Narcotic offences and drug use disorders among young refugees in Norway.

AIMS: We examined the patterns of healthcare utilisation for drug use disorders (DUDs) and charges related to narcotics among young refugees in Norway considering the role of sex, country of origin and condition of arrival (accompanied versus unaccompanied minors). METHODS: Based on national registers, sex-stratified Cox regression models were used to estimate hazard ratios to assess the risk of being charged with a narcotics offence and the use of healthcare services related to DUDs. The sample consisted of 15,068 young refugees and 573,241 young Norwegians born in Norway to two Norwegian-born parents. All of the young people in the sample were born between 1983 and 1994. The follow-up period was from January 2008 to December 2015. RESULTS: Compared with their Norwegian peers, both male and female refugees showed either a similar or lower risk of receiving healthcare for DUDs. However, male refugees showed an increased risk of being charged with a narcotic offence, except those from Afghanistan and the former Yugoslavia. Accompanied male refugees were at a higher risk of being charged, while unaccompanied male refugees showed a lower risk. CONCLUSIONS: Young male refugees generally had a higher risk of being charged for narcotic offences while showing a similar risk of receiving healthcare for DUDs compared to Norwegian-born young people. However, young men from Afghanistan and the former Yugoslavia deviated from this pattern. This may be partially explained by the length of time spent in Norway. The results add support to previous qualitative studies suggesting that punitive drug policies may disproportionately affect men from minority groups. Further research controlling for parental household-level factors is warranted.

Early substance use disorders and subsequent NEET-not in education, employment or training-a national cohort study.

BACKGROUND: Substance use problems have been associated with poor labour market outcomes. This study investigated whether substance use disorders (SUD) in emerging adulthood increase the likelihood of later being not in employment, education or training (NEET). METHODS: A national cohort study of 23 5295 males and 227 792 females born between 1981 and 1987. SUD was assessed between ages 17 and 24 years. Logistic regression models were used to estimate the odds ratios (ORs) of NEET, between ages 25-34. Sibling-comparison analysis was performed to account for potential shared genetic and environmental factors. RESULTS: Having been diagnosed with a SUD was associated with the likelihood of being NEET among males [OR = 1.37, 95% confidence interval (CI), 1.25-1.49] and females (1.19, 1.13-1.27) after adjusting for domicile, origin, psychiatric diagnosis and parental psychiatric diagnosis. Early SUD was also associated with a gradual increase in the ORs of accumulation of years being NEET. This was more evident among females. In the sibling-comparison analysis, we found a higher OR of NEET among same-sex sibling males 1.39 (1.06-1.82) and females 1.28 (0.99-1.66) with SUD. These risks were fully attenuated when another psychiatric diagnosis was adjusted for. CONCLUSION: Early SUD was associated with an increased likelihood of being NEET in both males and females. Neither origin, domicile, psychiatric diagnoses nor parental psychiatric diagnoses did fully explain the association. The combination of unmeasured familial factors and having other psychiatric disorders largely explained these associations.

Hospital admissions due to alcohol related disorders among young adult refugees who arrived in Sweden as teenagers - a national cohort study.

BACKGROUND: Psychological distress and lack of family support may explain the mental health problems that are consistently found in young unaccompanied refugees in Western countries. Given the strong relationship between poor mental health and alcohol misuse, this study investigated hospital admissions due to alcohol related disorders among accompanied and unaccompanied young refugees who settled in Sweden as teenagers. METHODS: The dataset used in this study was derived from a combination of different registers. Cox regression models were used to estimate the risks of hospital care due to alcohol related disorders in 15,834 accompanied and 4376 unaccompanied young refugees (2005-2012), aged 13 to 19 years old when settling in Sweden and 19 to 32 years old in December 2004. These young refugees were divided into regions with largely similar attitudes toward alcohol: the former Yugoslavian republics, Somalia, and the Middle East. The findings were compared with one million peers in the native Swedish population. RESULTS: Compared to native Swedes, hospital admissions due to alcohol related disorders were less common in young refugees, with a hazard ratio (HR) of 0.65 and 95% confidence interval (CI) between 0.56 and 0.77. These risks were particularly lower among young female refugees. However, there were some differences across the refugee population. For example, the risks were higher in unaccompanied (male) refugees than accompanied ones (HR = 1.49, 95% CI = 1.00-2.19), also when adjusted for age, domicile and income. While the risks were lower in young refugees from Former Yugoslavia and the Middle East relative to native Swedes, independent of their length of residence in Sweden, refugees from Somalia who had lived in Sweden for more than ten years showed increased risks (HR = 2.54, 95% CI = 1.71-3.76), after adjustments of age and domicile. These risks decreased considerably when income was adjusted for. CONCLUSION: Young refugees have lower risks of alcohol disorders compared with native Swedes. The risks were higher in unaccompanied young (male) refugees compared to the accompanied ones. Moreover, Somalian refugees who had lived in Sweden for more than ten years seems to be particularly vulnerable to alcohol related disorders.

Parental substance use disorders and psychiatric conditions in offspring: A Swedish population-based cohort study with over 1,000,000 individuals.

BACKGROUND: Exposure to parental substance use problems has been associated with offsprings poor health and adverse social outcomes. In this study, we examined the association between exposure to parental substance use disorder (SUD) during childhood, and adolescence and offspring psychiatric conditions in young adulthood. METHOD: This was a register-based cohort study comprising 562,095 males and 531,130 females born between 1981 and 1990 in Sweden. Parental SUD was captured between the offspring's birth and eighteenth birthday. Cox regression models were used to estimate the Hazard Ratio (HR) of psychiatric conditions from age 18 years to a maximum age of 35 years, from January 1, 1999 to December 31, 2016. RESULTS: About 4% of the study population was exposed to parental SUD during childhood and adolescence. The HR of psychiatric diagnosis was higher in males (1.80, 95% CI = 1.77-1.85) and females (1.56, 95% CI = 1.51-1.60) who were exposed to parental SUD, compared to those who were not; after adjusting for year of birth, domicile, origin, relative poverty, and other parental psychiatric diagnoses. The risks of psychiatric conditions were higher among males and females exposed to parental SUD during childhood compared to during adolescence. CONCLUSION: Exposure to parental SUD during childhood and adolescence was associated with an increased risk of psychiatric conditions in early adulthood for both males and females. Neither origin, poverty, municipality, or other parental psychiatric diagnoses fully explained the association. These risks seemed to be somewhat higher among males, and among those exposed during childhood when compared to during adolescence.

"Caring for Breast Cancer Patients Is a Work That Brings Sorrow": A Qualitative Interview Study with Nurses in Tanzania.

Introduction: Breast cancer is increasing in sub-Saharan Africa (SSA), and most women are diagnosed at a late stage. This leads to increased suffering for the patients and challenging care situations for nurses. Limited resources in healthcare, lack of oncology training, and low health literacy in society result in even more demanding situations for nurses. Objective: The objective was to explore nurses' experiences of caring women for with breast cancer in Tanzania. Methods: The study employed a descriptive qualitative design. Fifteen nurses, working in oncology units in three major hospitals in Tanzania were interviewed using a semistructured interview guide. The participants had a minimum of 6 months experience of caring for breast cancer patients. Purposive sampling was used. Data were analyzed by qualitative content analysis. Results: Two main themes emerged: Challenges in caring for breast cancer patients and Nurses' psychological distress. The late diagnosis was very challenging for the nurses. Low health literacy regarding breast cancer disease and treatment, patients' financial difficulties, minimal oncology nursing education, and technology in healthcare systems were also major challenges. The nurses experienced psychological distress, lost hope, and faced ethical dilemmas while providing cancer care. Conclusion: The findings of this study conclude that nurses face emotional distress and ethical dilemmas while caring for patients with breast cancer. Late diagnosis, lack of infrastructure and resources, and low health literacy among patients, family, and healthcare providers have a great impact on the stress that the nurses experience.

Quality of Cancer Care in Tanzania as Experienced by Patients: A Qualitative Study.

Introduction: Cancer is a disease of public importance in Tanzania. Considering a limited health care system with few cancer centers and low health literacy in general, people are diagnosed at late stage and face difficulties in accessing care for their cancer. All these challenges affect the caring situation for the nurses who meet the patients at the cancer care centers. Objective: This study aimed to explore the journey of cancer care experienced by patients with cancer.Research questions:How do patients experience the quality of care at the cancer care centers?How do patients experience the family's and the community's role? Methods: Semi-structured qualitative interviews were carried out with 15 patients treated for colorectal-, breast-, or prostate cancer in three cancer care centers in Tanzania. A purposive sampling was used. Qualitative content analysis according to Graneheim and Lundman was employed. Results: Three main themes and six sub-themes emerged. The main themes were e xperiences of cancer care services, the role of the family, community challenges and cancer care. The sub-themes were communication, resource allocation at the cancer care centers, fmily's denial, family challenges, limitations of primary care and misconceptions, and accessibility of cancer service and the health care system. The findings show that patients experienced incapacitated health care facilities for cancer care, misconceptions in the community and challenges for the families. Conclusions: The quality of cancer care in Tanzania needs to be improved, patients face challenges in all levels of health care facilities, including families, and the community at large. The distance to oncology care, economic hardship, and lack of knowledge in the community including families, lead to late diagnosis and suffering for the patients. There is a great need for education regarding cancer within healthcare, as well as in the community, to change the situation for patients with cancer.

Educational level and the risk of mental disorders, substance use disorders and self-harm in different age-groups: A cohort study covering 1,6 million subjects in the Stockholm region.

OBJECTIVE: To investigate the associations between low education and risk of mental disorders, substance use disorders and self-harm in different age-groups. METHODS: All subjects in Stockholm born between 1931 and 1990 were linked to their own or their parent's highest education in 2000 and followed-up for these disorders in health care registers 2001-2016. Subjects were stratified into four age-groups: 10-18, 19-27, 28-50, and 51-70 years. Hazard Ratios with 95% Confidence Intervals (CIs) were estimated with Cox proportional hazard models. RESULTS: Low education increased the risk of substance use disorders and self-harm in all age-groups. Males aged 10-18 with low education had increased risks of ADHD and conduct disorders, and females a decreased risk of anorexia, bulimia and autism. Those aged 19-27 years had increased risks of anxiety and depression, and those aged 28-50 had increased risks of all mental disorders except anorexia and bulimia in males with Hazard Ratios ranging from 1.2 (95% CIs 1.0-1.3) for bipolar disorder to 5.4 (95% CIs 5.1-5.7) for drug use disorder. Females aged 51-70 years had increased risks of schizophrenia and autism. CONCLUSION: Low education is associated with risk of most mental disorders, substance use disorders and self-harm in all age-groups, but especially among those aged 28-50 years.

Cross-Cultural Adaptation and Psychometric Properties of the Swahili Version of the European Organization for Research and Treatment of Cancer (EORTC) QLQ-BR45 among Breast Cancer Patients in Tanzania.

Breast cancer is the most frequent cancer in women in Africa and contributes to premature death and poor quality of life. This study aimed to determine the validity, reliability, and psychometric properties of the Swahili version of EORTC QLQ-BR45 among women with breast cancer in Tanzania. A cross-sectional study design with non-probability convenience sampling was employed. Data were collected in two tertiary hospitals and one national cancer institute; 414 participants completed the EORTC-QLQ-C-30 and EORTC-QLQ-BR45. The reliability of QLQ-BR45 was measured using Cronbach's alpha and McDonald's Omega coefficients. The factor structure of EORTC QLQ-BR45 was assessed using confirmatory factor analysis. The internal consistencies for the five dimensions were all above 0.7 indicating satisfaction, except for systemic therapy side effects with a marginal value of 0.594 and significant correlations between the dimensions of QLQ-C30 and BR45. The final model fit well to the data, with the comparative fit index = 0.953, Tucker-Lewis index = 0.947, root mean square error of approximation = 0.041 (90% CI: 0.035, 0.046), and standardized root mean square residual = 0.072. In conclusion, the QLQ BR45 Swahili version displayed good reliability, validity, and psychometric properties and can be used in Swahili-speaking Sub-Saharan countries.

Parental substance use disorder and offspring not in education, employment or training: a national cohort study of young adults in Sweden.

AIMS: To test the hypothesis that exposure to parental substance use disorder is associated with an increased risk of being not in education, employment or training (NEET) in male and female offspring during young adulthood. DESIGN, SETTING AND PARTICIPANTS: A register-based, national cohort study of 797 376 individuals born between 1984 and 1990, residing in Sweden at age 17 years. Participants were followed from age 17 years to maximum age 32 years and assessed annually for being NEET. MEASUREMENTS: The exposure variable was binary, defined as any diagnosis of substance use disorder (alcohol and/or drug use disorder) in one or both parents, measured between offspring's birth and age 17 years. Cox regression analysis was used to obtain hazard ratios (HRs) for being NEET, assessed annually as a binary variable using income and employment data. FINDINGS: We found that 4.4% of individuals were exposed to parental substance use disorder. When adjusted for birth year, domicile, origin, psychiatric diagnosis, household income and parental psychiatric diagnosis, HRs for being NEET were HR = 1.13 (95% CI 1.09-1.16) for males, and HR = 1.15 (95% CI 1.12-1.19) for females. When stratified by age, adjusted HRs for experiencing the first episode of NEET peaked at age 17-19 years, HR = 1.37 (95% CI 1.25-1.50) for males, and HR = 1.31 (95% CI 1.18-1.44) for females. CONCLUSIONS: In Sweden, exposure to parental substance use disorder before age 17 years is associated with increased risk of being not in education, employment or training during early adulthood. The risks were highest at age 17-19 years for both males and females, decreasing with greater age.

Poverty in adolescence and later drug use disorders: understanding the mediation and interaction effects of other psychiatric disorders.

BACKGROUND: Poverty in adolescence is associated with later drug use. Few studies have evaluated the role of adolescent psychiatric disorders in this association. AIMS: This study aimed to investigate mediation and interaction simultaneously, enabling the disentanglement of the role of adolescent psychiatric disorders in the association between poverty in adolescent and later drug use disorders. METHOD: A national cohort study of 634 223 individuals born in 1985-1990, residing in Sweden between the ages of 13 and 18 years, was followed from age 19 years until the first in-patient or out-patient care visit with a diagnosis of drug use disorder. A four-way decomposition method was used to determine the total effect of the association with poverty and possible mediation by and/or interaction with diagnosis of adolescent psychiatric disorders. RESULTS: The hazard ratios for drug use disorders among those experiencing poverty compared with those 'never in poverty' were 1.40 (95% CI, 1.32-1.63) in females and 1.43 (95% CI, 1.37-1.49) in males, after adjusting for domicile, origin and parental psychiatric disorders. Twenty-four per cent of this association in females, and 13% in males, was explained by interaction with and/or mediation by adolescent psychiatric disorders. CONCLUSIONS: Part of the association between poverty in adolescence and later drug use disorders was due to mediation by and/or interaction with psychiatric disorders. Narrowing socioeconomic inequalities in adolescence might help to reduce the risks of later drug use disorders. Interventions aimed at adolescents with psychiatric disorders might be especially important.

Trajectories of NEET (Not in Education, Employment, and Training) in emerging adulthood, and later drug use disorder - a national cohort study.

BACKGROUND: Being not in education, employment, or training (NEET) has been associated with poor health outcomes. This study aimed to investigate the association between NEET during emerging adulthood and later drug use disorder (DUD) among males and females. METHOD: A national cohort comprising 383,116 Swedish males and 362,002 females born between 1984 and 1990. NEET exposure was assessed annually between the ages 17 and 24 years, and follow-up for DUD between ages 25-33. Trajectories of NEET were estimated using group-based trajectory analysis. Cox regression analysis was used to estimate hazard ratios (HR) of DUD. Sibling-comparison model was performed to account for potential shared genetic and environmental factors. RESULTS: Four trajectories of NEET were identified: "constant low", "transient peak", "late increase", and "constant high". Compared with the "constant low", all other trajectories were associated with increased HRs of DUD. HR was highest among males and females in the "late increase trajectory"; HR = 4.10 (3.79-4.44, 95% CI) and HR = 3.73 (3.29-4.24, 95% CI), after adjusting for domicile, origin, birth year, psychiatric diagnoses, and parental psychiatric diagnoses. This association was reduced to about a twofold increased risk in the sibling comparison analysis. CONCLUSION: Being NEET during emerging adulthood was associated with later DUD for both males and females. Neither origin, psychiatric diagnoses, parental psychiatric diagnoses, nor shared familial factors did fully explain the association. Males and females belonging to the late increase NEET trajectory had about a twofold increased risk of DUD.

Association between poverty exposure during childhood and adolescence, and drug use disorders and drug-related crimes later in life.

AIMS: To examine whether poverty exposure in childhood/adolescence increases the risk of later drug use disorder and drug crime conviction. DESIGN, SETTING AND PARTICIPANTS: A national cohort study encompassing 634 284 individuals born between 1985 and 1990, residing in Sweden between 5 and 18 years of age, followed-up from January 2004 to December 2016, starting from the age of 19 years until the first visit to inpatient/outpatient care with a diagnosis of a drug use disorder or a drug crime offence. MEASUREMENTS: The exposure variable was 'trajectories of poverty' based on household income, assessed through group-based trajectory analysis. Cox regression analysis was used to obtain hazard ratios for drug use disorders and drug crime convictions using age as the underlying time scale. FINDINGS: We identified five trajectories of childhood/adolescence poverty: (1) 'moving out of poverty in childhood' (8.7%); (2) 'never poverty' (68.9%); (3) 'moving into poverty in adolescence' (11.0%); (4) 'moving out of poverty in adolescence' (5.4%); and (5) 'chronically poor' (5.9%). Compared with the 'never poor' group, almost all trajectory groups had higher risks for drug use problems. Young males 'moving into poverty in adolescence' had the highest risks of drug use disorder [hazard ratio (HR) = 1.48, 95% confidence interval (CI) = 1.40-1.57] and drug crime conviction (HR = 1.50, 95% CI = 1.38-1.62), after adjusting for calendar year, domicile, origin, psychiatric diagnosis and parental psychiatric diagnosis. The results were similar in females moving into poverty in adolescence (HR = 1.63, 95% CI = 1.52-1.76 and HR = 1.89, 95% CI = 1.74-2.05 for drug use disorders and drug crime, respectively). CONCLUSION: In Sweden, poverty exposure early in life seems to increase the risk of drug use problems in adulthood. These associations are not explained fully by domicile, origin or other psychiatric disorders. Young males and females moving into poverty in adolescence are at highest risk.

Increased risk of suicidal behaviour in non-European international adoptees decreases with age - A Swedish national cohort study.

BACKGROUND: Non-European international adoptees in Sweden were shown to have a three-to fourfold higher risk of suicidal behaviour in youth during 1986-1995 compared with the general population. The aim of this study was to investigate whether this high risk persists beyond youth and in later cohorts. METHODS: A register study of Swedish national cohorts born 1972-86 including 20 625 non-European international adoptees, and comparison populations of 10 915 non-European immigrants and 1 435 167 Swedish born was performed. The study population was followed from age 18 between 1991 and 2016, with suicide and hospital admissions due to suicide attempt as outcomes. Poisson regression models of person time in the study, adjusted for gender and household income at age 17, were fitted to calculate relative risks (RR). FINDINGS: Adjusted RR for suicide in non-European international adoptees was high at age 18-22, 2·74 (95% C.I. 1·95-3·86), but decreased gradually to age 33-43 when the risk was similar to Swedish-born. Adjusted RR for suicide attempts in international adoptees was 2·33 (2·15-2·52) at age 18-22, decreased slightly with older age, but remained higher than Swedish born in all age-classes. Risks for both outcomes were greatest, around three times higher compared with the Swedish-born in the oldest birth cohorts of non-European international adoptees, born 1972-76. Risks for both suicidal outcomes increased with higher age at adoption. INTERPRETATION: The risk of suicidal behaviour in non-European international adoptees in Sweden decreases with age and is lower in later birth cohorts and in infant adoptions.

Not in education, employment, or training (NEET) and risk of alcohol use disorder: a nationwide register-linkage study with 485 839 Swedish youths.

OBJECTIVE: To investigate to what extent being outside education, employment or training after completed secondary education in Sweden might affect the risk of subsequent alcohol use disorders (AUDs), with sociodemographic indicators, such as sex, domicile and origin, taken into account. DESIGN: Population register-based cohort study with 485 839 Swedish youths. SETTING: Sweden. PARTICIPANTS: All youths who were born between 1982 and 1991 and were aged between 19 and 24 years when they completed secondary education in Sweden, between 2005 and 2009. PRIMARY OUTCOME MEASURE: Cox regression models were used to estimate the HR of first record of entry into alcohol-related medical care with a diagnosis of an AUD, by level of labour market attachment, from 1 January 2009 to 31 December 2016. RESULTS: About 4% of the youth population were outside education, employment or training and 25% were in insecure workforce after they completed secondary education. The risk of AUD was higher among youths in insecure workforce, HR 1.40 (95% CI 1.30 to 1.50), and among those outside education, employment or training, HR 1.30 (95% CI 1.11 to 1.51), compared with youths within the core workforce, also after adjusting for age, domicile, sex and origin. Being in education was associated with lower HR of AUD, HR=0.84 (95% CI 0.78 to 0.90). CONCLUSION: Youths who are in insecure workforce and outside education, employment or training are at higher risk of AUD. Targeted policy actions are needed to support a successful school-work transition to secure equal opportunities for young people.

A Scoping Review and Conceptual Model of Social Participation and Mental Health among Refugees and Asylum Seekers.

Social participation plays a key role in the integration of refugees and asylum seekers into their host societies, and is also closely tied to the mental health of those populations. The aim of this scoping review was to study how the concept of social participation is described in empirical research, and how it is associated with mental health outcomes. METHODS: In total, 64 studies were identified through searches in PubMed, PsycInfo, and Sociological Abstracts. These studies describe various forms of social participation among refugees and asylum seekers, and 33 of them also addressed various forms of mental health outcomes. RESULTS: The identified studies described forms and conditions of social participation-both in the host country and transnationally-that could be synthesized into three broad dimensions: (1) Regulatory frameworks, conditions and initiatives; (2) Established societal organizations and social structures; and (3) Community organized groups. Each of these consisted of several sub-domains. The identified dimensions of social participation were also associated with psychosocial well-being and decreased psychological distress. CONCLUSIONS: There is a need for policies to enable and support the participation of refugees and asylum seekers in various dimensions of social structures in host societies. Social participation enhances resilience, re-establishes social lives, and acts as a protective factor against poor mental health outcomes.

Origin and schizophrenia in young refugees and inter-country adoptees from Latin America and East Africa in Sweden: a comparative study.

BACKGROUND: Migrants' socioeconomic adversity has been linked to schizophrenia. AIMS: To investigate whether the more favourable socioeconomic situation of adoptees prevents them from the high risk of schizophrenia found in other migrants. METHOD: Register study in a cohort of refugees and inter-country adoptees aged 16-40 years, born in East Africa (n=8389), Latin America (n=11 572) and 1.2 million native Swedes. Cox-regression models estimated hazard ratios (HRs) of schizophrenia in data from psychiatric care. RESULTS: Despite diverse income levels, HRs for schizophrenia were similar for refugees and adoptees, with East Africans having the highest HRs: 5.83 (3.30-10.27) and 5.80 (5.03-6.70), followed by Latin Americans: HRs 3.09 (2.49-3.83) and 2.31 (1.79-2.97), compared with native Swedes. Adjustment for income decreased these risks slightly for refugees, but not for adoptees. CONCLUSIONS: This study suggests that risk factors associated with origin are more important determinants of schizophrenia than socioeconomic adversity in the country of settlement. DECLARATION OF INTEREST: None. COPYRIGHT AND USAGE: © 2016 The Royal College of Psychiatrists. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

Hospital Admission and Criminality Associated with Substance Misuse in Young Refugees - A Swedish National Cohort Study.

BACKGROUND: High rates of mental health problems have been described in young refugees, but few studies have been conducted on substance misuse. This study aimed to investigate the patterns of hospital care and criminality associated with substance misuse in refugees who settled in Sweden as teenagers. METHODS: Gender stratified Cox regression models were used to estimate the risks of criminal convictions and hospital care associated with substance misuse from national Swedish data for 2005-2012. We focused on 22,992 accompanied and 5,686 unaccompanied refugees who were aged 13-19 years when they settled in Sweden and compared them with 1 million native Swedish youths from the same birth cohort. RESULTS: The risks of criminal conviction associated with substance misuse increased with the length of residency in male refugees, after adjustment for age and domicile. The hazard ratios (HRs) were 5.21 (4.39-6.19) for unaccompanied and 3.85 (3.42-4.18) for accompanied refugees after more than 10 years of residency, compared with the native population. The risks were slightly lower for hospital care, at 2.88 (2.18-3.79) and 2.52(2.01-3.01) respectively. Risks were particularly pronounced for male refugees from the Horn of Africa and Iran. The risks for all male refugees decreased substantially when income was adjusted for. Young female refugees had similar risks to the general population. CONCLUSION: The risks of criminality and hospital care associated with substance misuse in young male refugees increased with time of residency in Sweden and were associated with a low level of income compared with the native Swedish population. Risks were similar in accompanied and unaccompanied refugees.

Mortality in adult offspring of immigrants: a Swedish national cohort study.

BACKGROUND: Higher risks of psychiatric disorders and lower-than-average subjective health in adulthood have been demonstrated in offspring of immigrants in Sweden compared with offspring of native Swedes, and linked to relative socioeconomic disadvantage. The present study investigated mortality rates in relation to this inequity from a gender perspective. METHODS: We used data from national registers covering the entire Swedish population aged 18-65 years. Offspring of foreign-born parents who were either Swedish born or had received residency in Sweden before school age (<7 years) were defined as "offspring of immigrants." We used Cox regression models to examine the association between parental country of birth and mortality between 1990 and 2008, with adjustment for education, income, age and family type. RESULTS: Male offspring of immigrants from the Middle East (HR:2.00, CI:1.66-2.26), other non-European countries (HR:1.80, CI:1.36-2.36) and Finland (HR:1.56, CI:1.48-1.65) showed an age-adjusted excess mortality risk from all causes of death when compared to offspring with Swedish-born parents. Income, but not education, greatly attenuated these increased mortality risks. No excess mortality rates were found among female offspring of immigrants, with the exception of external cause of death among offspring of Finnish immigrants. CONCLUSION: The study demonstrates high mortality rates in male offspring of immigrants from Finland and non-European countries that are associated with economic, but not educational, disadvantage. No increased mortality rates were found among female offspring of immigrants. Future studies are needed to explain this gender differential and why income, but not education, predicts mortality in male offspring of immigrants.