Mental health service use among migrant and Swedish-born children and youth: a register-based cohort study of 472,129 individuals in Stockholm
Open accessAbstract
PURPOSE: Migrant children underutilize mental health services (MHS), but differences according to age, reason for migration, type of problem, and time have not been thoroughly analyzed. We aimed to explore utilization of MHS among migrant children and youth and to study if the hypothesized lower utilization could be explained by fewer neurodevelopmental assessments. METHODS: A cohort of the population aged 0-24 years in Stockholm, comprising 472,129 individuals were followed for maximum 10 years, between January 1, 2006 and December 31, 2015. We categorized individuals as accompanied refugee migrants, unaccompanied refugee migrants and non-refugee migrants, or Swedish-born. We used survival and logistic analyses to estimate rates of utilization of MHS. RESULTS: Migrant children and youth utilized less MHS than the majority population, with hazard ratios ranging from 0.62 (95% CI: 0.57; 0.67) to 0.72 (95% CI: 0.69; 0.76). Refugee and non-refugee children utilized less mental health care than their Swedish peers, apart from the youngest refugees (0-10 years) who had similar utilization as Swedish-born. The lower rates were partly explained by all migrant youths' lower risk of being diagnosed with a neurodevelopmental condition. Time in Sweden had a major impact, such that unaccompanied refugee minors had a higher utilization in their first 2 years in Sweden (OR: 3.39, 95% CI: 2.96; 3.85). CONCLUSION: Migrant youth use less MHS compared with native-born peers, and this is partly explained by fewer neurodevelopmental diagnoses. Strengthening the awareness about unmet needs, and the referring capacity by professionals in contact with migrant children could help reduce barriers to care.
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Cites
Gulliver, A., Griffiths, K. M., & Christensen, H. (2010) · BMC Psychiatry · doi:10.1186/1471-244x-10-113 · Cited by 3,292 · see citing works
Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., Morgan, C., Rüsch, N., Brown, J. S. L., & Thornicroft, G. (2015) · Psychological Medicine · doi:10.1017/s0033291714000129 · Cited by 3,152 · see citing works
A systematic review of empirical research on self-reported racism and health
Paradies, Y. (2006) · International Journal of Epidemiology · doi:10.1093/ije/dyl056 · Cited by 1,681 · see citing works
Fazel, M. S., Reed, R. V., Panter‐Brick, C., & Stein, A. L. (2011) · The Lancet · doi:10.1016/s0140-6736(11)60051-2 · Cited by 1,447 · see citing works
Psychological distress in refugee children: a systematic review
Bronstein, I., & Montgomery, P. (2011) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-010-0081-0 · Cited by 634 · see citing works
Choice of time‐scale in Cox's model analysis of epidemiologic cohort data: a simulation study
Thiébaut, A. C. M., & Bénichou, J. (2004) · Statistics in Medicine · doi:10.1002/sim.2098 · Cited by 633 · see citing works
The Social Determinants of Mental Health
Compton, M. T., & Shim, R. S. (2015) · Focus · doi:10.1176/appi.focus.20150017 · Cited by 564 · see citing works
Satinsky, E., Fuhr, D. C., Woodward, A., Sondorp, E., & Roberts, B. (2019) · Health Policy · doi:10.1016/j.healthpol.2019.02.007 · Cited by 539 · see citing works
Bean, T., Derluyn, I., Eurelings-Bontekoe, E. H. M., Broekaert, E., & Spinhoven, P. (2007) · The Journal of Nervous and Mental Disease · doi:10.1097/01.nmd.0000243751.49499.93 · Cited by 401 · see citing works
Mental health in migrant children.
Stevens, G., & Vollebergh, W. (2008) · Journal of Child Psychology and Psychiatry and Allied Disciplines · doi:10.1111/j.1469-7610.2007.01848.x · Cited by 388 · see citing works
Byrow, Y., Pajak, R., Specker, P., & Nickerson, A. (2020) · Clinical Psychology Review · doi:10.1016/j.cpr.2019.101812 · Cited by 345 · cited 1× · see citing works
“For example, negative perceptions about the social consequences of mental illness for the individual and the family [14, 15], internalized and treatment stigma [16, 17], parental perceptions of lack of cultural competency among providers [18], cultural differences in explanatory models of illness, and cultural variati…”
BackgroundBibliometric analysis of global migration health research in peer-reviewed literature (2000–2016)
Sweileh, W. M., Wickramage, K. P., Pottie, K. C., Hui, C. P., Roberts, B., Sawalha, A. F., & Zyoud, S. H. (2018) · BMC Public Health · doi:10.1186/s12889-018-5689-x · Cited by 261 · see citing works
Bussing, R., Schoenberg, N. E., & Perwien, A. (1998) · Social Science & Medicine (1967) · doi:10.1016/s0277-9536(97)00219-0 · Cited by 253 · see citing works
Kaltiala‐Heino, R., Sumia, M., Työläjärvi, M., & Lindberg, N. (2015) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/s13034-015-0042-y · Cited by 243 · see citing works
Ellis, B. H., Lincoln, A. K., Charney, M. E., Ford-Paz, R., Benson, M., & Strunin, L. (2010) · Transcultural Psychiatry · doi:10.1177/1363461510379933 · Cited by 181 · see citing works
Migration and autism spectrum disorder: population-based study
Magnusson, C., Rai, D., Goodman, A., Lundberg, M., Idring, S., Svensson, A., Koupil, I., Serlachius, E., & Dalman, C. (2012) · British Journal of Psychiatry · doi:10.1192/bjp.bp.111.095125 · Cited by 175 · see citing works
Self-citationShi, Y., Hunter Guevara, L. R., Dykhoff, H. J., Sangaralingham, L. R., Phelan, S., Zaccariello, M. J., & Warner, D. O. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.0321 · Cited by 158 · see citing works
Tinghög, P., Hemmingsson, T., & Lundberg, I. (2007) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-007-0253-5 · Cited by 131 · see citing works
What We Know and Don’t Know About Mental Health Problems Among Immigrants in Norway
Abebe, D., Lien, L., & Hjelde, K. H. (2012) · Journal of Immigrant and Minority Health · doi:10.1007/s10903-012-9745-9 · Cited by 131 · see citing works
Hjern, A. (2012) · Scandinavian Journal of Public Health · doi:10.1177/1403494812459610 · Cited by 127 · see citing works
McCann, T. V., Mugavin, J., Renzaho, A. M. N., & Lubman, D. I. (2016) · BMC Psychiatry · doi:10.1186/s12888-016-0984-5 · Cited by 123 · see citing works
Migrant density and well-being—A national school survey of 15-year-olds in Sweden
Hjern, A., Rajmil, L., Bergström, M., Berlin, M., Gustafsson, P. A., & Modin, B. E. (2013) · European Journal of Public Health · doi:10.1093/eurpub/ckt106 · Cited by 123 · see citing works
Use of health services among international migrant children – a systematic review
Markkula, N., Cabieses, B., V, Lehti, V., Uphoff, E., Astorga, S., & Stutzin, F. (2018) · Globalization and Health · doi:10.1186/s12992-018-0370-9 · Cited by 108 · see citing works
Abebe, D., Lien, L., & Elstad, J. I. (2017) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-017-1381-1 · Cited by 103 · see citing works
Bradby, H., Varyani, M., Oglethorpe, R., Raine, W. J. B., White, I., & Minnis, H. (2007) · Social Science & Medicine · doi:10.1016/j.socscimed.2007.07.025 · Cited by 88 · see citing works
Barghadouch, A., Kristiansen, M., Jervelund, S. S., Hjern, A., Montgomery, E., & Nørredam, M. L. (2016) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-016-1260-1 · Cited by 82 · see citing works
Lee‐Tauler, S. Y., Eun, J. D., Corbett, D., & Collins, P. Y. (2018) · Psychiatric Services · doi:10.1176/appi.ps.201700382 · Cited by 77 · see citing works
Nadeau, L., Jaimes, A., Johnson‐Lafleur, J., & Rousseau, C. (2017) · Journal of Child and Family Studies · doi:10.1007/s10826-017-0700-1 · Cited by 69 · see citing works
Immigrant Integration and Youth Mental Health in Four European Countries
Mood, C., Jönsson, J. Ö., & Låftman, S. B. (2016) · European Sociological Review · doi:10.1093/esr/jcw027 · Cited by 64 · see citing works
Forslund, T., Kosidou, K., Wicks, S., & Dalman, C. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02749-z · Cited by 63 · cited 1× · see citing works
“[33] for a detailed description of the different health care data registers).”
BackgroundSelf-citationStigma of mental illness and substance misuse in sub‐Saharan African migrants: A qualitative study
McCann, T. V., Renzaho, A. M. N., Mugavin, J., & Lubman, D. I. (2017) · International Journal of Mental Health Nursing · doi:10.1111/inm.12401 · Cited by 56 · see citing works
Manhica, H., Almquist, Y. B., Rostila, M., & Hjern, A. (2016) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796016000445 · Cited by 53 · see citing works
Association between immigrant background and ADHD : a nationwide population‐based case–control study
Lehti, V., Chudal, R., Suominen, A., Gissler, M., & Sourander, A. (2016) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12570 · Cited by 48 · see citing works
Björkenstam, E., Helgesson, M., Nørredam, M. L., Sijbrandij, M., de Montgomery, C. J., & Mittendorfer‐Rutz, E. (2020) · Psychological Medicine · doi:10.1017/s0033291720003190 · Cited by 45 · see citing works
Morinaga, M., Rai, D., Hollander, A., Petros, N. G., Dalman, C., & Magnusson, C. (2020) · European Journal of Public Health · doi:10.1093/eurpub/ckaa108 · Cited by 45 · see citing works
Self-citationHollander, A., Mackay, E., Sjöqvist, H., Kirkbride, J. B., Bäärnhielm, S., & Dalman, C. (2020) · BMJ Global Health · doi:10.1136/bmjgh-2020-002471 · Cited by 41 · see citing works
Self-citationJablonska, B., Kosidou, K., de León, A. P., Wettermark, B., Magnusson, C., Dal, H., & Dalman, C. (2016) · Journal of Attention Disorders · doi:10.1177/1087054716643257 · Cited by 29 · see citing works
Self-citationPsychiatric healthcare utilisation among refugee adolescents and their peers in Denmark
de Montgomery, C. J., Petersen, J. H., & Jervelund, S. S. (2020) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-020-01878-w · Cited by 29 · see citing works
Underutilisation of psychiatric care among refugee adolescents in Stockholm
Berg, L., Ljunggren, G., & Hjern, A. (2020) · Acta Paediatrica · doi:10.1111/apa.15520 · Cited by 28 · see citing works
Ivert, A., Svensson, R., Adler, H., Levander, S. E., Rydelius, P., & Levander, M. T. (2011) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/1753-2000-5-6 · Cited by 27 · see citing works
Pedrini, L., Sisti, D., Tiberti, A., Preti, A., Fabiani, M., Ferraresi, L., Palazzi, S., Parisi, R. A., Ricciutello, C., Rocchi, M., et al. (2015) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/s13034-015-0060-9 · Cited by 24 · see citing works
Ivert, A., Merlo, J., Svensson, R., & Levander, M. T. (2012) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-012-0589-3 · Cited by 24 · see citing works
Arat, A., Östberg, V., Burström, B., & Hjern, A. (2018) · BMC Psychiatry · doi:10.1186/s12888-017-1572-z · Cited by 24 · see citing works
Kim, Y., Evans, B. E., & Hagquist, C. (2019) · Journal of Immigrant and Minority Health · doi:10.1007/s10903-019-00951-0 · Cited by 18 · see citing works
Axelsson, L., Bäärnhielm, S., Dalman, C., & Hollander, A. (2020) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-020-01883-z · Cited by 17 · see citing works
Self-citationGhosh, M., Holman, C. D. J., & Preen, D. B. (2014) · Australian and New Zealand Journal of Public Health · doi:10.1111/1753-6405.12269 · Cited by 15 · see citing works
van Leeuwen, W., Nilsson, S., & Merlo, J. (2012) · BMJ Open · doi:10.1136/bmjopen-2012-001260 · Cited by 15 · see citing works
Ethnic Differences in Parent–Adolescent Agreement on Internalizing Disorders
Verhulp, E. E., Stevens, G. W. J. M., & Vollebergh, W. (2015) · Journal of Emotional and Behavioral Disorders · doi:10.1177/1063426615578174 · Cited by 8 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Lindegaard, T., Wasteson, E., Demetry, Y., Andersson, G., Richards, D., & Shahnavaz, S. (2022) · Internet Interventions · doi:10.1016/j.invent.2022.100533 · Cited by 30 · see citing works
Gubi, E., Sjöqvist, H., Dalman, C., Bäärnhielm, S., & Hollander, A. (2022) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796022000142 · Cited by 22 · see citing works
Self-citationMattelin, E., Söderlind, N., & Korhonen, L. (2024) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-024-02387-w · Cited by 8 · see citing works
Somo, C. M. (2024) · Education Sciences · doi:10.3390/educsci14030249 · Cited by 8 · see citing works
Manhica, H., Yacamán-Méndez, D., Sjöqvist, H., Lundin, A., & Danielsson, A. (2023) · European Journal of Public Health · doi:10.1093/eurpub/ckad105 · Cited by 7 · see citing works
Self-citationThe Mental Health of Refugee and Migrant Youth after Settlement: Outcomes of a Multinational Study
Lerias, D., Ziaian, T., Arthur, N. M., Augoustinos, M., Pir, T., & Miller, E. (2025) · Community Mental Health Journal · doi:10.1007/s10597-025-01474-9 · Cited by 6 · see citing works
Mattelin, E., Khanolkar, A. R., Andersson, J., Kutabi, H., & Korhonen, L. (2025) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2024.152571 · Cited by 8 · see citing works
Zheng, M., Chen, F., Pan, Y., Kong, D., Renzaho, A. M. N., Sahle, B. W., Mahumud, R. A., Ling, L., & Chen, W. L. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191610119 · Cited by 6 · see citing works
Chen, J., Mittendorfer‐Rutz, E., Berg, L., Nørredam, M. L., Sijbrandij, M., & Klimek, P. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1054261 · Cited by 6 · see citing works
Demetry, Y., Wasteson, E., Lindegaard, T., Abuleil, A., Geranmayeh, A., Andersson, G., & Shahnavaz, S. (2023) · JMIR Formative Research · doi:10.2196/46253 · Cited by 6 · see citing works
Gubi, E., Hollander, A., & Bäärnhielm, S. (2024) · Transcultural Psychiatry · doi:10.1177/13634615241250203 · Cited by 4 · see citing works
Self-citationCrowley, G., Roberts, A., Stewart, R. J., & Das‐Munshi, J. (2024) · The British Journal of Psychiatry · doi:10.1192/bjp.2024.100 · Cited by 4 · see citing works
Mattelin, E., Khanolkar, A. R., Korhonen, L., Åhs, J. W., & Fröberg, F. (2023) · PLOS Global Public Health · doi:10.1371/journal.pgph.0002433 · Cited by 3 · see citing works
Lay perceptions of mental health among Afghan forced migrants residing in Finland
Farahani, H., Martikainen, J., Eliasi, L. G., Tavakol, M., & Toikko, T. (2024) · Social Work in Mental Health · doi:10.1080/15332985.2024.2357357 · Cited by 2 · see citing works
Filiz, E. S., Patel, R., & Hodes, M. (2026) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2026.01.011 · Cited by 2 · see citing works
Stewart, S. L., Dimos, T., & Poss, J. W. (2023) · Child Psychiatry & Human Development · doi:10.1007/s10578-023-01570-5 · Cited by 2 · see citing works
Mattelin, E. (2024) · Linköping University medical dissertations · doi:10.3384/9789180755078 · Cited by 1 · see citing works
Latent Profile Analysis of Mental Health Among Children and Young Adults With Refugee Backgrounds
Andersson, J., Zhai, H., Kankaanpää, R., Bråhn, C., Mattelin, E., Peltonen, K., Münger, A.-C., & Korhonen, L. (2025) · JAACAP Open · doi:10.1016/j.jaacop.2025.06.003 · Cited by 1 · see citing works
Viksveen, P., Doudouh, L., Mustafa, M., & Salamonsen, A. (2026) · Transcultural Psychiatry · doi:10.1177/13634615251409677 · Cited by 1 · see citing works
A systematic review of global mental health service utilisation in young refugees and asylum seekers
Seif, N. A., Ching, B. C. F., Billings, J., Argyriou, A., Pile, V., & Smith, P. (2026) · BJPsych Open · doi:10.1192/bjo.2025.10963 · Cited by 2 · see citing works
Moseholm, E., Ameri, S., Storgaard, M., Pedersen, G., Johansen, I. S., Katzenstein, T. L., & Weis, N. M. (2023) · AIDS Patient Care and STDs · doi:10.1089/apc.2023.0104 · Cited by 1 · see citing works
Mental illness in young migrants: a systematic review
Basu, A., FISHER, K., Rice, S., ARMSTRONG, G., & Robinson, J. (2024) · Minerva Psychiatry · doi:10.23736/s2724-6612.23.02494-6
Schepisi, C., Ventura, M., Napoli, A. D., Aragona, M., Ciampichini, R., Fano, V., Napoli, C., Pacifici, M., Rosini, C., Silvestri, C., et al. (2026) · PLoS ONE · doi:10.1371/journal.pone.0324305
Andersson, J., Bråhn, C., Zhai, H., Mattelin, E., Münger, A.-C., & Korhonen, L. (2025) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-025-02858-8 · Cited by 1 · see citing works
Zarei, K., Sallin, K., Mattsson, M., Petrović, P., Lindevall, O., Ohlis, A., & Hollander, A. (2026) · BMC Psychiatry · doi:10.1186/s12888-026-07830-7
Self-citationKhanal, P., Upadhyaya, S., Ståhlberg, T., Heinonen, E., Luntamo, T., & Sourander, A. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2026.121519
Pantis, M., Bergmann, A., Mizgir, E., Hagmann, D., Schneider, P., Barth, G. M., Renner, T. J., & Allgaier, K. (2026) · BMC Public Health · doi:10.1186/s12889-026-26964-7
Bråhn, C., Söderlind, N., Zhai, H., Lindbom, I., Andersson, J., & Korhonen, L. (2026) · Scientific Reports · doi:10.1038/s41598-026-56584-5
Experiences And Mental Health Outcomes Of Immigrant Children: A Systematic ReviewPreprint
Ojo, J. O., Liverpool, S., Adeleke, O. T., & Ojo, A. B. (2026) · SSRN Electronic Journal · doi:10.2139/ssrn.6947818
Demetry, Y., Kanabi, S., Meurling, J., Amiri, M. A., Andersson, G., & Shahnavaz, S. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1735835
Moe, G., Getz, L., Mjølstad, B. P., & Ytterhus, B. (2026) · International Journal of Qualitative Studies on Health and Well-Being · doi:10.1080/17482631.2026.2705751
Hagström, A., Hollander, A., Assel, K. V., Hasson, H., & Augustsson, H. (2026) · BMJ Public Health · doi:10.1136/bmjph-2025-003272
Self-citationOjha, S., Thapa, S. B., Haag, K., Straiton, M., Nickerson, A., & Nissen, A. (2026) · Psychiatry Research · doi:10.1016/j.psychres.2026.117488
Assel, K. V., Hagström, A., Gubi, E., Place, V., Bäärnhielm, S., Rousseau, C., Dalman, C., Hollander, A., & Åhlén, J. (2026) · Journal of Migration and Health · doi:10.1016/j.jmh.2026.100452
Self-citation
- Authors
- Gubi, E., Sjöqvist, H., Viksten-Assel, K., Bäärnhielm, S., Dalman, C., & Hollander, A.-C.
- Affiliations
- Karolinska Institutet (SE)
- Region Stockholm (SE)
- Corresponding author
- Gubi, Ester
- Venue
- Social Psychiatry and Psychiatric Epidemiology
- Published
- 2021-07-28
- Volume
- 57
- Issue
- 1
- Pages
- 161-171
- ISSN
- 0933-7954 (ISSN-L)
- 1433-9285
- PMC
- PMC8761127
- OpenAlex
- W3183468377
- Cited by
- 34
- References
- 48
- Citations by year
- 2026: 14 · 2025: 4 · 2024: 7 · 2023: 6 · 2022: 3
- FWCI
- 2.73
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Social Psychiatry and Psychiatric Epidemiology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Forskningsrådet om Hälsa, Arbetsliv och Välfärd (2016-00870)
- Vetenskapsrådet (523-2010-1052)
- Karolinska Institute
- Topics
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Sociology and Political Science › Migration, Identity, and Health
- Keywords
- mental health service utilization, migrant children, refugee youth, unaccompanied refugee children, neurodevelopmental disorders, barriers to care, unmet mental health needs, child mental health
- MeSH terms
- Adolescent, Child, Humans, Mental Health Services, Refugees, Sweden, Transients and Migrants, Cohort Studies
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