Suicide rates among health-care professionals in Norway 1980-2021.

BACKGROUND: Suicide rates have been high in several health-care professions. Suicide rates were described in physicians, dentists, veterinarians, psychologists, pharmacists, nurses, as well as theologians, other graduates and the general population in Norway. METHODS: Data on educational attainment were linked to data on suicide and all-cause mortality from 1980 to 2021. Suicide rates were reported per 100,000 person-years. The total number of person-years included in the study was 66.4 and 67.2 million for males and females, respectively. RESULTS: Between 1980 and 2021, male veterinarians (35.9, 95 % CI 19.3-52.4), physicians (25.7, 21.3-30.2) and nurses (22.2, 16.6-27.7) had higher suicide rates compared others with higher education (11.7, 10.7-12.7). For females, this was the case for psychologists (15.0, 8.2-21.7) and nurses (9.3, 8.3-10.3), vs. others with higher education (5.1, 4.2-6.0). Suicide rates declined over the four decades for most groups. For physicians, suicide rates declined and approached the suicide rate of others with higher education. Suicide rates among physicians increased with age, with physicians over 60 years having twice as high suicide rates compared to others with higher education. LIMITATIONS: The study included only educational status, not current occupation or employment status. This is a descriptive study, with some known risk factors for suicide not accounted for. CONCLUSIONS: Suicide rates for physicians declined over time, but not for nurses. From 2010 to 2021, nurses of both genders was the only group with higher suicide rates compared to other graduates. The increased suicide rates among veterinarians, nurses, female psychologists and elderly physicians are concerning.

General practitioner consultations for mental health reasons prior to and following bereavement by suicide.

PURPOSE: Prior research has shown that the majority of those bereaved by suicide express a need for mental health care services. However, there is a lack of knowledge about these individuals' use of primary health care. The objective of our study was to estimate the association between suicide bereavement and general practitioner (GP) consultations for mental health reasons. METHODS: A population-wide, register-based cohort study identifying 25,580 individuals bereaved by suicide. Estimations of increases in consultation rate were modeled through individual fixed-effects linear analyses adjusted for age and time-period. RESULTS: Overall, 35% of those bereaved by suicide had a GP consultation for mental health reasons during the first 1-2 months, and 53% after two years. In the month immediately after bereavement by suicide, there was a large increase in the consultation rate with a GP for mental health reasons. In the months that followed, the consultation rate gradually decreased. One year after bereavement, the consultation rate stabilized at a somewhat higher level than before the death. The increase in consultation rate was evident across all kinship groups, and the increase was greatest for partners and smallest for siblings. Women had more contact with the GP before the suicide and a greater increase in contact than men. CONCLUSION: Our findings suggest that many of those bereaved by suicide seek assistance from primary health care, and that some are in need of prolonged follow-up from the GP. Health governments should be aware of this and seek to strengthen the GPs knowledge of the needs and challenges associated with this patient group. Measures should also be taken to remove barriers to contact the health care system, especially for men and bereaved siblings.

Morbidity among Adolescent Hypnotic Drug Users in Norway: An Observational Population-Based Study.

We have previously shown that the use of hypnotic drugs increased among young Scandinavians during 2012-2018. This study aimed to explore psychiatric and somatic morbidity among adolescent hypnotic drug users in a cohort study of 13-17-year-old individuals during 2008-2018 in Norway. Data sources were (i) prescription data from the Norwegian Prescription Database linked to specialist health care diagnoses from the Norwegian Patient Registry and (ii) sleep disorder diagnoses from the Primary Health Care Database. Hypnotic drugs were defined as the sedative antihistamine alimemazine and the ATC group "Hypnotics and Sedatives" (N05C), excluding midazolam. In 2017, 2519 girls (16.5/1000) and 1718 boys (10.7/1000) were incident (new) users of hypnotic drugs. Most of these new users (82% of girls, 77% of boys) were referred to secondary health care, where the most frequent diagnoses were mental and behavioral disorders (51.8% of girls, 46.2% of boys), while only 3.2% received a specific sleep disorder diagnosis. The most common mental and behavioral disorders were "Neurotic stress-related disorders" among girls (27.4%) and "Behavioral and emotional disorders" among boys (23.6%). In conclusion, the trend of increasing hypnotic drug use among adolescents reflects the initiation of hypnotic drugs in a subgroup of the population with a higher disease burden, mainly due to psychiatric disorders, than the general population.

Contact with primary care physicians among adults with pre-existing common mental health problems during the COVID-19 pandemic: a registry-based study from Norway.

BACKGROUND: During the COVID-19 pandemic, individuals with pre-existing mental health problems may have experienced additional stress, which could worsen symptoms or trigger relapse. Thus, this study aimed to investigate if the number of consultations with general practitioners (GPs) among individuals with a pre-existing common mental health problem during the pandemic differed from pre-pandemic years. METHODS: Data on consultations with GPs among 18-65-year-olds registered with common mental health problems in 2017-2021 were retrieved from the Norwegian Control and Payment of Health Reimbursements Database. Based on data from the pre-pandemic years (2017-2019), we predicted the number of consultations per week for depression, anxiety disorder, phobia/obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and eating disorders during the pandemic (March 2020-December 2021) among individuals with pre-existing mental health problems. The forecasted and observed trends in GP consultations per week during the pandemic were stratified by diagnosis, gender, and age groups. RESULTS: The observed number of consultations for anxiety disorder, PTSD, and eating disorders were significantly higher than forecasted during extended periods of the two pandemic years. The differences were largest for PTSD (on average 37% higher in men and 47% higher in women during the pandemic), and for eating disorders among women (on average 87% higher during the pandemic). There were only minor differences between the predicted and observed number of consultations for depression and phobia/OCD. CONCLUSIONS: During the pandemic, individuals with a recent history of mental health problems were more likely to seek help for anxiety disorder, PTSD, and eating disorders, as compared to pre-pandemic years.

Incidence rates of treated mental disorders before and during the COVID-19 pandemic-a nationwide study comparing trends in the period 2015 to 2021.

BACKGROUND: There is a concern that exposure to psychosocial stressors during the COVID-19 pandemic may have led to a higher incidence of mental disorders. Thus, this study aimed to compare trends in incidence rates of depressive disorder, anxiety disorders, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and eating disorders in primary- and specialist health care before (2015-2019) and during the COVID-19 pandemic (2020-2021). METHODS: We used aggregated population registry data to calculate incidence rates of mental disorders from primary- (The Norwegian Control and Payment of Health Reimbursements Registry (KUHR)) and specialist (The Norwegian Patient Registry (NPR)) health care. The analyses included all Norwegian residents aged 18-65 during the study period. Incident cases were defined as having no previous registration with the same mental disorder in KUHR (from 2006) or NPR (from 2008). We used linear prediction models and mean models to compare incidence rates and test trends before and during the pandemic. RESULTS: During the pandemic, the incidence rates among women were higher or as predicted for OCD in specialist health care and for eating disorders in both primary- and specialist health care. These findings were strongest among women aged 18-24 years. Incidence rates for depression and phobia/OCD among both genders in primary health care and phobic anxiety disorders among both genders in specialist health care were lower or as predicted. CONCLUSION: The COVID-19 pandemic may have led to more women needing treatment for OCD and eating disorders in the Norwegian population. The decreased incidence rates for some disorders might indicate that some individuals either avoided seeking help or had improved mental health during the pandemic.

Sickness absence around contact with outpatient mental health care services - differences between migrants and non-migrants: a Norwegian register study.

BACKGROUND: Mental disorders are a leading cause of sickness absence. Some groups of migrants are at higher risk of both mental disorder and sickness absence. Yet, research on sickness absence in relation to mental disorders among migrants is limited. This study investigates differences in sickness absence in the twelve-month period around contact with outpatient mental health services between non-migrants and various migrant groups with different length of stays. It also considers whether these differences are similar for men and women. METHODS: Using linked Norwegian register data, we followed 146,785 individuals, aged 18-66 years, who had attended outpatient mental health services and who had, or had recently had, a stable workforce attachment. The number of days of sickness absence was calculated for the 12-month period surrounding contact with outpatient mental health services. We applied logistic regression and zero-truncated negative binomial regression to assess differences in any sickness absence and number of days of absence between non-migrants and migrants, including refugees and non-refugees. We included interaction terms between migrant category and sex. RESULTS: Refugee men and other migrant men from countries outside the European Economic Area (EEA) had a higher probability of any sickness absence in the period surrounding contact with outpatient mental health services than their non-migrant counterparts. Women from EEA countries with stays of less than 15 years had a lower probability than non-migrant women. Additionally, refugees, both men and women, with 6-14 years in Norway had more days of absence while EEA migrants had fewer days than their non-migrant counterparts. CONCLUSIONS: Refugee men and other non-EEA migrant men appear to have higher sickness absence than non-migrant men around the time of contact with services. This finding does not apply to women. Several probable reasons for this are discussed, though further research is required to understand why. Targeted strategies to reduce sickness absence and support the return to work for refugees and other non-EEA migrant men are needed. Barriers to timely help-seeking should also be addressed.

Widening the knowledge of non-employment as a risk factor for suicide: a Norwegian register-based population study.

BACKGROUND: There is a known association between employment status and suicide risk. However, both reason for non-employment and the duration affects the relationship. These factors are investigated to a lesser extent. About one third of the Norwegian working age population are not currently employed. Due to the share size of this population even a small increase in suicide risk is of importance, and hence increased knowledge about this group is needed. METHODS: We used discrete time event history analysis to examine the relationship between suicide risk and non-employment due to either unemployment or health-problems, and the duration of these non-employment periods. We analyze data from the Norwegian population registry from 2004 to 2014, which includes all Norwegian residents in the ages 19-58 born between 1952 and 1989. In total the data consists of 1 063 052 men and 1 024 238 women, and 2 039 suicides. RESULTS: The suicide risk among the non-employed men and women is significantly higher than that of the employed. For the unemployed men, the suicide risk is significantly higher than the employed within the first 18 months. For the unemployed women we only find a significant association with suicide risk among those unemployed for six to twelve months. The suicide risk is especially increased among those with temporary health-related benefits. In the second year of health-related non-employment men have eightfold and women over twelvefold the OR for suicide, compared to the employed. CONCLUSION: There is an association between non-employment and suicide risk. Compared to the employed both unemployed men and men and women with health-related non-employment have elevated suicide risk, and the duration of non-employment may be the driving force. Considering the large share of the working age population that are not employed, non-employment status should be considered in suicide risk assessment by health care professionals and welfare providers.

Migrant background and the impact of the COVID-19 pandemic on mental healthcare consultations among children and adolescents in Norway: a nationwide registry study.

BACKGROUND: Despite concern about migrant children's mental health and their access to mental healthcare services during the COVID-19 pandemic, this topic has attracted little research attention. This study aimed to examine the impact of the COVID-19 pandemic on the use primary and specialist healthcare services for mental health problems among children and adolescents with migrant background. METHODS: Using event study models, we investigated the impact of lockdown and subsequent COVID-19 infection control measures on children's health service use for mental health problems according to migrant background. Drawing on reimbursement data from Norwegian public healthcare providers we observe consultations in a pre-pandemic (2017-2019) and pandemic cohort (2019-2021) in primary and specialised care. RESULTS: The pre-pandemic cohort included 77 324 migrants, 78 406 descendants of migrants and 746 917 non-migrants and the pandemic cohort included 76 830 migrants, 88 331 descendants and 732 609 non-migrants (age 6-19). The full cohorts were observed for mental healthcare use in primary care while a subsample (age 6-16) was observed for health care use in specialist care. Lockdown resulted in a dip in consultation volumes for mental disorders for all children, but this dip was relatively larger and more persistent for children with migrant background. After lockdown, consultation volumes rose more for non-migrant children than for children with migrant background. Consultations in primary healthcare peaked during January to April 2021 for non-migrants and descendants of migrants, but not for migrants (4%, 95% CI -4 to 11). In specialist care during the same period, consultations dropped by 11% for migrants (95% CI -21 to -1). By October 2021, all mental health consultations in specialist care were up with 8% for non-migrants (95% CI 0 to 15), and down with -18% for migrants and -2% for descendants (95% CIs -31 to -5 and -14 to 10). Migrant males experienced the largest reduction in consultations. CONCLUSIONS: Changes in consultation volumes among children with migrant background after lockdown were not as pronounced as for non-migrants, and at times actually decreased. This suggests that an increase in barriers to care emerged during the pandemic for children with a migrant background.

Impact of the COVID-19 pandemic on mental healthcare consultations among children and adolescents in Norway: a nationwide registry study.

The COVID-19 pandemic and its associated restrictions may have affected children and adolescent's mental health adversely. We cast light on this question using primary and specialist consultations data for the entire population of children of age 6-19 years in Norway (N = 908 272). Our outcomes are the monthly likelihood of having a consultation or hospitalization related to mental health problems and common mental health diagnoses. We compared a pandemic (2019-2021) to a pre-pandemic (2017-2019) cohort using event study and difference-in-difference designs that separate the shock of the pandemic from linear period trends and seasonal variation. We found temporary reductions in all mental health consultations during lockdown in spring 2020. In fall 2020 and winter 2021, consultation volumes in primary care increased, stabilizing at a higher level in 2021. Consultations in specialist care increased from spring 2021. Our findings could suggest a worsening of mental health among adolescents.

Mental disorder and subsequent marital separation among migrant and non-migrant women.

Using national register data between 2006-2014, we investigated the relationship between outpatient mental health service use (a proxy for mental disorder) and subsequent marital separation among women in Norway and whether the strength of the association differed for migrant and non-migrant women. Our sample population included 679,928 married women aged 18-60 years. Service use was strongly associated with marital separation among all women. The relationship was stronger for Filipinas but weaker for Somalis and Russians, compared with non-migrant women. Migration-related factors may influence marital separation among migrant women and barriers to care are likely to exist.

Adolescents' primary care consultations before and after parental suicide: evidence from population-wide data.

Parental bereavement is associated with distress and poorer long-term outcomes among adolescents. Adolescents who lose a parent to suicide fare worse than their peers even before bereavement. Based on the current literature, we cannot distinguish such initial differences from the medium and long-term effect of parental suicide. We study the impact of parental suicide on adolescents' General Practitioner visits for mental health or psychosocial reasons. Within-individual models account for time-invariant differences between the bereaved and non-bereaved. We investigate if effects differ from the impact of parental death from other causes, and vary with sex and socioeconomic background. Full population data on Norwegian residents aged 10-19 in the period 2006-2015 are drawn from registers (N = 1 405 suicide bereaved, 12 982 bereaved by other causes, and 1 182 819 non-bereaved controls). Records include data on use of health services, parental mortality, and sociodemographic characteristics of parent and child. Mental health consultations increase gradually in the quarters leading up to the parental suicide, significantly more for girls than for boys. Two years prior to bereavement, 2.4% of the subsequently suicide bereaved have a mental health consultation in any given quarter. In the year of bereavement, this increases with 6% points. Health care workers should be aware that boys are less likely to turn to their GP for support before parental bereavement from suicide.

Employment status and bereavement after parental suicide: a population representative cohort study.

OBJECTIVES: To examine employment status among adults bereaved by parental suicide at the time of bereavement and 2 and 5 years after the loss and to explore the importance of the gender of the adult child and the deceased parent. DESIGN: Population-based register study. SETTING: Norwegian population-based registries linked using unique personal identifiers. PARTICIPANTS: Norwegian residents aged 25-49 years in the period 2000-2014. Participants were divided into three groups: bereaved by parental suicide, bereaved by parental death of other causes and non-bereaved population controls. MAIN OUTCOME MEASURES: ORs for the risk of non-employment at the time of bereavement and 2 and 5 years after the loss. RESULTS: Those bereaved by parental suicide had a higher risk of non-employment already at the time of bereavement (OR 1.14, 95% CI 1.05 to 1.23). Stratified analyses showed that women accounted for this difference (OR 1.20, 95% CI 1.09 to 1.33), while no difference was found for men (OR 1.00, 95% CI 0.88 to 1.13). Looking at the gender of the parent, there was only a significant association of non-employment when losing a mother (OR 1.24, 95% CI 1.08 to 1.42), while not for losing a father (OR 1.09, 95% CI 0.99 to 1.20). Among those working at the time of bereavement, offspring bereaved by suicide were more likely to be non-employed at both 2 (OR 1.13, 95% CI 0.99 to 1.30) and 5 (OR 1.20, 95% CI 1.02 to 1.40) years after the loss compared with the general population. CONCLUSIONS: Women bereaved by parental suicide and those losing a mother to suicide were found to have a weaker attachment to the labour market already before losing their parent. Those who were employed when bereaved by suicide were somewhat more likely to be non-employed 5 years after the event.

The association between early marriage and mental disorder among young migrant and non-migrant women: a Norwegian register-based study.

BACKGROUND: Marriage is considered beneficial for mental health when stable and of high quality. Yet, it is unclear whether marriage is equally advantageous for everyone regardless of marital timing or migrant background. This study aimed to investigate the association between early marriage and mental disorder, defined by outpatient mental healthcare (OPMH) service use, and whether the association varies between migrant and non-migrant women. METHODS: Using data from four Norwegian national registers, we applied discrete-time logistic regression analyses to study the aims of interest, among 602 473 young women aged 17-35 years. All women were followed from 2006 or the year they turned 17, and until first OPMH consultation, 2015 (study end), the year they turned 35, when emigrated, died, or changed marital status from married to separated, divorced, or widowed. RESULTS: Results show that unmarried and early married women had increased odds of mental disorder when compared to on-time married women. However, the differences between the early and on-time married women were explained by differences in educational level. There was no significant interaction between marital status and migrant background. CONCLUSIONS: Differences in mental health between early- and on time married women are attributed to poorer educational attainment of women who marry early. Furthermore, migrant background seems to have a limited role in the association between marital timing and mental disorder. The promotion of formal education among young women could contribute to the accumulation of socioeconomic and psychosocial resources, thus, reducing the risk of mental disorder, also among early married women.

The relationship between motherhood and use of mental health care services among married migrant and non-migrant women: a national register study.

BACKGROUND: Giving birth to one's first child is a life changing event. Beyond the post-partum period, little is known about the association between becoming a mother and mental disorder among migrant women. This study investigates outpatient mental health (OPMH) service use, a proxy for mental disorder, among married migrant and non-migrant women who become mothers and those who do not. METHODS: Using Norwegian register data, we followed 90,195 married women, aged 18-40 years, with no children at baseline between 2008-2013 to see if becoming a mother was associated with OPMH service use. Data were analysed using discrete time analyses. RESULTS: We found an interaction between motherhood and migrant category. Married non-migrant mothers, both in the perinatal period and beyond, had lower odds of OPMH use than married non-mothers. There was no association between motherhood and OPMH service use for migrants. However, there was no significant interaction between motherhood and migrant category when we excluded women who had been in Norway less than five years. Among women aged 25-40 years, a stable labour market attachment was associated with lower odds of OPMH use for non-migrants but not migrants, regardless of motherhood status. CONCLUSIONS: The perinatal period is not associated with increased odds of OPMH use and appears to be associated with lower odds for married non-migrant women. Selection effects and barriers to care may explain the lack of difference in OPMH service use that we found across motherhood status and labour market attachment for married migrant women. Married migrant women in general have a lower level of OPMH use than married non-migrants. Married migrant women with less than five years in Norway and those with no/weak labour market attachment may experience the greatest barriers to care. Further research to bridge the gap between need for, and use of, mental health care among migrant women is required.

The association between persistent low parental income during preschool age and mental disorder in adolescence and early adulthood: a Norwegian register-based study of migrants and non-migrants.

BACKGROUND: Low socioeconomic status during childhood is associated with increased risk of mental disorders later in life. Yet, there is limited research on whether this association varies by migrant background, despite an overrepresentation of migrants among the economically disadvantaged. METHODS: Using national register data on a study population of 577,072 individuals, we investigated the association between persistent low parental income during preschool, measured at age 3-5 years and mental disorder during adolescence and early adulthood, measured between ages 16-25. Outpatient mental healthcare (OPMH) service use was a proxy for mental disorder and was measured between 2006 and 2015. We applied discrete-time logistic regression analyses with interaction terms to study differences in the relationship between persistent low parental income and OPMH service use by migrant background and gender. RESULTS: Persistent low parental income during preschool age was associated with increased odds of OPMH service use in adolescence and early adulthood (aOR = 1.99, 95% CI 1.90-2.08), even after adjusting for gender, migrant background, parental education and persistent lower income at later ages (aOR = 1.33, 95% CI 1.27-1.40). Statistically significant interactions between migrant background and persistent low parental income were recalculated and presented as marginal yearly probabilities. These results showed that the association was in the opposite direction for migrants; those in the higher income group had higher probability of OPMH service use, although the differences were non-significant for some groups. The relationship did not vary by gender. CONCLUSIONS: Social inequalities in mental health, as measured by OPMH service use, may have an onset already in childhood. Interventions to reduce inequalities should therefore start early in the life course. Since the association differed for migrants, future research should aim to investigate the mechanisms behind these disparities.

Mental disorder and first-time marriage formation among non-Western migrant women: A national register study.

PURPOSE: Studies show that there is a mental health selection into marriage among the general population. This study explored the association between mental disorder and marriage formation among non-Western migrant women living in Norway, and whether the association varied with region of origin, income, education and having a dependent child. METHODS: Using linked national register data, we followed 49,329 non-Western never married migrant women aged 18-60 living in Norway between 2006 and 2014. As a proxy for mental disorders, we investigated whether outpatient mental health service use was associated with marital formation using discrete time logistic regression analyses. RESULT: Overall, outpatient mental health service use was associated with lower odds of marital formation, even after controlling for sociodemographic factors. Interaction analyses suggested that the relationship was weaker for South Asian women, who had the highest odds of marriage formation, compared with Sub-Saharan African women, who had the lowest. The relationship was also stronger for women with children and women with low incomes. CONCLUSION: Mental health selection effects may depend on the universality of marriage. Since marriage may be associated with psychosocial and economic benefits, it is important to identify and treat mental disorder among non-Western migrant women, particularly those with childcare responsibilities and low income.

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

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.

Marital status, educational attainment, and suicide risk: a Norwegian register-based population study.

BACKGROUND: The presence and quality of social ties can influence suicide risk. In adulthood, the most common provider of such ties is one's partner. As such, the link between marital status and suicide is well-documented, with lower suicide risk among married. However, the association between marital status and educational level suggest that marriage is becoming a privilege of the better educated. The relationship between educational attainment and suicide is somewhat ambiguous, although several studies argue that there is higher suicide risk among the less educated. This means that unmarried with low education may concurrently experience several risk factors for suicide. However, in many cases, these associations apply to men only, making it unclear whether they also refer to women. We aim to investigate the association between marital status, educational attainment, and suicide risk, and whether these associations differ across sexes. METHODS: Our data consist of Norwegian residents aged 35-54, between 1975 and 2014. Using personal identification-numbers, we linked information from various registers, and applied event history analysis to estimate suicide risk, and predicted probabilities for comparisons across sexes. RESULTS: Overall, associations across sexes are quite similar, thus contradicting several previous studies. Married men and women have lower suicide risk than unmarried, and divorced and separated have significant higher odds of suicide than never married, regardless of sex. Low educational attainment inflates the risk for both sexes, but high educational attainment is only associated with lower risk among men. Being a parent is associated with lower suicide risk for both sexes. CONCLUSIONS: Higher suicide risk among the divorced and separated points to suicide risk being associated with ceasing of social ties. This is the case for both sexes, and especially those with low educational attainment, which both healthcare professionals and people in general should be aware of in order to promote suicide prevention.

Change in Work-Related Income Following the Uptake of Treatment for Mental Disorders Among Young Migrant and Non-migrant Women in Norway: A National Register Study.

Background: Women, and migrant women in particular, are at increased risk of many common mental disorders, which may potentially impact their labor market participation and their work-related income. Previous research found that mental disorders are associated with several work-related outcomes such as loss of income, however, not much is known about how this varies with migrant background. This study investigated the change in work-related income following the uptake of outpatient mental healthcare (OPMH) treatment, a proxy for mental disorder, in young women with and without migrant background. Additionally, we looked at how the association varied by income level. Methods: Using data from four national registries, the study population consisted of women aged 23-40 years residing in Norway for at least three consecutive years between 2006 and 2013 (N = 640,527). By using a stratified linear regression with individual fixed effects, we investigated differences between majority women, descendants and eight migrant groups. Interaction analysis was conducted in order to examine differences in income loss following the uptake of OPMH treatment among women with and without migrant background. Results: Results showed that OPMH treatment was associated with a decrease in income for all groups. However, the negative effect was stronger among those with low income. Only migrant women from Western and EU Eastern Europe with a high income were not significantly affected following OPMH treatment. Conclusion: Experiencing a mental disorder during a critical age for establishment in the labor market can negatively affect not only income, but also future workforce participation, and increase dependency on social welfare services and other health outcomes, regardless of migrant background. Loss of income due to mental disorders can also affect future mental health, resulting in a vicious circle and contributing to more inequalities in the society.