Migration background and specialized mental health care utilization in young adults: a register-based study in the Netherlands

Abstract Purpose This study aimed to examine the differences in specialized mental health care utilization among young conflict-affected migrants in the Netherlands, compared to their Dutch-born and non-conflict-affected peers, and to assess the role of benefit receipt and duration of stay. Methods This register-based study included 1,219,051 individuals aged 18–25 residing in the Netherlands on 1 January 2015. Participants were followed until 31 December 2018 for specialized mental health care contact. Adjusted hazard ratios (aHR) with 95% confidence intervals (CI) were estimated using Cox regression. Exploratory analyses examined how benefit receipt and duration of stay relate to specialized mental health service use. Results Compared to Dutch-born individuals, both conflict-affected (aHR 0.91, 95%CI 0.88–0.95) and non-conflict-affected migrants (aHR 0.63, 95%CI 0.61–0.65) had lower overall specialized mental health care utilization. Conflict-affected migrants showed higher utilization for psychotic (aHR 3.99, 95%CI 2.39–4.69) and anxiety disorders (aHR 1.27, 95%CI 1.17–1.38), whereas non-conflict-affected migrants had higher utilization for psychotic disorders (aHR 2.03, 95%CI 1.72–2.34) compared to Dutch-borns. Patterns of utilization also varied by benefit receipt and duration of stay, with differences across diagnostic categories. Conclusion Young migrants had lower overall use of specialized mental health care than Dutch-born peers, but higher use for psychotic, and anxiety disorders, varying by migration background. As unmet need cannot be assessed from our data, it remains unclear whether lower use reflects reduced need or access barriers. However, findings underscore persistent disparities and the need for policies ensuring equitable access.