On the basis of the hypothesis that immigrant status represents a risk factor for mental illness as well as for suicidal behaviour, a study was performed on the incidence of suicide in two different areas of Stockholm County. Sources of information were forensic autopsy reports, files from local psychiatric care units, and demographic statistics for the areas and the period studied - 1987-91. Our data disclosed that a covariation exists between suicide and immigrant status, and lack of psychiatric care. Immigrant groups were underrepresented among patients seeking psychiatric counselling and even more so among those admitted for inpatient mental health care (p = 0.008). Assuming that adequate psychiatric treatment will prevent suicidal behaviour, our results suggest that the needs of immigrants are insufficiently met by mental health programs in their present shape. First, there may be a bias against help-seeking for psychiatric problems on the part of the immigrants. Secondly, there may be a lack of awareness in Swedish mental health professionals with regard to specific problems concerning communication and symptom presentation, as well as concepts of honour, suffering, and ethnocultural values. Programs for the prevention of suicide in immigrants thus represent a new challenge for Swedish society and the mental care profession.
