Periodic Reporting for period 3 - MIGPACT (The impact of neighbourhoods, peers and families on psychiatric disorders, substance usedisorders and crime in first- and second-generation immigrants)
Reporting period: 2021-10-01 to 2023-03-31
The successful integration of the high numbers of refugees is one of the most critical issues facing the EU today. We will identify factors at the neighbourhood-, family-, peer-, and individual-levels that may protect immigrant children, adolescents and adults from psychiatric disorders, substance use disorders, and crime. We have access to highly accurate and almost complete nationwide sociodemographic data from 1960-2018 including, but not limited to, country of birth, education, income, employment, and social welfare, school grades, and reason for immigration linked to nationwide inpatient- and outpatient health care data, family relations, neighbourhood socioeconomic factors and indices of 250,000 neighbourhood goods and services. These timely data are available for more than 3 million 1st and 2nd generation immigrants, including over half a million more recent immigrants from the Middle East and Africa.
Since the start of this project, we have published six papers and two in press and finished the analyses of several other studies to be submitted soon for publication. In the first paper, published in Drug Alcohol Dependence in 2019, we presented data on immigrant enclaves and risk of drug involvement among asylum-seeking immigrants in Sweden (PMID: 31710993 DOI: 10.1016/j.drugalcdep.2019.107666). Residents of "immigrant enclave" neighborhoods (n = 960) were compared to residents of all other neighborhoods (n = 2,471). Overall, 29.7% of immigrants were assigned to, and 25.5% of Swedes lived in, an enclave. The cumulative incidence of ORDI (officially-recognized drug involvement) in enclaves was 6.34% as compared to 6.89% in other neighborhoods. Immigrants living in an enclave had a 14% lower risk of ORDI (Hazard ratio (HR): 0.86 95% Confidence Interval (CI): 0.77 - 0.96). This protective association was marginally stronger in lower poverty areas. Native-born Swedes living in an enclave had a higher risk of ORDI. Neighborhood immigrant composition is associated with risk of ORDI, with differential associations for immigrants and native-born populations. In a second paper published in 2019 in Epidemiology (doi: 10.1097/EDE.0000000000001160) we used two different analytic approaches where we provided insights in addition to prior neighborhood-health literature, and shed light on the possible differential effect of neighborhood deprivation on depression/anxiety by immigration status.
We will apply different causal models and our novel designs (e.g. identification of deprived immigrant enclaves, deviant peer contexts, and natural experiments) to examine our aims. We are in a unique position to carry out the entire sequence of the proposed research from direct clinical observations, formulation of novel hypotheses and use of innovative analytic methods to interpretation of findings tailored to subgroups of immigrant populations. Findings from Sweden are highly relevant to the EU as around 25% of the entire population are 1st or 2nd generation immigrants. Our findings will delineate meaningful subgroups of immigrants, including refugees, similar to those in other EU countries. Based on our results, we will develop recommendations at the neighbourhood-, family-, peer-, and individual-levels that, when tailored appropriately, will help guide EU policies and strategies, thus leading to decreased strain on health and social services, improved psychiatric health and successful integration of immigrant populations.