Raised Incidence Rates of All Psychoses Among Migrant Groups Findings From the East London First Episode Psychosis Study

Forensic Psychiatry Research Unit, St. Bartholomew's Hospital, William Harvey House, 61 Bartholomew Close, London EC1A7BE, England.
Archives of general psychiatry (Impact Factor: 14.48). 12/2008; 65(11):1250-8. DOI: 10.1001/archpsyc.65.11.1250
Source: PubMed


Certain black and minority ethnic groups are at increased risk for psychoses. It is unknown whether risk for second- and later-generation black and minority ethnic groups in the United Kingdom is universally increased or varies by ethnicity, population structure, or diagnostic category.
To examine whether excess risk in black and minority ethnic groups varies by generation status and to determine whether this is explained solely by an excess of broadly defined schizophrenia.
Population-based epidemiological survey of first-onset psychoses during a 2-year study period.
Three inner-city boroughs in East London, England. Patients Four hundred eighty-four patients with first-episode psychosis aged 18 to 64 years.
Nonaffective or affective psychoses according to the DSM-IV.
Raised incidence of both nonaffective and affective psychoses were found for all of the black and minority ethnic subgroups compared with white British individuals. The risk of nonaffective psychoses for first and second generations varied by ethnicity (likelihood ratio test, P = .06). Only black Caribbean second-generation individuals were at significantly greater risk compared with their first-generation counterparts (incidence rate ratio, 2.2; 95% confidence interval, 1.1-4.2) [corrected]. No significant differences between first and second generations were observed in other ethnic groups. Asian women but not men of both generations were at increased risk for psychoses compared with white British individuals. Patterns were broadly upheld for the affective psychoses.
Both first- and second-generation immigrants were at elevated risk for both nonaffective and affective psychoses, but this varied by ethnicity. Our results suggest that given the same age structure, the risk of psychoses in first and second generations of the same ethnicity will be roughly equal. 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.

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Available from: Jeremy Weir Coid, Mar 26, 2014
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    • "This public health tragedy appears to arise irrespective of typically reported national differences in inequality (Wilkinson and Pickett, 2010), as research from Canada (Ngamini Ngui et al., 2013b), Scandinavia (Mortensen et al., 1999; Zammit et al., 2010), the USA (Faris and Dunham, 1939; Silver et al., 2002) and the UK (Kirkbride et al., 2014) illustrate, raising the possibility that disadvantage relative to those in your immediate society may be key drivers, or reservoirs of sustained psychiatric morbidity. We also know that some foreign-born immigrant populations and their descendants, who are often overrepresented in more disadvantaged , urban communities, show elevated risk of psychosis (Bourque et al., 2010; Cantor-Graae and Selten, 2005; Coid et al., 2008), independent of urban living (Kirkbride et al., 2014). There is therefore a strong case for sustained public mental health investment in our most disadvantaged communities, in terms of both strategies to reduce exposure to the deleterious effects of disadvantage , and strategies to ensure adequate resourcing of health and social care services for people with serious mental illness. "
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    ABSTRACT: Recent research published in Health and Place (Ngamini Ngui et al., 2013b) found that one third of people with first episode psychosis [FEP] will have made a large-scale migration six years after initial diagnosis. Here, I extend this discussion around three important observations. Namely, at first presentation the most disadvantaged communities already shoulder the burden of psychotic morbidity; people with FEP in more rural communities migrate less often, and; people with FEP exhibit both upwards and downwards social mobility after onset. Understanding the reasons for (non-)migration before and after psychosis onset is now required for effective public mental health and service provision.
    Health & Place 05/2014; 28C(100):150-152. DOI:10.1016/j.healthplace.2014.04.010 · 2.81 Impact Factor
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    • "In the cited review of studies of incidence of psychosis in England [3] there is no study that assessed the incidence of affective and non-affective psychoses in both a rural and an urban setting. Thus, we chose for comparison data from two recent studies which showed the greatest contrast in terms of urbanicity: one from East London [18] and one from Northumberland [19]. With the exception of affective psychoses in the urban centre which rate is similar to ours (13.5), rates in England are higher than those we observed in France (non-affective psychoses urban 36.8, "
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    ABSTRACT: The aim of our study is to provide data on the incidence of psychotic disorders in France and compare the incidence rates in populations with different levels of urbanization. We prospectively included the incident cases of psychotic disorders from two catchment areas with contrasted levels of urbanization. In the more rural area we also calculated incidence rates in three different groups of population defined by the size of towns in which they live (small, medium and large towns). The annual incidence of psychosis was greater in the urban area (36.02/100000 person-year at risk) than in the rural area (17.2/100000 person-year at risk).Non-affective psychoses were the majority of cases and their incidence was greater in males and younger subjects. The affective psychoses were slightly more frequent in women and showed less variation with age. In the rural centre, greater levels of urbanicity were associated with an increase in the incidence of all psychoses (affective and non-affective). Our study confirms previous observations of increased incidence rates for non-affective psychoses in the more urbanized areas and suggests that a similar pattern might be present for affective psychoses.
    BMC Psychiatry 03/2014; 14(1):78. DOI:10.1186/1471-244X-14-78 · 2.21 Impact Factor
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    • "Historically, it has hosted a number of diverse migrant groups who settled in these borough over many years when coming to the United Kingdom. The study sample, data collection, design, consent and confirmation of ethical approval from the East London ethics committee have previously been reported in detail [21]. The study took place between December 1, 1996 and November 30, 1998 in City and Hackney; and from December 1, 1998, to November 30, 2000, in Newham and Tower Hamlets. "
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    ABSTRACT: The pathways to care in a first onset psychosis are diverse and may influence the chances of early treatment and therefore the duration of untreated psychosis. We test which pathways to care are associated with a delay in receiving treament and a longer duration of untreated psychosis (DUP). In a population based survey, we interviewed 480 people with first episode psychosis aged 18 to 64 years over a 2-year period. Information from structured interview and case files provided DSM-IV diagnostic, clinical, and demographic information. Consecutive contacts in the care pathway were mapped using the World Health Organisation's Encounter Form. Using information from all sources, DUP was defined as time from symptom onset to first treatment with antipsychotic medication. The most common first contacts were primary care physicians (35.2%), emergency rooms in general hospital settings (21.3%), and criminal justice agencies (25.4%). In multivariate regression models, compared to DUP for those first in contact with primary care, DUP was shortest for first encounters with psychiatric emergency clinics (RR = 0.4, 95% CI: 0.23-0.71) and longest for first encounters with criminal justice agencies (RR = 1.61, 95% CI: 1-2.58). Older age was associated with a longer DUP (RR = 1.01 per year, 95% CI: 1-1.04). A shorter DUP was associated with a diagnosis of mania and affective psychoses-NOS compared with schizophrenia (RR = 0.22, 95% CI: 0.14-0.35; RR = 0.18, 95% CI: 0.06-0.54, respectively), for Black compared with White ethnicity (RR = 0.52, 95% CI: 0.34-0.82), and for each close person in the social network (RR = 0.9, 95% CI: 0.84-0.96). To further reduce DUP, better links are needed between primary care, emergency rooms, criminal justice and psychiatric services.
    BMC Psychiatry 03/2014; 14(1):72. DOI:10.1186/1471-244X-14-72 · 2.21 Impact Factor
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