Leena Maria Johansson

Impact of ethnicity, violence and acculturation on displaced migrants: psychological distress and psychosomatic complaints among refugees in Sweden.

This study uses data collected in 1996 by the Swedish National Board of Health and Welfare. By means of interviews with 1980 foreign-born immigrants, an attempt was made to determine the impact of a) migration status (country of birth/ethnicity), b) exposure to violence, c) Antonovskys sense of coherence, d) acculturation status (knowledge of Swedish), e) sense of control over ones life, f) economic difficulties, and g) education, both on psychological distress (using General Health Questionnaire 12) and psychosomatic complaints (daytime fatigue, sleeping difficulties, and headache/migraine). Iranians and Chileans (age-adjusted) were at great risk for psychological distress as compared with Poles, whereas Turks and Kurds exhibited no such risk. When the independent factors were included in the model, the migration status effect decreased to insignificance (with the exception of Iranian men). A low sense of coherence, poor acculturation (men only), poor sense of control, and economic difficulties were strongly associated with the outcomes, generally accounting for a convincing link between migration status and psychological distress. Furthermore, a low sense of coherence, poor acculturation (men only), poor sense of control, and economic difficulties in exile seemed to be stronger risk factors for psychological distress in this group than exposure to violence before migration.

Suicide among foreign-born minorities and Native Swedes: an epidemiological follow-up study of a defined population

The increasing number of immigrants in Sweden during the past four decades has brought the health of ethnic groups into focus. The purpose of this study was to analyse the influence of ethnicity, age, sex, marital status and date of immigration on suicide rates. The study population consisted of all individuals over 15 years of age, N = 6,725,274, from the Swedish census of 1985 and is based on individual data. Suicides and undetermined deaths, during the follow-up period 1986-1989, were taken from the central Cause of Death Register. Ethnicity, defined as being foreign-born, was a risk factor for suicide for both men and women with risk ratios of 1.21 (1.11-1.31) and 1.36 (1.21-1.53), respectively, with control for age and marital status. Being unmarried was also a risk factor for both males and females with risk ratios from 1.26 to 5.55 in different age groups. The highest risk ratios for suicide in Sweden, adjusted for age, were found among males born in Russia and Finland. They also showed higher suicide risks than in their countries of birth. Females born in Hungary, Russia, Finland and Poland all had high risks of committing suicide in Sweden and they also had higher risks than in their countries of birth. Further, being of male sex, aged 45-54 or 75 and older, and born in Eastern Europe or Finland were significant risk factors for suicide. The same was true for those who had immigrated to Sweden in 1967 or earlier and were born in Finland, Eastern Europe or in non-European countries. These findings are of great importance for primary health care and psychiatric care planning.

Poor Self-reported Health and Sleeping Difficulties among Kurdish Immigrant Men in Sweden

This study explores the association between ethnicity and poor self-reported health and psychological distress, sleeping difficulties, and use of psychotropic drugs among immigrant Kurdish men and native Swedish men, based on data from the first Swedish National Survey of Immigrants and the Swedish Level-of-Living Surveys collected in 1996 by Statistics Sweden. The age-adjusted odds of poor self-reported health and sleeping difficulties among Kurdish men was about 3.5 times higher than among Swedish men. The odds ratio decreased to 2.1 and 2.7 respectively in a model adjusted for age and the other explanatory variables. Yearning for the home country, perceived discrimination and unemployment in the host country seem to be possible explanations for the higher levels of distress among Kurdish immigrants to Sweden.

Incidence of Mental Disorders in Second-Generation Immigrants in Sweden: A Four-Year Cohort Study

Background Few studies have investigated mental health among second-generation immigrants who have reached adulthood. The aim of this study was to examine whether second-generation adult immigrants have a higher risk of being hospitalised for mental disorders than the Swedish majority population after adjustment for socio-economic status. Methods In total 1.9 million Swedish-born women and men aged 16–34 were followed from 1 January 1995 to 31 December 1998 for first hospital admissions for mental disorders, categorised in four main diagnosis groups. Second-generation immigrants comprised four groups and the Swedish majority population was used as reference group. Cox proportional hazard models were used to analyse the data. Results Second-generation immigrants with one parent born in Sweden and second-generation Finns had higher risks of being hospitalised for psychotic disorders, affective disorders, neurotic disorders, and personality disorders than the Swedish majority population. For second-generation Finns the age- and sex-adjusted hazard ratio for psychotic disorders was 2.42 (CI = 2.09–2.80). No significant hazard ratios were found for second-generation labour immigrants. For second-generation refugees the risk of being hospitalised was higher than for the Swedish majority population but only for psychotic disorders. All results remained significant and decreased only slightly after adjustment for income and education. Conclusions Many groups of second-generation immigrants have a higher risk of being hospitalised for mental disorder than the majority population. With increasing global migration it is crucial for all industrialised countries to take measures to improve mental health among second-generation immigrants.

Mindfulness group therapy in primary care patients with depression, anxiety and stress and adjustment disorders: randomised controlled trial

BACKGROUND Individual-based cognitive-behavioural therapy (CBT) is in short supply and expensive. AIMS The aim of this randomised controlled trial (RCT) was to compare mindfulness-based group therapy with treatment as usual (primarily individual-based CBT) in primary care patients with depressive, anxiety or stress and adjustment disorders. METHOD This 8-week RCT (ClinicalTrials.gov ID: NCT01476371) was conducted during spring 2012 at 16 general practices in Southern Sweden. Eligible patients (aged 20-64 years) scored ≥10 on the Patient Health Questionnaire-9, ≥7 on the Hospital Anxiety and Depression Scale or 13-34 on the Montgomery-Åsberg Depression Rating Scale (self-rated version). The power calculations were based on non-inferiority. In total, 215 patients were randomised. Ordinal mixed models were used for the analysis. RESULTS For all scales and in both groups, the scores decreased significantly. There were no significant differences between the mindfulness and control groups. CONCLUSIONS Mindfulness-based group therapy was non-inferior to treatment as usual for patients with depressive, anxiety or stress and adjustment disorders.

Country of Birth and Suicide: A Follow-up Study of a National Cohort in Sweden

The aim of this study was to examine whether the hypothesized association between country of birth and suicide rates remains after adjustment for age, marital status, socioeconomic status, and hospitalization due to psychiatric disorders or substance abuse. A Swedish cohort of 4.4 million individuals aged 25–64 years was followed from January 1, 1994, to December 31, 1999 for suicide. Suicide rates varied according to country of birth. Among men the highest risk of suicide was found among men from Finland. Among women the highest risk of suicide was found among women from Finland, Poland, and Eastern Europe. Key factors to prevent suicide include early detection and treatment of psychiatric disorders and/or substance abuse, especially among certain population groups.

Psychological distress among Kurdish immigrants in Sweden

Aims: To analyse whether there is an association between sex and poor self-reported health (SRH) and psychological distress in Kurdish immigrants. Methods: This cross-sectional study is based on a sample consisting of immigrants, aged 27— 60 years, with self-reported Kurdish ethnicity (n=111, men; n=86, women) in Sweden originating from Iran and Turkey. It is based on data collected in 1996 from the first Swedish National Survey on the living conditions of immigrant groups conducted by Statistics Sweden. The prevalences of reporting poor health, sleeping difficulties, general fatigue and anxiety were estimated by sex. The association between sex and SRH and psychological distress was analysed by an unconditional logistic regression model estimating odds ratios (OR) with 95% confidence intervals. The final model was adjusted for age, marital status, education, housing and employment. Immigrant-specific migration-related variables were used to explore possible reasons for the sex differences. Results: Kurdish men and women had a high prevalence of poor SRH and psychological distress. Age-adjusted odds ratios for anxiety were higher in Kurdish women. Sex differences in anxiety remained even when marital status, education, housing and employment were taken into account. Conclusions: Kurdish men and women report a high prevalence of poor SRH and indicators of psychological distress. Women had a higher risk for anxiety than men. Negative experiences of pre-migration as well as post-migration experiences, such as economic difficulties, preoccupation with the political situation in the home country, perceived discrimination, and feelings of poor control over ones life, were associated with the outcomes.

Multivariate analyses of mortality from coronary heart disease due to biological and behavioural factors

Due to affluence and a sedentary life style a great deal of people in the western countries are affected by coronary heart disease (CHD). The relation between CHD and certain risk factors pertaining to life style is evaluated in this study. A primary purpose is to study certain crucial risk factors for women. The main variables are age, smoking, overweight (measured by BMI), blood pressure and exercise. This prospective study is based on self-reported data from the nation-wide Swedish Level of Living Survey and on data from the national Cause of Death Register. The data were analysed separately by sex using a proportional hazards model. The sample was divided into two strata: those with heart disease and/or diabetes initially, and all the rest. A sample of 2546 men and 2760 women between 45 and 74 years of age was followed from 1980 to the end of 1990. During this period 189 men and 75 women died of coronary heart disease (CHD). It was found that high blood pressure raised the relative risk (RR) of death from CHD by almost 60% in both men and women. Male smokers (< 14 cigarettes a day) had about 60% (significant) and female smokers (< 10 cigarettes a day) 150% (significant) excessive mortality from CHD. Different levels of overweight among women were strongly related to excess mortality from CHD, ranging between 100 and 300%. Among men there was no such relation. Lack of physical activity showed only a weak (non-significant) increased risk of death due to CHD. Diabetes was also found to be an important risk factor for mortality from CHD, especially among women, being seven times as high as among non diabetics. A test of sex differences revealed that there were two significant interactions, namely between sex and overweight, and between sex and age. Background variables in relation to mortality from all cardiovascular diseases (CVD) were also studied. There were of course many similarities between the effects of the background variables in both the disease groups, but there were interesting differences too, e.g. overweight turned out to be a significant risk factor also for men and physical inactivity for women.

Acculturation Strategies in Migration Stress Among Kurdish Men in Sweden: A Narrative Approach

Acculturation is defined as cultural changes and consequences of long contact between two different cultural groups. A total of 10 Kurdish men, aged from 24 to 60 years, were interviewed face-to-face to explore the acculturation pattern reported by them through their individual life stories during the whole migration process. The analysis was based on the narrative methodology. The adjustment strategies identified were contributing to Kurdish culture and the home country, getting an education, creating one’s own society/building a family, achieving inner security and balance, being active and occupied, and coping with ongoing political instability in the country of origin. The majority of them respond actively to stressful situations in their lives, and it is important for these Kurdish men to be included and acknowledged as individuals.

Suicide, Ethnicity and Psychiatric In-Patient Care: A Case-Control Study

This study compares patients with controls concerning sociodemographicvariables and describes Swedish and foreign-born patients concerningpsychiatric disorders, suicide risk, history of attempted suicide, suicidemethod, number of parasuicides and time from discharge to suicide. It isbased on 59 psychiatric in-patients who had committed suicide, of whom 46were native Swedes and 13 foreign-born, and on a random sample of 630controls living in the same area of Stockholm, Sweden. There was an excesssuicide risk for being foreign-born with a crude odds ratio of 1.94 (CI = 1.01 – 3.76) in an unconditional logisticregression. In the final model, single living, having a somatic disease andbeing unemployed were major risk factors for committing suicide. There wereno differences between Swedes and those of foreign birth concerningdistribution of certain background variables (i.e., suicide risk, diagnosesand quality of care assessed via clinical records). Only 39% of thepatients were classified as high risk by the doctor-in-charge at admission.This is significantly lower (p < 0.001) than theretrospectively rated risk. Planned aftercare was considered as satisfactoryfor about half of the patients. About two-thirds of the patients did notparticipate in aftercare or almost immediately discontinued the contact.More attention is necessary in order to motivate the patients to take partin aftercare and there is a need for better co-operation between hospitaland out-patient clinics.