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. 2023 Feb 27:57:101859.
doi: 10.1016/j.eclinm.2023.101859. eCollection 2023 Mar.

Suicide among psychiatric patients who migrated to the UK: a national clinical survey

Su-Gwan Tham  1 , Isabelle M Hunt  1 , Pauline Turnbull  1 , Louis Appleby  1 , Nav Kapur  1   2 , Duleeka Knipe  3
Affiliations

Suicide among psychiatric patients who migrated to the UK: a national clinical survey

Su-Gwan Tham et al. EClinicalMedicine. .

Abstract

Background: Within the UK, limited research has examined migration and suicide risk. To assist with tailoring mental health care to the needs of different migrant groups, it is important to identify the clinical profile and antecedents to suicide.

Methods: We focussed on two groups of migrants: those resident in the UK for less than 5 years (recent migrants) and those seeking permission to stay in the UK. Data on mental health patients who died by suicide in the UK between 2011 and 2019 were obtained as part of the National Confidential Inquiry into Suicide and Safety in Mental Health.

Findings: 13,948 patients died by suicide between 2011 and 2019: 593 were recent migrants with 48 seeking permission to stay in the UK. The overall suicide rate between 2011 and 2017 for patients seeking to stay was 23.8/100,000 (95% CI 17.3-32.1). There was some uncertainty around this estimate but it appeared higher than the general population suicide rate of 10.6/100,000 population (95% CI 10.5-10.7; p = .0001) for the same period. A higher proportion of migrants were from an ethnic minority group (15% recent migrants vs. 70% seeking to remain vs. 7% non-migrants) and more were viewed as at low long-term risk of suicide (63% recent migrants vs. 76% seeking to remain vs. 57% non-migrants). A higher proportion of recent migrants died within three months of discharge from psychiatric in-patient care (19% vs. 14%) compared to non-migrants. Proportionally more patients seeking to remain had a diagnosis of schizophrenia and other delusional disorders (31% vs. 15%) and more had experienced recent life events compared to non-migrants (71% vs. 51%).

Interpretation: A higher proportion of migrants had severe or acute illness at the time of their suicide. This may be linked to a range of serious stressors and/or lack of connection with services that could have identified signs of illness early. However, clinicians often viewed these patients as low risk. Mental health services should consider the breadth of stressors migrants may face and adopt a multi-agency approach to suicide prevention.

Funding: The Healthcare Quality Improvement Partnership.

Keywords: Mental health; Migrant; Migration; Suicide; UK.

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Conflict of interest statement

LA is Chair, National Suicide Prevention Strategy Advisory Group, DHSC. NK is a member of the Group, chaired the guideline development group for the 2012 National Institute for Health and Clinical Excellence (NICE) guidelines on the longer term management of self-harm, chaired the guideline development group for the 2022 NICE guideline on depression in adults and was a topic advisor for the 2022 NICE guideline on self-harm: assessment, management and preventing recurrence. Views expressed in the paper are those of the authors and not those of NICE or the Department of Health and Social Care. DK is a steering committee member of the Migration Health and Development Research Initiative and has close links with the International Organization for Migration. All other authors declare no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig. 1
Fig. 1
Rates of suicide for mental health patients who were seeking permission to stay in the UK per 100,000 asylum applications lodged in the UK (2011–2017). Error bars indicate 95% confidence intervals. Note: error bars indicate 95% confidence intervals.
See this image and copyright information in PMC

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