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Refugee migration and risk of schizophrenia and other non-affective psychoses: cohort study of 1.3 million people in Sweden
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OBJECTIVE: To determine whether refugees are at elevated risk of schizophrenia and other non-affective psychotic disorders, relative to non-refugee migrants from similar regions of origin and the Swedish-born population. DESIGN: Cohort study of people living in Sweden, born after 1 January 1984 and followed from their 14th birthday or arrival in Sweden, if later, until diagnosis of a non-affective psychotic disorder, emigration, death, or 31 December 2011. SETTING: Linked Swedish national register data. PARTICIPANTS: 1,347,790 people, including people born in Sweden to two Swedish-born parents (1,191,004; 88.4%), refugees (24,123; 1.8%), and non-refugee migrants (132,663; 9.8%) from four major refugee generating regions: the Middle East and north Africa, sub-Saharan Africa, Asia, and Eastern Europe and Russia. MAIN OUTCOME MEASURES: Cox regression analysis was used to estimate adjusted hazard ratios for non-affective psychotic disorders by refugee status and region of origin, controlling for age at risk, sex, disposable income, and population density. RESULTS: 3704 cases of non-affective psychotic disorder were identified during 8.9 million person years of follow-up. The crude incidence rate was 38.5 (95% confidence interval 37.2 to 39.9) per 100,000 person years in the Swedish-born population, 80.4 (72.7 to 88.9) per 100,000 person years in non-refugee migrants, and 126.4 (103.1 to 154.8) per 100,000 person years in refugees. Refugees were at increased risk of psychosis compared with both the Swedish-born population (adjusted hazard ratio 2.9, 95% confidence interval 2.3 to 3.6) and non-refugee migrants (1.7, 1.3 to 2.1) after adjustment for confounders. The increased rate in refugees compared with non-refugee migrants was more pronounced in men (likelihood ratio test for interaction χ(2) (df=2) z=13.5; P=0.001) and was present for refugees from all regions except sub-Saharan Africa. Both refugees and non-refugee migrants from sub-Saharan Africa had similarly high rates relative to the Swedish-born population. CONCLUSIONS: Refugees face an increased risk of schizophrenia and other non-affective psychotic disorders compared with non-refugee migrants from similar regions of origin and the native-born Swedish population. Clinicians and health service planners in refugee receiving countries should be aware of a raised risk of psychosis in addition to other mental and physical health inequalities experienced by refugees.
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“The large number of potential stressors during the three stages may help to explain why forced migration can lead to traumatisation and why the refugee population is more vulnerable to mental illness such as depression, anxiety, and posttraumatic stress disorder (PTSD) (Heeren et al., 2014; Hollander et al., 2016).”
From Refugees versus persons family reunified to a refugee: A comparison of sociodemographic factors, trauma history, baseline psychopathology and treatment effectiveness (2023) · cites this paper as Hollander et al., 2016
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Metadata
- Authors
- Hollander, A.-C., Dal, H., Lewis, G., Magnusson, C., Kirkbride, J. B., & Dalman, C.
- Affiliations
- Karolinska Institutet (SE)
- Region Stockholm (SE)
- University College London (GB)
- Corresponding author
- Hollander, Anna-Clara
- ORCID
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2016-03-15
- Volume
- 352
- Pages
- i1030
- ISSN
- 1756-1833 (ISSN-L)
- PMC
- PMC4793153
- OpenAlex
- W2298599425
- Cited by
- 240
- References
- 38
- Citations by year
- 2026: 5 · 2025: 12 · 2024: 16 · 2023: 16 · 2022: 21 · 2021: 32 · 2020: 34 · 2019: 41 · 2018: 31 · 2017: 26 · 2016: 6
- FWCI
- 46.41
- Type
- journal article
- Language
- en
- Update notices
- correction (2016-05-27)
- Open access
- hybrid
- doi.org
- Locations
- BMJ (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Wellcome Trust (101272, 101272/Z/13/Z)
- Vetenskapsrådet
- Forskningsrådet om Hälsa, Arbetsliv och Välfärd
- Topics
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Keywords
- refugees, schizophrenia, non-affective psychosis, psychosis risk, immigrant mental health, region of origin, sex differences, psychosis incidence, migration and mental health, Sweden, Middle East and North Africa, sub-Saharan Africa, Asia, population density, disposable income
- MeSH terms
- Adolescent, Adult, Aged, Europe, Eastern, Female, Humans, Male, Middle Aged, Psychotic Disorders, Refugees, Russia, Schizophrenia, Socioeconomic Factors, Sweden, Transients and Migrants, Proportional Hazards Models, Age Distribution, Sex Distribution, Africa South of the Sahara
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