Study sheds light on migrants’ use of psychotropic medication in Northern Ireland

A study published by ADR Northern Ireland (ADR NI) researchers has found underuse of mental services by first generation migrants. This open access study, undertaken by a team of interdisciplinary researchers from Queen’s University Belfast, the University of Helsinki, and the American University of Beirut as part of ADR NI’s migrant health project, aimed to explore the uptake of medication for different mental health difficulties by migrant residents in Northern Ireland.

Northern Ireland has a small but growing migrant population, with 4.4% of the population born outside of the Republic of Ireland (RoI) or United Kingdom (UK), compared to 1.1% 10 years earlier. Internationally, research has shown a higher prevalence of mental disorders for first-generation migrants compared to non-migrants, with some group-dependent differences, such as for refugees and migrants from, and to, low-income countries.

Access to mental healthcare has also been found to be more challenging; studies have shown  lower use of mental health services by migrant groups at the primary care level, compared to non-migrants, and higher use at the secondary or tertiary level. These treatment gaps are thought to be related to structural barriers in accessing primary care, poor cultural competence of healthcare providers, shame and stigma, and differing conceptualisations of mental health and mental healthcare. This is the first population-based administrative data linkage study to examine access to mental healthcare by analysing psychotropic prescriptions for first-generation migrants resident in Northern Ireland.

Using data linkage methodology through the ADR NI, the entire enumerated population of Northern Ireland in the 2011 Census was linked to individual psychotropic prescriptions using data from the Enhanced Prescribing Database in Northern Ireland.

What did this study show?

Results showed significantly lower prescription dispensation for antidepressants and anxiolytics, predominantly used for common mental health disorders like depression and anxiety, after adjustment for differences in socio-economic and demographic characteristics. The lower prescription rates were observed for all migrant groups compared to the UK and RoI born majority, with the sole exception of migrants from Germany. For antipsychotic medication prescriptions, significantly lower dispensation was found only for migrants born in Poland, Lithuania and other Central and Eastern European countries.

The study shows that first-generation migrants have an overall lower use of psychotropic prescriptions for common mental disorders compared to the majority population in Northern Ireland, which is in line with findings from previous studies in other countries. It is likely that the results reflect similar barriers to accessing primary mental healthcare. Some migrant groups, such as those from Eastern European countries, were found to be particularly less likely to access care even for medications used for more severe and enduring mental illnesses.

Although the study can only identify underuse of psychotropic medication, and not other forms of treatment like talking therapies, the findings indicate a need to improve the match between resources, services, and the health and social care needs of migrants. Further research is required to understand the barriers to care, in order to address this inequality in service provision.

Lead author Dr Tania Bosqui, Assistant Professor of Clinical Psychology at the American University of Beirut and Visiting Research Fellow at Queen’s University Belfast, said: “Results showed that people who have moved to Northern Ireland from outside the UK and RoI are less likely to access mental health services than the rest of the population. We found that this was the case for some groups, particularly for migrants born in Eastern European countries, even for medications for severe and enduring mental health difficulties. This is worrying because such illnesses can be treated effectively, but migrants are less able to access these treatments. The treatment gap has implications for the wellbeing and safety of migrants in Northern Ireland, and for social and health equality”.

You can access the full report on the International Journal of Mental Health Systems website.

Visit our blog for more information about the ADR Northern Ireland migrant health project.