Psychoses and Schizophrenia
See also the EU page for literature on schizophrenia and migration in several countries.
Migration and Schizophrenia
This information is mainly based on the article by Bhugra (2004):
Bhugra's (2004) paper quotes one paper as stating that all migrants have an increased risk of schizophrenia. One hospital study showed that rates of admission for cases with schizophrenia were elevated for the Irish, Indian, Pakistani and Caribbean-born individuals when compared with the native White population. In general, it was found that foreign-born males had higher rates of admission, whereas for females rates were very low for Pakistani women. It was suggested that this finding was a reflection of the fact that these women dropped out of the formal mental health care system and may have returned back to their country of origin. Another study showed that the ratio of schizophrenia between African-Caribbeans and whites varies from 2.5 to 8.4 times. Some hypotheses to explain these high rates of schizophrenia among migrant groups were:
- Sending countries have high rates of schizophrenia- However, rates in younger (2nd) generation of African-Caribbeans are higher in the UK when compared to the first generation. Also, several studies show lower rates of schizophrenia in the countries of origin. It is likely that other social and environmental factors may influence the development of schizophrenia.
- Schizophrenia predisposes people to migrate- Selective migration has been put forward as a reason. It could be that the illness contributed to the restlessness in the individual which led them to seek migration. It is possible that some vulnerable people migrate and often the stress of migration develops schizophrenia. Schizotypal personality traits are considered as a possible vulnerability.
- Migration produces stress and elevated rates of schizophrenia- However, it has been shown that elevated rates of schizophrenia occur 10-12 years after migration, which would make it unlikely that stress because of migration would be a causative factor.
- High rates can be explained by misdiagnosis- Bhugra (2004) does not provide much information on this hypothesis. Please note that there is great controversy about this hypothesis. Ingleby (2008) gives an overview of more recent studies that have been done. You can access this article on the EU page. See also the article by Fearon et al. (2006) below.
- Symptom differences- Symptoms of schizophrenia can be more common in some cultures than in others. Some cultures report more visual hallucinations, religious delusions or non-specific symptoms like worrying and irritability.
Also, stress enhancing factors in migration such as a drop in professional status and a lack of social support might influence the prevalence of schizophrenia.
Bhugra D (2004). Migration and Mental Health.Acta Psychiatrica Scandinavica. 109.243-258. Abstract
Prevalence of Schizophrenia in migrant and minority populations
Fearon, P. et al. (2006). Incidence of schizophrenia and other psychoses in ethnic minority groups: results from the MRC AESOP Study. Psychological Medicine, 36(11), p.1541-50. Abstract
Perception of disadvantage and psychosis
Cooper C, Morgan C, Byrne M, Dazzan P, Morgan K, Hutchinson G, Doody GA, Harrison G, Leff J, Jones P, Ismail K, Murray R, Bebbington P, Fearon P. (2008). Perceptions of disadvantage, ethnicity and psychosis. Br J Psychiatry, 192(3), p. 185-90. Abstract
Schizophrenia in the African-Caribbean population
Members of the African-Caribbean population have been identified as far more likely (3-12 more times likely) to be diagnosed with schizophrenia than their white English counterparts. This may be more marked for those children born in the UK of first generation migrants than for their parents. See also above "migration and schizophrenia" for possible explanations of these differences.
Laurens KR, West SA, Murray RM, Hodgins S (2007). Psychotic-like experiences and other antecedents of schizophrenia in children aged 9-12 years: a comparison of ethnic and migrant groups in the United Kingdom. Psychol Med, p. 1-9
Mclean C; Campbell C and Cornish F (2003). African-Caribbean interactions with mental health services in the UK: experiences and expectations of exclusion as (re)productive of health inequalities. Social Science and Medicine. 56.657-669.
SCMH (2002). Breaking the Circles of Fear. A review of the relationship between mental health services and African and Caribbean communities. London: Sainsbury Centre for Mental Health.