Family Socioeconomic Status and Adolescent Suicide: A Comparative Study of Immigrant and Non-Immigrant Adolescents in Sweden

Objectives: While adolescents from high socioeconomic status (SES) backgrounds are generally protected against suicide, recent studies from the United States suggest that these effects may be weaker for marginalized populations, including immigrants—a pattern known as Marginalization-related Diminished Returns (MDRs). However, knowledge on the diminished returns of SES indicators on adolescent suicide among immigrants in European settings remains scarce. Aims: This longitudinal study examined the association between an SES summary score, along with four specific family SES indicators, and adolescent suicide (attempts or completions). It also compared these associations between immigrant and non-immigrant adolescents. Methods: Utilizing a retrospective cohort design, we analyzed data from nationwide registers in Sweden from January 2001 to December 2020, including immigrant and non-immigrant adolescents aged 12-18 years. Independent variables included an SES summary score (based on principal component analysis), parental education, parental employment, family income, and parental presence. The outcome was adolescent suicide, based on the Swedish national patient and mortality registers. Sex and study year served as confounders, and immigration status as a moderator. Cox regression models were employed for statistical analysis. Results: Higher SES summary scores, as well as individual SES indicators such as higher parental education, parental employment, higher income, and the presence of two parents in the family, were associated with a reduced risk of adolescent suicide. However, 12 statistically significant interactions indicated differential protective effects of these SES indicators. Nine of these interactions suggested weaker protective effects of SES indicators like parental education, parental employment, household income, and two parents in the family for immigrant adolescents compared to non-immigrant adolescents while three interactions suggested stronger effects of the SES indicators for immigrant adolescents. Conclusions: There is a need to investigate the societal and structural causes behind the differential protective effects of family SES against adolescent suicide in immigrant and non-immigrant families in Sweden. These results have implications for the prevention of adolescent suicide in intersectional groups based on SES and immigration. Clinical trial number: not applicable.