High Suicide Rates Among Unaccompanied Minors/Youth Seeking Asylum in Sweden

Data Collection

We gathered data on suicide rates and background factors by contacting 23 different sources, specifically state agencies and nongovernmental organizations (NGOs). Out of these 23 sources, four state agencies and two NGOs provided data.

Population of Unaccompanied Minors and the Host Population

It is difficult to estimate the exact population size of asylum seekers as the population size may change on a daily basis. In order to estimate the population size, information was derived from the Migration Agency (MA). To have an estimate covering all possible asylum seekers during 2017, we summed the number of individuals with a new application for asylum during 2017 and the number of individuals with ongoing asylum applications from 2016. The Swedish population size was derived from the official statistics provided by the National Board of Health and Welfare (NBHW).

Information on Number of Suicides

The number of unaccompanied minors seeking asylum who died by suicide was collected through information from the NGOs ("Vi står inte ut" and "The association of unaccompanied youth") and from reports to the Health and Social Care Inspectorate. Findings from these sources were cross-checked to verify individual information. This information was then validated using the register database on all forensic autopsies held by the National Board of Forensic Medicine (NBFM) in Sweden. Data on the number of suicides in the host population were derived from the NBHW. For both the asylum seekers and the host population, suicides were coded according to the International Classification of Diseases version 10 (ICD-10) codes: X60–X84. Moreover, events of undetermined intent (ICD-10 code Y10-Y34) were included to limit the risk of underreporting as well as variations in case ascertainment. The ICD codes also provided information on the methods of suicide.

Background Factors

Information on background factors of the asylum seekers was gathered from the MA. Such factors included age, schooling, as well as conditions during premigration and during the asylum process in Sweden.

Data Analysis

Suicide rates were calculated per 100,000 individuals in the respective population. We performed a sensitivity analysis and calculated suicide rates for unaccompanied minors and the host population between 14 and 18 years of age.

The study was approved by the Regional Ethical Review Board of Stockholm (dnr 2017/M1687-31/2).

Background Factors

All unaccompanied minors who died by suicide in 2017 were young men and most of them from Afghanistan (83%). According to the information provided from the MA, many of the asylum-seeking individuals who died by suicide with available information (75%) had little or no schooling (67%), had endured harassment and abuse (56%), and had experienced violence and poverty before seeking asylum in Sweden (67%). Suicide by hanging was the most frequent method (about 60%). All the boys who died by suicide in 2017 had applied for asylum in 2015.

The boys who died by suicide had different legal status in four broad categories according to the MA:

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  Decision pending (ongoing protection claims), n = 5;
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  Rejection, no information on appeal, n = 3;
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  Asylum application approved, n = 2; and
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  Case not opened (no interview), n = 2.

Suicide Methods

Around 60% of the unaccompanied minors who died by suicide used hanging as a method. Hanging is a lethal suicide method; about 70% of people using this method die as a consequence of their suicidal behavior (Gunnell, Bennewith, Hawton, Simkin, & Kapur, 2005). People who use a method with a high probability of a fatal outcome such as, for example, hanging can therefore be assumed to have a strong suicidal intention, thus a strong intention to die.

The majority of the suicides among unaccompanied minors occurred during an ongoing asylum process without a final decision on their application or their case in court. This finding is in contrast to a common belief that refusal of an application for asylum constitutes a trigger for suicidal behavior. In addition, we found that all unaccompanied minors who died by suicide in 2017 had applied for asylum in 2015. Long processing times in the asylum process might be a cause of mental ill health and therefore a contributing factor to suicidal behavior (Oppedal & Idsoe, 2015; Socialstyrelsen, 2017). Of note, before 2015 the asylum process was approximately 6 months long, which is a recommended process time for children, and after 2015 the mean process time was over 1 year (Migrationsverket, 2019). The unaccompanied minors who died by suicide in 2017 had several risk factors for suicide, that is, male gender, experience of poverty, traumatic events, and low socioeconomic status (Bridge, Goldstein, & Brent, 2006; Gomez et al., 2017). Of the unaccompanied minors who died by suicide in 2017, 83% were from Afghanistan; this can be compared with the share of unaccompanied minors arriving in Sweden in 2015 from Afghanistan being 66%.