Migration history and risk of psychosis: results from the multinational EU-GEI study

Abstract

Background Psychosis rates are higher among some migrant groups. We hypothesized that psychosis in migrants is associated with cumulative social disadvantage during different phases of migration. Methods We used data from the EUropean Network of National Schizophrenia Networks studying Gene-Environment Interactions (EU-GEI) case–control study. We defined a set of three indicators of social disadvantage for each phase: pre-migration, migration and post-migration. We examined whether social disadvantage in the pre- and post-migration phases, migration adversities, and mismatch between achievements and expectations differed between first-generation migrants with first-episode psychosis and healthy first-generation migrants, and tested whether this accounted for differences in odds of psychosis in multivariable logistic regression models. Results In total, 249 cases and 219 controls were assessed. Pre-migration (OR 1.61, 95% CI 1.06–2.44, p = 0.027) and post-migration social disadvantages (OR 1.89, 95% CI 1.02–3.51, p = 0.044), along with expectations/achievements mismatch (OR 1.14, 95% CI 1.03–1.26, p = 0.014) were all significantly associated with psychosis. Migration adversities (OR 1.18, 95% CI 0.672–2.06, p = 0.568) were not significantly related to the outcome. Finally, we found a dose–response effect between the number of adversities across all phases and odds of psychosis (⩾6: OR 14.09, 95% CI 2.06–96.47, p = 0.007). Conclusions The cumulative effect of social disadvantages before, during and after migration was associated with increased odds of psychosis in migrants, independently of ethnicity or length of stay in the country of arrival. Public health initiatives that address the social disadvantages that many migrants face during the whole migration process and post-migration psychological support may reduce the excess of psychosis in migrants.

Refugee Mental Health, Global Health Policy, and the Syrian Crisis

“…A number of studies describing the mental health difficulties faced by refugees from different countries of origin now living in Western countries—such as Australia and Sweden—reveal increased risks for psychotic disorders ( 71 ), prolonged grief ( 72 ), and suicide ( 73 , 74 ). This is consistent with evidence of a general association between migration and psychosis, as there appears to be a dose-response relationship between number of social adversities—across the phases of pre-migration and post-migration—and psychosis ( 75 ). A detailed accounting of migration risk will require more research, though there has been significant progress.…”

Schizophrenia Polygenic Risk and Experiences of Childhood Adversity: A Systematic Review and Meta-analysis

“…Environmental risk factors have also been shown to contribute to the likelihood of developing schizophrenia; evidence exists for illicit drug use (in particular cannabis), 7–10 obstetric complications, 11–13 season of birth, 14 urbanicity, 15–17 and migration. 18 , 19 Childhood adversity is one of the most widely replicated environmental risk factors for psychosis, 20 but the association has also been extended to schizophrenia. 21 Childhood adversity is common worldwide and could involve anything that presents a serious threat to a child’s physical or psychological well-being such as trauma, abuse, neglect, parental death or separation, and bullying.…”

Language proficiency and mental disorders among migrants: A systematic review

“…Several hypotheses have sought to explain the poor mental health in migrants. Both pre-and postmigratory factors such as lack of social support, social networks and social opportunities in the host country have been invoked [4,5,67], and LP may play a role in this process [50]. Deficits in social skills and executive functions have proved to be a key feature of several mental disorders and may prevent appropriate LP acquisition, exacerbate isolation and lead to psychiatric symptoms [68].…”