Health among youth and young adults born in the nordic countries to immigrant parents- a scoping review

Abstract

Introduction

A considerable number of individuals born in the Nordic countries to immigrant parents are now entering youth and young adulthood, but we have limited knowledge about their health. This scoping review aimed to map and summarize existing knowledge on the health of this group.

Methods

This research followed guidelines from the Joanna Briggs Institute. The literature search was performed in the databases Ovid Medline, Embase, APA PsycInfo, CINAHL, Scopus, SveMed+, Cochrane Central Register of Controlled Trials Issue, and Epistemonikos. Two researchers screened titles and abstracts of all records, and then full-texts of potentially relevant studies. Any disagreements were solved by discussion. Reference lists of the included studies were screened for additional relevant articles. Included articles should report on health outcomes among persons aged 16–30 years, born in a Nordic country to immigrant parents. Evidence was extracted and summarized.

Results

The initial search resulted in 2452 unique records. A total of 11 articles were included in the final scoping review. Most of the studies were on mental health and concluded that descendants of immigrants had higher levels of self-reported mental health problems than native-background youths and young adults. They were, however, less likely to use mental health services.

Conclusion

Available studies suggest that young adults born in the Nordics to immigrant parents have a greater burden of mental health problems but use mental health services less, than natives. Further studies on the reasons for this are warranted to elucidate possible action points.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-025-21426-y.

Introduction

In many European countries, there is a growing number of individuals born immigrant parents [1]. These individuals do not have a migration experience themselves, but their health may be affected by their parents` immigrant background in several ways. Many immigrants face socioeconomic challenges such as lower income, unstable employment, and poor housing conditions [2], which could impact the health of their children negatively. These conditions can create an environment where children experience higher levels of stress, lower access to quality healthcare, and poorer health outcomes. Furthermore, parents` perceptions of health, their understanding of healthcare systems, and their healthcare-seeking behaviour could also influence the health of their children. Some immigrants, for instance, might delay seeking medical care due to language barriers, lack of knowledge about the local healthcare system. Discrimination is experienced by both immigrants and their descendants [3] and is linked to a range of negative health outcomes, including stress-related and cardiovascular conditions [4]. Moreover, migration-related stress experienced by parents— such as uncertainty about immigration status, economic instability, or cultural adaptation—can create a strained family environment that negatively impacts their children [5]. The mental health and emotional well-being of parents can therefore, shape family dynamics, affecting children’s own emotional development and their ability to cope with stress [5].

Adult immigrants are often relatively healthy upon arrival in a new country [6]. However, many experience a deterioration of health after longer duration of stay, and a related disproportionate burden of disease, particularly non-communicable diseases including diabetes and cardiovascular diseases, compared to native populations [7–9]. Immigrants also more often than others suffer from mental health issues [7, 10]. However, other conditions, such as cancers, are generally experienced at lower rates among immigrants [11, 12]. Health varies substantially between groups of immigrants and differences between groups are dependent on factors occurring before, during, or after migration [13]. Some studies consistently suggest that children of immigrants are at higher risk than other children of overweight and obesity [14–18] and some types of infections [19, 20]. Some studies also indicate that children of immigrants may have higher rates of mental health issues than children with a native background [18]. Most such studies focus on younger children. Moreover, many studies do not distinguish between children with a migration experience and children born in a new country.

The Nordic countries have differences and similarities in migration patterns, social welfare, healthcare systems, and relatively equal access to services. Notably, immigration on a larger scale is a relatively new phenomenon. However, some immigrant groups now have a longer duration of residence, and for the first time, Nordic-born youth and young adults to immigrant parents are a group of considerable size [21]. Because the growth of this group is recent, there is limited evidence on their health and health-related challenges Knowledge of their healthcare needs is crucial for healthcare service planning and ensuring these needs are adequately met. The objective of this scoping review is to systematically assess and summarise the emerging evidence from various studies on the health of Nordic-born youth and young adults with immigrant parents. The knowledge gained will help to direct future research in the field.

Methods

We followed the Joanna Briggs Institute’s methodology for scoping reviews and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews [22, 23] (supplementary file 1). Our scoping review followed the five approaches described by Arksey and O’Malley [24]: formulating the research question, identifying relevant studies, selecting eligible studies, charting data, and summarizing the findings. Protocol registration was made available at the Open Science Framework ID: https://osf.io/cqyex/.

We aimed to summarise the current knowledge of the health of youth and young adults (aged 16–30 years) born in the Nordic countries to immigrant parents, and our research question was: What is currently known about the health of descendants of immigrants in the Nordic countries in their youth and early adulthood? We collaborated with a health science librarian who assisted us in developing search strategies and conducting database searches. These eight databases were searched: Ovid Medline, Embase, APA, PsycINFO, CINAHL, Scopus, SveMed+, Cochrane Central Register of Controlled Trials Issue, and Epistemonikos. The search strategy is built on Medical Subject Headings (MeSH) and relevant free-text words. The search strategies were customised to the different databases, and the full search logs are included in supplementary file 2.

The search included four main search concepts. The first reflected our focus on immigrants and included search terms such as ‘immigrant’, ‘birth country’, ‘birthplace’, ‘ethnicity’, ‘refugees’, and ‘asylum seekers’. We conceptualised immigrants broadly at this stage to ensure we found all relevant articles. The articles finally included in the scoping review focused on youth and young adults born in the Nordic countries to immigrant parents. We refer to this group as descendants, though some articles use the term ‘second generation’. We focus primarily on those with two immigrant parents, not those with only one immigrant parent. Not all studies stated whether descendants included only those with two immigrant parents. Studies were excluded only if the authors clearly stated that descendants included those with one immigrant parent. The second search concept reflected our focus on age and included terms like ‘adolescents’, ‘young adults’, ‘minors’, and ‘adults’. We focused on youth and young adults aged 16–30 years. During middle to late adolescence, individuals in most Nordic countries can seek medical advice and participate in research independently without requiring parental or guardian consent [25]. This autonomy empowers them to make decisions about their healthcare while maintaining confidentiality in their interactions with healthcare providers. This makes it particularly valuable to examine the health of individuals just before they reach the legal age of adulthood, as it offers insight into key health transitions during this developmental stage. We also sought to capture the full transition from adolescence to adulthood. As such, we included studies that addressed individuals up to the age of 30. The concept of young adulthood has evolved, as many individuals are still engaged in tertiary education during this period, and they often only begin to establish financial independence in their late twenties. Furthermore, the age at which people marry or have children has increased significantly, suggesting that the limits of young adulthood have extended. However, relevant studies included different age groups and applied different age cut-offs. We have thus exercised some discretion in the selection of studies to include. For example, if a study included descendants aged 18 and above, we assumed (according to the age distribution of descendants) that the proportion of participants above the age of 30 years was small and included that study. Further, when articles included several age groups, we included only articles in which results within our focus age group could be extracted. The third search concept related to outcomes and terms like ‘health’, ‘health status’, ‘mental health’, and ‘physical health’ were used, capturing both self-reported health and diagnoses given in health care. The fourth search term related to our focus on the Nordic countries: ‘Norway’, ‘Sweden’, ‘Finland’, ‘Denmark’ and ‘Iceland’.

Inclusion and exclusion criteria

Our search was limited to articles published in English between the 1st of January 2007 and the 25th of October 2024. As mentioned, the group of descendants of immigrants in the Nordics, having reached youth and early adulthood, has just recently reached substantial numbers. We thus hypothesised that there would be few relevant studies published before 2007. Moreover, the few descendants who were already young adults before this would be a different group than those in this age span today. We excluded studies related to the COVID-19 pandemic, studies in which participants were themselves immigrants (e.g. un-accompanied immigrant youth, not born in the Nordics), studies about adoption, intervention studies (unless they were reporting baseline data), studies carried out outside the Nordic countries, and studies that did not have health-related outcomes. We also excluded grey literature, which is often published in national languages, and we could not identify, assess, and read such reports and publications in all Nordic languages. Including grey literature from some countries could lead to an under-represention of studies in other countries.

Screening of articles and data extraction

The identified studies were uploaded into EndNote 20 and Rayyan (Web-based software) to detect duplicates and review the relevant studies. Two independent reviewers (NSS, MKK) screened all titles and abstracts against the inclusion criteria and read potentially relevant articles in full text. Any disagreements that arose between the reviewers at each stage of the selection process were resolved through discussion. Reasons for exclusion at full-text screening were recorded and reported (Supplementary file 3, Table 1). In addition, we screened the reference lists of included articles and related reviews identified in the search for additional relevant studies. We extracted the following information for the scoping review presented in supplementary file 4: author(s), year of publication, study aims, study design, country, population (gender and age), sample size, and the country or regional background of descendants. Additionally, we included details on the health outcomes of the study population, how these outcomes were measured, and the findings related to the health of the population, as aligned with the objectives of the scoping review.

Results

Figure 1 shows article inclusion and exclusion and details each stage of the selection process. We identified 4775 articles through our initial search (of which 2323 were duplicates), 2452 were screened on title and abstract, and 50 were assessed in full text for eligibility. One article was included after screening the reference lists of included articles. A total of 11 articles were included in the final scoping review and are presented in supplementary file 3, Table 2.

Fig. 1.

Flow diagram of articles assessed, excluded, and included in this review

Characteristics of the included studies

Descriptive characteristics of the included studies are presented in Table 1. The majority of the studies (n = 6) were conducted in Sweden [26–31], followed by three studies conducted in Denmark [32–34], two in Norway [35, 36]. No peer-reviewed published studies focused on youth and young adults of descendants in Finland and Iceland were identified. The studies were all quantitative in nature and included both males and females. Nine studies reported on mental health [26–29, 31–33, 35, 36], and three of these studies also included measures of physical health [31, 33, 36]. Three of the studies were based on self-report of symptoms or diagnoses [28, 29, 31], five were based on diagnoses or medication from registers [26, 27, 32, 35, 36], and two were based on hospitalisation from registers [32, 33]. Two studies reported on self-reported general health [30, 34]. The sample sizes ranged from 446 to 2 178 321 participants. The diagnoses and health outcomes reported in the included studies are shown in Table 2 and also summarised in supplementary file 5.

Table 1.

Descriptive characteristics of the included studies

Characteristics of the studies	Number of studies	References
Country
Sweden	6	[26–31]
Denmark	3	[32–34]
Norway	2	[35, 36]
Topics studied*
Mental health	9	[26–29, 31–33, 35, 36]
Self-report of symptoms/ diagnoses/ treatment (from survey)	3	[28, 29, 31]
Diagnoses in health care/medication (from registers)	5	[26, 27, 32, 35, 36]
Hospitalisation (from registers)	2	[32, 33]
Physical health	3	[31, 33, 36]
Self-report of symptoms (from survey)	1	[31]
Hospitalisation (from registers)	2	[33, 36]
Self-rated general health	2	[30, 34]
Number of study participants
<1000	1	[31]
1001 − 100,000	5	[28–30, 32, 34]
100,001–1,000,000	3	[26, 35, 36]
>1,000,000	2	[27, 33]
Year of publication
Before 2010	1	[30]
2011–2015	4	[28, 29, 31, 34]
2016–2020	3	[26, 27, 32]
2021 & 2024	3	[33, 35, 36]
Parental region of origin*
Africa	8	[26, 27, 30, 32–36]
Asia	8	[26, 27, 30, 32–36]
Europe	8	[26, 27, 30, 32–36]
America (North/South)	5	[26, 27, 30, 33, 36]
Australia/New Zealand	4	[26, 27, 30, 33]
Not specified	3	[28, 29, 31]

*Each article could be included in several categories; number of articles per characteristic can thus be > 11

Table 2.

Diagnosis and health outcomes reported in the included studies

Outcome	Disorder/measure	Country			References
		Denmark	Norway	Sweden
Mental health	Depression symptoms/disorder		X		[35, 36]
	Anxiety symptoms/disorder		X		[35, 36]
	Post Traumatic Stress Disorder (PTSD)		X		[35]
	General mental/psychiatric problems		X		[36]
	Neurotic or stress-related problems	X			[32]
	Affective disorders	X			[32]
	Sleep			X	[31]
	Emotional reaction			X	[31]
	Social isolation			X	[31]
	Attention Deficit Hyperactivity Disorder (ADHD)		X		[36]
	Developmental disorder	X			[32]
	Psychotic disorders			X	[26]
	Bipolar affective disorder		X		[35]
	Schizophrenia	X	X		[32, 35]
	Compulsory treatments			X	[29]
	Hospitalisation for mental disorders	X			[32, 33]
	Substance or psycho-active drug use	X	X	X	[29, 32, 35, 36]
	Self-harm & Suicide attempts			X	[27, 28]
Physical health	Epilepsy		X		[36]
	Cancer		X		[36]
	Diabetes		X		[36]
	Ulcerative		X		[36]
	Overweight		X		[36]
	Injuries		X		[36]
	Pain		X	X	[31, 36]
	Physical mobility			X	[31]
	Energy level			X	[31]
	Hospitalisation for physical illnesses	X			[33]
General health Status		X		X	[30, 34]

Mental disorders

Most identified articles focused on mental health outcomes [26–29, 31–33, 35, 36]. One study reported higher levels of psychological distress among those with a non-European background compared to natives [28]. Others reported lower scores for energy levels, poorer emotional reactions, and sleep difficulties [31] among descendants compared to natives. Among youths in treatment for narcotics use, descendants more often than natives reported experiencing compulsory treatment as a result of self-harm caused by substance use [29]. In studies drawing on register data, descendants with parents from low- or middle-income countries have lower rates of most psychiatric diagnoses [36]. Compared with the native Norwegian population, Pakistani descendants had lower risk of alcohol use disorder, bipolar affective disorder, recurrent depressive disorder, and anxiety disorder, but higher risk of drug use disorder, schizophrenia and PTSD [35]. Dunlavy et al. [27] reported that descendants, and especially men, had higher rates of suicide than natives. Studies on the use of health services showed that descendants of labour migrants were less likely than the majority population to ever have a healthcare contact for most psychiatric diagnoses, except schizophrenia [32] and had fewer prescription purchases than the majority population [32]. Descendant girls were less likely than majority girls to ever be in contact with psychiatric health services. In Denmark, descendants of immigrants in general had a lower risk than natives to be hospitalized for a mental health condition. This held for both women and men with parents from all global regions, except for Latin America, and for men with parents from Africa, who have a higher likelihood than natives [33].

Physical and self-rated health

Only three studies reported on physical health [31, 33, 36]. Evensen et al. [36] reported lower odds of diagnosis for asthma, injuries, pain, diabetes, epilepsy, and cancer, but higher odds for overweight and ulcerative conditions among descendants of immigrants in Norway. Tegunimataka et al. [33] showed that descendant men had higher, and women lower, likelihood than natives to be hospitalized for a physical health issue. By parental region of origin, men with a background from Europe and Western countries, Middle East and Africa had higher likelihood, and men with a background from Latin America had lower likelihood than native men. Among women, those with a background from Europe and Western countries, Asia and Latin America had lower likelihood than native women, whereas women with a background from the Middle East had higher likelihood. Two studies assessed self-rated general health [30, 34]. In Sweden, descendants with parents from outside the Organisation for Economic Co-operation and Development (OECD) reported better, and those with parents from Finland reported poorer, self-rated health than natives [30]. In Denmark, descendants reported better general health than the majority population [34].

Comparison of health status between descendants and immigrants

Most of the included studies compared the health status of descendants with that of immigrants. One study showed no difference in self-reported mental health among descendants compared to other immigrants [28]. Among young adults in narcotics treatment, a lower proportion of those born outside of the Nordic countries reported compulsory treatment compared with descendants [29]. Studies based on registers suggested that immigrants had a higher likelihood than descendants of receiving a diagnosis of PTSD, and immigrant refugees also had a higher likelihood of psychotic disorders [26]. Descendants, however, had higher suicide rates than immigrants [27]. Results also suggested that descendant boys, but not girls, had lower inpatient hospitalisation rates and emergency room contacts for psychiatric disorders than immigrants [32]. Descendants had a higher likelihood than immigrants of being hospitalised for physical health conditions [33]. The differences were less pronounced for mental health conditions [33]. Descendants reported better self-rated health than immigrants [30, 34].

Discussion

In this scoping review, we summarised studies regarding the health of Nordic-born youth and young adults with immigrant parents. The included studies were conducted in Sweden, Denmark and Norway and most focused on mental health outcomes. Results based on register data showed that in comparison to native groups, descendants of immigrants have a lower likelihood of being treated for most mental health disorders and developmental disorders but a higher likelihood of being treated for schizophrenia or PTSD. At the same time, descendants are more likely to report psychological problems. Self-reported general health is, according to two studies, better in descendants compared to natives.

The evidence regarding mental health issues among descendants of immigrants in the Nordic countries varies, depending on the measurement methods used. In self-report studies, descendants consistently report more mental health problems than their native peers. In studies using register data, among descendants, there is lower use of health services for “less severe” disorders (ADHD, depression, anxiety) but higher use for more severe ones (schizophrenia, PTSD). Results on self-reported mental health issues are in line with studies among immigrants, which repeatedly show higher burdens of mental health problems than natives [37]. This has often been linked to factors associated with social and economic deprivation [38], as well as with migration-related stress, social inclusion and discrimination [39]. Descendants have grown up with their immigrant parents, so their mental health may have been affected by some of the same factors, and by poor parental mental health. In addition, there may be barriers to seeking health care when experiencing mental illness starting early in life due to parental lack of knowledge of the health system, language barriers and differences in perceptions of mental health and stigma [10, 40]. However, when entering youth and early adulthood, descendants do not have the same structural barriers to seeking health care, such as language and health care system knowledge, as their parents do. Friends may also be more important than family for health-seeking behaviour at this age [41]. Moreover, descendants of immigrants in general are overrepresented in higher education and have higher employment rates than their parents [42]. Thus, descendants may experience some advantages which may facilitate health care seeking for mental health issues to a greater extent than their immigrant parents. Yet, the higher likelihood of self-reported mental health problems but fewer contacts with mental health services among Nordic-born youth with immigrant parents may indicate that they, nonetheless, experience barriers to seeking mental health care. One barrier could be that many still face their own or others’ cultural barriers to seeking health care for mental health issues. Additionally, they might more often experience mild mental health issues, and less frequently moderate to severe issues requiring treatment in health care. Importantly, there are large variations between groups of descendants in all these factors.

Studies included in this review assessed and adjusted for factors that might explain differences in health between descendants and natives, including socio-economic status or its components such as education, employment, and income [26–30, 32–34] and some also adjusted for socio-cultural factors such as integration and family context [26, 30, 32, 33]. These factors could, however, not explain differences in health outcomes and indicators between descendants and natives in youth and early adulthood. This is in line with previous research among children of immigrants [18]. Challenges connected to prejudice and discrimination, as well as cultural conflicts, could be alternative explanations of poorer self-reported mental health among descendants than natives [43–45].

Strengths and limitations

The methodological strengths of this review include its comprehensive adherence to review guidelines and a thorough search of several databases. The inclusion of both mental and physical health measures, as well as self-report and registered data, gives a holistic and multi-faceted view of the health disparities experienced by the target population. This diversity of data sources reduces the risk of bias associated with relying on a single data type. However, all studies identified and included in this review utilised a quantitative approach, which may not give a full picture of the complexity or diversity of descendants’ health experiences. Therefore, there is also a need for qualitative research to gain deeper insights into the lived experience of descendants of immigrants and the factors influencing their health outcomes. Our review only included studies published in English in peer-reviewed journals after 2006, and we did not include specific diagnoses in our search terms. This was because we did not want to limit our search to only some specific diagnoses to the exclusion of others. This may have led to us missing some relevant studies, but the number, if any, is believed to be small.

There are also some limitations to the interpretation of the results. First, some of the included studies did not specify the parental country of origin [28, 29, 31] or reasons for migration. There might be substantial differences in health by country of origin, which are not reflected in the results [46]. Second, not all included studies defined descendants explicitly as those having two immigrant parents. There may, therefore, be some variations in the compositions of the groups studied. Finally, since the primary aim of this study is to map existing literature, rather than assess the quality of individual studies, critical appraisal was not performed. A critical appraisal is not a mandatory component of JBI Manual for Evidence Synthesis for the scoping reviews.

Based on our review of the emerging literature, we can offer several recommendations for future studies. The described discrepancy between patterns of self-related mental health and related diagnoses given in health care points towards barriers to mental health care among descendants of immigrants. Future research should focus on understanding the relationship between self-rated mental health and health care use in this group and the important barriers to health care use. One possibility is to combine the use of data from surveys and registers. Qualitative research could also be useful to unveil the barriers to the utilisation of mental health care among young descendants in Nordic countries. In this scoping review, the socioeconomic factors adjusted for could not explain differences in health outcomes between descendants and native background youth and young adults. Future studies should also be planned to more broadly assess which factors could be important in understanding differences in health, and especially in mental health, between descendants and natives. Moreover, future studies could be planned to better understand differences in health among descendants by parental region or country of origin, reason for migration, and on the effect of parental migration-dependent stress and trauma. This could potentially also point towards explanatory factors.

Conclusion

This scoping review highlights that descendants of immigrants in Nordic countries have more self-reported mental health issues but less use of health services. Further research to assess whether this group experiences special barriers to mental health care is warranted. Moreover, the knowledge about physical health issues in this population is still scarce and should be targeted in future studies. The results from this study will benefit public health researchers, and policymakers by understanding the health profiles and needs of descendants of immigrants as they enter adulthood.

Electronic supplementary material

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Abbreviations

SEP

Socioeconomic position

MeSH

Medical subject headings

ADHD

Attention deficit hyperactivity disorder

PTSD

Post-traumatic stress disorder

OECD

Organisation for economic co-operation and development

Author contributions

NSS and MKRK conceived the idea for the article, NSS and MKRK did reference screening and data extraction, NSS drafted the article and all authors (NSS, GPEB, MLS and MKRK) contributed in revising the manuscript and interpreting the results. All authors have approved the submitted version.

Funding

This study is part of a project exploring health of youth and young adults of immigrant background and is funded by the Norwegian University of Life Science and the Norwegian Institute of Public Health.

Data availability

The scoping review is based on articles available in the databases searched.

Declarations

Ethics approval and consent to participate

This review does not require ethics approval from institutional review board. The data used in this study does not involve any human or animal participants and unpublished secondary data is excluded.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.