title: Duration of residence and psychotropic drug use in recently settled refugees in Sweden--a register-based study.
abstract: BACKGROUND
  Recently settled refugee populations have consistently been reported to have high rates of mental health problems, particularly Post-traumatic stress disorder, depression, and anxiety disorders. The aim of this study was to investigate psychotropic drug use among young adult refugees according to duration of residence during the first 10 years in Sweden.
  
  
  METHODS
  Cross-sectional register study of a national cohort of 43 403 refugees and their families (23-35 years old) from Iraq, Iran, Eritrea, Ethiopia, Somalia and Afghanistan and a comparison population of 1.1 million Swedish-born residents. Logistic regression was used to assess the association between duration of residence in Sweden and the dispensing of at least one psychotropic medication during 2009 in four categories (any drug, neuroleptics, antidepressants and anxiolytics/hypnotics), adjusting for age, gender and domicile.
  
  
  RESULTS
  Rates of dispensed psychotropic drugs among recently settled refugees were low, compared to the Swedish-born, with an increase with duration of residence. For refugee men and women from Iraq/Iran who had resided for 0-3 years the adjusted ORs compared to Swedish natives, were 0.83 (95% CI 0.77-0.90) and 0.48 (0.44-0.53) respectively; for men and women from the Horn of Africa the ORs were 0.50 (0.42-0.61) and 0.36 (0.30-0.41) respectively. After 7-10 years of residence, the ORs in these refugee groups approached the Swedish comparison population. Refugees from Afghanistan presented ORs similar to the Swedish-born, with no consistent trend by duration of residence. Women from the Horn of Africa and Iraq/Iran consumed less psychotropic drugs compared with men from these regions of origin, relative to the Swedish-born (p < 0.01). The ORs for dispensed neuroleptics were similar between the different refugee study groups, while the ORs for dispensed antidepressants differed fourfold between the group with the lowest (Horn of Africa) and the highest (Afghanistan).
  
  
  CONCLUSIONS
  The rates of dispensed psychotropic drugs in the newly settled refugee populations in this study were low, with an increase with longer duration of residence. This pattern suggests barriers to access mental health care. Interventions that can lower these barriers are needed to enable newly settled refugees to access mental health care on equal terms with the native population.
authors.affiliation: Copenhagen School of Medicine, University of Copenhagen, Copenhagen, Denmark. mariab79@hotmail.com.
authors.forename: Maria
authors.initials: M
authors.lastname: Brendler-Lindqvist
authors.affiliation: Danish Research Centre for Migration, Ethnicity and Health, Section of Health Service Research, Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark. mano@sund.ku.dk.|Section of Immigrant Medicine, Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark. mano@sund.ku.dk.
authors.forename: Marie
authors.initials: M
authors.lastname: Norredam
authors.affiliation: Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden. anders.hjern@chess.su.se.|Centre for Health Equity Studies, Karolinska Institutet/Stockholm University, 106 91, Stockholm, Sweden. anders.hjern@chess.su.se.
authors.forename: Anders
authors.initials: A
authors.lastname: Hjern
mesh_terms: D000069:Acculturation; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy / Q000453:epidemiology; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012036:Refugees / Q000523:psychology / Q000706:statistics & numerical data*; D012042:Registries / Q000706:statistics & numerical data; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult
chemical_list: D011619:Psychotropic Drugs