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Continuity of antipsychotic medication use among migrant and Finnish-born populations with a psychotic disorder: a register-based study

Published online by Cambridge University Press:  02 June 2021

Venla Lehti Open the ORCID record for Venla Lehti [Opens in a new window] ,
Heidi Taipale ,
Mika Gissler ,
Antti Tanskanen ,
Martta Elonheimo ,
Jari Tiihonen  and
Jaana Suvisaari
Venla Lehti*
Affiliation:
Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
Heidi Taipale
Affiliation:
Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden School of Pharmacy, University of Eastern Finland, Kuopio, Finland
Mika Gissler
Affiliation:
Research Centre for Child Psychiatry, University of Turku, Turku, Finland Information Services Department, Finnish Institute for Health and Welfare, Helsinki, Finland Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
Antti Tanskanen
Affiliation:
Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden Impact Assessment Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
Martta Elonheimo
Affiliation:
Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland Specialized Psychiatric Services, Helsinki, Finland Doctoral Programme in Clinical Research, Faculty of Medicine, University of Helsinki, Helsinki, Finland
Jari Tiihonen
Affiliation:
Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
Jaana Suvisaari
Affiliation:
Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
*
Author for correspondence: Venla Lehti, E-mail: venla.lehti@utu.fi
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Abstract

Background

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.

Methods

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 (n = 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.

Results

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.

Conclusions

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.

Keywords

Antipsychoticimmigrantmedicationmigrantpsychosis
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 3 , February 2023 , pp. 833 - 843
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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