PROJECT SUMMARY Background: Approximately 3.4 million refugees and asylum-seekers are resettled in high-income countries, a figure which is projected to rise given increased displacements of individuals seeking safety from war, conflict, and natural disasters. Refugee mental health is a particularly salient issue in Sweden, which resettled the highest number of Syrian refugees per capita following the onset of the Syrian conflict in 2011. Despite the availability of publicly funded mental health services in Sweden, there is evidence of underutilization of these services among displaced populations due to various structural barriers, including language, transportation, trust, and cultural stigma. Study Objective: To understand barriers and facilitators to mental health care utilization among refugee adults in Sweden using national registry data and qualitative interviews, with a focus on the Syrian refugee population. Lessons from the Swedish example can be applied to understanding barriers and facilitators to mental health service utilization in other high-income countries, including the United States. Specific Aims: 1) To compare mental health service utilization over time by refugee adults to non-refugee migrant populations and to the native population in Sweden; 2) To identify predictors of mental health service utilization over time among refugee adults in Sweden; and 3) To explore barriers and facilitators of mental health care utilization among Syrian refugee adults in Sweden. Approach: This study utilizes an explanatory, sequential mixed methods approach. Aims 1 and 2 will include secondary data analysis of longitudinal data made available by Swedish national registries. Aim 1 will use Cox proportional hazards modelling to identify rates in mental health service utilization using national inpatient and outpatient registers. Aim 2 will use Cox regression modelling to identify predictors of mental health service utilization. Applying findings from Aims 1 and 2, Aim 3 will qualitatively explore barriers and facilitators identified in Aims 1 and 2 through in-depth interviews with Syrian refugee adults, who represent the highest number of refugees displaced to Sweden. Fellowship Information: The proposed research is in fulfillment of the doctoral dissertation of Ms. Diana Rayes, a current PhD student in the Department of International Health at Johns Hopkins University. This study directly aligns with NIMH’s priorities to reduce disparities and advance equity in mental health services and outcomes. The training and research will be supported by one Sponsor, one Co-Sponsor, two Consultants, and one Special Contributor who, combined, offer expertise in mixed methods and health disparities research as it pertains to the health of trauma-affected, marginalized populations. Training includes coursework, field research and other opportunities to prepare Ms. Rayes to become a leading researcher in public mental health.