Migration and Mental Health: Epidemiological Studies of Immigrants in Sweden

Abstract Aims: To analyse the influence of migration status (country of birth/ethnicity), accultura-tion, socio-economic and psychosocial factors on self-reported psychiatric illness, suicide attempt, total mortality and violent death. Methods: Three main data sources were used: suicide attempts in the catchment area of Lund University Hospital (PASIS) during 1991–94; the Swedish Survey of Living Conditions (ULF) 1979–1985 (n=39,155) and 1986–93 (n=36,890); the Swedish National Survey of Immigrants (born in Iran, Chile, Turkey, Kurdistan or Poland) from 1996 (n=1,980). Statistical methods used were chi-squared test, Poisson regression, proportional hazard model and logistic regression. Results: Being foreign-born was associated with an increased age-adjusted risk of attempted suicide, all cause mortality (men only) compared with Swedes. Immigrants born in Finland (men only), Southern Europe or in non-European non-Westernised countries demonstrated a greater risk of self-reported long-standing psychiatric illness (LSPI). Male immigrants from Finland and women born in non-European non-Westernised countries showed an increased risk of intake of benzodiazepines. Female and male immigrants from Iran and Chile exhibited increased risk of psychological distress (GHQ 12) and psychosomatic complaints compared with Poles. Immigrants born in Iran, Chile, Turkey and Poland demonstrated increased risk of LSPI but not of excessive intake of psychotropic drugs compared with native Swedes. Low SoC (sense of coherence), low control, poor acculturation (poor knowledge of Swedish), and poor economic resources (men only) were independent risk factors for psychological distress (GHQ 12). Living alone, poor acculturation, non-employment and low SoC were strong risk factors for LSPI and intake of psychotropic drugs among the five immigrant groups. Conclusion: Experience of migration (being foreign-born), social position (socio-economic and psychosocial factors), sense of control, SoC and acculturation (knowledge of Swedish) are powerful independent variables associated with mental health. Exposure to violence before migration seems to be less important for psychological distress than socio-economic and psychosocial factors.