Inequalities in psychiatric service use and mortality by migrant status following a first diagnosis of psychotic disorder: a Swedish cohort study of 1.3m people
It is unclear whether inequalities in mental healthcare and mortality following the onset of psychosis exist by migrant status and region-of-origin. We investigated whether (i) mortality; (ii) admission type (in- or out-patient), and; (iii) in-patient length of stay at first diagnosis for psychotic disorder presentation, and; (iv) time-to-readmission for psychotic disorder differed for refugees, non-refugee migrants and by region-of-origin. We established a cohort of 1,335,192 people aged up to 33 years old, born 1984-1997, and living in Sweden from 1st January 1998, followed from their 14th birthday or arrival to Sweden, until death, emigration, or 31 December 2016. The cohort included 9,399 individuals first diagnosed with ICD-10 psychotic disorder (F20-33) during follow-up. Logistic, linear and competing risks regression survival models were used to estimate disparities in outcomes by migrant status or region-of-origin, adjusted for covariates. People with psychotic disorder were 6.70 (95%CI: 5.93-7.58) times more likely to die than the general population, but this did not vary by migrant status (p=0.15) or region-of-origin (p=0.31). Non-refugee (odds ratio [OR]: 1.40, 95%CI: 1.21-1.61) and refugee migrants (OR: 1.42, 95%CI: 1.09-1.84) were more likely to receive inpatient care at first diagnosis. No differences in inpatient length of stay at first diagnosis were observed. Sub-Saharan African migrants with psychotic disorder were readmitted more quickly than their Swedish-born counterparts (sub-Hazard ratio: 1.19; 95% CI: 1.05-1.35). Our findings highlight the need to understand the drivers of disparities in psychosis treatment and the mortality gap experienced by all people with disorder, irrespective of migrant status or region-of-origin.