title: Labour market marginalisation subsequent to suicide attempt in young migrants and native Swedes.
abstract: This study aimed to compare young individuals who differed in terms of birth region and history of suicide attempt regarding socio-demographic and healthcare factors, and with regard to their risks of subsequent unemployment, sickness absence and disability pension.
  
  
  
  Prospective cohort study based on register linkage of 2,801,558 Swedish residents, aged 16-40 years in 2004, without disability pension and with known birth country, followed up 2005-2011. Suicide attempters treated in inpatient care during 2002-2004 (N = 9149) were compared to the general population of the same age without attempt 1987-2011 (N = 2,792,409). Hazard ratios (HR) and 95% confidence intervals (CIs) for long-term unemployment (>180 days), sickness absence (>90 days), and disability pension were calculated with Cox regression, adjusted for several risk markers.
  
  
  
  Compared to Swedish natives with suicide attempt, migrants of non-Western origin with attempt received less specialised mental healthcare. Distinct differences between native Swedes and migrants were present for the three labour market outcomes, but differences between migrant subgroups were inconsistent. As compared to native Swedes without attempts, non-European migrants with suicide attempt had adjusted HRs and CIs for subsequent unemployment 2.8 (2.5-3.1), sickness absence 2.0 (1.7-2.3) and disability pension 2.2 (1.8-2.6). Respective estimates for natives with suicide attempt were 2.0 (1.9-2.1); 2.7 (2.6-2.9) and 3.4 (3.2-3.6), respectively.
  
  
  
  Migrant suicide attempters receive less specialised mental health care before their attempt than native Swedes, and their marginalzation patterns are different. Healthcare and policy makers need to take the differential risk profile for migrant and native populations into account.
authors.affiliation: Suicide Research Unit, Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria. Thomas.niederkrotenthaler@meduniwien.ac.at.
authors.forename: T
authors.initials: T
authors.lastname: Niederkrotenthaler
authors.affiliation: Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, 17 177, Stockholm, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Wang
authors.affiliation: Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, 17 177, Stockholm, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Helgesson
authors.affiliation: Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA.
authors.forename: H
authors.initials: H
authors.lastname: Wilcox
authors.affiliation: NYS Psychiatric Institute, Columbia University, New York, NY, 10032, USA.
authors.forename: M
authors.initials: M
authors.lastname: Gould
authors.affiliation: Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, 17 177, Stockholm, Sweden.
authors.forename: E
authors.initials: E
authors.lastname: Mittendorfer-Rutz
mesh_terms: D000293:Adolescent; D000328:Adult; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D010415:Pensions / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013406:Suicide, Attempted / Q000208:ethnology* / Q000523:psychology*; D013548:Sweden / Q000208:ethnology; D014171:Transients and Migrants / Q000523:psychology*; D014478:Unemployment / Q000523:psychology*; D055815:Young Adult
keywords: Labour market; Migration; Suicide attempt; Sweden; Unemployment