Are refugees at increased risk of suicide compared with non-refugee migrants and the host population

Abstract

Background It is hypothesised that refugees have an elevated risk of suicide compared with non-refugee migrants due to exposure to traumatic life events. We aimed to investigate risk of suicide in refugees compared with both non-refugee migrants from refugee-generating countries and the native-born Swedish population. Methods Design: National population-based cohort study living in Sweden, born 1/1/67 to 31/12/84. Setting: Linked Swedish national register data on 1.8 million people. Participants: 1,787,160 people were followed from their 15th birthday, or their date of arrival in Sweden, whichever was later, until death from suicide or any other cause, emigration or 31/12/11, whichever came first. We excluded asylum-seekers or undocumented migrants. Main outcome measures: We used Cox regression analysis to estimate adjusted hazard ratios for suicide (ICD-10 codes X60-84 for suicide and Y10-34 for death by undetermined intent) by refugee status and region of origin, controlling for attained age, sex, and disposable income. Results Swedish-born residents had a higher risk of death by suicide compared to all migrants, both refugees and non-refugees. However, these differences declined over time as the risks of death by suicide among migrants converged to the level of the Swedish-born. Conclusions Although previous research has found that refugee status is associated with traumatic experiences and mental disorders, we found that it is not a risk factor for suicide when compared with non-refugees and Swedish-born residents. Instead, our findings suggest that cumulative post-migration stressors may account for a convergence of suicide risk between migrants from refugee-generating countries and the host population.