Risk of Psychosis Among Refugees

Brandt, Lasse; Henssler, Jonathan; Mûller, Martín; Wall, Stephanie; Gabel, David; Heinz, Andreas

doi:10.1001/jamapsychiatry.2019.1937

Cited by 78 publications

(45 citation statements)

References 50 publications

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“…Several studies already support the hypothesis that a personal history of migration is associated with an increased likelihood of psychosis (Cantor-Graae & Pedersen, 2007), but, to the best of our knowledge, no previous studies have simultaneously evaluated the risk factors of the three migration phases. Findings indicating that refugees have a higher risk of developing psychosis compared to non-refugee migrants provide indirect evidence that the circumstances before and during migration matter (Brandt et al, 2019;Hollander et al, 2016). We evaluated the risk factors pre-, during and post-migration directly and provide preliminary evidence that social disadvantages across different migration phases, along with the subjective evaluation of a mismatch between achievements and expectations, may be important factors in the development of psychosis in migrants.…”

Section: Comparison With Previous Evidencementioning

confidence: 99%

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

et al. 2021

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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.

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Section: Comparison With Previous Evidencementioning

confidence: 99%

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

et al. 2021

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“…This distress is often exacerbated upon arriving to a new host country given various social, economic, and legal barriers imposed on refugees and asylum-seekers ( 5 , 6 ). Recent studies also report high prevalence rates of up to 75% of mental distress among Syrian refugees resettled in Germany and an increased risk among refugees for developing a severe mental illness in comparison to the host population ( 7 , 8 ). Language barriers, culture shock, and lack of economic opportunities ( 9 ) further discourage refugee populations from engaging with host communities and therefore, delay or inhibit successful integration.…”

Section: Introductionmentioning

confidence: 99%

Faith-Based Coping Among Arabic-Speaking Refugees Seeking Mental Health Services in Berlin, Germany: An Exploratory Qualitative Study

et al. 2021

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Background: The benefits of faith-based coping or using religious and spiritual beliefs as a stabilizing force for interpreting stressful or distressing events are largely unexplored among the exodus of Arabic-speaking refugee populations from Muslim-majority countries, particularly those resettled in Europe. The present study aimed to explore the manifestation of faith-based coping strategies among Arabic-speaking refugee adults seeking mental healthcare services in Berlin, Germany and explore how favorable faith-based coping strategies can be optimized from a mental health service-delivery and broader integration perspective.Methods: A total of 17 qualitative interviews were conducted with Arabic-speaking refugee adults (six females, 11 males) seeking mental health services at the Charité Universitaetsmedizin in Berlin. Research questions aimed to solicit comprehensive perspectives from refugee adults on their mental health, with an emphasis on faith-based coping, and how this facilitated or impeded their integration into German society. Interview transcripts were translated to English from Arabic and analyzed using MAXQDA (2018) to highlight thematic patterns using a grounded theory approach.Results: Findings were structured into four themes, including: (I) faith-based coping methods during flight, (II) changes in faith practices upon arrival, (III) faith-based coping methods to address distress during integration, and (IV) advice for German mental healthcare providers. Participants who demonstrated a stronger commitment to faith were more likely to utilize faith-based coping strategies when seeking mental health services and facing the challenges of displacement and integration. Examples of faith-based coping included prayer, supplication, reciting scripture, and seeking help from a local religious leader.Conclusion: The findings suggest how faith and faith practices play a significant role in the mental health and integration of refugee populations in Germany and provide insight on how mental healthcare can be delivered in a culturally-sensitive manner, providing alternatives to the social, cultural, and linguistic barriers posed by the German health system. These findings are particularly relevant for mental health professionals, non-governmental organizations, and humanitarian aid agencies providing mental healthcare to Arabic-speaking populations recently resettled in Western contexts.

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“…The potential vulnerability of psychiatric patients to the burden of lockdown measures is compounded by other demographic factors, in particular migration background. People with a migration background show generally worse health outcomes (15), this applies more specifically to anxiety disorders, including PTSD (16), depression (17), psychosis (18,19) and suicide mortality (20,21). Effects of psychiatric problems can be intergenerational, for example, traumatized survivors of war can have a harsh punitive parenting style, leading to greater aggression, parental depression and anxiety affects early attachment (22).…”

Section: Introductionmentioning

confidence: 99%

The Differential Impact of Lockdown Measures Upon Migrant and Female Psychiatric Patients – A Cross-Sectional Survey in a Psychiatric Hospital in Berlin, Germany

et al. 2021

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The COVID-19 pandemic could have major effects on already vulnerable individuals with psychiatric disorders. It is important to assess how different patient groups respond to stress related to the pandemic, and what additional factors influence it, including family-related stress, migration background, and sex. We conducted a survey in a sample of 294 psychiatric patients in a large outpatient clinic in Berlin, measuring level of distress in relation to COVID-19 lockdown as well as family-related distress. We also measured potential influencing factors such as media consumption and medical support. In the migration background group, we found that women had more lockdown related psychological distress than men. This was not apparent in those patients with a German background. We found that females were more strongly affected by family-related distress, particularly those with a migration background. People with PTSD were most strongly affected by family-related distress, whereas people with psychotic disorders and addiction reported the least distress. There were no effects of media consumption. There were no differences in ability to abide by the lockdown related restrictions across diagnoses. Our results support earlier findings on differential vulnerability of diagnostic groups to these stressors. Thus, clinicians can optimize treatment by taking family-related stressors into account particularly for females and people with a migrant background.

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Risk of Psychosis Among Refugees

Cited by 78 publications

References 50 publications

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

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

Faith-Based Coping Among Arabic-Speaking Refugees Seeking Mental Health Services in Berlin, Germany: An Exploratory Qualitative Study

The Differential Impact of Lockdown Measures Upon Migrant and Female Psychiatric Patients – A Cross-Sectional Survey in a Psychiatric Hospital in Berlin, Germany

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