Association between mental health screening and healthcare utilization among refugees and asylum seekers in Sweden: A retrospective cohort study

Abstract

Background

Asylum seekers and refugees are at increased risk of mental illness. Previous research suggests underutilization and delayed access to care in this the population. This study aims to explore if screening during a health examination is associated with mental health care utilization among refugees and asylum seekers.

Methods

A retrospective cohort study examined mental healthcare utilization patterns during the five months following voluntary health examinations among asylum seekers and refugees screened with the Refugee Health Screener (RHS-13). We analyzed data from 7726 individuals across five primary healthcare clinics in the Stockholm Region, Sweden, between 2019 and 2022. Outcomes included utilization of mental healthcare within primary care, with and without a recorded diagnosis, and referrals to other mental health units.

Results

Individuals who were screened had a fivefold increase in mental healthcare utilization compared to those who were not screened (odds ratio (OR) 5.09, 95% confidence interval (CI): 3.69–7.04). Both individuals aged 26–39 OR 2.13, (95% CI 1.37–3.31) and 40 year and older OR 2.11, (95% CI 1.34–3.31) were significantly more likely to utilize healthcare compared to the youngest group. Refugees and asylum seekers from the Middle East and North Africa (OR 0.59, 95% CI 0.38–0.90) had a lower likelihood of utilizing mental health care compared to those from Asia.

Conclusion

Screening was associated with a significant increase in mental healthcare utilization. This underscores that integrating mental health screening into routine health examinations can identify mental illness earlier and create more accessible pathways to mental health services.