Kautzky Alexander, Pettersson Emma, Amin Ridwanul, Akhtar Aemal, Tanskanen Antti, Taipale Heidi, Wancata Johannes, Gemes Katalin, Mittendorfer-Rutz Ellenor
Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Department for Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
Bipolar Disord. 2025 May;27(3):192-204. doi: 10.1111/bdi.70007. Epub 2025 Mar 7.
Deviations in treatment practices toward immigrant groups compared to host populations are common in mental disorders but unknown in bipolar disorder (BD). We aim to close this research gap by analyzing age-stratified use patterns of antidepressants, mood stabilizers, and antipsychotics following an incident diagnosis of BD in Swedish-born, second- and first-generation nonrefugee immigrants, and refugees.
Individuals with incident BD between 2006 and 2018 were identified through Swedish national registers. Medication use was followed up until 5 years after diagnosis. Use rates adjusted for sociodemographic and disease-related covariates were computed with generalized estimation equations for each population group. Marginal means with 95% confidence intervals (CIs) and significance tests for main and interaction effects of population group and time points are presented. Furthermore, significant effects of population group, age group, time point, and their interaction were tested by Type III joint test yielding F and p values.
Three months after diagnosis, estimated rates of lack of treatment differed significantly between population groups (p < 0.0001) as Swedish-born (17.3%, CI: 16.8-17.7) lacked disease-specific treatment less often than second-generation immigrants (21.1%, 19.7-22.5), first-generation nonrefugee immigrants (23.1%, 21.3-25.0) and refugees (26.8%, 24.4-29.4). Antidepressant monotherapy was estimated in 17.7% (17.2-18.1) of Swedish-born, 16.8% (15.5-18.3) of second-generation immigrants, 17.7% (16.2-19.4) of first-generation nonrefugee immigrants, and was most prevalent in refugees (20.3%, 18.2-22.7; population group p = 0.0002). Mood stabilizers were most dispensed by Swedish-born (51.3%, 50.6-51.9), followed by second-generation (47.9%, 46.1-49.8) and first-generation nonrefugee immigrants (44.5%, 42.4-46.7) and refugees (35.4%, 32.8-38.2; population group p < 0.0001). Use rates of antipsychotics were similar between population groups (p > 0.05) and estimated at 14.1% (13.7-14.6) in Swedish-born, 14.0% (12.8-15.3) in second-generation, 13.0% in first-generation nonrefugee immigrants (12.0-14.6), and 12.9% (11.1-15.0) in refugees. Following up significant interactions of population and age group, lithium use was estimated to be lower in refugees aged 36-65 years (9.9%, 7.9-12.5; population group p = 0.0008) and olanzapine use to be higher in refugees aged 16-35 (9.2%, 7.1-11.9; population group p = 0.0002), respectively, compared to other population groups of the same age.
Immigrants, especially refugees, are at risk of not receiving adequate treatment following BD diagnosis, putatively owing to a lack of transcultural competence in healthcare, economic restraints, and community factors. Antidepressant monotherapy should be reduced, while recommended options such as mood stabilizers and specifically lithium should be considered more often.
与宿主人群相比，针对移民群体的精神障碍治疗实践存在偏差，这在精神疾病中很常见，但在双相情感障碍（BD）中尚不清楚。我们旨在通过分析瑞典出生的第二代和第一代非难民移民以及难民在BD确诊后按年龄分层的抗抑郁药、心境稳定剂和抗精神病药使用模式，来填补这一研究空白。
通过瑞典国家登记册识别出2006年至2018年间确诊为BD的个体。药物使用情况随访至诊断后5年。使用广义估计方程计算每个群体经社会人口统计学和疾病相关协变量调整后的使用率。给出了95%置信区间（CI）的边际均值以及群体和时间点的主要效应和交互效应的显著性检验。此外，通过III型联合检验对群体、年龄组、时间点及其交互作用的显著效应进行检验，得出F值和p值。
诊断后三个月，各群体间未接受治疗的估计率存在显著差异（p<0.0001），因为瑞典出生的人（17.3%，CI：16.8 - 17.7）比第二代移民（21.1%，19.7 - 22.5）、第一代非难民移民（23.1%，21.3 - 25.0）和难民（26.8%，24.4 - 29.4）更少缺乏针对特定疾病的治疗。抗抑郁药单药治疗在17.7%（17.2 - 18.1）的瑞典出生者、16.8%（15.5 - 18.3）的第二代移民、17.7%（16.2 - 19.4）的第一代非难民移民中使用，在难民中最为普遍（20.3%，18.2 - 22.7；群体p = 0.0002）。心境稳定剂的配发量在瑞典出生者中最高（51.3%，50.6 - 51.9），其次是第二代（47.9%，46.1 - 49.8）和第一代非难民移民（44.5%，42.4 - 46.7）以及难民（35.4%，32.8 - 38.2；群体p<0.0001）。各群体间抗精神病药的使用率相似（p>0.05），瑞典出生者中的估计使用率为14.1%（13.7 - 14.6），第二代中为14.0%（12.8 - 15.3），第一代非难民移民中为13.0%（12.0 - 14.6），难民中为12.9%（11.1 - 15.0）。在对群体和年龄组的显著交互作用进行随访时，估计36 - 65岁难民中锂的使用率较低（9.9%，7.9 - 12.5；群体p = 0.0008），16 - 35岁难民中奥氮平的使用率较高（9.2%，7.1 - 11.9；群体p = 0.0002），与同年龄的其他群体相比。
移民，尤其是难民，在BD诊断后有未得到充分治疗的风险，推测是由于医疗保健中缺乏跨文化能力、经济限制和社区因素。应减少抗抑郁药单药治疗，同时应更频繁地考虑推荐的药物，如心境稳定剂，特别是锂盐。
