Prolonged periods of waiting for an asylum decision and the risk of psychiatric diagnoses: a 22-year longitudinal cohort study from Denmark

Abstract

Background: The high prevalence of psychiatric disorders among resettled refugees necessitates identification of factors that reduce the risk of mental illness. In this 22-year longitudinal cohort study, we assessed whether the length of asylum-decision waiting periods is associated with resettled refugees’ risk of being diagnosed with a psychiatric disorder. Methods: We used full-population data from the Danish Civil Registration System to establish a cohort of 46 104 refugees resettled in Denmark during 1995–2016. Hazard ratios (HRs) for first-time psychiatric hospital contact (ICD-10) after residence permit issuance across varying lengths of asylum-decision waiting periods were estimated by cross-linkage with the Danish National Patient Register. Results: Long asylum-decision waiting periods were associated with an increased risk of psychiatric disorders. Compared with refugees who waited 0–6 months for their asylum decision, the HRs of any psychiatric diagnosis were 1.22 [95% confidence interval (CI): 1.12–1.33] for those who waited 13–24 months and 1.46 (95% CI: 1.27–1.69) for those who waited 25–71 months. Associations varied across diagnoses and length of follow-up: whereas the risk of nervous disorders increased with longer asylum-decision waiting periods in the follow-ups of 0–2.9, 3–5.9 and 6–11.9 years, the risk of psychotic disorders was associated with longer asylum-decision procedures only in the 0–2.9-year follow-up. Conclusion: Resettled refugees who waited longer than 1 year for an asylum decision face an increased risk of psychiatric disorders. Host countries should consider that long asylum-decision waiting periods could lead to mental illness among refugees.