 2.Centre for Health Equity Studies (CHESS)Karolinska Institutet/Stockholm UniversityStockholmSweden
  3. 3.Clinical Epidemiology, Department of MedicineKarolinska Institutet/Stockholm UniversityStockholmSweden
  4. 4.DIGNITY–Danish Institute Against TortureCopenhagenDenmark
  5. 5.Section of Immigrant Medicine, Department of Infectious DiseasesCopenhagen University HospitalHvidovreDenmark

Personalised recommendations