Outpatient mental health service use following contact with primary health care among migrants in Norway: A national register study

Melanie L. Straiton*, Aart C. Liefbroer, Anna Clara Hollander, Lars Johan Hauge

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review


Majority of mental health problems are treated in primary care, while a minority require specialised treatment. This study aims to identify factors that predict contact with outpatient mental healthcare services (OPMH) among individuals who have been diagnosed with a mental health problem in primary healthcare services (PHC), with a special focus on migrants. Using linked national Norwegian registry data, we followed 1,002,456 individuals who had been diagnosed with a mental health problem in PHC for a period of two years. Using Cox regression, we applied Andersen's Model of Healthcare Utilisation to assess differences in risk of OPMH use between the majority population and eight migrant groups. We also conducted interaction analyses to see if the relationship between OPMH use and predisposing factors (gender, age, migrant status, civil status, education) differed across migrant groups. Migrants from Nordic countries, Western Europe and the Middle-East/North Africa had a higher risk of using OPMH services compared to the majority, while migrants from EU Eastern Europe, Sub-Saharan Africa and South Asia had a lower risk after controlling for all factors. Hazard ratios for non-EU Eastern Europeans and East/South East Asian's did not differ. Men had a higher risk than women. Additionally, the relationship between predisposing factors and OPMH use differed for some migrant groups. Education was not related to OPMH contact among five migrant groups. While lack of help-seeking at the primary care level may explain some of the lower rates of specialist service use observed for migrants compared to non-migrants in previous studies, there appear to be barriers for some migrant groups at the secondary level too. This warrants further investigation. Future research should look at differences between referrals and actual uptake of services among different migrant groups.

Original languageEnglish
Article number114725
Pages (from-to)1-9
Number of pages9
JournalSocial Science and Medicine
Early online date13 Jan 2022
Publication statusPublished - Feb 2022

Bibliographical note

Funding Information:
This research was funded by the Research Council of Norway (grant number 273262/H10 ) through the ‘Women's Health programme’. The funding body had no role in the design of the study, collection, analysis, interpretation of data or in writing the manuscript. ACH's contribution to the article was funded by Hollander/Forte 2016-00870 /Psykiatrisk vård bland utrikesfödda.

Publisher Copyright:
© 2022 The Author(s)


  • Health service use
  • Inequalities
  • Mental health
  • Migrant


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