Refugee Migration Background and Healthcare Contacts Prior to First-Episode Psychosis in Young Adults in Denmark and Sweden: Are Patterns Consistent Across Countries?

Introduction
The objective of this study was to examine group differences in healthcare contacts prior to a first diagnosis of non-affective psychotic disorders (NAPDs) comparing young refugees settled in Denmark and Sweden before turning 18 non-refugee migrants and native-born individuals.

Methods
Using nationwide register data, we identified all individuals aged 18–35 who received an NAPD diagnosis during 2006–2018. Healthcare contacts for other psychiatric disorders were categorised as inpatient, outpatient (grouped by discharge diagnosis) or dispensed antidepressant medication. Logistic regression was used in each country to compare contacts within 12 months prior to NAPD diagnosis, yielding odds ratios (OR) and corresponding 95% confidence intervals (CI), while standardised prevalence ratios (SPR), reported in percentages, were used to compare healthcare contact across countries.

Results
We included 11,679 individuals in Denmark and 11,088 in Sweden. The likelihood of prior contact of any type was lower in both countries for both refugees [Denmark: OR = 0.75(CI: 0.63, 0.90); Sweden: OR = 0.61(CI: 0.55, 0.68)] and non-refugee migrants [Denmark: OR = 0.78(CI: 0.64, 0.95); Sweden: OR = 0.55(CI: 0.49, 0.62)] compared with majority peers. The largest differences were observed for dispensed antidepressants in both countries [Denmark: ORrefugees = 0.58(CI: 0.47, 0.71); Sweden: ORrefugees = 0.52(CI: 0.45, 0.61)]. Outpatient contacts in particular were more common in Sweden than in Denmark across all groups [SIRrefugees = 151% (CI: 125, 180)].

Conclusion
Young refugees and non-refugee migrants in both Denmark and Sweden were less likely to have healthcare contact for other psychiatric disorders prior to NAPD onset than host populations. As healthcare contacts offer opportunities to identify treatment needs early, these groups may be vulnerable to delays in the pathway to treatment.