Health outcomes in young adulthood among former child refugees in Denmark, Norway and Sweden: A cross-country comparative study

Aims: This study aimed at comparing several health outcomes in young adulthood among child refugees who settled in the different immigration and integration policy contexts of Denmark, Norway and Sweden. Methods: The study population included refugees born between 1972 and 1997 who immigrated before the age of 18 and settled in the three Nordic countries during 1986–2005. This population was followed up in national registers during 2006–2015 at ages 18–43 years and was compared with native-born majority populations in the same birth cohorts using sex-stratified and age-adjusted regression analyses. Results: Refugee men in Denmark stood out with a consistent pattern of higher risks for mortality, disability/illness pension, psychiatric care and substance misuse relative to native-born majority Danish men, with risk estimates being higher than comparable estimates observed among refugee men in Norway and Sweden. Refugee men in Sweden and Norway also demonstrated increased risks relative to native-born majority population men for inpatient psychiatric care, and in Sweden also for disability/illness pension. With the exception of increased risk for psychotic disorders, outcomes among refugee women were largely similar to or better than those of native-born majority women in all countries. Conclusions: The observed cross-country differences in health indicators among refugees, and the poorer health outcomes of refugee men in Denmark in particular, may be understood in terms of marked differences in Nordic integration policies. However, female refugees in all three countries had better relative health outcomes than refugee men did, suggesting possible sex differentials that warrant further investigation.

Download Full-text

Age at entry to UK military service and long-term mental health

BMJ Military Health ◽

10.1136/bmjmilitary-2021-001786 ◽

2021 ◽

pp. bmjmilitary-2021-001786

Author(s):

Beverly P Bergman ◽

DF Mackay ◽

NT Fear ◽

JP Pell

Keyword(s):

Mental Health ◽

Health Outcomes ◽

Military Service ◽

Armed Forces ◽

Mental Health Disorder ◽

Mental Health Outcomes ◽

Birth Cohorts ◽

Increased Risk ◽

The Uk

IntroductionIt has been suggested that ‘junior entry’ to the UK Armed Forces (prior to age 17.5 years) increases the risk of adverse mental health outcomes. We used data from a large cohort of veterans to examine long-term mental health outcomes in veterans by age at entry to the UK Armed Forces, compared with non-veterans.MethodsRetrospective cohort study of 78 157 veterans in Scotland, born between 1945 and 1995 and and 252 637 matched non-veterans, with up to 37 years follow-up, using Cox proportional hazard models to examine the association between veteran status and cumulative risk of major mental health disorder, stratified by birth cohort, and age at recruitment for the veterans.ResultsThe risk of mental health disorder in the veterans increased with age at entry, ranging from HR 1.12, 95% CI 1.06 to 1.18, p<0.001 for junior entrants to HR 1.37, 95% CI 1.27 to 1.80, p<0.001 for those aged 20–25 years at entry. The pattern was most marked for veterans born before 1960, and age at recruitment had little impact in recent birth cohorts. Post-traumatic stress disorder accounted for most of the observed differences. Younger age at recruitment was associated with longer service, median 7.4 years (IQR 3.0–14.7) compared with 5.6 years (IQR 2.1–11.7) for entrants aged 20–25 years.ConclusionWe found no evidence that early recruitment is associated with adverse impact on long-term mental health. Paradoxically, it was veterans who entered service at age 20–25 years who demonstrated increased risk, although this attenuated in more recent birth cohorts.

Download Full-text

Outcomes of a digitally delivered, culturally-sensitive behaviour change platform for BAME adults with type 2 diabetes: 1 year health and engagement outcomes (Preprint)

10.2196/preprints.18674 ◽

2020 ◽

Author(s):

Charlotte Summers

Keyword(s):

Type 2 Diabetes ◽

Body Weight ◽

Health Outcomes ◽

Behavioural Change ◽

Culturally Sensitive ◽

Lifestyle Changes ◽

Haemoglobin A1c ◽

Central Asian ◽

Increased Risk

BACKGROUND People from Black, Asian and Minority Ethnic (BAME) groups are known to have an increased risk of developing type 2 diabetes and face greater barriers to accessing healthcare resources compared to their “white British” counterparts. The main mediators of lifestyle behavioural change are gender, generation, geography, genes, God/religion, and gaps in knowledge and economic resources. Dietary and cultural practices of these individuals significantly vary according to gender, generation, geographical origin and religion. Recognition of these factors and implementing culturally sensitive interventions for type 2 diabetes prevention and management is essential in increasing knowledge of healthy eating, engagement in physical activity and improving health outcomes in BAME communities. Few health apps are tailored for BAME populations, and BAME communities are considered hard-to-reach. OBJECTIVE Our objective was to establish whether the Low Carb Program is a viable scalable solution that can be used as an effective tailored type 2 diabetes intervention for BAME communities. We hypothesized that by taking into account cultural sensitivities, providing the platform in native languages and personalising the platform in accordance with known barriers to health disparities including gender, generation, dietary preferences and religion, the app would engage BAME communities and improve type 2 diabetes related health outcomes. METHODS The study used a quasi-experimental research design comprised of an open-label, single-arm, pre-post intervention using a sample of convenience. All 705 adults with type 2 diabetes who had activated their referral to the Low Carb Program as a result of an NHS consultation between September 2018 and March 2019 were followed for a period of 12 months; mean age 54.61 (SD 16.69) years; 58.2% (410/705) women; 45.1% (318/705) white, 28.5% (201/705) Indian/Pakistani/Bangladeshi/Other Central Asian, 10.8% (76/705) Arab, 6.2% (44/705) Mixed/Multiple ethnic groups, 6% (43/705) black, 1.8% (13/705) other, (7/705) 1% Chinese/Japanese/Other East Asian. Mean starting glycated haemoglobin A1c (HbA1c) 7.99% (SD 2.05%); mean body weight 88.96kg (SD 23.25kg). RESULTS Of the 705 study participants, 513 (72.76%) had completed the Low Carb Program at 12 months. There were statistically significant reductions in body weight and HbA1c in white, Indian/Pakistani/Bangladeshi/Other Central Asian, Arabic and black participants with the most significant differences in the Indian/Pakistani/Bangladeshi/Other Central Asian population HbA1c -1.18% (SD 1.49%) and weight 8.03kg (SD 10.65kg). 82.9% of all participants (419/705) of all participants lost at least 5% of their body weight. CONCLUSIONS Offering the culturally tailored Low Carb Program that empowers members to make dietary and lifestyle changes to different BAME groups is an effective and engaging tool in the management of type 2 diabetes. Most importantly, BAME populations in particular people from Indian/Pakistani/Bangladeshi and Arabic groups who achieve better health outcomes than their white counterparts.

Download Full-text

Long-Term Physical Health Outcomes of Resettled Refugee Populations in the United States: A Scoping Review

Journal of Immigrant and Minority Health ◽

10.1007/s10903-021-01146-2 ◽

2021 ◽

Author(s):

Gayathri S. Kumar ◽

Jenna A. Beeler ◽

Emma E. Seagle ◽

Emily S. Jentes

Keyword(s):

Health Outcomes ◽

Physical Health ◽

Public Health Practice ◽

The United States ◽

Inclusion Criteria ◽

Physical Health Outcomes ◽

Increased Risk ◽

The Us ◽

Bhutanese Refugee

AbstractSeveral studies describe the health of recently resettled refugee populations in the US beyond the first 8 months after arrival. This review summarizes the results of these studies. Scientific articles from five databases published from January 2008 to March 2019 were reviewed. Articles were included if study subjects included any of the top five US resettlement populations during 2008–2018 and if data described long-term physical health outcomes beyond the first 8 months after arrival in the US. Thirty-three studies met the inclusion criteria (1.5%). Refugee adults had higher odds of having a chronic disease compared with non-refugee immigrant adults, and an increased risk for diabetes compared with US-born controls. The most commonly reported chronic diseases among Iraqi, Somali, and Bhutanese refugee adults included diabetes and hypertension. Clinicians should consider screening and evaluating for chronic conditions in the early resettlement period. Further evaluations can build a more comprehensive, long-term health profile of resettled refugees to inform public health practice.

Download Full-text

Perceived major experiences of discrimination, ethnic group, and risk of psychosis in a six-country case−control study

Psychological Medicine ◽

10.1017/s0033291721000453 ◽

2021 ◽

pp. 1-9

Author(s):

Supriya Misra ◽

Bizu Gelaye ◽

David R. Williams ◽

Karestan C. Koenen ◽

Christina P.C. Borba ◽

...

Keyword(s):

Ethnic Groups ◽

Psychotic Disorders ◽

Case Control Study ◽

Perceived Discrimination ◽

Case Control ◽

Excess Risk ◽

Minority Ethnic Groups ◽

Increased Risk ◽

Minority Ethnic ◽

Control Study

Abstract Background Perceived discrimination is associated with worse mental health. Few studies have assessed whether perceived discrimination (i) is associated with the risk of psychotic disorders and (ii) contributes to an increased risk among minority ethnic groups relative to the ethnic majority. Methods We used data from the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions Work Package 2, a population-based case−control study of incident psychotic disorders in 17 catchment sites across six countries. We calculated odds ratios (OR) and 95% confidence intervals (95% CI) for the associations between perceived discrimination and psychosis using mixed-effects logistic regression models. We used stratified and mediation analyses to explore differences for minority ethnic groups. Results Reporting any perceived experience of major discrimination (e.g. unfair treatment by police, not getting hired) was higher in cases than controls (41.8% v. 34.2%). Pervasive experiences of discrimination (≥3 types) were also higher in cases than controls (11.3% v. 5.5%). In fully adjusted models, the odds of psychosis were 1.20 (95% CI 0.91–1.59) for any discrimination and 1.79 (95% CI 1.19–1.59) for pervasive discrimination compared with no discrimination. In stratified analyses, the magnitude of association for pervasive experiences of discrimination appeared stronger for minority ethnic groups (OR = 1.73, 95% CI 1.12–2.68) than the ethnic majority (OR = 1.42, 95% CI 0.65–3.10). In exploratory mediation analysis, pervasive discrimination minimally explained excess risk among minority ethnic groups (5.1%). Conclusions Pervasive experiences of discrimination are associated with slightly increased odds of psychotic disorders and may minimally help explain excess risk for minority ethnic groups.

Download Full-text

Depression and its Somatic Consequences: Allostatic Load as the Connecting Link

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.055 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S62-S62

Author(s):

B. Penninx

Keyword(s):

Health Outcomes ◽

Psychiatric Disorders ◽

Allostatic Load ◽

Cellular Aging ◽

Health Consequences ◽

Somatic Health ◽

Depressed Patients ◽

Physiological Dysregulation ◽

Increased Risk ◽

The Impact

Stress-related psychiatric disorders, such as depressive and anxiety disorders, have been associated with increased risk of overall mortality as well as with the onset of various aging-related somatic diseases. In addition to unhealthy lifestyles and poorer (self) care, various stress-related physiological processes likely contribute to these detrimental health consequences of psychiatric disorders. Considering the fact that the impact of stress-related disorders is visible on many different somatic health outcomes, it is unlikely that contributing biological systems are very specific. In fact, it is likely that multiple dysregulations of stress systems, including the immune, HPA-axis and autonomic nervous systems, but also various general proteomic or metabolomic pathways are involved. The concept of Allostatic Load (AL) emphasizes the presence of a multi-system physiological dysregulation.In this talk I will summarize what the evidence is for somatic health consequences of psychiatric conditions, with depression as an important example. Subsequently, I will provide an overview of the various stress systems that are dysregulated in depressed patients. In addition, I will provide empirical data from the Netherlands Study of Depression and Anxiety (n = 2981) that illustrate that there is evidence that depressed patients are especially at risk for a dysregulation in multiple physiological stress systems. I will also illustrate how such a state of AL can impact on basis cellular aging indicators like telomere length and epigenetic age.In sum, this talk will highlight the current state-of-evidence for an association between depressions with the onset of many adverse somatic health outcomes, and will provide insight into the contributing role of a multisystem physiological dysregulation.Disclosure of interestThe author has not supplied his declaration of competing interest.

Download Full-text

SEASON OF BIRTH AND NEURODEVELOPMENTAL DISORDERS: SUMMER BIRTH IS ASSOCIATED WITH DYSLEXIA

PEDIATRICS ◽

10.1542/peds.94.2.212 ◽

1994 ◽

Vol 94 (2) ◽

pp. 212-212

Author(s):

Richard Livingston ◽

Balkozar S. Adam ◽

H. Stefan Bracha

Keyword(s):

Smooth Curve ◽

Early Summer ◽

Season Of Birth ◽

Schizophrenia Spectrum Disorders ◽

Birth Cohorts ◽

Neurological Soft Signs ◽

Schizophrenia Spectrum ◽

Child Bearing ◽

Increased Risk ◽

Clinic Population

Objective: Increased risk for certain psychiatric disorders has been associated with season of birth. This study was undertaken to look for hypothesized season-of-birth effects for dyslexia, schizophrenia spectrum disorders, and neurological soft signs in children and adolescents. Method: Month of birth and the diagnostic findings in question were examined based on charts from a clinic population of 585 boys. Odds ratios and etiological fractions were calculated. Results: Neurological soft signs showed a sporadic peak for June births and schizophrenia spectrum showed a peak for August and November. A smooth curve suggesting true seasonality was evident in dyslexia for births in May, June, and July. For different 5-year birth cohorts, early summer birth accounts for 24 to 71% of cases of dyslexia. Conclusions: The authors suggest that viral infection, especially influenza, during the second trimester of pregnancy is the most attractive hypothesis to explain these findings. If this hypothesis is supported, immunization in women of child-bearing age could reduce the incidence of dyslexia. Secondary prevention could also be enhanced by early identification and treatment of children who were exposed in utero.

Download Full-text

The Dietary Inflammatory Index and Human Health: An Umbrella Review of Meta-Analyses of Observational Studies

Advances in Nutrition ◽

10.1093/advances/nmab037 ◽

2021 ◽

Author(s):

Wolfgang Marx ◽

Nicola Veronese ◽

Jaimon T Kelly ◽

Lee Smith ◽

Meghan Hockey ◽

...

Keyword(s):

Chronic Disease ◽

Health Outcomes ◽

Observational Studies ◽

Dietary Inflammatory Index ◽

Credibility Assessment ◽

Umbrella Review ◽

Inflammatory Index ◽

Increased Risk ◽

Meta Analyses ◽

Study Designs

ABSTRACT Numerous observational studies have investigated the role of the Dietary Inflammatory Index (DII®) in chronic disease risk. The aims of this umbrella review and integrated meta-analyses were to systematically synthesize the observational evidence reporting on the associations between the DII and health outcomes based on meta-analyses, and to assess the quality and strength of the evidence for each associated outcome. This umbrella review with integrated meta-analyses investigated the association between the DII and a range of health outcomes based on meta-analyses of observational data. A credibility assessment was conducted for each outcome using the following criteria: statistical heterogeneity, 95% prediction intervals, evidence for small-study effect and/or excess significance bias, as well as effect sizes and P values using calculated random effects meta-analyses. In total, 15 meta-analyses reporting on 38 chronic disease-related outcomes were included, incorporating a total population of 4,360,111 subjects. Outcomes (n = 38) were examined through various study designs including case-control (n = 8), cross-sectional (n = 5), prospective (n = 5), and combination (n = 20) study designs. Adherence to a pro-inflammatory dietary pattern had a significant positive association with 27 (71%) of the included health outcomes (P value < 0.05). Using the credibility assessment, Class I (Convincing) evidence was identified for myocardial infarction only, Class II (Highly suggestive) evidence was identified for increased risk of all-cause mortality, overall risk of incident cancer, and risk of incident site-specific cancers (colorectal, pancreatic, respiratory, and oral cancers) with increasing (more pro-inflammatory) DII score. Most outcomes (n = 31) presented Class III (Suggestive) or lower evidence (Weak or No association). Pro-inflammatory dietary patterns were nominally associated with an increased risk of many chronic disease outcomes. However, the strength of evidence for most outcomes was limited. Further prospective studies are required to improve the precision of the effect size.

Download Full-text

Long term outcome of childhood onset headache: A prospective community study

Cephalalgia ◽

10.1177/0333102417727536 ◽

2017 ◽

Vol 38 (6) ◽

pp. 1159-1166 ◽

Cited By ~ 9

Author(s):

Matti Sillanpää ◽

Maiju M Saarinen

Keyword(s):

Young Adulthood ◽

Childhood Onset ◽

Term Outcome ◽

Long Term Outcome ◽

Recurrent Headache ◽

Childhood Migraine ◽

Early School ◽

Increased Risk

Purpose To examine prevalence, course, and long-term outcome of childhood migraine and other headaches. Method Using questionnaires, 1185 children were followed for recurrent headaches at ages seven, 14 and 32 years, respectively. Results At age seven years, 4.0% of the 1185 children (girls 3.7%, boys 4.3%) had migraine and 24% (25%/23%) had nonmigrainous headache. In adulthood, 16% (22%/8%) had migraine and 60% (64%/54%) nonmigrainous headache. Childhood migraine persisted into adulthood in 65% of females and 21% of males, and nonmigrainous headache in 62% and 59%, respectively. After childhood, 17% of females and 7% of males started to have episodes of migraine. No recurrent headache during the follow-up was reported by 11% (6%/16%). In a multivariate analysis, compared with no childhood headache, childhood migraine increased the risk of adulthood migraine by 3.36-fold (95% CI 1.94–5.82) and that of nonmigrainous headache by 1.72-fold (1.14–2.60). Discussion and conclusions Headaches are generally as common in preschool girls as boys. From early school years, headaches steadily increase up to young adulthood, but among boys the prevalence levels off after adolescence. About two thirds of children experienced changes in their headache status during a 25-year follow-up. Any kind of recurrent headache at school entry predicts an increased risk of headache in young adulthood. Special attention should be paid to girls and particularly those girls who have recurrent headache when they start school.

Download Full-text

Adolescent cannabis use, baseline prodromal symptoms and the risk of psychosis

The British Journal of Psychiatry ◽

10.1192/bjp.2017.52 ◽

2018 ◽

Vol 212 (4) ◽

pp. 227-233 ◽

Cited By ~ 21

Author(s):

Antti Mustonen ◽

Solja Niemelä ◽

Tanja Nordström ◽

Graham K. Murray ◽

Pirjo Mäki ◽

...

Keyword(s):

Substance Use ◽

General Population ◽

Birth Cohort ◽

Psychotic Disorders ◽

Temporal Order ◽

Population Based ◽

Cannabis Use ◽

Prodromal Symptoms ◽

Increased Risk ◽

Icd 10

BackgroundThe association between cannabis use and the risk of psychosis has been studied extensively but the temporal order still remains controversial.AimsTo examine the association between cannabis use in adolescence and the risk of psychosis after adjustment for prodromal symptoms and other potential confounders.MethodThe sample (n = 6534) was composed of the prospective general population-based Northern Finland Birth Cohort of 1986. Information on prodromal symptoms of psychosis and cannabis use was collected using questionnaires at age 15–16 years. Participants were followed up for ICD-10 psychotic disorders until age 30 years using nationwide registers.ResultsThe risk of psychosis was elevated in individuals who had tried cannabis five times or more (hazard ratio, (HR) = 6.5, 95% CI 3.0–13.9). The association remained statistically significant even when adjusted for prodromal symptoms, other substance use and parental psychosis (HR = 3.0, 95% CI 1.1–8.0).ConclusionsAdolescent cannabis use is associated with increased risk of psychosis even after adjustment for baseline prodromal symptoms, parental psychosis and other substance use.Declaration of interestNone.

Download Full-text

Risk of schizophrenia, schizoaffective, and bipolar disorders by migrant status, region of origin, and age-at-migration: a national cohort study of 1.8 million people

Psychological Medicine ◽

10.1017/s0033291718003227 ◽

2018 ◽

Vol 49 (14) ◽

pp. 2354-2363 ◽

Cited By ~ 11

Author(s):

Jennifer Dykxhoorn ◽

Anna-Clara Hollander ◽

Glyn Lewis ◽

Cecelia Magnusson ◽

Christina Dalman ◽

...

Keyword(s):

Psychotic Disorders ◽

Proportional Hazards ◽

Bipolar Disorders ◽

Cox Proportional Hazards ◽

Migrant Status ◽

Region Of Origin ◽

Related Factors ◽

Increased Risk ◽

Age At Migration ◽

National Cohort

AbstractBackgroundWe assessed whether the risk of various psychotic disorders and non-psychotic bipolar disorder (including mania) varied by migrant status, a region of origin, or age-at-migration, hypothesizing that risk would only be elevated for psychotic disorders.MethodsWe established a prospective cohort of 1 796 257 Swedish residents born between 1982 and 1996, followed from their 15th birthday, or immigration to Sweden after age 15, until diagnosis, emigration, death, or end of 2011. Cox proportional hazards models were used to model hazard ratios by migration-related factors, adjusted for covariates.ResultsAll psychotic disorders were elevated among migrants and their children compared with Swedish-born individuals, including schizophrenia and schizoaffective disorder (adjusted hazard ratio [aHR]migrants: 2.20, 95% CI 1.96–2.47; aHRchildren : 2.00, 95% CI 1.79–2.25), affective psychotic disorders (aHRmigrant1.42, 95% CI 1.25–1.63; aHRchildren: 1.22 95% CI 1.07–1.40), and other non-affective psychotic disorders (aHRmigrant: 1.97, 95% CI 1.81–2.14; aHRchildren: 1.68, 95% CI 1.54–1.83). For all psychotic disorders, risks were generally highest in migrants from Africa (i.e. aHRschizophrenia: 5.24, 95% CI 4.26–6.45) and elevated at most ages-of-migration. By contrast, risk of non-psychotic bipolar disorders was lower for migrants (aHR: 0.58, 95% CI 0.52–0.64) overall, and across all ages-of-migration except infancy (aHR: 1.20; 95% CI 1.01–1.42), while risk for their children was similar to the Swedish-born population (aHR: 1.00, 95% CI 0.93–1.08).ConclusionsIncreased risk of psychiatric disorders associated with migration and minority status may be specific to psychotic disorders, with exact risk dependent on the region of origin.

Download Full-text