Common mental disorders among young refugees in Sweden: The role of education and duration of residency

Emma Björkenstam*, Magnus Helgesson, Marie Norredam, Marit Sijbrandij, Christopher Jamil de Montgomery, Ellenor Mittendorfer-Rutz

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review

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Background: Studies investigating risks of common mental disorders (CMDs) in refugee youth are sparse. The current study examined health care use due to CMDs in unaccompanied and accompanied refugee youth and Swedish-born, and the role of education and residency duration. Methods: This longitudinal cohort study included 746,517 individuals (whereof 36,347 refugees) between 19 and 25 years, residing in Sweden in 2009. Refugees were classified as unaccompanied/accompanied. Risk estimates of CMDs, measured as health care use and antidepressant treatment, between 2010–2016 were calculated as adjusted hazard ratios (aHR) with 95% confidence intervals (CI). Highest attained education in 2009, and residency duration were examined as potential modifiers. Results: Compared to Swedish-born youth, refugees had a lower risk of treated major depressive and anxiety disorders (aHR): 0.67 (95% CI 0.63–0.72) and 0.67 (95% CI 0.63–0.71) respectively), but a higher risk for posttraumatic stress disorders (PTSD). Compared to Swedish-born, unaccompanied had a nearly 6-fold elevated risk for PTSD (aHR: 5.82, 95% CI 4.60–7.34) and accompanied refugees had a 3-fold risk of PTSD (aHR: 3.08, 95% CI 2.54–3.74). Rates of PTSD decreased with years spent in Sweden. The risk of CMDs decreased with increasing education. Limitations: The study lacked information on pre-migration factors. There may further be a potential misclassification of untreated CMDs. Conclusion: Refugees had a lower risk of treated depressive and anxiety disorders but a higher risk for PTSD. In refugees, the rates of anxiety disorders increased slightly over time whereas the rates of PTSD decreased. Last, low education was an important predictor for CMDs.

Original languageEnglish
Pages (from-to)563-571
Number of pages9
JournalJournal of Affective Disorders
Early online date4 Feb 2020
Publication statusPublished - 1 Apr 2020


  • Cohort
  • Common mental disorders
  • Education
  • Epidemiology
  • Health care
  • Migration
  • Sweden
  • Young refugees


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