How Does Migrant Status Affect Quality of Care and Outcomes for Patients Hospitalized with Depression?

What you need to know

• Migrants hospitalized for major depression in Denmark received lower quality inpatient care compared to native Danes.
• Migrant patients, especially those from Western countries, had higher 1-year mortality rates after hospitalization.
• Migrants had lower rates of readmission for depression and all causes, which may indicate problems with care continuity and access.
• These findings highlight the need for interventions to improve care quality and outcomes for migrant patients with depression.

Depression among migrants: An important public health issue

Depression is a common and serious mental health condition that affects people worldwide. As global migration continues to increase, the mental health of migrant populations has become an important public health issue. Research shows that migrants, especially refugees, are at higher risk of developing depression compared to native-born populations. This may be due to factors like trauma exposure, isolation, discrimination, and difficulties adjusting to a new culture and environment.

While we know migrants face a higher burden of depression, less is known about their experiences when seeking treatment, especially in hospital settings. Do migrants receive the same quality of care as native-born patients? Do they have similar outcomes after being hospitalized for depression? A team of researchers in Denmark set out to investigate these questions by analyzing nationwide data on patients hospitalized for major depressive disorder.

Examining care quality and outcomes for migrants vs. native Danes

The researchers conducted a large study looking at all adult patients admitted to psychiatric hospitals in Denmark with a primary diagnosis of major depressive disorder between 2011-2017. They compared migrants to Danish-born patients on several measures:

1. Quality of inpatient care - How well did the care follow clinical guidelines?
2. All-cause mortality - What was the death rate in the year after hospitalization?
3. Suicidal behavior - What was the rate of suicide attempts or deaths in the following year?
4. Readmissions - How often were patients readmitted for depression or any cause within a year?

The study included over 20,000 patients, with about 8.4% being migrants. The migrant group was further divided into those from Western countries (like other European nations) and those from non-Western countries.

Key findings: Lower care quality and worse outcomes for migrants

After analyzing the data, the researchers found several concerning disparities between migrant and Danish-born patients:

Lower quality of inpatient care

Migrants were less likely to receive high-quality care that followed clinical guidelines. Only 28.2% of migrants received care meeting the benchmark for high quality, compared to 31.6% of Danish-born patients.

The researchers looked at several specific measures of care quality, such as:

• Being examined by a psychiatrist within 7 days
• Receiving a proper medical workup
• Getting a social worker assessment
• Having suicide risk evaluated
• Making arrangements for follow-up care after discharge

On nearly all these measures, migrants were less likely to receive the recommended care. The differences were generally small but consistent across different aspects of treatment.

Higher mortality rates

In the year after hospitalization, migrants had a significantly higher death rate from all causes compared to Danish-born patients. The increase in mortality risk was especially pronounced for migrants from Western countries.

Similar rates of suicidal behavior

The study did not find any clear differences between migrants and Danish-born patients in rates of suicidal behavior (attempts or deaths) in the year after hospitalization. Rates were around 5% for all groups.

Lower readmission rates

Interestingly, migrants had lower rates of being readmitted to the hospital, both for depression specifically and for any cause. At first glance, lower readmissions may seem positive. However, the researchers suggest this could actually indicate problems with continuity of care and access to needed services after discharge.

Possible explanations for the disparities

The study was not designed to determine the exact reasons for these differences in care quality and outcomes. However, the researchers propose several potential contributing factors:

Language and cultural barriers

Difficulties communicating or cultural differences in how mental health is understood could impact the care migrants receive. Healthcare providers may struggle to do a thorough assessment or explain treatments if there are language barriers.

Unfamiliarity with the healthcare system

Migrants may have trouble navigating an unfamiliar healthcare system, making it harder to access needed follow-up care after discharge.

Discrimination

Conscious or unconscious bias among healthcare providers could potentially lead to differences in care.

Lack of culturally competent care

Healthcare workers may lack training in providing culturally appropriate care for diverse populations.

Socioeconomic factors

While the study tried to account for differences in education, income, and employment, these factors likely still play a role in health disparities.

Implications and next steps

This study provides valuable evidence of disparities in depression care and outcomes for migrants, even in a country with universal healthcare like Denmark. The findings highlight the need for targeted interventions to improve care quality and continuity for migrant patients with depression.

Some potential approaches suggested by the researchers include:

• Developing more inclusive mental health promotion and prevention programs
• Strengthening mental health services in primary care settings
• Ensuring timely diagnosis, treatment, and rehabilitation services for migrants
• Improving healthcare provider training on cultural competence and implicit bias
• Further research to better understand the causes of these disparities

While the study focused on Denmark, the researchers note that similar or even greater disparities may exist in countries with less equitable healthcare systems. More research is needed in diverse settings to fully understand and address this important public health issue.

Conclusions

• Migrants hospitalized for depression in Denmark received lower quality inpatient care compared to native-born patients.
• Migrant patients had higher mortality rates in the year after hospitalization, especially those from Western countries.
• Lower readmission rates for migrants may reflect problems with care continuity and access rather than better outcomes.
• Targeted interventions are needed to improve depression care and outcomes for migrant populations.