More psychosis risk for immigrants in UK

Family bonds and close communities may offer protection, says report

04 November 2008. Immigrants to Britain are more likely to suffer serious mental health problems than the native population, but strong family and community ties may help to protect them, said researchers.

Previous studies have shown a higher risk of psychoses such as schizophrenia and bipolar disorder among immigrants facing discrimination and alienation, but the new findings pointed to surprising variations among different ethnic communities.

"The black Caribbean group provides an illustration of this: first- and second-generation immigrants were both at significantly greater risk for non-affective psychoses than the white British group, but the magnitude of this risk was significantly greater in the second generation; this is principally because first-generation black Caribbean immigrants have now largely passed through the main period of risk of psychoses," they write.

Asian women but not men of both generations were at increased risk for psychoses compared with white British individuals.

"We suggest that socioenvironmental factors operate differentially by ethnicity, but not generation status, even if the exact specification of these stressors differs across generations. Research should focus on differential rates of psychoses by ethnicity rather than between generations," the authors write.

Social factors rather than genetics may explain the differences, said Jeremy Coid, a researcher at St. Bartholomew’s Hospital in London who led the study published in the Archives of General Psychiatry .

"Maybe instead of thinking about risk we need to think about what is protective," Coid mentioned. "There may be some kind of protection from living in a close community." Coid and his colleagues studied 484 immigrants aged 18 to 64 living in three inner-city neighborhoods of East London, an area that has historically been a first stop for new arrivals. All developed a mental disorder between 1996 and 2000.

The ethnic subgroups included white from countries including Ireland and continental Europe, black Caribbean, black African, Asian from the Indian subcontinent, and all other groups including Chinese, other Asians and those of mixed ethnicity.

The researchers found an overall elevated risk for immigrants and more specifically that some groups seemed less affected by the hardships new arrivals often face. Immigrants from the Indian sub-continent were only 1.3 times more likely to develop psychosis compared to the native population, suggesting that community ties and family bonds may offer protection against discrimination based on things like skin color, the researchers said.

White immigrants to Britain were two times more likely to develop psychosis, while black Caribbean new arrivals were four times more likely to suffer in this way.

The patients, age 18 to 64, provided information about their self-described ethnicity, place of birth, and the place where their parents were born. Participants fell into six ethnic subgroups: white British, white other (including Irish and European), black Caribbean, black African, Asian (including Indian, Pakistani and Bangladeshi group) and all other groups (including Chinese, other Asian and those of mixed ethnicity).

An elevated risk for psychoses—psychiatric disorders such as schizophrenia that are characterized by a disconnect from reality—have been observed among migrant groups since 1932, when Norwegians moving to the United States displayed higher rates, according to background information in the research presentation.

"Immigration is an important life event and difficulties in assimilation may remain chronic as conceptualized within the stress-vulnerability model of risk for psychosis, although individual risk is still considered to be mediated through genetic susceptibility," the authors write.

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