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

doi:10.1016/j.socscimed.2022.114725

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

Soc Sci Med. 2022 Feb:294:114725. doi: 10.1016/j.socscimed.2022.114725. Epub 2022 Jan 13.

Authors

Melanie L Straiton¹, Aart C Liefbroer², Anna-Clara Hollander³, Lars Johan Hauge⁴

Affiliations

¹ Division for Mental and Physical Health, Norwegian Institute of Public Health, PO Box 222, Skøyen, 0213, Oslo, Norway. Electronic address: Melanie.Straiton@fhi.no.
² Netherlands Interdisciplinary Demographic Institute, PO Box 11650, AR, 2502, The Hague, the Netherlands; Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands; Department of Sociology, Vrije Universiteit, Amsterdam, the Netherlands.
³ Epidemiology of Psychiatric Conditions, Substance Use and Social Environment, Department of Global Public Health, Karolinska Institute, 171 77, Stockholm, Sweden.
⁴ Division for Mental and Physical Health, Norwegian Institute of Public Health, PO Box 222, Skøyen, 0213, Oslo, Norway.

PMID: 35063865
DOI: 10.1016/j.socscimed.2022.114725

Abstract

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.

Keywords: Health service use; Inequalities; Mental health; Migrant.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Female
Humans
Male
Mental Health Services*
Norway / epidemiology
Outpatients
Primary Health Care
Transients and Migrants*