Suicide risk among native- and foreign-origin persons in Sweden: a longitudinal examination of the role of unemployment status

• Published in: Social Psychiatry and Psychiatric Epidemiology Vol. 54; no. 5; pp. 579 - 590
• Main Authors: Dunlavy, Andrea C., Juárez, Sol, Toivanen, Susanna, Rostila, Mikael
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.05.2019; Springer; Springer Nature B.V
• Subjects: Adults; Age; Confidence intervals; Employment; Employment status; Epidemiology; Hazards; Health aspects; Health equity; Health risk assessment; Labor market; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Migrant mental health; Migration; Original Paper; Psychiatry; Risk; Statistical models; Suicide; Suicides & suicide attempts; Sweden; Unemployment; Sweden; Health equity; Sweden; Suicide; Migrant mental health; Employment status
• ISSN: 0933-7954; 1433-9285; 1433-9285
• DOI: 10.1007/s00127-018-1621-z

Purpose Prior research has documented an association between unemployment and elevated suicide risk. Yet, few Swedish studies have explicitly considered how such risk may vary by different migration background characteristics among persons of foreign-origin, who often experience diverse forms of labor market marginalization. This study examines the extent to which unemployment status may differentially influence suicide risk among the foreign-origin by generational status, region of origin, age at arrival, and duration of residence. Methods Population-based registers were used to conduct a longitudinal, open cohort study of native-origin and foreign-origin Swedish residents of working age (25–64 years) from 1993 to 2008. Hazard ratios and 95% confidence intervals for suicide mortality were estimated using gender-stratified Cox proportional hazards models. Results Elevated suicide risk observed among foreign-origin unemployed groups was generally of a similar or lower magnitude than that found in unemployed native-origin, although unemployed second-generation Swedish men demonstrated significantly greater ( p  < 0.05) excess risk of suicide than that observed among their native-origin counterparts. Unemployed foreign-born men with a younger age at arrival and longer duration of residence demonstrated an increased risk of suicide, while those who arrived as adults, and a shorter duration of residence did not show any increased risk. Among foreign-born women, excess suicide risk persisted regardless of age at arrival and duration of residence in the long-term unemployed. Conclusions Multiple migration background characteristics should be considered when examining relationships between employment status and suicide among the foreign-origin.