Abstract
Purpose
To investigate the psychiatric healthcare utilisation of refugees vis-à-vis their peers in Denmark during the ages 15–22.
Methods
This paper utilises comprehensive full-population registry data from 1995 to 2016 to explore the psychiatric healthcare utilisation during the transition from childhood to adulthood for refugees (N = 13,027), a comparison group of children of labour migrants from Morocco, Pakistan, and Turkey (N = 13,413), and the majority population (N = 693,043) in Denmark. To test for population differences in types of admission for particular types of disorders, odds ratios for a first contact during ages 15–22 were calculated using logistic regression. For those with at least one diagnosis-specific hospital contact, differences in the amount and type of treatment were tested using negative binomial regression to estimate means ratios of days hospitalised, days in outpatient care, number of outpatient contacts, consultations with psychiatrists in private practice, and prescribed medicine purchases.
Results
Refugees and the comparison group were generally less likely than the majority population to have a first contact for most disorders (adjusted ORs 0.03–0.88), but not for schizophrenia for boys (adjusted ORs 0.92–2.13). Among those who did have a first contact, youths from the ethnic minority groups tended to have more or similar inpatient and emergency room contacts (MRs 0.89–2.10), hospitalisations of refugee girls being an exception (MR 0.46; CI [0.23–0.94]), but fewer outpatient contacts, consultations with psychiatrists in private practice, and prescribed medicine purchases (MRs 0.23–0.94).
Conclusions
The results suggest that refugee and other ethnic minority groups may face barriers both to initial contact and to completing adequate treatment beyond the first contact.
Similar content being viewed by others
References
Hjern A (2005) Chapter 11: Refugee children’s long-term adaptation in Sweden; general outcomes and prognostic factors. In: Andersson HE, Ascher H, Björnberg U, Eastmond M, Mellander L (eds) The asylum-seeking child in Europe. Centre for European Research at Göteborg University (CERGU), Gothenburg, pp 127–133
Montgomery E (2010) Trauma and resilience in young refugees: a 9-year follow-up study. Dev Psychopathol 22:477–489
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 379:266–282
Fazel M, Wheeler J, Danesh J (2005) Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. Lancet 365(9):1309–1314
Ellis BH, Betancourt TS (2007) Children and adolescents. In: Walker P, Barnett E (eds) Immigrant medicine. Elsevier, Amsterdam, pp 673–680
Vervliet M, Lammertyn J, Broekaert E, Derluyn I (2014) Longitudinal follow-up of the mental health of unaccompanied refugee minors. Eur Child Adolesc Psychiatry 23(5):337–346
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 8:1–9
Kinzie JD, Jaranson JM, Kroupin GV (2007) Diagnosis and treatment of mental illness. In: Walker P, Barnett E (eds) Immigrant medicine. Elsevier Inc., Amsterdam, pp 639–651
Kim-Cohen J, Caspi A, Moffitt TE, Harrington H, Milne BJ, Poulton R (2003) Prior juvenile diagnoses in adults with mental disorder: developmental follow-back of a prospective-longitudinal cohort. Arch Gen Psychiatry 60(7):709–717
Vaage AB, Garløv I, 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(3):440–458
Fenta H, Hyman I, Noh S (2007) Health service utilization by Ethiopian immigrants and refugees in Toronto. J Immigr Minor Health 9(4):349–357
Anagnostopoulos DC, Vlassopoulou M, Rotsika V, Pehlivanidou H, Legaki L, Rogakou E et al (2004) Psychopathology and mental health service utilization by immigrants’ children and their families. Transcult Psychiatry 41(4):465–486
Wallby T, Hjern A (2011) Child health care uptake among low-income and immigrant families in a Swedish county. Acta Paediatr 100(11):1495–1503
Barghadouch A, Kristiansen M, Jervelund SS, Hjern A, Montgomery E, Norredam M (2016) Refugee children have fewer contacts to psychiatric healthcare services: an analysis of a subset of refugee children compared to Danish-born peers. Soc Psychiatry Psychiatr Epidemiol 51(8):1125–1136
Barghadouch A, Carlsson J, Norredam M (2018) Psychiatric disorders and predictors hereof among refugee children in early adulthood: a register-based cohort study. J Nerv Ment Dis 206(1):3–10
Nielsen SS, Jensen NK, Kreiner S, Norredam M, Krasnik A (2015) Utilisation of psychiatrists and psychologists in private practice among non-Western labour immigrants, immigrants from refugee-generating countries and ethnic Danes: the role of mental health status. Soc Psychiatry Psychiatr Epidemiol 50(1):67–76
Nielsen SS, Hempler NF, Waldorff FB, Kreiner S, Krasnik A (2012) Is there equity in use of healthcare services among immigrants, their descendents, and ethnic Danes? Scand J Public Health 40(3):260–270
de Montgomery CJ, Petersen JH, Jervelund SS (2020) Diminishing social inequality between refugee children and their peers growing up in Denmark. J Ethn Migr Stud 46(7):1301–1329. https://doi.org/10.1080/1369183X.2018.1526061
Scheppers E, Van Dongen E, Dekker J, Geertzen J, Dekker J (2006) Potential barriers to the use of health services among ethnic minorities: a review. Fam Pract 23(3):325–348
Vermeire E, Hearnshaw H, Van Royen P, Denekens J (2001) Patient adherence to treatment: three decades of research. A comprehensive review. J Clin Pharm Ther. 26(5):331–342
Kessler RC, Amminger GP, Aguilar-Gaxiola S, Alonso J, Lee S, Ustun TB (2007) Age of onset of mental disorders: a review of recent literature. Curr Opin Psychiatry 20(4):359
Shanahan MJ (2000) Pathways to adulthood in changing societies: variability and mechanisms in life course perspective. Annu Rev Sociol 26:667–692
Statistics Denmark. Opholdstilladelser på individniveau [Internet]. 2014. https://www.dst.dk/ext/927999836/0/befolkning/Opholdstilladelser-paa-individniveau-pdf. Accessed 11 Sep 2019
Andridge RR, Little RJA (2010) A review of hot deck imputation for survey non-response. Int Stat Rev 78(1):40–64
Mors O, Perto GP, Mortensen PB (2011) The Danish psychiatric central research register. Scand J Public Health. 39(7_suppl):54–57
Sahl Andersen J, de Fine ON, Krasnik A (2011) The Danish national health service register. Scand J Public Health. 39(7_suppl):34–37
Wallach Kildemoes H, Toft Sørensen H, Hallas J (2011) The Danish national prescription registry. Scand J Public Health. 39(7_suppl):38–41
Lynge E, Sandegaard JL, Rebolj M (2011) The Danish national patient register. Scand J Public Health 39(7):30–33
Jakobsen KD, Frederiksen JN, Hansen T, Jansson LB, Parnas J, Werge T (2005) Reliability of clinical ICD-10 schizophrenia diagnoses. Nord J Psychiatry 59(3):209–212
Lauritsen MB, Jørgensen M, Madsen KM, Lemcke S, Toft S, Grove J et al (2010) Validity of childhood autism in the Danish Psychiatric Central Register: findings from a cohort sample born 1990–1999. J Autism Dev Disord 40(2):139–148
Stovel K, Savage M, Bearman P (1996) Ascription into achievement: models of career systems at Lloyds Bank, 1890–1970. Am J Sociol 102(2):358–399
Regioner D (2007) OPUS—Opsøgende behandling af psykotiske unge. Danske Regioner, Copenhagen
Aleman A, Kahn RS, Selten J-P (2003) Sex differences in the risk of schizophrenia: evidence from meta-analysis. Arch Gen Psychiatry 60(6):565–571
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(5):497–502
Jensen NK, Norredam M, Priebe S, Krasnik A (2013) How do general practitioners experience providing care to refugees with mental health problems? A qualitative study from Denmark. BMC Fam Pract 14(1):17
Gage-Bouchard EA (2017) Culture, Styles of Institutional Interactions, and Inequalities in Healthcare Experiences. J Health Soc Behav 58(2):147–165
Link BG, Phelan JC, Bresnahan M, Stueve A, Pescosolido BA (1999) Public conceptions of mental illness: labels, causes, dangerousness, and social distance. Am J Public Health 89(9):1328–1333
Brach C, Fraserirector I (2000) Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model. Med Care Res Rev 57(1_suppl):181–217
Betancourt JR, Green AR, Carrillo JE, Owusu Ananeh-Firempong II (2016) Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Rep 118:293–302
Snowden LR (2007) Explaining mental health treatment disparities: ethnic and cultural differences in family involvement. Cult Med Psychiatry 31(3):389–402
Copenhagen: Sundhedsdatastyrelsen. Retrieved May 13, 2020 from https://sundhedsdatastyrelsen.dk/-/media/sds/filer/find-tal-og-analyser/sundhedsvaesnet/noegletal-sundhedsvaesen/udvalgte-noegletal-for-sundhedsvaesen-2009_2017-(pdf).pdf
Rasmussen LI (2016) Danmark er et diagnosesamfund. Politiken 27:4
Fenger-Grøndahl M, Nissen J (2006) Verden kom til Danmark, 50 år med flygtninge. Dansk Flygtningehjælp, Copenhagen
Funding
Funding was provided by NordForsk (Grant no. 74645).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Rights and permissions
About this article
Cite this article
de Montgomery, C.J., Petersen, J.H. & Jervelund, S.S. Psychiatric healthcare utilisation among refugee adolescents and their peers in Denmark. Soc Psychiatry Psychiatr Epidemiol 55, 1457–1468 (2020). https://doi.org/10.1007/s00127-020-01878-w
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00127-020-01878-w