TY - JOUR

T1 - Antipsychotic treatment patterns in refugees and their Swedish-born peers with first-episode non-affective psychosis

T2 - findings from the REMAIN study

AU - Goppers, Julia Spaton

AU - Mittendorfer-Rutz, Ellenor

AU - Cullen, Alexis E.

AU - de Montgomery, Christopher Jamil

AU - Tanskanen, Antti

AU - Norredam, Marie

AU - Taipale, Heidi

PY - 2023

Y1 - 2023

N2 - BackgroundPrevious studies suggest that migrants tend to utilise antipsychotics less often than their native-born peers. However, studies examining antipsychotic use among refugees with psychosis are lacking. AimsTo compare the prevalence of antipsychotic drug use during the first 5 years of illness among refugees and Swedish-born individuals with a newly diagnosed non-affective psychotic disorder, and to identify sociodemographic and clinical factors associated with antipsychotic use. MethodThe study population included refugees (n = 1656) and Swedish-born persons (n = 8908) aged 18-35 years during 2007-2018, with incident diagnosis of non-affective psychotic disorder recorded in the Swedish in-patient or specialised out-patient care register. Two-week point prevalence of antipsychotics use was assessed every 6 months in the 5 years following first diagnosis. Factors associated with antipsychotic use (versus non-use) at 1 year after diagnosis were examined with modified Poisson regression. ResultsRefugees were somewhat less likely to use antipsychotics at 1 year after first diagnosis compared with Swedish-born persons (37.1% v. 42.2%, age- and gender-adjusted risk ratio 0.88, 95% CI 0.82-0.95). However, at the 5-year follow-up, refugees and Swedish-born individuals showed similar patterns of antipsychotic use (41.1% v. 40.4%). Among refugees, higher educational level (>12 years), previous antidepressant use and being diagnosed with schizophrenia/schizoaffective disorder at baseline were associated with an increased risk of antipsychotics use, whereas being born in Afghanistan or Iraq (compared with former Yugoslavia) was associated with decreased risk. ConclusionsOur findings suggest that refugees with non-affective psychotic disorders may need targeted interventions to ensure antipsychotic use during the early phase of illness.

AB - BackgroundPrevious studies suggest that migrants tend to utilise antipsychotics less often than their native-born peers. However, studies examining antipsychotic use among refugees with psychosis are lacking. AimsTo compare the prevalence of antipsychotic drug use during the first 5 years of illness among refugees and Swedish-born individuals with a newly diagnosed non-affective psychotic disorder, and to identify sociodemographic and clinical factors associated with antipsychotic use. MethodThe study population included refugees (n = 1656) and Swedish-born persons (n = 8908) aged 18-35 years during 2007-2018, with incident diagnosis of non-affective psychotic disorder recorded in the Swedish in-patient or specialised out-patient care register. Two-week point prevalence of antipsychotics use was assessed every 6 months in the 5 years following first diagnosis. Factors associated with antipsychotic use (versus non-use) at 1 year after diagnosis were examined with modified Poisson regression. ResultsRefugees were somewhat less likely to use antipsychotics at 1 year after first diagnosis compared with Swedish-born persons (37.1% v. 42.2%, age- and gender-adjusted risk ratio 0.88, 95% CI 0.82-0.95). However, at the 5-year follow-up, refugees and Swedish-born individuals showed similar patterns of antipsychotic use (41.1% v. 40.4%). Among refugees, higher educational level (>12 years), previous antidepressant use and being diagnosed with schizophrenia/schizoaffective disorder at baseline were associated with an increased risk of antipsychotics use, whereas being born in Afghanistan or Iraq (compared with former Yugoslavia) was associated with decreased risk. ConclusionsOur findings suggest that refugees with non-affective psychotic disorders may need targeted interventions to ensure antipsychotic use during the early phase of illness.

KW - Psychotic disorders

KW - refugees

KW - antipsychotics

KW - epidemiology

KW - schizophrenia

KW - ACTING INJECTABLE ANTIPSYCHOTICS

KW - NATIONWIDE COHORT

KW - SCHIZOPHRENIA

KW - MEDICATION

KW - MORTALITY

KW - NONADHERENCE

KW - ADHERENCE

KW - CLOZAPINE

KW - RISK

U2 - 10.1192/bjo.2023.38

DO - 10.1192/bjo.2023.38

M3 - Journal article

C2 - 37013904

VL - 9

JO - BJPsych Open

JF - BJPsych Open

SN - 2056-4724

IS - 3

M1 - 57

ER -