Mental healthcare utilization among migrants and Swedish-born adults accounting for probable needs, 2006-2022

Migrants use less mental healthcare than non-migrants, but it is unclear how much this reflects differing needs and whether this gap has changed over time. We examined differences in mental healthcare use by migrant status between 2006 and 2022 while considering probable mental healthcare needs.

We used data from four cross-sectional surveys conducted in Stockholm County (2006, 2010, 2014 and 2021) in which self-reported need indicators, including psychological distress, were measured. Survey participants, 81,650 adults (18-64), were linked to administrative registries to estimate differences in mental healthcare use (both likelihood and frequency), within 6 months of survey response. Logistic regression and zero-truncated negative binomial regression were used, with survey weights and adjustments for sex, age, income, education, psychological distress (main need-indicator), general health status and long-term limiting illness.

Non-Nordic migrants were more likely to report increased levels of psychological distress but were less likely to use services than non-migrants. The gap in mental healthcare use was initially marginal but increased with adjustment for mental healthcare needs, as well as over time (2006-2022). The odds ratios comparing the likelihood of mental healthcare use between European migrants with Swedish-born individuals decreased from 0.93 (95% confidence intervals: 0.77-1.11) in 2006/2007 to 0.48 (0.39-0.59) in 2021/2022, adjusting for sociodemographic factors and psychological distress. For non-European migrants, the corresponding odds ratios decreased from 0.72 (0.62-0.85) to 0.46 (0.39-0.54). Further adjustments for general health status and long-term limiting illness widened the gap even more. In 2021/2022, the gap was larger in secondary than in primary care and for online than in-office services.Nordic-born migrants had similar utilization patterns as Swedish-born individuals. Differences in the frequency of outpatient visits between migrants and Swedish-born individuals, conditional on having at least one visit, were marginal. For instance, the rate ratios comparing non-European migrants with Swedish-born individuals changed from 0.67 (0.48-0.93) in 2006/2007 to 0.90 (0.65-1.26) in 2021/2022.

Despite indicating greater needs, non-Nordic migrants faced persistent inequities in mental healthcare access, but differences in intensity/continuity of care were marginal among those who accessed services. Inequities in access grew over the study period and were largest during the COVID-19 pandemic, particularly in access to online mental healthcare services and specialized care. These findings should be interpreted cautiously given potential selection bias from declining survey participation and changes in distress scales.