Suicide among post-Arabellion refugees in Germany

Abstract

Background: Although immigrants are considered to be vulnerable to mental illness, there is limited knowledge regarding their suicide mortality.

Aims: To investigate standardised mortality ratios (SMR) for suicide among the largest immigrant populations in Germany before and after the refugee movement of 2015.

Method: Data on immigrants and the general population in Germany between 2000 and 2020 were provided by the scientific section of the Federal Statistical Office. SMR with 95% confidence intervals were calculated by indirect standardisation for gender, age and calendar year for the pre-2015 and post-2015 time interval, first for all the immigrant populations studied and second for the Syrian, Afghan and Iraqi populations separately.

Results: Immigrants from the countries studied showed a lower suicide risk compared with the German reference population (SMR = 0.38, 95% CI = 0.35-0.41). No differences in SMR were found between pre- and post-2015 time intervals, in either the aggregate data for all populations or the data for Syrian, Afghan and Iraqi populations. Post-2015, Afghan immigrants (SMR = 0.68, 95% CI = 0.54-0.83) showed a higher SMR than Syrians (SMR = 0.30, 95% CI = 0.25-0.36) or Iraqis (SMR = 0.37, 95% CI = 0.26-0.48).

Conclusions: Despite the many and varied stresses associated with flight, comparison of the pre- and post-2015 time intervals showed that the suicide risk of the populations studied did not change and was considerably lower than that of the German reference population. We attribute this to lower suicide rates in the countries of origin but also to flight-related selection processes that favour more resilient individuals.

Keywords: Arabellion and Arab Spring; Germany; Suicide; flight; immigration.

Fig. 1

(a) Time course of the population size of Syrians (grey), Afghans (white), Iraqis (dark grey) and other populations of interest (patterned). (b) Demographics of Syrian (SYR), Afghan (AFG) and Iraqi (IRQ) populations in Germany before (left) and after (middle) the refugee movement in 2015. Dark grey indicates males; light grey indicates females. GER, German reference population (2000–2020). In both parts, the figures are based on census data published on 31 December of the respective index year.

Fig. 2

Standardised mortality ratios (SMR) for suicide and 95% confidence intervals for the populations studied. Unfilled squares represent the pre-2015 period and black-filled squares the post-2015 period; POI, aggregated populations of interest; SYR, Syrian; AFG, Afghan; IRQ, Iraqi. Dotted line indicates the SMR of the German reference population.

Fig. 3

Annual standardised mortality ratios (SMR) for suicide and 95% confidence intervals for aggregated populations of interest. Dotted line indicates the SMR of the German reference population.

Fig. 4

Standardised mortality ratios (SMR) for suicide for the largest populations over time. SYR, Syrian; AFG, Afghan; IRQ, Iraqi. Horizontal line indicates the average SMR of pre-2015 years; dotted line indicates the SMR of the German reference population.