Is refugee experience in childhood a risk for poorer health in adulthood?-A Swedish national survey study.

Studies on experiences of migration in childhood and subsequent health in adulthood report conflicting results. While there is limited research on the long-term health outcomes of refugee children as they transition into adulthood, it is often observed that refugee children experience adverse health conditions upon their arrival in the host country. We examined whether adults with a childhood refugee experience were more likely to have poorer mental health, general health, and risk-behaviours compared to non-refugee migrants and Swedish-born peers We included a nationally representative sample of 18-64-year-olds who answered the Swedish National Public Health survey in 2018 or 2020. Using official register data, we categorized individuals as: 1) refugees in childhood (

Health and health-related behaviours in refugees and migrants who self-identify as sexual or gender minority - A National population-based study in Sweden.

Background: To examine health and health-related behaviors in migrant and refugee individuals who identify as sexual or gender minority, and in comparison to their heterosexual peers. Methods: The study included 168,952 individuals (aged 16-84 years, males: 45·9%, sexual or gender minorities: 3·1%) who answered the Swedish National Public Health Survey in 2018 and 2020. Participants were grouped into Swedish-and Western-born (White) heterosexual, White sexual- or gender minority, migrant heterosexual, migrant sexual- or gender minority, refugee heterosexual, and refugee sexual- or gender minority. Outcomes included mental health (for example suicidal ideation, wellbeing), general health, risky behaviors (risk alcohol use, risk gambling, and substance use), and experiences of violence. Associations between 1) sexual- or gender -ethnic identities and 2) gender-ethnic identities and all outcomes were analyzed using logistic and linear regression adjusting for sex, age, and educational level. Findings: Being a sexual- or gender minority, regardless of ethnic minority status, was associated with worse general health and mental ill-health compared to heterosexual peers including suicidal ideation in refugee sexual- or gender minority individuals (OR 2·42, 95 % CI 1·44-4·08). Ethnic minorities (heterosexual and sexual- or gender minority migrants and refugees) had lower odds of drug and risk alcohol use compared to White heterosexual peers but higher odds of risk gambling (1·88, 1·49-2·37 for refugee heterosexuals). Transgender refugees had high odds for risk gambling (8·62, 1·94-38·40) and exposure to physical violence (7·46, 2·97-18·70). Interpretation: In this national population-based study, sexual and gender minority individuals have worse mental and general health regardless of ethnic minority status. We did not find evidence for worse health in sexual- or gender minority refugees in comparison to migrant, and White sexual- or gender minorities and their heterosexual peers. Transgender individuals (White and ethnic minority) experienced significantly higher levels of physical violence. Public health policy should emphasize preventive measures to reduce exposure to violence and discrimination in sexual- and gender minority individuals, increase access and use of mental healthcare services and sensitise healthcare professionals about higher rates of health and related issues faced by sexual- and gender minority individuals including those with multiple minority identities. Funding: We received no external funding for this study and hence the funder had no role in the study design, data collection, data analysis, data interpretation, writing of the manuscript and the decision to submit.

A systematic review of studies on resilience and risk and protective factors for health among refugee children in Nordic countries.

The Nordic welfare model is often used as an example for the promotion of health and wellbeing, even in vulnerable groups of children, such as refugees. Nonetheless, there are no published reviews on resilience and/or risk and protective factors for physical and mental health among refugee children living in Nordic countries. In this systematic review, we identified 5181 studies on the topic, screened titles, and abstracts, viewed 632, and finally included 26 studies. These studies described 18 samples with a total of 34,080 individuals ranging in ages 0-18 years. Overall, the studies were of good quality. Nearly all studies assessed adversity. Six studies reported physical health outcomes and all studies mental health outcomes, most often post-traumatic stress disorder and anxiety. None explicitly studied resilience. While we found that age and sex are the most frequently studied  risk- and protective factors, findings are inconclusive, since the direction of the associations was different in the different studies. This systematic review indicates that there is still a need for well-designed and -powered studies using clear definitions of key study concepts to examine health outcomes and resilience among refugee children in Nordic countries.

'Long journey to shelter': a study protocol: a prospective longitudinal analysis of mental health and its determinants, exposure to violence and subjective experiences of the migration process among adolescent and young adult migrants in Sweden.

INTRODUCTION: According to the UN Refugee Agency (UNHCR), around 40% of the 79.5 million forcibly displaced persons in the end of the year 2019 were children. Exposure to violence and mental health problems such as posttraumatic stress disorder are frequently reported among migrant children, but there is a knowledge gap in our understanding of the complex longitudinal interplay between individual, social and societal risk and resilience factors that impact mental health and well-being, quality of life and ability to function and adapt. There is also an urgent societal need to facilitate interdisciplinary and intersectoral collaborative efforts to develop effective methods to prevent, detect and respond to the needs of the migrants. This project will study adolescent and young adult migrants in Sweden using multiple methods such as quantitative analysis of data from a prospective cohort study and qualitative analysis of data gathered from teller-focused interviews. The aim is to understand how different factors impact mental health and integration into the Swedish society. Furthermore, individual experiences related to the migration process and exposure to violence will be studied in detail. METHODS AND ANALYSIS: Study participants will include 490 migrants aged 12-25 years recruited through social services, healthcare, social media and the civil society. A subsample of adolescents (n=160) will be re-interviewed after 1 year. Data are collected using structured and semi-structured interviews along with saliva and hair sampling. Measures include sociodemographic data, longitudinal data on mental health and its determinants, including genotypes and stress-hormone levels, access to healthcare and the process of migration, including settlement in Sweden. ETHICS AND DISSEMINATION: The Regional Ethics Board of Linköping (2018/292-31 and 2018/504-32) and the National Ethics Board (2019-05473,2020-00949 and 2021-03001) have approved the study. Results will be made available to participants, their caregivers, professionals working with migrants, researchers and the funders.

Comparative analysis of distinct phenotypes in gambling disorder based on gambling preferences.

BACKGROUND: Studies examining gambling preferences have identified the importance of the type of gambling practiced on distinct individual profiles. The objectives were to compare clinical, psychopathological and personality variables between two different groups of individuals with a gambling disorder (strategic and non-strategic gamblers) and to evaluate the statistical prediction capacity of these preferences with respect to the severity of the disorder. METHOD: A total sample of 2010 treatment-seeking patients with a gambling disorder participated in this stand-alone study. All were recruited from a single Pathological Gambling Unit in Spain (1709 strategic and 301 non-strategic gamblers). The design of the study was cross-sectional and data were collected at the start of treatment. Data was analysed using logistic regression for binary outcomes and analysis of variance (ANOVA) for quantitative responses. RESULTS: There were significant differences in several socio-demographic and clinical variables, as well as in personality traits (novelty seeking and cooperativeness). Multiple regression analysis showed harm avoidance and self-directedness were the main predictors of gambling severity and psychopathology, while age at assessment and age of onset of gambling behaviour were predictive of gambling severity. Strategic gambling (as opposed to non-strategic) was significantly associated with clinical outcomes, but the effect size of the relationships was small. CONCLUSIONS: It is possible to identify distinct phenotypes depending on the preference of gambling. While these phenotypes differ in relation to the severity of the gambling disorder, psychopathology and personality traits, they can be useful from a clinical and therapeutic perspective in enabling risk factors to be identified and prevention programs targeting specific individual profiles to be developed.

The association between compulsory school achievement and problem gambling among Swedish young people.

PURPOSE: We aimed to examine the association between school grades at the age of 16 years and problem gambling at the age of 17-25 years among Swedish females and males. METHODS: In a cohort design, we followed the 16- to 24-year-old participants in the representative Swedish Longitudinal Gambling Study for 2 years, 2008/2009 and 2009/2010, generating 3,816 person-years of follow-up time. The outcome, incidence of mild and moderate/severe gambling problems, was measured by the Problem Gambling Severity Index in telephone interviews. The exposure was register-linked information about final grades in compulsory school. The association between school grades and problem gambling was estimated in multinomial logistic regressions. RESULTS: Low and average school grades were associated with increased incidence of mild and moderate/severe problem gambling compared to high grades, adjusted for sociodemographic characteristics, psychological distress, and alcohol use. Low grades, compared to high grades, were associated with a higher risk of mild gambling problems for adolescent males, whereas the incidence proportion of moderate/severe problem gambling was high for males aged 20-25 years with low grades, among whom unemployment was also very high. Furthermore, we found a strong and graded association between school grades and moderate/severe problem gambling for women in both age groups, despite a low prevalence of gambling participation among females compared to males. CONCLUSIONS: Our findings show that Swedish youth with low school achievement have an increased risk of gambling problems up to 8 years after school graduation, after control for confounding from sociodemographic characteristics, psychological distress, and alcohol use, and that this association is stronger for females than males.

The Incidence of Problem Gambling in a Representative Cohort of Swedish Female and Male 16-24 Year-Olds by Socio-demographic Characteristics, in Comparison with 25-44 Year-Olds.

We aimed to estimate the incidence of a first episode of problem gambling among Swedish 16-24 year-olds by demographic and socio-economic characteristics, and to compare the incidence between 16-24 and 25-44 year-olds, and between young women and men. Other aims were to estimate the proportions of recovery and incidence in recurrent problem gambling, and prevalence of problem gambling among 16-44 year-olds in Sweden. We selected 4,358 participants aged 16-44 from the nationally representative Swedish Longitudinal Gambling Study in 2008/2009 and 2009/2010. The primary outcome measure was a first episode of problem gambling during 12 months before the follow-up as measured by the Problem Gambling Severity Index among participants without a history of problem gambling at baseline. The incidence proportion of a first episode of problem gambling among 16-24 year-olds was 2.26% (95% confidence interval 1.52-3.36); three times lower among females (1.14; 0.42-3.07%) than males (3.32; 2.19-5.01%). Young age and household financial problems were associated with first episode problem gambling among young women. Among 25-44 year-olds, the incidence proportion of a first episode of problem gambling was 0.81% (0.41-1.56). Recovery from problem gambling was high, in particular among females. Individual transitions from problem gambling to recovery and to recurrent problem gambling, between baseline and follow-up, were common regardless of age. This study adds further evidence to research suggesting that there is a high mobility in and out of problem gambling over time on an individual level. The high incidence of first episode problem gambling among youth in Sweden stresses the importance of prevention of problem gambling at an early age.

Is pathological gambling moderated by age?

The age of a patient is a strong moderator of both the course and the evolution of disorders/diseases. However, the effects of current age in pathological gambling (PG) have rarely been examined. The aim of this study is to explore the moderating effects of the patients' current age in relation to personality traits and clinical outcomes of PG. A total sample of 2,309 treatment-seeking patients for PG, diagnosed according to DSM-IV criteria, participated in this study and were assessed with the Diagnostic Questionnaire for Pathological Gambling according to DSM-IV criteria, the South Oaks Gambling Screen, the Symptom Checklist, the Temperament and Character Inventory-R, and other clinical and psychopathological measures. Orthogonal polynomial contrasts showed linear trends in the relationship between age and PG: the older the patient, the more comorbid health problems were visible. The presence of additional quadratic trends also suggests that age plays a significant role in moderating the possibility of existing PG problems and general psychopathology. No interaction term was found between age and sex, but it was present for age and some personality traits: self-transcendence and reward dependence (these two traits were only relevant to the level of impairment due to PG at specific ages). This study suggests that the patients' age influences psychopathological and clinical aspects associated to PG. Intervention in the earliest manifestations of this complex problem is essential in order to better address the need of successful treatment planning.

Typologies of young pathological gamblers based on sociodemographic and clinical characteristics.

OBJECTIVE: The aim of this study is to explore empirical clusters within the population of young Spanish individuals attending outpatient pathological gambling treatment. METHOD: The South Oaks Gambling Screen (SOGS), the Symptom Checklist (SCL-90-R), the Temperament and Character Inventory-R (TCI-R) and other clinical and psychopathological measures were administered to 154 patients (between 17 and 25 years old). The two-step cluster analysis explored the presence of empirical heterogeneous groups based on clinical and socio-demographic characteristics. RESULTS: Three clusters of young pathological gambling patients emerged. Type I showed less psychopathology and more functional personality traits. Type II showed a profile characterized by major emotional distress, shame, immaturity, hostility and negative feelings. Type III showed the most severe psychopathological profile and most psychopathological disturbances and schizotypal traits. CONCLUSIONS: These results suggest that three distinct endophenotypes exist, and that environmental factors have a stronger influence in the first, while in the second and third, individual factors related to deficits of emotional regulation stand out.

Psychosocial health and gambling problems among men and women aged 16-24 years in the Swedish National Public Health Survey.

BACKGROUND: This study aimed to explore the association between psychosocial health, gambling and gambling problems in a nationally representative sample of Swedish youth aged 16-24 years. Another aim was to examine whether these associations were different between young men and women. METHODS: Data were from the cross-sectional Swedish National Public Health Survey in 2004-07. With a response rate of 60.1%, the sample consisted of 19 016 youth. Using a sex-stratified multinomial logistic regression, we estimated associations between psychosocial health variables and gambling and gambling problems. RESULTS: Among males, we found that the higher the alcohol consumption, the higher the likelihood of gambling and gambling problems. Men with high alcohol consumption had an almost four times higher likelihood of gambling problems than men with no or low alcohol consumption (OR 3.94, 95% CI: 2.17-7.14). Moreover, young male victims of violence were more than twice as likely to have gambling problems than non-victims (OR 2.35, 95% CI: 1.39-3.99). Among young women, we found an inverse association between high alcohol consumption and gambling problems (OR 0.15, 95% CI: 0.05-0.44), opposite that of the young men. Furthermore, psychological distress (OR 6.15, 95% CI: 2.15-17.60) and suicidality (OR 2.88, 95% CI: 1.16-7.17) were associated with higher probabilities of gambling problems among young women. CONCLUSION: Alcohol use, violence victimization and poor mental health are associated with gambling problems among Swedish youth, however, with important sex differences. Prevention of youth gambling should consider sex differences and psychosocial health in addition to gambling.