Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.
Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Psychol Med. 2023 Feb;53(3):833-843. doi: 10.1017/S003329172100218X. Epub 2021 Jun 2.
Higher incidence of psychotic disorders and underuse of mental health services have been reported among many migrant populations. This study examines the initiation and continuity of antipsychotic treatment among migrants and non-migrants with a non-affective psychosis during a new treatment episode.
This study is based on a nationwide sample of migrants and Finnish-born controls. Participants who were diagnosed with a psychotic disorder in 2011-2014 were identified from the Care Register for Health Care ( = 1693). Information on purchases of antipsychotic drugs in 2011-2015 was collected from the National Prescription Register. The duration of antipsychotic treatment since diagnosis was estimated using the PRE2DUP model. Cox regression analysis was used to study factors that are associated with discontinuing the use of medication.
There were fewer initiators of antipsychotic treatment after being diagnosed with psychosis among migrants (68.1%) than among Finnish-born patients (73.6%). After controlling for sociodemographic background and factors related to the type of disorder and treatment, migrants were more likely to discontinue medication (adjusted hazard ratio 1.28, 95% confidence interval 1.08-1.52). The risk of discontinuation was highest among migrants from North Africa and the Middle East and Sub-Saharan Africa and among recent migrants. Non-use of antipsychotic treatment before being diagnosed with psychosis, involuntary hospitalization and diagnosis other than schizophrenia were associated with earlier discontinuation both among migrants and non-migrants.
Migrants with a psychotic disorder are less likely to continue antipsychotic treatment than non-migrants. The needs of migrant patients have to be addressed to improve adherence.
许多移民群体中报告了精神障碍发病率较高和精神卫生服务利用不足的情况。本研究在新的治疗阶段检查了移民和非移民的非情感性精神病患者开始和继续接受抗精神病治疗的情况。
本研究基于全国范围内的移民和芬兰出生对照者的样本。从医疗保健关怀登记处（ = 1693）中确定了 2011-2014 年间被诊断为精神障碍的患者。从国家处方登记处收集了 2011-2015 年购买抗精神病药物的信息。使用 PRE2DUP 模型估计自诊断以来抗精神病药物治疗的持续时间。使用 Cox 回归分析研究与停止使用药物相关的因素。
与芬兰出生的患者（73.6%）相比，移民被诊断为精神病后开始抗精神病治疗的人数较少（68.1%）。在控制社会人口统计学背景以及与疾病类型和治疗相关的因素后，移民更有可能停止用药（调整后的危险比 1.28，95%置信区间 1.08-1.52）。来自北非和中东、撒哈拉以南非洲以及最近移民的移民停止用药的风险最高。在被诊断为精神病之前未使用抗精神病药物、非自愿住院治疗以及除精神分裂症以外的诊断与移民和非移民的提前停药有关。
与非移民相比，患有精神障碍的移民继续接受抗精神病治疗的可能性较低。需要解决移民患者的需求，以提高其治疗依从性。
