(65) Association of Medication Clusters and Labor Market Marginalization in Refugee Youths and Swedish-Born with Common Mental Disorder in Sweden

Publication Number: 396

Background: Little is known about how the use of psychotropic medication over time associates with social integration among refugee youths and Swedish-born with common mental disorder (CMD).

Objectives: To identify groups of patients with similar psychotropic medication patterns and examine the relation between the identified medication groups and subsequent labor market marginalization (LMM) in refugee youths and Swedish-born with CMD (depressive, anxiety, and stress related disorders).

Methods: The study used a longitudinal matched cohort from Swedish registers from 2006—2014, including data on demography, medications, medical history, and reported LMM of Swedish residents 19-25 years with CMD. Exposure measure was based on psychotropic medication (antidepressants, antipsychotics, anxiolytics, sedative-hypnotics, mood stabilizers) dispensing collected one year before and after CMD diagnosis. Louvain clustering was applied to identify groups of individuals with similar patterns of dispensed psychotropic medications. Outcome was a composite LMM measure defined as being granted disability pension, long-term sickness absence (>90 days), or >180 days unemployment and it was followed from one year after diagnosis until the end of data linkage, death or emigration.Group membership was used as exposure for the Cox regression (yielding Hazard ratios, HR, and 95% Confidence intervals, CI).

Results: Among the 12,472 youths with CMD, 4,206 persons (33.7%) had any measure of LMM during a mean follow-up of 4.1 years (SD 2.3 years). Refugees had a lower cumulative dosage in all medications, except antipsychotics, compared to the Swedish-born. Six clusters of patients were identified based on their psychotropic medication use patterns over time. A patient cluster characterized by multiple sustained medications after the peak of the dosages at CMD diagnosis was associated with the highest HRs of the composite LMM (HR (95% CI): 1.84[1.59,2.11]), whereas the lowest HRs were observed within a cluster with a sharp peak in antidepressants only (1.12[0.90,1.40]). No differences between refugees and Swedish-born with regard to the association between clusters and LMM occurred.

Conclusions: Refugee youths had lower overall psychotropic medication use than their Swedish-born counterparts. Medication use patterns, represented by cluster membership, were differentially associated with LMM similarly for refugees and Swedish-born.