Differences in Prevalence and Treatment of Bipolar Disorder among Immigrants: Results from an Epidemiologic Survey

Abstract

Objective: To add to the limited data on the prevalence, clinical characteristics, and treatment of bipolar disorder (BD) among immigrants. Method: Data were obtained from a large epidemiologic survey, the Canadian Community Health Survey-Mental Health and Well-Being (CCHS 1.2). Lifetime prevalence rates of BD were compared between immigrant and nonimmigrant respondents. Among BD subjects (n = 831), sociodemographic, clinical, and mental health treatment use variables were compared based on immigrant status. Logistic regression was used to determine the correlates of lifetime contact with a mental health professional and 12-month psychotropic medication use. Results: Lifetime prevalence rate of CCHS 1.2-defined BD was significantly lower among immigrant, compared with nonimmigrant, participants (1.50% and 2.27%, P = 0.01). There were few sociodemographic or clinical differences, yet immigrants with BD were significantly less likely to report any lifetime contact with mental health professionals (OR = 0.25, 95% CI 0.13 to 0.50, P < 0.001). Past-year psychotropic medication use was numerically lower among immigrants with BD (24.5% and 41.0%); however, this did not reach statistical significance when controlling for other factors (OR = 0.49, 95% CI 0.24 to 1.01, P = 0.05). Conclusions: Based on the results of this study, there are in the range of 56 000 to 104 000 immigrants with BD in Canada. Further efforts are needed to better understand and address the barriers to mental health treatment use among immigrants who have BD.

Migration and social determinants of mental health: Results from the Canadian Health Measures Survey

“…This observation is consistent with data from the CCHS, which shows lower risk of mental illness among migrants. [16][17][18][19] However, it is inconsistent with international data on migrants' mental health, which shows higher risk among migrants, though these results may not be generalizable to Canada per se. 4,15 Our analyses revealed that participants who had recently migrated to Canada, within 5 years, had better mental health scores than those who had migrated to Canada more than 10 years before.…”

“…Findings from the Canadian Community Health Survey (CCHS) point to lower rates of psychiatric disorders, including unipolar and bipolar disorders, among first-generation migrants compared with Canadian-born residents. [16][17][18][19] However, results from regional studies do not always concur with those from the CCHS. 20,21 For example, some studies in specific Canadian cities report greater incidence rates of mental health disorders among migrant populations.…”

First- Generation Immigrants and Hospital Admission Rates for Psychosis and Affective Disorders: An Ecological Study in Ontario

“…Accordingly, hospital admission for affective disorders may be less common among immigrant groups. 28,39 Consistent with this notion, Schaffer et al 64 found that in Canada immigrants were less likely than members of the host population to use outpatient mental health services for affective disorders.…”

Childhood trauma mediates the association between ethnic minority status and more severe hallucinations in psychotic disorder

“…A number of studies have reported more hallucinations in ethnic minorities with psychotic disorders (Harvey et al 1990;Arnold et al 2004;Kennedy et al 2004), and in a literature review childhood abuse was found to be a causal factor in the development of psychosis and schizophrenia, more specifically hallucinations and particularly voices commenting and command hallucinations (Kapur, 2003). We suggest that this could partially explain the reasons why several studies have found a skewed distribution of psychosis diagnosis, with patients from ethnic minorities receiving more schizophrenia diagnoses and less bipolar disorder diagnoses than patients from the majority population (Schaffer et al 2009;Gara et al 2012). This first-rank symptom is considered sufficient to meet the A criterion of characteristic symptoms of schizophrenia in DSM-IV (APA, 1994).…”