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Fernández I, Juncal-Ruiz M, González-Menéndez AM, Paino M. Environmental and psychopathological predictors of clinical high-risk of psychosis in adolescence. J Clin Psychol 2024; 80:2063-2076. [PMID: 38838109 DOI: 10.1002/jclp.23723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVES Clinical high-risk of psychosis (CHRp) samples can be heterogeneous, consisting essentially of people with not only psychotic-like experiences but also nonspecific symptoms that may reflect common mental disorders such as depression, anxiety, or substance abuse pathologies. Few studies have attempted to analyze and understand psychosis risk in relation to both environmental (ER) and psychopathological risk (PsR) factors. This study aimed to determine the clinical risk of psychosis in adolescents. METHODS A representative sample of 1824 Spanish adolescents from the general population was evaluated using different scales to thoroughly examine the possible interaction of CHRp with various ER and PsR factors. Partial correlations were calculated to assess the relationships between the variables. A series of hierarchical linear regression models were then used to obtain a CHRp predictor model. RESULTS The CHRp predictor model indicated that PsR was the most significant determining factor, explaining 22% of the total associated variance of CHRp. However, the ER factor also emerged as a significant predictor of high-risk psychosis (accounting for 9% of the variance). CONCLUSIONS A predictive model for CHRp in adolescents was found, in which common psychological problems were presented as more determinant risk factors than ER disruptors. Furthermore, certain transdiagnostic processes, such as psychological inflexibility, may play a central role in the development of mental health problems, including psychosis. Specifying the mechanisms underlying the emergence of CHRp in adolescence is the key to optimizing the focus of preventive therapeutic interventions in these early stages.
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Affiliation(s)
| | - Maria Juncal-Ruiz
- Department of Psychiatry (Child and Adolescent Mental Health Unit), Sierrallana Hospital, IDIVAL, School of Medicine, University of Cantabria, Torrelavega, Spain
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Gutiérrez G, Goicoa T, Ugarte MD, Aranguren L, Corrales A, Gil-Berrozpe G, Librero J, Sánchez-Torres AM, Peralta V, García de Jalon E, Cuesta MJ, Martínez M, Otero M, Azcarate L, Pereda N, Monclús F, Moreno L, Fernández A, Ariz MC, Sabaté A, Aquerreta A, Aguirre I, Lizarbe T, Begué MJ. Small area variations in non-affective first-episode psychosis: the role of socioeconomic and environmental factors. Eur Arch Psychiatry Clin Neurosci 2024; 274:1497-1506. [PMID: 37612449 DOI: 10.1007/s00406-023-01665-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 07/31/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND There is strong evidence supporting the association between environmental factors and increased risk of non-affective psychotic disorders. However, the use of sound statistical methods to account for spatial variations associated with environmental risk factors, such as urbanicity, migration, or deprivation, is scarce in the literature. METHODS We studied the geographical distribution of non-affective first-episode psychosis (NA-FEP) in a northern region of Spain (Navarra) during a 54-month period considering area-level socioeconomic indicators as putative explanatory variables. We used several Bayesian hierarchical Poisson models to smooth the standardized incidence ratios (SIR). We included neighborhood-level variables in the spatial models as covariates. RESULTS We identified 430 NA-FEP cases over a 54-month period for a population at risk of 365,213 inhabitants per year. NA-FEP incidence risks showed spatial patterning and a significant ecological association with the migrant population, unemployment, and consumption of anxiolytics and antidepressants. The high-risk areas corresponded mostly to peripheral urban regions; very few basic health sectors of rural areas emerged as high-risk areas in the spatial models with covariates. DISCUSSION Increased rates of unemployment, the migrant population, and consumption of anxiolytics and antidepressants showed significant associations linked to the spatial-geographic incidence of NA-FEP. These results may allow targeting geographical areas to provide preventive interventions that potentially address modifiable environmental risk factors for NA-FEP. Further investigation is needed to understand the mechanisms underlying the associations between environmental risk factors and the incidence of NA-FEP.
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Affiliation(s)
- Gerardo Gutiérrez
- Department of Psychiatry, Navarra University Hospital, Pamplona, Spain
- Mental Health Department, Navarra Health Service-Osasunbidea, Pamplona, Spain
| | - Tomas Goicoa
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- Statistics, Computer Science and Mathematics, Public University of Navarra, Pamplona, Spain
- Institute for Advanced Material and Mathematics, INAMAT2, Public University of Navarra, Pamplona, Spain
| | - María Dolores Ugarte
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- Statistics, Computer Science and Mathematics, Public University of Navarra, Pamplona, Spain
- Institute for Advanced Material and Mathematics, INAMAT2, Public University of Navarra, Pamplona, Spain
| | - Lidia Aranguren
- Department of Psychiatry, Navarra University Hospital, Pamplona, Spain
- Mental Health Department, Navarra Health Service-Osasunbidea, Pamplona, Spain
| | - Asier Corrales
- Department of Psychiatry, Navarra University Hospital, Pamplona, Spain
- Mental Health Department, Navarra Health Service-Osasunbidea, Pamplona, Spain
| | - Gustavo Gil-Berrozpe
- Department of Psychiatry, Navarra University Hospital, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Julián Librero
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- Navarrabiomed, Navarra University Hospital, Public University of Navarra, Pamplona, Spain
| | - Ana M Sánchez-Torres
- Department of Psychiatry, Navarra University Hospital, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Victor Peralta
- Mental Health Department, Navarra Health Service-Osasunbidea, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Elena García de Jalon
- Mental Health Department, Navarra Health Service-Osasunbidea, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Manuel J Cuesta
- Department of Psychiatry, Navarra University Hospital, Pamplona, Spain.
- Mental Health Department, Navarra Health Service-Osasunbidea, Pamplona, Spain.
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Knight S, Yang XQ, Jarvis GE. "Dem sey mi mad": a scoping review of the attitudes and beliefs of English-speaking Afro-Caribbeans about psychosis. Front Psychiatry 2024; 15:1385525. [PMID: 39224480 PMCID: PMC11366823 DOI: 10.3389/fpsyt.2024.1385525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 06/24/2024] [Indexed: 09/04/2024] Open
Abstract
Introduction The mental health disparities suffered by the English-speaking Afro-Caribbean diaspora living with psychosis in North America and the United Kingdom have been well described for decades, but the root causes of these disparities remain poorly understood. Part of the problem may be that the attitudes and beliefs of Caribbean communities regarding psychosis have never been systematically assessed. Such an inquiry could lay the foundation for changes to how psychiatric services for psychosis are implemented with migrant Caribbean communities. The ideal would be a re-design of services, or cultural adaptation of care, based on input from community members, patients, and their families, with the hope that disparities of care would be reduced or eliminated as clinicians co-create interventions that are more appropriate and acceptable to Caribbean people. To lay the groundwork of such an important endeavor, we investigated the shared attitudes, beliefs, experiences, practices, and traditions of English-speaking Afro-Caribbean people in relation to psychosis and psychiatric care. Methods We conducted a scoping review by searching Medline, PsychINFO and Scopus, reviewing 764 articles, and selecting 220 for thematic content analysis. Results We highlighted the heterogeneity in the Caribbean diaspora living in North America and the UK. Five principal themes emerged: (1) The enduring effects of colonialism on the psychiatric care of Afro-Caribbean migrants; (2) The effects of adaptation to migration on the experience of psychosis; (3) Pervasive cultural mistrust of psychiatry and mental health institutions; (4) A collective approach to life; and (5) The role of religion and spirituality in the understanding of psychosis. Conclusion Historical, sociocultural, and geopolitical themes characterize the English Afro-Caribbean experience of psychosis and inform culturally adapted clinical interventions for patients with psychosis and their families. Careful attention to these adaptations will reduce clinical bias and misdiagnosis, optimize adherence to treatment, engage patients and families in recovery, and ultimately, reduce treatment disparities while empowering Afro-Caribbean people and their communities. By bringing forward the themes in this chapter, individual clinicians will be given tools to change how they work with Caribbean people with psychosis in addition to laying the foundation for higher order changes in the mental health professions and society as a whole.
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Affiliation(s)
- Sommer Knight
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Xin Qiang Yang
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - G. Eric Jarvis
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Culture and Mental Health Research Unit, Institute of Community and Family Psychiatry, Jewish General Hospital, Montreal, QC, Canada
- Division of Social and Transcultural Psychiatry, McGill University, Montreal, QC, Canada
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González-Rodríguez A, Natividad M, Palacios-Hernández B, Ayesa-Arriola R, Cobo J, Monreal JA. An Evaluation of a Women's Clinic: The Healthcare and Learning Project of the Functional Unit for Women with Schizophrenia. Healthcare (Basel) 2024; 12:1483. [PMID: 39120186 PMCID: PMC11312130 DOI: 10.3390/healthcare12151483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 07/23/2024] [Accepted: 07/24/2024] [Indexed: 08/10/2024] Open
Abstract
Gender differences exist in mental and physical health in schizophrenia, and healthcare education is part of the associated clinical approach. The main goal of the present paper is to describe a women's clinic for schizophrenia and carry out a narrative review about innovative healthcare and learning strategies in the context of women who suffer from schizophrenia, and to discuss innovative strategies for both healthcare and learning projects to be applied in this context. Observing the development of our unit, four clear innovation phases can be distinguished: the generation of new ideas (clinical and social needs), strategic planning (five observatories), the execution of these strategies (observatories/teams/interventions) and feedback, iteration and scaling. We found that the observatory for morbi-mortality adopted a retroactive proactive approach, and the observatory for hyperprolactinemia was proactive and deliberate. We describe the innovation aspects, both clinical and educational, as incremental. There was one exception, the introduction of a social exclusion and discrimination observatory, that from our perspective, was not gradual, but transformative. Future learning projects should include the role of social sciences and humanities and new technologies. Our pilot project gave us the opportunity to apply new learning methods to a relatively neglected field of care.
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Affiliation(s)
- Alexandre González-Rodríguez
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.A.M.)
| | - Mentxu Natividad
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.A.M.)
| | - Bruma Palacios-Hernández
- Perinatal Mental Health Research Laboratory, Center for Transdisciplinary Research in Psychology (CITPsi), Autonomous University of the State of Morelos, Cuernavaca 62350, Mexico;
| | - Rosa Ayesa-Arriola
- Department of Psychiatry, Marqués de Valdecilla University Hospital, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), School of Medicine, University of Cantabria, 39005 Santander, Spain;
- Faculty of Psychology, National University of Distance Education (UNED), 39008 Santander, Spain
| | - Jesús Cobo
- Department of Mental Health, Hospital Universitari Parc Taulí, 1 Parc Taulí, 08208 Sabadell, Spain;
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Spain
| | - José A. Monreal
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.A.M.)
- Institut de Neurociències, Universitat Autònoma de Barcelona (UAB), 08221 Terrassa, Spain
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Oliver D, Chesney E, Cullen AE, Davies C, Englund A, Gifford G, Kerins S, Lalousis PA, Logeswaran Y, Merritt K, Zahid U, Crossley NA, McCutcheon RA, McGuire P, Fusar-Poli P. Exploring causal mechanisms of psychosis risk. Neurosci Biobehav Rev 2024; 162:105699. [PMID: 38710421 PMCID: PMC11250118 DOI: 10.1016/j.neubiorev.2024.105699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/17/2024] [Accepted: 04/28/2024] [Indexed: 05/08/2024]
Abstract
Robust epidemiological evidence of risk and protective factors for psychosis is essential to inform preventive interventions. Previous evidence syntheses have classified these risk and protective factors according to their strength of association with psychosis. In this critical review we appraise the distinct and overlapping mechanisms of 25 key environmental risk factors for psychosis, and link these to mechanistic pathways that may contribute to neurochemical alterations hypothesised to underlie psychotic symptoms. We then discuss the implications of our findings for future research, specifically considering interactions between factors, exploring universal and subgroup-specific factors, improving understanding of temporality and risk dynamics, standardising operationalisation and measurement of risk and protective factors, and developing preventive interventions targeting risk and protective factors.
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Affiliation(s)
- Dominic Oliver
- Department of Psychiatry, University of Oxford, Oxford, UK; NIHR Oxford Health Biomedical Research Centre, Oxford, UK; OPEN Early Detection Service, Oxford Health NHS Foundation Trust, Oxford, UK; Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Edward Chesney
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, London SE5 8AF, UK
| | - Alexis E Cullen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Cathy Davies
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Amir Englund
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, London SE5 8AF, UK
| | - George Gifford
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Sarah Kerins
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paris Alexandros Lalousis
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Yanakan Logeswaran
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Biostatistics & Health Informatics, King's College London, London, UK
| | - Kate Merritt
- Division of Psychiatry, Institute of Mental Health, UCL, London, UK
| | - Uzma Zahid
- Department of Psychology, King's College London, London, UK
| | - Nicolas A Crossley
- Department of Psychiatry, University of Oxford, Oxford, UK; Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Chile
| | - Robert A McCutcheon
- Department of Psychiatry, University of Oxford, Oxford, UK; Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Oxford Health NHS Foundation Trust, Oxford, UK
| | - Philip McGuire
- Department of Psychiatry, University of Oxford, Oxford, UK; NIHR Oxford Health Biomedical Research Centre, Oxford, UK; OPEN Early Detection Service, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Munich, Germany; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; OASIS Service, South London and Maudsley NHS Foundation Trust, London SE11 5DL, UK
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Qi R, Qureshi M, Gire N, Chaudhry IB, Vass V, McIntyre JC, Barlow K, Bentall RP, White RG, Husain N. Ethnic density and first episode psychosis in the British Pakistani population: findings from the East Lancashire Early Intervention Service. Br J Psychiatry 2024; 225:268-273. [PMID: 38634312 DOI: 10.1192/bjp.2024.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
BACKGROUND Elevated risk of psychosis for ethnic minority groups has generally been shown to be mitigated by high ethnic density. However, past survey studies examining UK Pakistani populations have shown an absence of protective ethnic density effects, which is not observed in other South Asian groups. AIMS To assess the ethnic density effect at a local neighbourhood level, in the UK Pakistani population in East Lancashire. METHOD Data was collected by the East Lancashire Early Intervention Service, identifying all cases of first episode psychosis (FEP) within their catchment area between 2012 and 2020. Multilevel Poisson regression analyses were used to compare incidence rates between Pakistani and White majority groups, while controlling for age, gender and area-level deprivation. The ethnic density effect was also examined by comparing incidence rates across high and low density areas. RESULTS A total of 455 cases of FEP (364 White, 91 Pakistani) were identified. The Pakistani group had a higher incidence of FEP compared to the White majority population. A clear effect of ethnic density on rates of FEP was shown, with those in low density areas having higher incidence rates compared to the White majority, whereas incidence rates in high density areas did not significantly differ. Within the Pakistani group, a dose-response effect was also observed, with risk of FEP increasing incrementally as ethnic density decreased. CONCLUSIONS Higher ethnic density related to lower risk of FEP within the Pakistani population in East Lancashire, highlighting the impact of local social context on psychosis incidence.
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Affiliation(s)
- Robert Qi
- Institute of Population Health, University of Liverpool, UK
| | - Masood Qureshi
- Early Intervention Service, Lancashire South Cumbria NHS Foundation Trust, Accrington, UK
| | - Nadeem Gire
- School of Medicine, The University of Central Lancashire, Preston, UK
- Global Centre for Research on Mental Health Inequalities, Mersey Care NHS Foundation Trust, Prescot, UK
| | - Imran B Chaudhry
- Department of Psychiatry, Ziauddin Hospital, Karachi, Pakistan
- Division of Psychology and Mental Health, University of Manchester, UK
| | - Victoria Vass
- Institute of Population Health, University of Liverpool, UK
| | | | - Kaylee Barlow
- Early Intervention Service, Lancashire South Cumbria NHS Foundation Trust, Accrington, UK
| | | | - Ross G White
- School of Psychology, Queen's University Belfast, UK
| | - Nusrat Husain
- Global Centre for Research on Mental Health Inequalities, Mersey Care NHS Foundation Trust, Prescot, UK
- Division of Psychology and Mental Health, University of Manchester, UK
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Florentin S, Rosca P, Keller S, Reuveni I, Haled R, Yakirevich Amir N, Neumark Y. Ethnic inequalities in community rehabilitation use and psychiatric hospitalizations among people with chronic psychotic disorder. Soc Psychiatry Psychiatr Epidemiol 2024; 59:1235-1242. [PMID: 37615710 DOI: 10.1007/s00127-023-02551-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 08/15/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE Community rehabilitation is crucial for the long-term treatment of people with chronic psychotic disorder. Ethnic minorities are less likely to seek care and have accessible treatment. This study examines whether the use of rehabilitation services and the relationship between rehabilitation and number of hospitalization days differ between Arabs and Jews. METHODS Data from the Israel National Psychiatric Case Register on 18,684 adults with schizophrenia/schizoaffective disorders hospitalized in 1963-2016 were merged with data from the national Mental Rehabilitation Register. Associations between the use of rehabilitation services and demographic and clinical characteristics were assessed through logistic regression modeling. Associations between ethnicity and duration of rehabilitation (housing or vocational) and annual hospitalization days during Period1: 2001-2009 and Period2: 2010-2016 were analyzed using ANOVA. RESULTS Among Jewish patients (N = 2556), 37% and 57% used rehabilitation services during Period1 and Period2, respectively, compared with 18% and 40% among Arab patients (N = 15,145) (p < 0.0001). The use of rehabilitation services was significantly higher among Jews (adjusted OR = 2.26, 95% CI 2.07-2.47). Average duration of housing and vocational rehabilitation services did not differ between Arab and Jewish patients. In both groups, duration of rehabilitation was inversely associated with annual hospitalization days. CONCLUSIONS The ethnic disparity in the use of rehabilitation services has narrowed over time, yet remains. Although fewer Arab patients use rehabilitation, Jewish and Arab benefit similarly from the services with regard to reduced hospitalization days. To further close the ethnic gap, greater efforts must be made to expand the availability of culturally appropriate rehabilitation services for the Arab minority.
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Affiliation(s)
- Sharon Florentin
- Department of Psychiatry, Hadassah Medical Center, Jerusalem, Israel.
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Paola Rosca
- Department for the Treatment of Substance Abuse, Ministry of Health, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shikma Keller
- Department of Psychiatry, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Inbal Reuveni
- Department of Psychiatry, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Razek Haled
- Department of Psychiatry, Hadassah Medical Center, Jerusalem, Israel
- Department for the Treatment of Substance Abuse, Ministry of Health, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Noa Yakirevich Amir
- Department of Psychiatry, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yehuda Neumark
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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Tortelli A, Perozziello A, Mercuel A, Dauriac-Le Masson V, Perquier F. Factors associated with the psychosis continuum among homeless people: Comparison between natives and migrants in the SAMENTA study. J Migr Health 2024; 10:100240. [PMID: 39040890 PMCID: PMC11261881 DOI: 10.1016/j.jmh.2024.100240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 08/10/2023] [Accepted: 06/21/2024] [Indexed: 07/24/2024] Open
Abstract
Background In the last decades, there has been a documented increase in the proportion of migrants among homeless people in Europe. While homelessness is associated with psychosis, little is known about the factors associated with psychosis among migrants in this context. Methods Our study analyzed data collected in the SAMENTA cross-sectional survey conducted among 859 adult French-speaking homeless people living in the Greater Paris area. We analyzed the prevalence of psychosis and psychotic-like experiences (PLE) and associated factors by migrant status, using bivariate analysis and multivariable logistic regression models. Results Our sample comprised 280 natives and 559 migrants in France. Psychosis was significantly more prevalent among natives (21.6 %) than among migrants (7.5 %) (p = 0.003). The total prevalence of PLE was 30.8% (95 % CI: 24.3 - 38.2), and not statistically different between groups (p = 0.215) or sex (p = 0.528). Adverse events over the past year were associated with the increased odds of psychosis in both groups and with PLE among migrants. Sexual abuse during childhood was associated with both outcomes among natives. Among migrants, exposure to war or life-threatening events increased the odds of psychosis and PLE. Increased odds of psychosis were found among migrants who had been living in France for more than 10 years (OR = 3.34, 95 % CI: 1.41-7.93, p = 0.007). Conclusion Differences were found in the factors associated with the psychosis continuum by migrant status, they highlight the impact of experiences related to migration. Prospective studies are needed to better understand these underlying pathways.
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Affiliation(s)
- Andrea Tortelli
- Groupe Hospitalier Universitaire Paris Psychiatrie & Neurosciences, Pôle Psychiatrie Précarité, Paris, France
- INSERM U955, Créteil, France
- INSERM UMR_S 1136, Paris, France
- Institut Convergences Migration, Paris, France
| | - Anne Perozziello
- Groupe Hospitalier Universitaire Paris Psychiatrie & Neurosciences, Département d'Epidémiologie, Paris, France
| | - Alain Mercuel
- Groupe Hospitalier Universitaire Paris Psychiatrie & Neurosciences, Pôle Psychiatrie Précarité, Paris, France
| | - Valérie Dauriac-Le Masson
- Groupe Hospitalier Universitaire Paris Psychiatrie & Neurosciences, Département d'Information Médicale, Paris, France
| | - Florence Perquier
- Groupe Hospitalier Universitaire Paris Psychiatrie & Neurosciences, Département d'Epidémiologie, Paris, France
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9
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Schalbroeck R, van Hooijdonk CFM, Bos DPA, Booij J, Selten JP. Chronic social stressors and striatal dopamine functioning in humans: A systematic review of SPECT and PET studies. Mol Psychiatry 2024:10.1038/s41380-024-02581-x. [PMID: 38760501 DOI: 10.1038/s41380-024-02581-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 04/18/2024] [Accepted: 04/22/2024] [Indexed: 05/19/2024]
Abstract
The dopamine hypothesis of schizophrenia posits that elevated striatal dopamine functioning underlies the development of psychotic symptoms. Chronic exposure to social stressors increases psychosis risk, possibly by upregulating striatal dopamine functioning. Here we systematically review single photon emission computed tomography (SPECT) and positron emission tomography (PET) studies that examined the relationship between chronic social stress exposure and in vivo striatal dopamine functioning in humans. We searched the scientific databases PubMed and PsycINFO from inception to August 2023. The quality of the included studies was evaluated with the ten-item Observational Study Quality Evaluation (PROSPERO: CRD42022308883). Twenty-eight studies were included, which measured different aspects of striatal dopamine functioning including dopamine synthesis capacity (DSC), vesicular monoamine transporter type 2 binding, dopamine release following a pharmacological or behavioral challenge, D2/3 receptor binding, and dopamine transporter binding. We observed preliminary evidence of an association between childhood trauma and increased striatal DSC and dopamine release. However, exposure to low socioeconomic status, stressful life events, or other social stressors was not consistently associated with altered striatal dopamine functioning. The quality of available studies was generally low. In conclusion, there is insufficient evidence that chronic social stressors upregulate striatal dopamine functioning in humans. We propose avenues for future research, in particular to improve the measurement of chronic social stressors and the methodological quality of study designs.
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Affiliation(s)
- Rik Schalbroeck
- Mental Health and Neuroscience Research Institute, Maastricht University, Maastricht, The Netherlands.
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Carmen F M van Hooijdonk
- Mental Health and Neuroscience Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Daniëlle P A Bos
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan Booij
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jean-Paul Selten
- Mental Health and Neuroscience Research Institute, Maastricht University, Maastricht, The Netherlands
- Rivierduinen Institute for Mental Healthcare, Leiden, The Netherlands
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10
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Hall H. Dissociation and misdiagnosis of schizophrenia in populations experiencing chronic discrimination and social defeat. J Trauma Dissociation 2024; 25:334-348. [PMID: 36065490 DOI: 10.1080/15299732.2022.2120154] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/12/2022] [Indexed: 10/14/2022]
Abstract
As recently as the late 20th century, Schizophrenia, a category of mental illness with widely varying phenotypic symptoms, was believed by psychobiologists to be a genetically based disorder in which the environment played a limited etiological role. Yet a growing body of evidence indicates a strong correlation between schizophrenia and environmental factors. This theoretical paper explores the relationship between highly elevated rates of schizophrenia in some low-income minority communities worldwide and trauma-related dissociative symptoms that often mimic schizophrenia. Elevated rates of schizophrenia in racially and ethnically isolated, inner-city Black populations are well documented. This paper contains evidence proposing that this amplification in the rate of schizophrenia is mediated by childhood trauma, disorganized attachment, and social defeat. Further, evidence demonstrating how these three variables combine in early childhood to incubate dissociative disorders will also be conveyed. The misdiagnosis of dissociative disorders as schizophrenia is theorized to partially mediate the increased rate of schizophrenia in communities that experience high levels of racial/ethnic discrimination. It is argued that this misdiagnosis is often attributable to cultural misunderstanding and/or a lack of knowledge about dissociative disorders.
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11
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Zhang Y, Coid J. Childhood Adversity Determines the Syndemic Effects of Violence, Substance Misuse, and Sexual Behavior on Psychotic Spectrum Disorder Among Men. Schizophr Bull 2024; 50:684-694. [PMID: 38019938 PMCID: PMC11059794 DOI: 10.1093/schbul/sbad165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
BACKGROUND AND HYPOTHESIS Childhood adversity (CA) increases the risk for several adult psychiatric conditions. It is unclear why some exposed individuals experience psychotic symptoms and others do not. We investigated whether a syndemic explained a psychotic outcome determined by CA. STUDY DESIGN We used self-reported cross-sectional data from 7461 British men surveyed in different population subgroups. Latent class analysis (LCA) identified categorical psychopathological outcomes. LCs were tested by interaction analysis between syndemic factors derived from confirmatory factor analysis according to CA experiences. Pathway analysis using partial least squares path modeling. RESULTS A 4-class model with excellent fit identified an LC characterized by both psychotic and anxiety symptoms (class 4). A syndemic model of joint effects, adducing a 3-component latent variable of substance misuse (SM), high-risk sexual behavior (SH), violence and criminality (VC) showed synergy between components and explained the psychotic outcome (class 4). We found significant interactions between factor scores on the multiplicative scale, specific only to class 4 (psychosis), including SM × SH, SH × VC, and SM × VC (OR > 1, P < .05); and on the additive scale SM × SH (relative excess risk due to interaction >0, P < .05), but only for men who experienced CA. CONCLUSION Multiplicative synergistic interactions between SM, SH, and VC constituted a mechanism determining a psychotic outcome, but not for anxiety disorder, mixed anxiety disorder/depression, or depressive disorder. This was specific to men who had experienced CA along direct and syndemic pathways. Population interventions should target SM and VC in adulthood but prioritize primary prevention strategies for CA.
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Affiliation(s)
- Yamin Zhang
- Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Major Ppsychiatric Ddisorder Workgroup, Liangzhu Laboratory, MOE Frontier Science Center for Brain Science and Brain-machine Integration, State Key Laboratory of Brain-machine Intelligence, Zhejiang University, Hangzhou, China
| | - Jeremy Coid
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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12
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D'Souza VC. Posttraumatic Stress Disorder in Our Migrant Youth. Child Adolesc Psychiatr Clin N Am 2024; 33:207-218. [PMID: 38395506 DOI: 10.1016/j.chc.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
There is an ongoing diagnostic and treatment challenge for migrant youth with posttraumatic stress disorder (PTSD) that many clinicians face. Current studies have helped clinicians to develop a better understanding of the migrant youth's journey including potentially traumatic and adverse events they encounter. This includes determining if premigration, migration, and postmigration stressors have had an impact on the individual. This has also helped clinicians, educators, and legal advocates to use a collaborative approach to address the migrant youth's needs for managing the severity of PTSD symptoms.
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Affiliation(s)
- Vanessa C D'Souza
- Department of Psychiatry and Psychology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
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13
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Zahid U, Lawrence EG, de Freitas DF, Parri LA, Quadros W, Hua P, Harriss E, Oliver D, Hosang GM, Bhui K. Understanding psychosis complexity through a syndemic framework: A systematic review. Neurosci Biobehav Rev 2024; 159:105614. [PMID: 38432448 DOI: 10.1016/j.neubiorev.2024.105614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/04/2023] [Accepted: 02/29/2024] [Indexed: 03/05/2024]
Abstract
Psychotic conditions pose significant challenges due to their complex aetiology and impact on individuals and communities. Syndemic theory offers a promising framework to understand the interconnectedness of various health and social problems in the context of psychosis. This systematic review aims to examine existing literature on testing whether psychosis is better understood as a component of a syndemic. We conducted a systematic search of 7 databases, resulting in the inclusion of five original articles. Findings from these studies indicate a syndemic characterized by the coexistence of various health and social conditions, are associated with a greater risk of psychosis, adverse health outcomes, and disparities, especially among ethnic minorities and deprived populations. This review underscores the compelling need for a new paradigm and datasets that can investigate how psychosis emerges in the context of a syndemic, ultimately guiding more effective preventive and care interventions as well as policies to improve the health of marginalised communities living in precarity.
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Affiliation(s)
- Uzma Zahid
- Department of Psychiatry, University of Oxford, Oxford, UK; Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Bodleian Health Care Libraries, University of Oxford, Oxford, UK.
| | - Erin Grace Lawrence
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, UK; Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Daniela Fonseca de Freitas
- Department of Psychiatry, University of Oxford, Oxford, UK; Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Lois A Parri
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Wesley Quadros
- Department of Psychiatry, University of Oxford, Oxford, UK; Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Phuong Hua
- Department of Psychiatry, University of Oxford, Oxford, UK; Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, UK; Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Eli Harriss
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK; Nuffield Department of Primary Care Health Sciences, Wadham College, University of Oxford, Oxford, UK
| | - Dominic Oliver
- Department of Psychiatry, University of Oxford, Oxford, UK; Bodleian Health Care Libraries, University of Oxford, Oxford, UK; NIHR Oxford Health Biomedical Research Centre, Oxford OX3 7JX, UK; Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - Georgina M Hosang
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, UK; Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Kamaldeep Bhui
- Department of Psychiatry, University of Oxford, Oxford, UK; Bodleian Health Care Libraries, University of Oxford, Oxford, UK; Nuffield Department of Primary Care Health Sciences, Wadham College, University of Oxford, Oxford, UK; NIHR Oxford Health Biomedical Research Centre, Oxford OX3 7JX, UK; Queen Mary University London Global Policy Institute, London, UK; Collaborating Centre of World Psychiatric Association, Oxford, UK.
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14
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Jonas KG, Cannon TD, Docherty AR, Dwyer D, Gur RC, Gur RE, Nelson B, Reininghaus U, Kotov R. Psychosis superspectrum I: Nosology, etiology, and lifespan development. Mol Psychiatry 2024; 29:1005-1019. [PMID: 38200290 PMCID: PMC11385553 DOI: 10.1038/s41380-023-02388-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 12/05/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024]
Abstract
This review describes the Hierarchical Taxonomy of Psychopathology (HiTOP) model of psychosis-related psychopathology, the psychosis superspectrum. The HiTOP psychosis superspectrum was developed to address shortcomings of traditional diagnoses for psychotic disorders and related conditions including low reliability, arbitrary boundaries between psychopathology and normality, high symptom co-occurrence, and heterogeneity within diagnostic categories. The psychosis superspectrum is a transdiagnostic dimensional model comprising two spectra-psychoticism and detachment-which are in turn broken down into fourteen narrow components, and two auxiliary domains-cognition and functional impairment. The structure of the spectra and their components are shown to parallel the genetic structure of psychosis and related traits. Psychoticism and detachment have distinct patterns of association with urbanicity, migrant and ethnic minority status, childhood adversity, and cannabis use. The superspectrum also provides a useful model for describing the emergence and course of psychosis, as components of the superspectrum are relatively stable over time. Changes in psychoticism predict the onset of psychosis-related psychopathology, whereas changes in detachment and cognition define later course. Implications of the superspectrum for genetic, socio-environmental, and longitudinal research are discussed. A companion review focuses on neurobiology, treatment response, and clinical utility of the superspectrum, and future research directions.
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Affiliation(s)
- Katherine G Jonas
- Department of Psychiatry & Behavioral Health, Stony Brook University, Stony Brook, NY, USA.
| | - Tyrone D Cannon
- Department of Psychology, Yale University, New Haven, CT, USA
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Anna R Docherty
- Huntsman Mental Health Institute, Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Dominic Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Ruben C Gur
- Brain Behavior Laboratory, Department of Psychiatry and the Penn-CHOP Lifespan Brain Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Raquel E Gur
- Brain Behavior Laboratory, Department of Psychiatry and the Penn-CHOP Lifespan Brain Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Barnaby Nelson
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- ESRC Centre for Society and Mental Health and Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Roman Kotov
- Department of Psychiatry & Behavioral Health, Stony Brook University, Stony Brook, NY, USA
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15
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Birk R, Manning N. How to think about the social in psychiatric research? On language games and styles of social thought. Soc Psychiatry Psychiatr Epidemiol 2024; 59:537-544. [PMID: 37838629 PMCID: PMC10944384 DOI: 10.1007/s00127-023-02570-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/28/2023] [Indexed: 10/16/2023]
Abstract
Over the last 20 years, the importance of 'the social' has again become a crucial theme within psychiatric research, as evidenced for example by the recent focus on the social determinants of mental health. However, what is less clear is what is meant, in this kind of research, by the very idea of the social-and what consequences those ideas have. The key purpose of the article is therefore to discuss what is often meant by the concept of 'the social'; what different ideas of the social do; and what can be at stake in the different, explicit and implicit, understandings of social life that proliferate in contemporary psychiatric research. We propose that there are, roughly, three widespread styles of social thought, wherein (a) the social is seen as structural, (b) the social is seen as individual, and (c) the social is seen as relational/processual. We exemplify these by discussing examples of 'social defeat' and 'therapeutic communities', focused on what might be at stake in different understandings of social life. Lastly, we draw on the philosopher Ludwig Wittgenstein to argue that a singular understanding of 'the social' is not achievable.
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Affiliation(s)
- Rasmus Birk
- Department of Communication and Psychology, Aalborg University, Aalborg, Denmark.
| | - Nick Manning
- Department of Global Health and Social Medicine, King's College London, London, UK
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16
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Bhui K, Cipriani A. Understanding and responding to the drivers of inequalities in mental health. BMJ MENTAL HEALTH 2023; 26:e300921. [PMID: 38114130 DOI: 10.1136/bmjment-2023-300921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 11/21/2023] [Indexed: 12/21/2023]
Affiliation(s)
- Kamaldeep Bhui
- Department of Psychiatry, University of Oxford, Oxford, UK
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17
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Kalofonos I. Meaning in Psychosis: A Veteran's Critique of the Traumas of Racism, Sexual Violence, and Intersectional Oppression. Cult Med Psychiatry 2023; 47:1090-1112. [PMID: 37138030 PMCID: PMC10654173 DOI: 10.1007/s11013-023-09824-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2023] [Indexed: 05/05/2023]
Abstract
This clinical case study presents the case of a Latina Veteran experiencing psychosis and draws on eclectic theoretical sources, including user/survivor scholarship, phenomenology, meaning-oriented cultural psychiatry & critical medical anthropology, and Frantz Fanon's insight on 'sociogeny,' to emphasize the importance of attending to the meaning within psychosis and to ground that meaning in a person's subjective-lived experience and social world. The process of exploring the meaning and critical significance of the narratives of people experiencing psychosis is important for developing empathy and connection, the fundamental prerequisite for developing trust and therapeutic rapport. It also helps us to recognize some of the relevant aspects of a person's lived experiences. To be understood, this Veteran's narratives must be contextualized in her past and ongoing life experience of racism, social hierarchy, and violence. Engaging in this way with her narratives pushes us towards a social etiology that conceptualizes psychosis as a complex response to life experience, and in her case, a critical embodiment of intersectional oppression.
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Affiliation(s)
- Ippolytos Kalofonos
- HSR&D Center for the Study of Helathcare Innovation, Implementation & Policy (CSHIIP) & Mental Illness Research Education & Clinical Center (MIRECC) Health Services Unit, Greater Los Angeles VA Health System, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA.
- Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, UCLA, Los Angeles, CA, 90095, USA.
- UCLA International Institute, 11248 Bunche Hall, Los Angeles, CA, 90095, USA.
- UCLA Department of Anthropology, 375 Portola Plaza, Los Angeles, CA, 90095, USA.
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18
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Manuel J, Pitama S, Clark M, Crowe M, Crengle S, Cunningham R, Gibb S, Petrović-van der Deen FS, Porter RJ, Lacey C. Racism, early psychosis, and institutional contact: A qualitative study of Indigenous experiences. Int J Soc Psychiatry 2023; 69:2121-2127. [PMID: 37665228 PMCID: PMC10685688 DOI: 10.1177/00207640231195297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
BACKGROUND There is evidence of Indigenous and ethnic minority inequities in the incidence and outcomes of early psychosis. Racism has been implicated as having an important role. AIM To use Indigenous experiences to develop a more detailed understanding of how racism operates to impact early psychosis outcomes. METHODS Critical Race Theory informed the methodology used. Twenty-three Indigenous participants participated in four family focus group interviews and thirteen individual interviews, comprising of 9 Māori youth with early psychosis, 10 family members and 4 Māori mental health professionals. An analysis of the data was undertaken using deductive structural coding to identify descriptions of racism, followed by inductive descriptive and pattern coding. RESULTS Participant experiences revealed how racism operates as a socio-cultural phenomenon that interacts with institutional policy and culture across systems pertaining to social responsiveness, risk discourse, and mental health service structures. This is described across three major themes: 1) selective responses based on racial stereotypes, 2) race related risk assessment bias and 3) institutional racism in the mental health workforce. The impacts of racism were reported as inaction in the face of social need, increased use of coercive practices and an under resourced Indigenous mental health workforce. CONCLUSION The study illustrated the inter-related nature of interpersonal, institutional and structural racism with examples of interpersonal racism in the form of negative stereotypes interacting with organizational, socio-cultural and political priorities. These findings indicate that organizational cultures may differentially impact Indigenous and minority people and that social responsiveness, risk discourse and the distribution of workforce expenditure are important targets for anti-racism efforts.
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Affiliation(s)
- Jenni Manuel
- Māori/Indigenous Health Innovation, University of Otago Christchurch, New Zealand
- Department of Psychological Medicine, University of Otago Christchurch, New Zealand
| | - Suzanne Pitama
- Māori/Indigenous Health Innovation, University of Otago Christchurch, New Zealand
| | | | - Marie Crowe
- Department of Psychological Medicine, University of Otago Christchurch, New Zealand
| | - Sue Crengle
- Department of Preventive and Social Medicine, University of Otago, Dunedin School of Medicine, New Zealand
| | - Ruth Cunningham
- Department of Public Health, University of Otago Wellington, Newtown, Wellington, New Zealand
| | - Sheree Gibb
- Department of Public Health, University of Otago Wellington, Newtown, Wellington, New Zealand
| | | | - Richard J Porter
- Department of Psychological Medicine, University of Otago Christchurch, New Zealand
- Te Whatu Ora Waitaha, New Zealand
| | - Cameron Lacey
- Māori/Indigenous Health Innovation, University of Otago Christchurch, New Zealand
- Department of Psychological Medicine, University of Otago Christchurch, New Zealand
- Te Whatu Ora Waitaha, New Zealand
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19
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Chung W, Jiang SF, Milham MP, Merikangas KR, Paksarian D. Inequalities in the Incidence of Psychotic Disorders Among Racial and Ethnic Groups. Am J Psychiatry 2023; 180:805-814. [PMID: 37789743 DOI: 10.1176/appi.ajp.20220917] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
OBJECTIVE The authors examined recent trends in incidence of psychotic disorders, demographic characteristics, and comorbid psychiatric and medical conditions among six racial/ethnic groups. METHOD A retrospective cohort study design was used to examine the incidence of psychotic disorders across race/ethnicity groups and comorbid psychiatric and medical conditions among members of Kaiser Permanente Northern California from 2009 to 2019 (N=5,994,758). Poisson regression was used to assess changes in annual incidence, and Cox proportional hazards and logistic regression models adjusted for age and sex were used to test correlates and consequences. RESULTS Overall, the incidence of nonaffective psychotic disorders decreased slightly over the study period. Compared with White members, the risk of nonaffective psychosis diagnosis was higher among Black (hazard ratio=2.13, 95% CI=2.02-2.24) and American Indian or Alaskan Native (AIAN) (hazard ratio=1.85, 95% CI=1.53-2.23) members and lower among Asian (hazard ratio=0.72, 95% CI=0.68-0.76) and Hispanic (hazard ratio=0.91, 95% CI=0.87-0.96) members, as well as those whose race/ethnicity was categorized as "other" (hazard ratio=0.92, 95% CI=0.86-0.99). Compared with White members, the risk of affective psychosis diagnosis adjusted for age and sex was higher among Black (hazard ratio=1.76, 95% CI=1.62-1.91), Hispanic (hazard ratio=1.09, 95% CI=1.02-1.16), and AIAN (hazard ratio=1.38, 95% CI=1.00-1.90) members and lower among Asian (hazard ratio=0.77, 95% CI=0.71-0.83), Native Hawaiian or other Pacific Islander (hazard ratio=0.69, 95% CI=0.48-0.99), and "other" (hazard ratio=0.86, 95% CI=0.77-0.96) members. Psychotic disorders were associated with significantly higher odds of suicide (odds ratio=2.65, 95% CI=2.15-3.28), premature death (odds ratio=1.30, 95% CI=1.22-1.39), and stroke (odds ratio=1.64, 95% CI=1.55-1.72) and lower odds of health care utilization (odds ratio=0.44, 95% CI=0.42-0.47). CONCLUSIONS This study demonstrates racial and ethnic variation in incident psychotic disorder diagnoses in the United States, compared with non-Hispanic Whites. Individuals diagnosed with psychosis face a greater burden of other negative health outcomes and lower odds of health care utilization, reflecting personal and economic impacts. Identifying risk factors for elevated rates and protective influences in subgroups can inform strategies for prevention and interventions to ameliorate severe consequences of psychotic syndromes.
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Affiliation(s)
- Winston Chung
- Department of Psychiatry, Kaiser Permanente Northern California, San Francisco (Chung); Division of Research, Kaiser Permanente Northern California, Oakland (Jiang); Center for the Developing Brain, Child Mind Institute, New York (Milham); Center for Biomedical Imaging and Neuromodulation, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, N.Y. (Milham); Genetic Epidemiology Research Branch, NIMH, Bethesda, Md. (Merikangas, Paksarian)
| | - Sheng-Fang Jiang
- Department of Psychiatry, Kaiser Permanente Northern California, San Francisco (Chung); Division of Research, Kaiser Permanente Northern California, Oakland (Jiang); Center for the Developing Brain, Child Mind Institute, New York (Milham); Center for Biomedical Imaging and Neuromodulation, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, N.Y. (Milham); Genetic Epidemiology Research Branch, NIMH, Bethesda, Md. (Merikangas, Paksarian)
| | - Michael P Milham
- Department of Psychiatry, Kaiser Permanente Northern California, San Francisco (Chung); Division of Research, Kaiser Permanente Northern California, Oakland (Jiang); Center for the Developing Brain, Child Mind Institute, New York (Milham); Center for Biomedical Imaging and Neuromodulation, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, N.Y. (Milham); Genetic Epidemiology Research Branch, NIMH, Bethesda, Md. (Merikangas, Paksarian)
| | - Kathleen R Merikangas
- Department of Psychiatry, Kaiser Permanente Northern California, San Francisco (Chung); Division of Research, Kaiser Permanente Northern California, Oakland (Jiang); Center for the Developing Brain, Child Mind Institute, New York (Milham); Center for Biomedical Imaging and Neuromodulation, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, N.Y. (Milham); Genetic Epidemiology Research Branch, NIMH, Bethesda, Md. (Merikangas, Paksarian)
| | - Diana Paksarian
- Department of Psychiatry, Kaiser Permanente Northern California, San Francisco (Chung); Division of Research, Kaiser Permanente Northern California, Oakland (Jiang); Center for the Developing Brain, Child Mind Institute, New York (Milham); Center for Biomedical Imaging and Neuromodulation, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, N.Y. (Milham); Genetic Epidemiology Research Branch, NIMH, Bethesda, Md. (Merikangas, Paksarian)
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20
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Kasai K, Kumagaya SI, Takahashi Y, Sawai Y, Uno A, Kumakura Y, Yamagishi M, Kanehara A, Morita K, Tada M, Satomura Y, Okada N, Koike S, Yagishita S. "World-Informed" Neuroscience for Diversity and Inclusion: An Organizational Change in Cognitive Sciences. Clin EEG Neurosci 2023; 54:560-566. [PMID: 35695218 DOI: 10.1177/15500594221105755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
By nature, humans are "tojisha (participating subjects/player-witnesses)" who encounter an unpredictable real world. An important characteristic of the relationship between the individual brain and the world is that it creates a loop of interaction and mutual formation. However, cognitive sciences have traditionally been based on a model that treats the world as a given constant. We propose incorporating the interaction loop into this model to create "world-informed neuroscience (WIN)". Based on co-productive research with people with minority characteristics that do not match the world, we hypothesize that the tojisha and the world interact in a two-dimensional way of rule-based and story-based. By defining the cognitive process of becoming tojisha in this way, it is possible to contribute to the various issues of the real world and diversity and inclusion through the integration of the humanities and sciences. The critical role of the brain dopamine system as a basis for brain-world interaction and the importance of research on urbanicity and adolescent development as examples of the application of WIN were discussed. The promotion of these studies will require bidirectional translation between human population science and animal cognitive neuroscience. We propose that the social model of disability should be incorporated into cognitive sciences, and that disability-informed innovation is needed to identify how social factors are involved in mismatches that are difficult to visualize. To promote WIN to ultimately contribute to a diverse and inclusive society, co-production of research from the initial stage of research design should be a baseline requirement.
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Affiliation(s)
- Kiyoto Kasai
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- The International Research Center for Neurointelligence (WPI-IRCN) at The University of Tokyo Institutes for Advanced Study (UTIAS), The University of Tokyo, Tokyo, Japan
- University of Tokyo Institute for Diversity & Adaptation of Human Mind (UTIDAHM), Tokyo, Japan
- UTokyo Center for Integrative Science of Human Behavior (CiSHuB), Graduate School of Art and Sciences, The University of Tokyo, Tokyo, Japan
- Center for Diversity in Medical Education and Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shin-Ichiro Kumagaya
- Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Yusuke Takahashi
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- St Luke's International Hospital, Tokyo, Japan
| | - Yutaka Sawai
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akito Uno
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yousuke Kumakura
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mika Yamagishi
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akiko Kanehara
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kentaro Morita
- Department of Rehabilitation, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mariko Tada
- Center for Research on Counseling and Support Services, The University of Tokyo, Tokyo, Japan
| | - Yoshihiro Satomura
- Center for Diversity in Medical Education and Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Naohiro Okada
- The International Research Center for Neurointelligence (WPI-IRCN) at The University of Tokyo Institutes for Advanced Study (UTIAS), The University of Tokyo, Tokyo, Japan
| | - Shinsuke Koike
- The International Research Center for Neurointelligence (WPI-IRCN) at The University of Tokyo Institutes for Advanced Study (UTIAS), The University of Tokyo, Tokyo, Japan
- University of Tokyo Institute for Diversity & Adaptation of Human Mind (UTIDAHM), Tokyo, Japan
- UTokyo Center for Integrative Science of Human Behavior (CiSHuB), Graduate School of Art and Sciences, The University of Tokyo, Tokyo, Japan
- Center for Evolutionary Cognitive Sciences, Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan
| | - Sho Yagishita
- Department of Structural Physiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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D'Andrea G, Lal J, Tosato S, Gayer-Anderson C, Jongsma HE, Stilo SA, van der Ven E, Quattrone D, Velthorst E, Berardi D, Rossi Menezes P, Arango C, Parellada M, Lasalvia A, La Cascia C, Ferraro L, La Barbera D, Sideli L, Bobes J, Bernardo M, Sanjuán J, Santos JL, Arrojo M, Del-Ben CM, Tripoli G, Llorca PM, de Haan L, Selten JP, Tortelli A, Szöke A, Muratori R, Rutten BP, van Os J, Jones PB, Kirkbride JB, Murray RM, di Forti M, Tarricone I, Morgan C. Child maltreatment, migration and risk of first-episode psychosis: results from the multinational EU-GEI study. Psychol Med 2023; 53:6150-6160. [PMID: 36305570 PMCID: PMC10520604 DOI: 10.1017/s003329172200335x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/29/2022] [Accepted: 10/06/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Child maltreatment (CM) and migrant status are independently associated with psychosis. We examined prevalence of CM by migrant status and tested whether migrant status moderated the association between CM and first-episode psychosis (FEP). We further explored whether differences in CM exposure contributed to variations in the incidence rates of FEP by migrant status. METHODS We included FEP patients aged 18-64 years in 14 European sites and recruited controls representative of the local populations. Migrant status was operationalized according to generation (first/further) and region of origin (Western/non-Western countries). The reference population was composed by individuals of host country's ethnicity. CM was assessed with Childhood Trauma Questionnaire. Prevalence ratios of CM were estimated using Poisson regression. We examined the moderation effect of migrant status on the odds of FEP by CM fitting adjusted logistic regressions with interaction terms. Finally, we calculated the population attributable fractions (PAFs) for CM by migrant status. RESULTS We examined 849 FEP cases and 1142 controls. CM prevalence was higher among migrants, their descendants and migrants of non-Western heritage. Migrant status, classified by generation (likelihood test ratio:χ2 = 11.3, p = 0.004) or by region of origin (likelihood test ratio:χ2 = 11.4, p = 0.003), attenuated the association between CM and FEP. PAFs for CM were higher among all migrant groups compared with the reference populations. CONCLUSIONS The higher exposure to CM, despite a smaller effect on the odds of FEP, accounted for a greater proportion of incident FEP cases among migrants. Policies aimed at reducing CM should consider the increased vulnerability of specific subpopulations.
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Affiliation(s)
- Giuseppe D'Andrea
- Department of Medical and Surgical Sciences, Bologna Transcultural Psychosomatic Team (BoTPT), University of Bologna, Bologna, Italy
- Community Mental Health Center of Sassuolo, Department of Mental Health and Drug Abuse, AUSL Modena, Modena, Italy
| | - Jatin Lal
- Department of Medical and Surgical Sciences, Bologna Transcultural Psychosomatic Team (BoTPT), University of Bologna, Bologna, Italy
| | - Sarah Tosato
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Charlotte Gayer-Anderson
- ESRC Center for Society and Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Hannah E Jongsma
- Centre for Transcultural Psychiatry 'Veldzicht', Balkbrug, The Netherlands
- University Centre for Psychiatry, University Medical Centre Groningen, Groningen, The Netherlands
| | - Simona A Stilo
- Department of Mental Health and Addiction Services, ASP Crotone, Crotone, Italy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Els van der Ven
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Diego Quattrone
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Eva Velthorst
- Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Domenico Berardi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Section of Psychiatry, University of Bologna, Bologna, Italy
| | - Paulo Rossi Menezes
- University Hospital, Section of Epidemiology, University of São Paulo, São Paulo, Brazil
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Mara Parellada
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Antonio Lasalvia
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Caterina La Cascia
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Psychiatry Section, University of Palermo, Palermo, Italy
| | - Laura Ferraro
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Psychiatry Section, University of Palermo, Palermo, Italy
| | - Daniele La Barbera
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Psychiatry Section, University of Palermo, Palermo, Italy
| | - Lucia Sideli
- Department of Human Science, LUMSA University, Rome, Italy
| | - Julio Bobes
- Department of Medicine, Psychiatry Area, School of Medicine, Universidad de Oviedo, ISPA, Ineuropa, CIBERSAM, Oviedo, Spain
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Department of Medicine, Neuroscience Institute, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain
| | - Julio Sanjuán
- Department of Psychiatry, School of Medicine, Universidad de Valencia, Centro de Investigación Biomédica en Red de Salud Mental, Valencia, Spain
| | - Jose Luis Santos
- Department of Psychiatry, Servicio de Psiquiatría Hospital "Virgen de la Luz", Cuenca, Spain
| | - Manuel Arrojo
- Department of Psychiatry, Psychiatric Genetic Group, Instituto de Investigación Sanitaria de Santiago de Compostela, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago, Spain
| | - Cristina Marta Del-Ben
- Neuroscience and Behavior Department, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Giada Tripoli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Psychiatry Section, University of Palermo, Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Piazza delle Cliniche, 290127 Palermo, Italy
| | | | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jean-Paul Selten
- School for Mental Health and Neuroscience, University of Maastricht, Maastricht, The Netherlands
| | | | - Andrei Szöke
- Univ Paris Est Creteil, INSERM, IMRB, AP-HP, Hôpitaux Universitaires « H. Mondor », DMU IMPACT, Fondation Fondamental, F-94010 Créteil, France
| | - Roberto Muratori
- Department of Mental Health and Pathological Addiction, Local Health Authority, Bologna, Italy
| | - Bart P Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Marta di Forti
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Ilaria Tarricone
- Department of Medical and Surgical Sciences, Bologna Transcultural Psychosomatic Team (BoTPT), University of Bologna, Bologna, Italy
- Department of Mental Health and Pathological Addiction, Local Health Authority, Bologna, Italy
| | - Craig Morgan
- ESRC Center for Society and Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
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22
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Florentin S, Rosca P, Reuveni I, Haled R, Neumark Y. Patterns of psychiatric hospitalizations of Arab and Jewish adults with chronic psychotic disorders, before and after national mental health reforms, Israel, 1991-2016. BMC Psychiatry 2023; 23:653. [PMID: 37670229 PMCID: PMC10478495 DOI: 10.1186/s12888-023-05132-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/23/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Members of the Arab minority in Israel are at increased risk of developing mental illness, although less likely to seek care and have accessible treatment. This study compares trends in psychiatric hospitalizations between Arabs and Jews with chronic psychotic disorders, before and after introduction of the Community Rehabilitation of Persons with Mental Disability Law in 2000, and governmental recognition of the need to allocate resources for patients with co-occurring substance use disorder and mental illness in 2010. METHODS The National Psychiatric Case Registry provided data on 18,684 adults with schizophrenia/schizoaffective disorder, hospitalized in 1991-2016 (at least once in 2010-2015). Repeated-measures ANOVA was used to measure the effect (and interactions) of population-group (Arabs and Jews), time-period (Period1: 1991-2000, Period2: 2001-2009, Period3: 2010-2016) and sex, on average length of stay (LOS), annual number of hospitalizations and hospitalization days. RESULTS The proportion of Arab patients hospitalized with a diagnosis of chronic psychotic disorder (14.4%) was significantly lower than their proportion in the general population (21%), and their average age at first hospitalization (28.4 years) was older than that of Jewish inpatients (27.0 years). The average number of hospitalization days and LOS of Jewish patients were double that of Arab patients in Period1. Following implementation of the Rehabilitation Law, hospitalization days increased among Arab patients and decreased slightly among Jewish patients, such that by Period3 the average number of hospitalization days was similar among Jewish (41) and Arab (37) patients. The increase in hospitalization days among Arab patients was limited to men with no change noted among women. The number of hospitalization days among Arab women was about half that of Jewish women (p < 0.0001). CONCLUSIONS The findings reveal a narrowing of disparities in psychiatric hospitalizations between Arab and Jewish patients in Israel over time. However, among Arab women the number of hospitalization days remains considerably lower than that of Jewish women, raising concerns that Arab women may be receiving insufficient care. Further study is needed to fully understand the underpinnings of these disparities, although increasing the number of Arabic-language mental health services and providing psycho-education, will help further close the gap.
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Affiliation(s)
- Sharon Florentin
- Department of Psychiatry, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Paola Rosca
- Department for the Treatment of Substance Abuse, Ministry of Health; The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Inbal Reuveni
- Department of Psychiatry, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Razek Haled
- Department of Psychiatry, Hadassah Medical Center, Jerusalem, Israel
- Braun School of Public Health & Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yehuda Neumark
- Braun School of Public Health & Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
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23
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Ghanem M, Evangeli-Dawson C, Georgiades A. The role of culture on the phenomenology of hallucinations and delusions, explanatory models, and help-seeking attitudes: A narrative review. Early Interv Psychiatry 2023; 17:843-863. [PMID: 37458202 DOI: 10.1111/eip.13449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/23/2023] [Accepted: 07/02/2023] [Indexed: 09/07/2023]
Abstract
AIM Culture has been posited to be involved in the formation and maintenance of delusions and hallucinations. The extent of these differences and how they affect explanatory models of psychosis and help-seeking attitudes remains to be understood. This review aims to present a cultural formulation to account for psychosis onset, symptom maintenance, and help-seeking attitudes. METHODS A narrative review was conducted to summarize the existing evidence base regarding cross-cultural differences in hallucinatory and delusional prevalence, explanatory models, and help-seeking attitudes in First Episode Psychosis (FEP) and Non-FEP Schizophrenia samples. RESULTS Sixteen studies were eligible for inclusion. In terms of positive symptom specificity, cross-cultural differences were found. Specifically, auditory and visual hallucinations occurred most frequently in African patients, persecutory and grandiose delusions occurred at higher rates in African, Pakistani, and Latino patients, while delusions of reference were most prevalent in White-British groups. Three explanatory models were identified. Westerners tended to endorse a bio-psychosocial explanation, which was associated with increased help-seeking, engagement, and positive medication attitudes. Asian, Latino, Polish, and Māori patients endorsed religious-spiritual explanatory models, while African patients opted for a bewitchment model. The religious-spiritual and bewitchment models were associated with a longer duration of untreated psychosis (DUP) and poorer engagement with mental health services. CONCLUSIONS These findings highlight the important influence of culture in the formation and maintenance of positive symptoms of psychosis, engagement, and help-seeking attitudes across different ethnic groups. The incorporation of cultural beliefs in formulation development could facilitate enriched CBTp practices and improved engagement amongst different cultural groups with Early Intervention Services.
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Affiliation(s)
- Mawada Ghanem
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
- Brent Early Intervention Service, CNWL, NHS Foundation Trust, London, UK
| | - Christian Evangeli-Dawson
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
- Brent Early Intervention Service, CNWL, NHS Foundation Trust, London, UK
| | - Anna Georgiades
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
- Brent Early Intervention Service, CNWL, NHS Foundation Trust, London, UK
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24
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Zahid U, Hosang GM, de Freitas DF, Mooney R, Bhui K. Ethnic inequality, multimorbidity and psychosis: can a syndemic framework resolve disputed evidence? SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:37. [PMID: 37296141 DOI: 10.1038/s41537-023-00367-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 05/02/2023] [Indexed: 06/12/2023]
Abstract
Syndemic theory is described as population-level clustering or co-occurrence of health conditions in the context of shared aetiologies that interact and can act synergistically. These influences appear to act within specific places of high disadvantage. We suggest ethnic inequality in experiences and outcomes of multimorbidity, including psychosis, may be explained through a syndemic framework. We discuss the evidence for each component of syndemic theory in relation to psychosis, using psychosis and diabetes as an exemplar. Following this, we discuss the practical and theoretical adaptations to syndemic theory in order to apply it to psychosis, ethnic inequality and multimorbidity, with implications for research, policy, and practice.
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Affiliation(s)
- Uzma Zahid
- Department of Psychiatry, University of Oxford, Oxford, UK.
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Georgina M Hosang
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Daniela Fonseca de Freitas
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Roisin Mooney
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Kamaldeep Bhui
- Department of Psychiatry, University of Oxford, Oxford, UK.
- Nuffield Department of Primary Care Health Sciences, Wadham College, University of Oxford, Oxford, UK.
- Queen Mary University London Global Policy Institute, London, UK.
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25
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Manuel J, Pitama S, Clark MTR, Crowe M, Crengle S, Cunningham R, Gibb S, Petrović-van der Deen FS, Porter RJ, Lacey C. Racism, early psychosis and institutional contact: a qualitative study of Indigenous experiences. Int Rev Psychiatry 2023; 35:323-330. [PMID: 37267030 DOI: 10.1080/09540261.2023.2188074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/03/2023] [Indexed: 06/03/2023]
Abstract
There is evidence of Indigenous and ethnic minority inequities in the incidence and outcomes of early psychosis. racism has an important role. This study aimed to use Indigenous experiences to develop a more detailed understanding of how racism operates to impact early psychosis. Critical Race Theory informed the methods used. Twenty-three Indigenous participants participated in 4 family focus group interviews and 13 individual interviews, comprising of 9 youth, 10 family members and 4 mental health professionals. An analysis of the data was undertaken using deductive structural coding to identify descriptions of racism, followed by inductive descriptive and pattern coding. Participant experiences revealed how racism operates as a socio-cultural phenomenon that interacts with institutional policy and culture across systems. This is described across three themes: (1) selective responses based on racial stereotypes, (2) race related risk assessment bias and (3) institutional racism in the mental health workforce. The impacts of racism were reported as inaction in the face of social need, increased coercion and an under resourced Indigenous workforce. These findings indicate that organizational cultures may differentially impact Indigenous and minority people and that social responsiveness, risk discourse and the distribution of workforce expenditure are important targets for anti-racism efforts.
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Affiliation(s)
- Jenni Manuel
- Department of Māori Indigenous Health Innovation (MIHI), University of Otago Christchurch, Christchurch, New Zealand
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Suzanne Pitama
- Department of Māori Indigenous Health Innovation (MIHI), University of Otago Christchurch, Christchurch, New Zealand
| | | | - Marie Crowe
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Sue Crengle
- Department of Preventive and Social Medicine, University of Otago, Dunedin School of Medicine, Dunedin, New Zealand
| | - Ruth Cunningham
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Sheree Gibb
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | | | - Richard J Porter
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand
- Te Whatu Ora Waitaha, Christchurch, New Zealand
| | - Cameron Lacey
- Department of Māori Indigenous Health Innovation (MIHI), University of Otago Christchurch, Christchurch, New Zealand
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand
- Te Whatu Ora Waitaha, Christchurch, New Zealand
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26
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Rotenberg M, Tuck A, Anderson KK, McKenzie K. Neighbourhood-level social capital, marginalisation, and the incidence of schizophrenia and schizoaffective disorder in Toronto, Canada: a retrospective population-based cohort study. Psychol Med 2023; 53:2643-2651. [PMID: 34809726 PMCID: PMC10123822 DOI: 10.1017/s003329172100458x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 10/18/2021] [Accepted: 10/22/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Studies have shown mixed results regarding social capital and the risk of developing a psychotic disorder, and this has yet to be studied in North America. We sought to examine the relationship between neighbourhood-level marginalisation, social capital, and the incidence of schizophrenia and schizoaffective disorder in Toronto, Canada. METHODS We used a retrospective population-based cohort to identify incident cases of schizophrenia and schizoaffective disorder over a 10 year period and accounted for neighbourhood-level marginalisation and a proxy indicator of neighbourhood social capital. Mixed Poisson regression models were used to estimate adjusted incidence rate ratios (aIRRs). RESULTS In the cohort (n = 649 020) we identified 4841 incident cases of schizophrenia and schizoaffective disorder. A 27% variation in incidence was observed between neighbourhoods. All marginalisation dimensions, other than ethnic concentration, were associated with incidence. Compared to areas with low social capital, areas with intermediate social capital in the second [aIRR = 1.17, 95% confidence interval (CI) 1.03-1.33] and third (aIRR = 1.23, 95% CI 1.08-1.40) quintiles had elevated incidence rates after accounting for marginalisation. There was a higher risk associated with the intermediate levels of social capital (aIRR = 1.18, 95% CI 1.00-1.39) when analysed in only the females in the cohort, but the CI includes the possibility of a null effect. CONCLUSIONS The risk of developing schizophrenia and schizoaffective disorder in Toronto varies by neighbourhood and is associated with socioenvironmental exposures. Social capital was not linearly associated with risk, and risk differs by sex and social capital quintile. Future research should examine these relationships with different forms of social capital and examine how known individual-level risk factors impact these findings.
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Affiliation(s)
- Martin Rotenberg
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Andrew Tuck
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Kelly K. Anderson
- Department of Epidemiology & Biostatistics, Department of Psychiatry, The University of Western Ontario, London, ON, Canada
| | - Kwame McKenzie
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
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Carr G, Cunningham R, Petrović-van der Deen FS, Manuel J, Gibb S, Porter RJ, Pitama S, Crowe M, Crengle S, Lacey C. Evolution of first episode psychosis diagnoses and health service use among young Māori and non-Māori-A New Zealand national cohort study. Early Interv Psychiatry 2023; 17:290-298. [PMID: 35733282 DOI: 10.1111/eip.13327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/06/2022] [Accepted: 05/29/2022] [Indexed: 11/24/2022]
Abstract
AIMS The validity of diagnostic classification in early psychosis has important implications for early intervention; however, it is unknown if previously found disparities between Māori (Indigenous people of New Zealand) and non-Māori in first episode diagnoses persist over time, or how these differences impact service use. METHODS We used anonymized routine mental health service data and a previously established cohort of over 2400 13-25-year-old youth diagnosed with FEP between 2009 and 2012, to explore differences in diagnostic stability of psychosis diagnoses, comorbid (non-psychosis) diagnoses, and mental health service contacts between Māori and non-Māori in the five-year period following diagnosis. RESULTS Differences in schizophrenia and affective psychosis diagnoses between Māori and non-Māori were maintained in the five-year period, with Māori being more likely to be diagnosed with schizophrenia (51% vs. 35%), and non-Māori with bipolar disorder (28% vs. 18%). Stability of diagnosis was similar (schizophrenia 75% Māori vs. 67% non-Maori; bipolar disorder 55% Māori vs. 48% non-Māori) and those with no stable diagnosis at FEP were most likely to move towards a schizophrenia disorder diagnosis in both groups. Māori had a lower rate of diagnosed co-morbid affective and anxiety symptoms and higher rates of continued face to face contact and inpatient admission across all diagnoses. CONCLUSIONS Indigenous differences in schizophrenia and affective psychosis diagnoses could be related to differential exposure to socio-environmental risk or assessor bias. The lower rate of co-morbid affective and anxiety disorders indicates a potential under-appreciation of affective symptoms in Māori youth with first episode psychosis.
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Affiliation(s)
- Gawen Carr
- Capital and Coast District Health Board, Wellington, New Zealand
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Ruth Cunningham
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Frederieke S Petrović-van der Deen
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
- Department of Māori/Indigenous Health Innovation (MIHI), University of Otago Christchurch, Christchurch, New Zealand
| | - Jenni Manuel
- Department of Māori/Indigenous Health Innovation (MIHI), University of Otago Christchurch, Christchurch, New Zealand
| | - Sheree Gibb
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand
- Canterbury District Health Board, Christchurch, New Zealand
| | - Suzanne Pitama
- Department of Māori/Indigenous Health Innovation (MIHI), University of Otago Christchurch, Christchurch, New Zealand
| | - Marie Crowe
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Sue Crengle
- Department of Preventive and Social Medicine, University of Otago, Dunedin School of Medicine, Dunedin, New Zealand
| | - Cameron Lacey
- Department of Māori/Indigenous Health Innovation (MIHI), University of Otago Christchurch, Christchurch, New Zealand
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand
- Canterbury District Health Board, Christchurch, New Zealand
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28
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Selten JP, Ormel J. Low status, humiliation, dopamine and risk of schizophrenia. Psychol Med 2023; 53:609-613. [PMID: 36695070 PMCID: PMC9976000 DOI: 10.1017/s0033291722003816] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/28/2022] [Accepted: 12/01/2022] [Indexed: 01/26/2023]
Abstract
The social defeat hypothesis of schizophrenia, which proposes that the chronic experience of outsider status or subordinate position leads to increased striatal dopamine activity and thereby to increased risk, has been criticized. The aims of this paper are to improve the definition of defeat and to integrate the social defeat hypothesis with the neurodevelopmental hypothesis. Marmot advanced the idea that low status is pathogenic in that it is associated with a lack of social participation and a lack of autonomy. Given the similarity with outsider status and subordinate position, we re-define social defeat as low status. From this new perspective it is also likely that pre-schizophrenic impairments (of neurodevelopmental origin or not) are pathogenic in that they contribute to low status. The effect of low status may be enhanced by repeated exposure to humiliation, but few studies have measured this variable. Since most individuals exposed to low status do not develop schizophrenia, we propose that this risk factor increases the risk of disorder in the presence of a poor homeostatic control of dopamine neurons in midbrain and dorsal striatum. This is consistent with studies of healthy subjects which report a negative association between low socio-economic status and dopamine D2/D3 receptor availability in the dorsal striatum. In this new version of the social defeat hypothesis we propose that the combination of low status, repeated humiliation and poor homeostatic control of dopamine neurons in midbrain and dorsal striatum leads to increased striatal dopamine activity and thereby to an increased risk of schizophrenia.
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Affiliation(s)
- Jean Paul Selten
- University of Maastricht, School for Mental Health and Neuroscience, Maastricht, The Netherlands
- Rivierduinen Institute for Mental Health Care, Leiden, The Netherlands
| | - Johan Ormel
- Department of Psychiatry, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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29
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McBride O, Duncan C, Twigg L, Keown P, Bhui K, Scott J, Parsons H, Crepaz-Keay D, Cyhlarova E, Weich S. Effects of ethnic density on the risk of compulsory psychiatric admission for individuals attending secondary care mental health services: evidence from a large-scale study in England. Psychol Med 2023; 53:458-467. [PMID: 34011424 PMCID: PMC9899561 DOI: 10.1017/s0033291721001768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 04/17/2021] [Accepted: 04/21/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Black, Asian and minority ethnicity groups may experience better health outcomes when living in areas of high own-group ethnic density - the so-called 'ethnic density' hypothesis. We tested this hypothesis for the treatment outcome of compulsory admission. METHODS Data from the 2010-2011 Mental Health Minimum Dataset (N = 1 053 617) was linked to the 2011 Census and 2010 Index of Multiple Deprivation. Own-group ethnic density was calculated by dividing the number of residents per ethnic group for each lower layer super output area (LSOA) in the Census by the LSOA total population. Multilevel modelling estimated the effect of own-group ethnic density on the risk of compulsory admission by ethnic group (White British, White other, Black, Asian and mixed), accounting for patient characteristics (age and gender), area-level deprivation and population density. RESULTS Asian and White British patients experienced a reduced risk of compulsory admission when living in the areas of high own-group ethnic density [odds ratios (OR) 0.97, 95% credible interval (CI) 0.95-0.99 and 0.94, 95% CI 0.93-0.95, respectively], whereas White minority patients were at increased risk when living in neighbourhoods of higher own-group ethnic concentration (OR 1.18, 95% CI 1.11-1.26). Higher levels of own-group ethnic density were associated with an increased risk of compulsory admission for mixed-ethnicity patients, but only when deprivation and population density were excluded from the model. Neighbourhood-level concentration of own-group ethnicity for Black patients did not influence the risk of compulsory admission. CONCLUSIONS We found only minimal support for the ethnic density hypothesis for the treatment outcome of compulsory admission to under the Mental Health Act.
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Affiliation(s)
| | | | - Liz Twigg
- University of Portsmouth, Portsmouth, UK
| | - Patrick Keown
- Academic Psychiatry Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Kamaldeep Bhui
- Department of Psychiatry, University of Oxford, Oxford, UK
- The World Psychiatric Associations UK Collaborating Centre, London, UK
| | - Jan Scott
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Helen Parsons
- Warwick Medical School Clinical Trials Unit, University of Warwick, Coventry, UK
| | | | - Eva Cyhlarova
- London School of Economics and Political Science, London, UK
| | - Scott Weich
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Ermansons G, Kienzler H, Asif Z, Schofield P. Refugee mental health and the role of place in the Global North countries: A scoping review. Health Place 2023; 79:102964. [PMID: 36628805 DOI: 10.1016/j.healthplace.2023.102964] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 12/16/2022] [Accepted: 12/22/2022] [Indexed: 01/09/2023]
Abstract
Post-migration factors significantly influence refugee mental health. This scoping review looks at the role of place in refugee mental health. We included 34 studies in Global North high-income countries that elaborated on the place characteristics of facilities, neighbourhoods, urban and rural areas, and countries. While the role of place remains under-theorised, all studies reveal common characteristics that support a strong relationship between place of residence, refugee mental health and wellbeing outcomes in post-migration context. Given that refugees often have little or no choice of where they ultimately live, we suggest future research should focus on how characteristics of place co-constitute post-migration refugee mental health risks, protections, and outcomes.
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Affiliation(s)
- Guntars Ermansons
- Department of Global Health & Social Medicine, School of Global Affairs, King's College London, 40 Aldwych, Bush House (NE), London, WC2B 4BG, UK.
| | - Hanna Kienzler
- Department of Global Health & Social Medicine, School of Global Affairs, King's College London, 40 Aldwych, Bush House (NE), London, WC2B 4BG, UK.
| | - Zara Asif
- Department of Global Health & Social Medicine, School of Global Affairs, King's College London, 40 Aldwych, Bush House (NE), London, WC2B 4BG, UK.
| | - Peter Schofield
- Department of Population Health Sciences, School of Life Course & Population Sciences, King's College London, 3rd Floor, Addison House, Guy's Campus, London, SE1 1UL, UK.
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Positiv psychotische Symptome in Kindheit und Jugend. Prax Kinderpsychol Kinderpsychiatr 2022; 71:640-657. [DOI: 10.13109/prkk.2022.71.7.640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Barbato M, Liu L, Bearden CE, Cadenhead KS, Cornblatt BA, Keshavan M, Mathalon DH, McGlashan TH, Perkins DO, Seidman LJ, Stone W, Tsuang MT, Walker EF, Woods SW, Cannon TD, Addington J. Migrant status, clinical symptoms and functional outcome in youth at clinical high risk for psychosis: findings from the NAPLS-3 study. Soc Psychiatry Psychiatr Epidemiol 2022; 58:559-568. [PMID: 36348056 DOI: 10.1007/s00127-022-02383-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 10/28/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Migrant status is a known risk factor for psychosis, but the underlying causes of this vulnerability are poorly understood. Recently, studies have begun to explore whether migrant status predicts transition to psychosis in individuals at clinical high risk (CHR) for psychosis. Results, however, have been inconclusive. The present study assessed the impact of migrant status on clinical symptoms and functional outcome in individuals at CHR for psychosis who took part in the NAPLS-3 study. METHODS Participants' migrant status was classified as native-born, first-generation, or second-generation migrant. Clinical symptoms were assessed using the Structured Interview for Psychosis-Risk Syndromes (SIPS); functional outcome was measured using the Global Functioning Scales:Social and Role (GF:S; GF:R). Assessments were conducted at baseline, 12-months, 18-months, and 24-months follow-up. Generalized linear mixed models for repeated measures were used to examine changes over time and differences between groups. RESULTS The overall sample included 710 individuals at CHR for psychosis (54.2% males; Age: M = 18.19; SD = 4.04). A mixed model analysis was conducted, and no significant differences between groups in symptoms or functioning were observed at any time point. Over time, significant improvement in symptoms and functioning was observed within each group. Transition rates did not differ across groups. CONCLUSION We discuss potential factors that might explain the lack of group differences. Overall, migrants are a heterogeneous population. Discerning the impact of migration from that of neighborhood ethnic density, social disadvantage or socio-economic status of different ethnic groups could help better understand vulnerability and resilience to psychosis.
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Affiliation(s)
- Mariapaola Barbato
- Department of Psychology, College of Natural and Health Sciences, Zayed University, Dubai, UAE
| | - Lu Liu
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Carrie E Bearden
- Departments of Psychiatry and Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
| | | | | | - Matcheri Keshavan
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, USA
| | - Daniel H Mathalon
- Department of Psychiatry, UCSF, and SFVA Medical Center, San Francisco, CA, USA
| | | | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Larry J Seidman
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, USA
| | - William Stone
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, USA
| | - Ming T Tsuang
- Department of Psychiatry, UCSD, San Diego, CA, USA
- Institute of Genomic Medicine, University of California, La Jolla, CA, USA
| | - Elaine F Walker
- Departments of Psychology and Psychiatry, Emory University, Atlanta, GA, USA
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Tyrone D Cannon
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
- Mathison Centre for Mental Health Research & Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
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The Mental Health of Young Return Migrants with Ancestral Roots in Their Destination Country: A Cross-Sectional Study Focusing on the Ethnic Identities of Japanese-Brazilian High School Students Living in Japan. J Pers Med 2022; 12:jpm12111858. [PMID: 36579606 PMCID: PMC9694424 DOI: 10.3390/jpm12111858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/25/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The number of young Japanese Brazilians, who are return migrants with Japanese ancestral roots, is increasing rapidly in Japan. However, the characteristics of their mental health and the relation between mental health and a complex ethnic identity remains unclear. METHODS This cross-sectional study compared 25 Japanese-Brazilian high school students with 62 Japanese high school students living in the same area. Research using self-report questionnaires on mental health, help-seeking behavior tendencies, and ethnic identity was conducted. The Japanese-Brazilian group was also divided into high and low ethnic identity groups, and their mental health conditions were compared. RESULTS The Japanese-Brazilian group had significantly poorer mental health conditions and lower ethnic identities than the Japanese group and were less likely to seek help from family members and close relatives. Among the Japanese Brazilians, those with low ethnic identity had significantly poorer mental health than those with high ethnic identity. CONCLUSIONS Young Japanese Brazilians may face conflicts of ethnic identity that can disturb their mental health. To build an inclusive society, the establishment of community services to support mental health and to help return migrants develop their ethnic identity is essential.
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Carvalho LDA, Andrade LH, Ang PL, Santana CLAD, Lotufo Neto F, Biazoli Junior CE. Perspectives on a psychiatric outpatient service for immigrants and refugees in São Paulo, Brazil over a 15-year period. Int J Soc Psychiatry 2022; 68:1418-1427. [PMID: 34151631 DOI: 10.1177/00207640211027207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Immigrants and refugees have specific mental health needs. Studies of immigrant/refugee psychiatric patients in Latin America are scarce. AIMS Present the profile of patients from an outpatient psychiatric service in Sao Paulo (Brazil) to better inform mental health service planning for immigrants and refugees in the Global South. METHODS Exploratory study to characterize the sociodemographic and mental health profile of refugees and immigrants attending outpatient psychiatric service from 2003 to 2018. Chi-square tests and logistic regressions were used to examine the association of demographic variables, exposure to violence, and immigrant status with psychiatric diagnosis. Cluster analysis was used to identify subgroups within the sample. RESULTS A total of 162 immigrants and refugees referred to the service obtained treatment. Of these patients, 57.4% were men, 59.8% were refugees/asylum seekers, 51.9% were Black, 48.8% were single, 64.2% had 10 years of education, and 57.4% were unemployed; the mean age of the sample was 35.9. Half of the sample (52.5%) was exposed to violence. The most common diagnosis was depression (54.2%), followed by PTSD (16.6%). Approximately 34% of the participants sought psychiatric care within 6 months of arrival. Logistic regressions showed that men had lower odds of presenting with depression (OR = 0.34). Patients with PTSD were more likely to be refugees (OR = 3.9) and not have a university degree (OR = 3.1).In the cluster analysis, a cluster of patients with PTSD included almost all Black refugee men exposed to violence. Most patients diagnosed with psychotic disorders were also Black refugee men. CONCLUSION Immigrants and refugees represent a vulnerable group. The majority of the sample was Black, refugee men, who were also more likely to present with PTSD. Future studies are needed to better understand issues in treatment adherence in relation to socioeconomic characteristics.
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Affiliation(s)
- Luciana de Andrade Carvalho
- Programa de Psiquiatria Social e Cultural (ProSol), Institute of Psychiatry - Hospital das Clínicas - University of São Paulo, Brazil
| | - Laura Helena Andrade
- Núcleo de Epidemiologia Psiquiátrica (NEP), Institute of Psychiatry - Hospital das Clínicas - University of São Paulo, Brazil
| | - Patrícia Lin Ang
- Programa de Psiquiatria Social e Cultural (ProSol), Institute of Psychiatry - Hospital das Clínicas - University of São Paulo, Brazil
| | | | - Francisco Lotufo Neto
- Programa de Psiquiatria Social e Cultural (ProSol), Institute of Psychiatry - Hospital das Clínicas - University of São Paulo, Brazil
| | - Claudinei Eduardo Biazoli Junior
- Programa de Psiquiatria Social e Cultural (ProSol), Institute of Psychiatry - Hospital das Clínicas - University of São Paulo, Brazil.,Center of Mathematics, Computing and Cognition - Federal University of ABC, Brazil.,Department of Biological and Experimental Psychology, Queen Mary University of London, UK
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Johnson KA, Shrier LA, Eiduson R, Parsa N, Lilly M, D'Angelo E, Straus JH, Woodberry KA. Depressive symptom screening and endorsement of psychosis risk-related experiences in a diverse adolescent and young adult outpatient clinic in the US. Schizophr Res 2022; 248:353-360. [PMID: 34840005 DOI: 10.1016/j.schres.2021.11.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 11/05/2021] [Accepted: 11/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Early identification and intervention is a gold standard for psychotic disorders, for which delays in care can have serious consequences. Screening for psychosis in primary care may circumvent barriers related to stigma and facilitate shorter pathways to care. Yet, there is debate regarding the benefit-risk balance for psychosis screening in general adolescent populations. METHODS Primary care patients of an adolescent/young adult medical clinic in the US ages 14-21 self-administered surveys assessing age, sex, receipt of psychotherapy, and occurrence, frequency (1-5), and distress (0-3) for 23 psychosis risk (PR) symptoms, including 6 general/nonspecific items and 17 psychosis-specific items. Participants also completed the 9-item Patient Health Questionnaire (PHQ-9); scores of ≥10 suggested clinically significant depressive symptoms. Analyses characterized PR symptoms and examined associations of PR symptom distress with current therapy and depressive symptom severity. RESULTS Of 212 patients who completed the survey, 75% endorsed ≥1 PR symptom and 27% rated ≥3 on distress for psychosis-specific items. Those with high PHQ-9 scores reported higher PR distress overall (t = -6.1, df = 52.3, p < 0.001) but not on psychosis-specific items such as hallucinations and suspiciousness. One in 9 participants reported heightened PR distress without being in therapy or having high depressive symptoms. CONCLUSIONS Most adolescents in this primary care sample endorsed symptoms associated with PR. Distress related to these symptoms was less common but occurred even in the absence of depressive symptoms. PR screening only in youth with high depressive symptom screens or in mental health care may miss youth needing further assessment for psychosis.
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Affiliation(s)
- Kelsey A Johnson
- Beth Israel Deaconess Medical Center Department of Psychiatry, Boston, MA, USA; Boston Children's Hospital, Boston, MA, USA.
| | - Lydia A Shrier
- Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | | | - Megan Lilly
- Beth Israel Deaconess Medical Center Department of Psychiatry, Boston, MA, USA
| | - Eugene D'Angelo
- Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - John H Straus
- Massachusetts Behavioral Health Partnership, Beacon Health Options, Boston, MA, USA
| | - Kristen A Woodberry
- Beth Israel Deaconess Medical Center Department of Psychiatry, Boston, MA, USA; Maine Medical Center, Center for Psychiatric Research, Portland, ME, USA; Tufts School of Medicine, USA; Harvard Medical School, Boston, MA, USA
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Tarricone I, D'Andrea G, Jongsma HE, Tosato S, Gayer-Anderson C, Stilo SA, Suprani F, Iyegbe C, van der Ven E, Quattrone D, di Forti M, Velthorst E, Rossi Menezes P, Arango C, Parellada M, Lasalvia A, La Cascia C, Ferraro L, Bobes J, Bernardo M, Sanjuán I, Santos JL, Arrojo M, Del-Ben CM, Tripoli G, Llorca PM, de Haan L, Selten JP, Tortelli A, Szöke A, Muratori R, Rutten BP, van Os J, Jones PB, Kirkbride JB, Berardi D, Murray RM, Morgan C. Migration history and risk of psychosis: results from the multinational EU-GEI study. Psychol Med 2022; 52:2972-2984. [PMID: 33563347 PMCID: PMC9693676 DOI: 10.1017/s003329172000495x] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 11/18/2020] [Accepted: 11/25/2020] [Indexed: 01/05/2023]
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.
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Affiliation(s)
- Ilaria Tarricone
- Department of Medical and Surgical Sciences, Bologna Transcultural Psychosomatic Team (BoTPT), University of Bologna, Bologna, Italy
- Department of Mental Health and Pathological Addiction, Local Health Authority, Bologna, Italy
| | - Giuseppe D'Andrea
- Department of Medical and Surgical Sciences, Bologna Transcultural Psychosomatic Team (BoTPT), University of Bologna, Bologna, Italy
- Department of Biomedical and NeuroMotor Sciences, Psychiatry Unit, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Hannah E. Jongsma
- PsyLife Group, Division of Psychiatry, UCL, London, England
- Department of Psychiatry, University of Cambridge, Cambridge, England
| | - Sarah Tosato
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Charlotte Gayer-Anderson
- Department of Health Service and Population Research, Institute of Psychiatry, King's College London, London, UK
| | - Simona A. Stilo
- Department of Mental Health and Addiction Services, ASP Crotone, Crotone, Italy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
| | - Federico Suprani
- Department of Medical and Surgical Sciences, Bologna Transcultural Psychosomatic Team (BoTPT), University of Bologna, Bologna, Italy
| | - Conrad Iyegbe
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
| | - Els van der Ven
- Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Diego Quattrone
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Marta di Forti
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Eva Velthorst
- Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Paulo Rossi Menezes
- University Hospital, Section of Epidemiology, University of São Paulo, São Paulo, Brazil
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Mara Parellada
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Antonio Lasalvia
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Caterina La Cascia
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Via G. La Loggia 1, 90129, Palermo, Italy
| | - Laura Ferraro
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Via G. La Loggia 1, 90129, Palermo, Italy
| | - Julio Bobes
- Department of Medicine, Psychiatry Area, School of Medicine, Universidad de Oviedo, Centro de Investigación Biomédica en Red de Salud Mental, Oviedo, Spain
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Department of Medicine, Neuroscience Institute, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain
| | - Iulio Sanjuán
- Department of Psychiatry, School of Medicine, Universidad de Valencia, Centro de Investigación Biomédica en Red de Salud Mental, Valencia, Spain
| | - Jose Luis Santos
- Department of Psychiatry, Servicio de Psiquiatría Hospital ‘Virgen de la Luz’, Cuenca, Spain
| | - Manuel Arrojo
- Department of Psychiatry, Psychiatric Genetic Group, Instituto de Investigación Sanitaria de Santiago de Compostela, Complejo Hospitalario Universitario de Santiago de Compostela, Spain
| | - Cristina Marta Del-Ben
- Neuroscience and Behavior Department, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Giada Tripoli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
- Department of Biomedicine, neurosciences, and advanced diagnostics, University of Palermo, Italy
| | | | - Lieuwe de Haan
- Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Jean-Paul Selten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Andrei Szöke
- Univ Paris Est Creteil (UPEC), AP-HP, Hôpitaux Universitaires « H. Mondor », DMU IMPACT, INSERM, IMRB, Fondation FondaMental, F-94010 Creteil, France
| | - Roberto Muratori
- Department of Mental Health and Pathological Addiction, Local Health Authority, Bologna, Italy
| | - Bart P. Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Psychiatry, Brain Center Rudolf Magnus, Utrecht University Medical Centre, Utrecht, The Netherlands
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, England
- CAMEO Early Intervention Service, Cambridgeshire and Peterborough National Health Service Foundation Trust, Cambridge, England
| | | | - Domenico Berardi
- Department of Biomedical and NeuroMotor Sciences, Psychiatry Unit, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Robin M. Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
| | - Craig Morgan
- Department of Health Service and Population Research, Institute of Psychiatry, King's College London, London, UK
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Manuel J, Cunningham R, Gibb S, Petrović-van der Deen FS, Porter RJ, Pitama S, Crowe M, Crengle S, Carr G, Lacey C. Non-Indigenous privilege in health, justice and social services preceding first episode psychosis: A population-based cohort study. Aust N Z J Psychiatry 2022; 57:834-843. [PMID: 36002996 DOI: 10.1177/00048674221119964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is evidence of disparities between non-Indigenous and Indigenous incidence of psychotic disorders. Despite these disparities being a clear signpost of the impact of structural racism, there remains a lack of evidence to target institutional factors. We aimed to investigate non-Indigenous and Indigenous differences in government service use prior to first episode diagnosis as a means of identifying points of intervention to improve institutional responses. METHODS We used a previously established national New Zealand cohort of 2385 13 to 25-year-old youth diagnosed with psychosis between 2009 and 2012 and a linked database of individual-level multiple government agency administration data, to investigate the differences in health, education, employment, child protection and criminal-justice service use between non-Indigenous (60%) and Indigenous youth (40%) in the year preceding first episode diagnosis. Further comparisons were made with the general population. RESULTS A high rate of health service contact did not differ between non-Indigenous and Indigenous youth (adjusted rate ratio 1.0, 95% confidence interval [0.9, 1.1]). Non-Indigenous youth had higher rates of educational enrolment (adjusted rate ratio 1.2, 95% confidence interval [1.1, 1.3]) and employment (adjusted rate ratio 1.2, 95% confidence interval [1.1, 1.3]) and were 40% less likely to have contact with child protection services (adjusted rate ratio 0.6, 95% confidence interval [0.5, 0.8]) and the criminal-justice system (adjusted rate ratio 0.6, 95% confidence interval [0.5, 0.7]). Both first episode cohorts had a higher risk of criminal justice contact compared to the general population, but the difference was greater for non-Indigenous youth (risk ratio 3.0, 95% confidence interval [2.7, 3.4] vs risk ratio 2.0, 95% confidence interval [1.8, 2.2]), explained by the lower background risk. INTERPRETATION The results indicate non-Indigenous privilege in multiple sectors prior to first episode diagnosis. Indigenous-based social disparities prior to first episode psychosis are likely to cause further inequities in recovery and will require a response of health, education, employment, justice and political systems.
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Affiliation(s)
- Jenni Manuel
- Department of Māori/Indigenous Health Innovation (MIHI), University of Otago, Christchurch, Christchurch, New Zealand
| | - Ruth Cunningham
- Department of Public Health, University of Otago, Wellington, Wellington, New Zealand
| | - Sheree Gibb
- Department of Public Health, University of Otago, Wellington, Wellington, New Zealand
| | - Frederieke S Petrović-van der Deen
- Department of Māori/Indigenous Health Innovation (MIHI), University of Otago, Christchurch, Christchurch, New Zealand.,Department of Public Health, University of Otago, Wellington, Wellington, New Zealand
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand.,Department of Specialist Mental Health Service, Canterbury District Health Board, Christchurch, New Zealand
| | - Suzanne Pitama
- Department of Māori/Indigenous Health Innovation (MIHI), University of Otago, Christchurch, Christchurch, New Zealand
| | - Marie Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Sue Crengle
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Gawen Carr
- Department of Specialist Mental Health Service, Capital and Coast District Health Board, Wellington, New Zealand
| | - Cameron Lacey
- Department of Māori/Indigenous Health Innovation (MIHI), University of Otago, Christchurch, Christchurch, New Zealand.,Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand.,Department of Specialist Mental Health Service, Canterbury District Health Board, Christchurch, New Zealand
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Fonseca de Freitas D, Pritchard M, Shetty H, Khondoker M, Nazroo J, Hayes RD, Bhui K. Ethnic inequities in multimorbidity among people with psychosis: a retrospective cohort study. Epidemiol Psychiatr Sci 2022; 31:e52. [PMID: 35844106 PMCID: PMC9305726 DOI: 10.1017/s2045796022000385] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/16/2022] [Accepted: 06/16/2022] [Indexed: 11/16/2022] Open
Abstract
AIMS Research shows persistent ethnic inequities in mental health experiences and outcomes, with a higher incidence of illnesses among minoritised ethnic groups. People with psychosis have an increased risk of multiple long-term conditions (MLTC; multimorbidity). However, there is limited research regarding ethnic inequities in multimorbidity in people with psychosis. This study investigates ethnic inequities in physical health multimorbidity in a cohort of people with psychosis. METHODS In this retrospective cohort study, using the Clinical Records Interactive Search (CRIS) system, we identified service-users of the South London and Maudsley NHS Trust with a schizophrenia spectrum disorder, and then additional diagnoses of diabetes, hypertension, low blood pressure, overweight or obesity and rheumatoid arthritis. Logistic and multinomial logistic regressions were used to investigate ethnic inequities in odds of multimorbidity (psychosis plus one physical health condition), and multimorbidity severity (having one or two physical health conditions, or three or more conditions), compared with no additional health conditions (no multimorbidity), respectively. The regression models adjusted for age and duration of care and investigated the influence of gender and area-level deprivation. RESULTS On a sample of 20 800 service-users with psychosis, aged 13-65, ethnic differences were observed in the odds for multimorbidity. Controlling for sociodemographic factors and duration of care, compared to White British people, higher odds of multimorbidity were found for people of Black African [adjusted Odds Ratio = 1.41, 95% Confidence Intervals (1.23-1.56)], Black Caribbean [aOR = 1.79, 95% CI (1.58-2.03)] and Black British [aOR = 1.64, 95% CI (1.49-1.81)] ethnicity. Reduced odds were observed among people of Chinese [aOR = 0.61, 95% CI (0.43-0.88)] and Other ethnic [aOR = 0.67, 95% CI (0.59-0.76)] backgrounds. Increased odds of severe multimorbidity (three or more physical health conditions) were also observed for people of any Black background. CONCLUSIONS Ethnic inequities are observed for multimorbidity among people with psychosis. Further research is needed to understand the aetiology and impact of these inequities. These findings support the provision of integrated health care interventions and public health preventive policies and actions.
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Affiliation(s)
- D. Fonseca de Freitas
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - M. Pritchard
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Biomedical Research Centre Nucleus, South London and Maudsley NHS Foundation Trust, London, UK
| | - H. Shetty
- Biomedical Research Centre Nucleus, South London and Maudsley NHS Foundation Trust, London, UK
| | - M. Khondoker
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - J. Nazroo
- Sociology, School of Social Sciences, University of Manchester, Manchester, UK
| | - R. D. Hayes
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - K. Bhui
- Department of Psychiatry, University of Oxford, Oxford, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Termorshuizen F, van der Ven E, Tarricone I, Jongsma HE, Gayer-Anderson C, Lasalvia A, Tosato S, Quattrone D, La Cascia C, Szöke A, Berardi D, Llorca PM, de Haan L, Velthorst E, Bernardo M, Sanjuán J, Arrojo M, Murray RM, Rutten BP, Jones PB, van Os J, Kirkbride JB, Morgan C, Selten JP. The incidence of psychotic disorders among migrants and minority ethnic groups in Europe: findings from the multinational EU-GEI study. Psychol Med 2022; 52:1376-1385. [PMID: 32958094 PMCID: PMC9157293 DOI: 10.1017/s0033291720003219] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/03/2020] [Accepted: 08/17/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND In Europe, the incidence of psychotic disorder is high in certain migrant and minority ethnic groups (hence: 'minorities'). However, it is unknown how the incidence pattern for these groups varies within this continent. Our objective was to compare, across sites in France, Italy, Spain, the UK and the Netherlands, the incidence rates for minorities and the incidence rate ratios (IRRs, minorities v. the local reference population). METHODS The European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) study was conducted between 2010 and 2015. We analyzed data on incident cases of non-organic psychosis (International Classification of Diseases, 10th edition, codes F20-F33) from 13 sites. RESULTS The standardized incidence rates for minorities, combined into one category, varied from 12.2 in Valencia to 82.5 per 100 000 in Paris. These rates were generally high at sites with high rates for the reference population, and low at sites with low rates for the reference population. IRRs for minorities (combined into one category) varied from 0.70 (95% CI 0.32-1.53) in Valencia to 2.47 (95% CI 1.66-3.69) in Paris (test for interaction: p = 0.031). At most sites, IRRs were higher for persons from non-Western countries than for those from Western countries, with the highest IRRs for individuals from sub-Saharan Africa (adjusted IRR = 3.23, 95% CI 2.66-3.93). CONCLUSIONS Incidence rates vary by region of origin, region of destination and their combination. This suggests that they are strongly influenced by the social context.
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Affiliation(s)
- Fabian Termorshuizen
- Rivierduinen Institute for Mental Health Care, Sandifortdreef 19, 2333 ZZ Leiden, The Netherlands
| | - Els van der Ven
- Mailman School of Public Health, Columbia University, New York City, USA
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Ilaria Tarricone
- Department of Medical and Surgical Science, Bologna Transcultural Psychosomatic Team (BoTPT), Alma Mater Studiorum Università di Bologna, Viale Pepoli 5, 40126 Bologna, Italy
- Department of Biomedical and Neuro-motor Sciences, Psychiatry Unit, Alma Mater Studiorum Università di Bologna, 40126 Bologna, Italy
| | - Hannah E. Jongsma
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain & Mind Sciences, Forvie Site, Robinson Way, Cambridge, CB2 0SZ, UK
- Psylife Group, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Charlotte Gayer-Anderson
- Department of Health Service and Population Research, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, SE5 8AF, London, UK
| | - Antonio Lasalvia
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Sarah Tosato
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Diego Quattrone
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill SE5 8AF, London, UK
| | - Caterina La Cascia
- Unit of Psychiatry, “P. Giaccone” General Hospital, Via G. La Loggia n.1, 90129 Palermo, Italy
| | - Andrei Szöke
- INSERM, U955, Equipe 15, 51 Avenue de Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Domenico Berardi
- Department of Biomedical and Neuro-motor Sciences, Psychiatry Unit, Alma Mater Studiorum Università di Bologna, 40126 Bologna, Italy
| | - Pierre-Michel Llorca
- CMPB CHU Clermont-Ferrand, EA 7280, University Clermont Auvergne, Clermont-Ferrand, France
| | - Lieuwe de Haan
- Department of Psychiatry, Early Psychosis Section, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands
| | - Eva Velthorst
- Department of Psychiatry and Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain
- Department of Medicine, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Julio Sanjuán
- Department of Psychiatry, School of Medicine, Universidad de Valencia, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), C/Avda. Blasco Ibáñez 15, 46010 Valencia, Spain
| | - Manuel Arrojo
- Department of Psychiatry, Psychiatry Genetic Group, Instituto de Investigación Sanitaria de Santiago de Compostela, Complejo Hospitalario Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Spain
| | - Robin M. Murray
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill SE5 8AF, London, UK
| | - Bart P. Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain & Mind Sciences, Forvie Site, Robinson Way, Cambridge, CB2 0SZ, UK
- CAMEO Early Intervention Service, Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, CB21 5EF, UK
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill SE5 8AF, London, UK
- Department Psychiatry, Brain Center Rudolf Magnus, Utrecht University Medical Centre, Utrecht, The Netherlands
| | - James B. Kirkbride
- Psylife Group, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Craig Morgan
- Department of Health Service and Population Research, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, SE5 8AF, London, UK
| | - Jean-Paul Selten
- Rivierduinen Institute for Mental Health Care, Sandifortdreef 19, 2333 ZZ Leiden, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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Misra S, Etkins OS, Yang LH, Williams DR. Structural Racism and Inequities in Incidence, Course of Illness, and Treatment of Psychotic Disorders Among Black Americans. Am J Public Health 2022; 112:624-632. [PMID: 35319958 PMCID: PMC8961835 DOI: 10.2105/ajph.2021.306631] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 11/04/2022]
Abstract
Psychotic disorders (e.g., schizophrenia, schizoaffective disorder) are a leading cause of morbidity and premature mortality and an overlooked health inequity in the United States. European data indicate inequities in incidence, severity, and treatment of psychotic disorders, particularly for Black communities, that appear to be primarily attributable to social adversities. The dominant US narrative is that any observed differences are primarily a result of clinician bias and misdiagnosis. We propose that employing the framework of structural racism will prompt European and US research to converge and consider the multifaceted drivers of inequities in psychotic disorders among Black Americans. In particular, we describe how historical and contemporary practices of (1) racialized policing and incarceration, and (2) economic exploitation and disinvestment, which are already linked to other psychiatric disorders, likely contribute to risks and experiences of psychotic disorders among Black Americans. This framework can inform new strategies to (1) document the role of racism in the incidence, severity, and treatment of psychotic disorders; and (2) dismantle how racism operates in the United States, including defunding the police, abolishing carceral systems, and redirecting funds to invest in neighborhoods, housing, and community-based crisis response and mental health care. (Am J Public Health. 2022;112(4):624-632. https://doi.org/10.2105/AJPH.2021.306631).
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Affiliation(s)
- Supriya Misra
- Supriya Misra is with the Department of Public Health, San Francisco State University, San Francisco, CA. Onisha S. Etkins and David R. Williams are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY
| | - Onisha S Etkins
- Supriya Misra is with the Department of Public Health, San Francisco State University, San Francisco, CA. Onisha S. Etkins and David R. Williams are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY
| | - Lawrence H Yang
- Supriya Misra is with the Department of Public Health, San Francisco State University, San Francisco, CA. Onisha S. Etkins and David R. Williams are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY
| | - David R Williams
- Supriya Misra is with the Department of Public Health, San Francisco State University, San Francisco, CA. Onisha S. Etkins and David R. Williams are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY
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Mooney R, Newbigging K, McCabe R, McCrone P, Halvorsrud K, Raghavan R, Joseph D, Bhui K. Experience-based investigation and codesign of approaches to prevent and reduce Mental Health Act use (CO-PACT): a protocol. BMJ Open 2022; 12:e060086. [PMID: 35131837 PMCID: PMC8823141 DOI: 10.1136/bmjopen-2021-060086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION The Independent Review of the Mental Health Act (MHA) in England and Wales confirmed increasing levels of compulsory detentions, especially for racialised communities. This research aims to: (a) understand the causes of and propose preventive opportunities to reduce the disproportionate use of the MHA, (b) use an adapted form of experience-based codesign (EBCD) to facilitate system-wide changes and (c) foreground the voices of service users at risk of detention to radically reform policy and implement new legislation to ensure the principles of equity are retained. METHODS AND ANALYSIS This is a qualitative study, using a comparative case study design. This study is composed of five work packages; photovoice workshops will be conducted in eight local systems with service users and healthcare professionals separately (WP1); a series of three EBCD workshops in each local system to develop approaches that reduce detentions and improve the experience of people from racialised communities. This will inform a comparative analysis and national knowledge exchange workshop (WP2); an evaluation led by the patient and public involvement group to better understand what it is like for people to participate in photovoice, codesign and participatory research (WP3); an economic evaluation (WP4) and dissemination strategy (WP5). The impact of the involvement of patients and public will be independently evaluated. ETHICS AND DISSEMINATION This study is sponsored by the University of Oxford and granted ethical approval from the NHS Research Ethics Committee and Health Research Authority (21/SC/0204). The outputs from this study will be shared through several local and national channels.
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Affiliation(s)
- Roisin Mooney
- CHiMES Collborative, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Karen Newbigging
- CHiMES Collborative, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Rose McCabe
- School of Health Sciences, City University of London, London, UK
| | - Paul McCrone
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Kristoffer Halvorsrud
- NIHR ARC North Thames, Department of Applied Health Research, University College London, London, UK
| | - Raghu Raghavan
- School of Nursing and Midwifery, De Montfort University, Leicester, UK
| | - Doreen Joseph
- CHiMES Collborative, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Kamaldeep Bhui
- CHiMES Collborative, Department of Psychiatry, University of Oxford, Oxford, UK
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He Y, Gu Y, Wang S, Li Y, Li G, Hu Z. Migration, Schizophrenia, and Crime: A Study From a Forensic Psychiatric Sample. Front Psychiatry 2022; 13:869978. [PMID: 35599762 PMCID: PMC9120637 DOI: 10.3389/fpsyt.2022.869978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 04/13/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The association between mental health problems and crime in immigrants has attracted recent academic interest, with results suggesting that there were possible interactions between immigration, schizophrenia, and criminal behavior. However, very few studies have examined these interactions, especially in developing countries that have mass internal immigration. Therefore, this study sought to identify the associations between the sociodemographic, clinical, and criminal factors in migrants and non-migrants with schizophrenia who had been involved in criminal activities in China. METHODS Forensic archives of suspects who had been referred for criminal responsibility assessments in the Sichuan West China Forensic Center from January 2015 to December 2019 were reviewed. The sociodemographic, and criminal activity information of the suspects were extracted, while the clinical and social function were measured by the Brief Psychiatric Rating Scale (BPRS) and Social Disability Screening Schedule (SDSS) based on the archives. A Chi-squared test, a T-test, a Mann-Whitney U test, and Multinomial logistic regression were employed for the statistical analysis. RESULTS A total of 552 patients were reviewed and evaluated, 17.2% (n = 95) of which were migrants. The migrant patient group was younger than the non-migrant patient group. The BPRS and SDSS scores for the migrant patient group were lower than for the non-migrant patient group. The migrant patient group had more work experience and more had been employed at the time of the crime than the non-migrant patient group. The unemployed migrant patients were more likely to commit a property-related crime. CONCLUSIONS Compared to the non-migrant schizophrenia patient group, the migrant patient group had less severe psychiatric symptoms and less social function impairments. Employment was an important factor in preventing criminality in patients with schizophrenia, especially for migrant patients. Vocational rehabilitation focuses on developing appropriate employment that can significantly assist in schizophrenia patient recovery, which in turn could reduce their chances of committing crime. Besides, reducing other obstacles to stigma, housing and health insurance would also be beneficial to crime reduction.
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Affiliation(s)
- Yong He
- Department of Forensic Psychiatry, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Sichuan, China
| | - Yan Gu
- Department of Forensic Psychiatry, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Sichuan, China
| | - Shujian Wang
- Shanghai Key Laboratory of Forensic Medicine, Key Lab of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, China
| | - Yan Li
- Department of Forensic Psychiatry, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Sichuan, China
| | - Gangqin Li
- Department of Forensic Psychiatry, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Sichuan, China
| | - Zeqing Hu
- Department of Forensic Psychiatry, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Sichuan, China
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Schultze-Lutter F, Kindler J, Ambarini TK, Michel C. Positive psychotic symptoms in childhood and adolescence. Curr Opin Psychol 2021; 45:101287. [PMID: 35016089 DOI: 10.1016/j.copsyc.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 10/21/2021] [Accepted: 11/24/2021] [Indexed: 11/30/2022]
Abstract
Based on the assumption of a universal neurodevelopmental model of psychosis, especially of the schizophrenia spectrum, the diagnosis (and treatment) of psychosis in minors commonly follows those in adults. Yet, as our review demonstrates, recent years have seen an emergence of studies of minors indicating that developmental aspects may play a crucial role in the prevalence and appraisal of diagnostically relevant positive psychotic symptoms in their full-blown and subthreshold forms, including neurobiogenetic and other risk factors, such as migration. Thus, caution is advised to not overpathologize potentially transient and clinically irrelevant occurrence of (subthreshold) positive psychotic symptoms in the diagnosis and treatment of psychotic disorders and their clinical high-risk states in minors. More studies on developmental aspects are urgently needed.
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Affiliation(s)
- Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Bergische Landstraße 2, 40470 Düsseldorf, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstr, 111, 3000 Bern 60, Switzerland; Department of Psychology, Faculty of Psychology, Airlangga University, Airlangga 4-6, Surabaya 60286, Indonesia.
| | - Jochen Kindler
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstr, 111, 3000 Bern 60, Switzerland
| | - Tri Kurniati Ambarini
- Department of Psychology, Faculty of Psychology, Airlangga University, Airlangga 4-6, Surabaya 60286, Indonesia
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstr, 111, 3000 Bern 60, Switzerland
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Baker SJ, Jackson M, Jongsma H, Saville CWN. The ethnic density effect in psychosis: a systematic review and multilevel meta-analysis. Br J Psychiatry 2021; 219:632-643. [PMID: 35048877 PMCID: PMC8636614 DOI: 10.1192/bjp.2021.96] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND An 'ethnic' or 'group' density effect in psychosis has been observed, whereby the risk of psychosis in minority group individuals is inversely related to neighbourhood-level proportions of others belonging to the same group. However, there is conflicting evidence over whether this effect differs between minority groups and limited investigation into other moderators. AIMS To conduct a comprehensive systematic review and meta-analysis of the group density effect in psychosis and examine moderators. METHOD Four databases were systematically searched. A narrative review was conducted and a three-level meta-analysis was performed. The potential moderating effect of crudely and specifically defined minority groups was assessed. Country, time, area size and whether studies used clinical or non-clinical outcomes were also tested as moderators. RESULTS Thirty-two studies were included in the narrative review and ten in the meta-analysis. A 10 percentage-point decrease in own-group density was associated with a 20% increase in psychosis risk (OR = 1.20, 95% CI 1.09-1.32, P < 0.001). This was moderated by crudely defined minority groups (F6,68 = 6.86, P < 0.001), with the strongest associations observed in Black populations, followed by a White Other sample. Greater heterogeneity was observed when specific minority groups were assessed (F25,49 = 7.26, P < 0.001). CONCLUSIONS This is the first review to provide meta-analytic evidence that the risk of psychosis posed by lower own-group density varies across minority groups, with the strongest associations observed in Black individuals. Heterogeneity in effect sizes may reflect distinctive social experiences of specific minority groups. Potential mechanisms are discussed, along with the implications of findings and suggestions for future research.
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Affiliation(s)
- Sophie J. Baker
- School of Psychology, Bangor University, UK,Correspondence: Sophie J. Baker.
| | - Mike Jackson
- North Wales Clinical Psychology Programme, School of Psychology, Bangor University; and Betsi Cadwaladr University Health Board, Bangor, UK
| | - Hannah Jongsma
- Centre for Transcultural Psychiatry Veldzicht, Balkbrug; and Department of Psychiatry, University of Groningen; and University Medical Centre Groningen, The Netherlands
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Montemitro C, D’Andrea G, Cesa F, Martinotti G, Pettorruso M, Di Giannantonio M, Muratori R, Tarricone I. Language proficiency and mental disorders among migrants: A systematic review. Eur Psychiatry 2021; 64:e49. [PMID: 34315554 PMCID: PMC8390337 DOI: 10.1192/j.eurpsy.2021.2224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/15/2021] [Accepted: 07/13/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In this review, we aimed to evaluate the association between language proficiency (LP) and the prevalence and severity of mental disorders in migrants. Secondarily, we aimed to consider whether sociodemographic and migration-related factors may affect the correlation between LP and mental disorders. METHODS MEDLINE, PsycArticles, EMBASE, and PsycInfo were systematically searched in April 2020 to identify original studies reporting prevalence of psychiatric symptoms or disorders among migrants and taking into account linguistic factors. RESULTS The search of electronic databases initially yielded 1,944 citations. Of the 197 full texts assessed for eligibility, 41 studies were selected for inclusion in the systematic review. Thirty-five of the papers included reported a significant negative association between low LP and prevalence and/or severity of psychiatric symptoms or disorders, whereas only two records found the opposite relationship and four papers reported no association between them. Inadequate LP was consistently associated with several mental disorders in migrants, including psychotic, mood, anxiety, and post-traumatic stress disorders. Notably, all the four longitudinal studies that met inclusion criteria for this review reported a positive effect of LP acquisition over time on prevalence or symptom severity of mental disorders. CONCLUSIONS Even though larger prospective studies are needed to better evaluate the relationship between LP and psychiatric disorders among migrants, we believe that the present findings could be inspiring for authorities to provide support and courses to improve migrants' language proficiency upon arrival.
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Affiliation(s)
- C. Montemitro
- Department of Neuroscience Imaging and Clinical Science, “G. d’Annunzio” University of Chieti, Chieti, Italy
| | - G. D’Andrea
- Department of Biomedical and NeuroMotorSciences (DIBINEM), Section of Psychiatry, University of Bologna, Bologna, Italy
| | - F. Cesa
- Department of Biomedical and NeuroMotorSciences (DIBINEM), Section of Psychiatry, University of Bologna, Bologna, Italy
| | - G. Martinotti
- Department of Neuroscience Imaging and Clinical Science, “G. d’Annunzio” University of Chieti, Chieti, Italy
- Department of Pharmacy, Pharmacology and Clinical Science, University of Hertfordshire, Herts, United Kingdom
| | - M. Pettorruso
- Department of Neuroscience Imaging and Clinical Science, “G. d’Annunzio” University of Chieti, Chieti, Italy
| | - M. Di Giannantonio
- Department of Neuroscience Imaging and Clinical Science, “G. d’Annunzio” University of Chieti, Chieti, Italy
| | - R. Muratori
- Department of Mental Health, AUSL Bologna, Bologna, Italy
| | - I. Tarricone
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
- Department of Mental Health, AUSL Bologna, Bologna, Italy
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Anglin DM, Ereshefsky S, Klaunig MJ, Bridgwater MA, Niendam TA, Ellman LM, DeVylder J, Thayer G, Bolden K, Musket CW, Grattan RE, Lincoln SH, Schiffman J, Lipner E, Bachman P, Corcoran CM, Mota NB, van der Ven E. From Womb to Neighborhood: A Racial Analysis of Social Determinants of Psychosis in the United States. Am J Psychiatry 2021; 178:599-610. [PMID: 33934608 PMCID: PMC8655820 DOI: 10.1176/appi.ajp.2020.20071091] [Citation(s) in RCA: 124] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors examine U.S.-based evidence that connects characteristics of the social environment with outcomes across the psychosis continuum, from psychotic experiences to schizophrenia. The notion that inequitable social and economic systems of society significantly influence psychosis risk through proxies, such as racial minority and immigrant statuses, has been studied more extensively in European countries. While there are existing international reviews of social determinants of psychosis, none to the authors' knowledge focus on factors in the U.S. context specifically-an omission that leaves domestic treatment development and prevention efforts incomplete and underinformed. In this review, the authors first describe how a legacy of structural racism in the United States has shaped the social gradient, highlighting consequential racial inequities in environmental conditions. The authors offer a hypothesized model linking structural racism with psychosis risk through interwoven intermediary factors based on existing theoretical models and a review of the literature. Neighborhood factors, cumulative trauma and stress, and prenatal and perinatal complications were three key areas selected for review because they reflect social and environmental conditions that may affect psychosis risk through a common pathway shaped by structural racism. The authors describe evidence showing that Black and Latino people in the United States suffer disproportionately from risk factors within these three key areas, in large part as a result of racial discrimination and social disadvantage. This broad focus on individual and community factors is intended to provide a consolidated space to review this growing body of research and to guide continued inquiries into social determinants of psychosis in U.S. contexts.
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Affiliation(s)
- Deidre M Anglin
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Sabrina Ereshefsky
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Mallory J Klaunig
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Miranda A Bridgwater
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Tara A Niendam
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Lauren M Ellman
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Jordan DeVylder
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Griffin Thayer
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Khalima Bolden
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Christie W Musket
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Rebecca E Grattan
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Sarah Hope Lincoln
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Jason Schiffman
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Emily Lipner
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Peter Bachman
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Cheryl M Corcoran
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Natália B Mota
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Els van der Ven
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
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Tortelli A, Simon P, Lehouelleur S, Skurnik N, Richard JR, Baudin G, Ferchiou A, Leboyer M, Schürhoff F, Szöke A. Characteristics associated with the risk of psychosis among immigrants and their descendants in France. Brain Behav 2021; 11:e02096. [PMID: 33835727 PMCID: PMC8119809 DOI: 10.1002/brb3.2096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 01/11/2021] [Accepted: 02/15/2021] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To explore the sociodemographic characteristics that might explain the increased incidence of psychosis among immigrants and their descendants in France. METHODS Data were collected for all subjects with first contact for psychosis aged between 18 and 64 years, in two catchment areas in the Paris region. Incidence rates (IR) and incidence rate ratios (IRR) were adjusted for gender and age. RESULTS During 805,396 persons-year at risk, we identified 321 cases of first-episode psychosis, of which 129 were immigrants and 78 descendants of immigrants. We found that the geographic origin was associated with the risk of psychosis although generation has little impact. Sub-Saharan African immigrants and their descendants showed the highest risk (IRR = 3.1 and IRR = 2.9, respectively). We observed that living in deprived areas increased the incidence of psychosis (IRR = 1.3, 95CI%: 1.0-1.6), particularly among immigrants (IRR = 1.6; 95% CI: 1.1-2.5). Finally, our study showed that subjects having unstable housing (a proxy for "hard to count population") could inflate the incidence rates among immigrants. CONCLUSION The current study shows that the increased risk of psychosis in groups with an immigration background in France is associated with their origin and highlights the importance of socioeconomic factors in modulating this risk.
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Affiliation(s)
- Andrea Tortelli
- INSERM U955 Translational Neuropsychiatry, Créteil, France.,Pôle GHU Psychiatrie Précarité, Groupe Hospitalier Universitaire Paris Psychiatrie & Neurosciences, Paris, France.,Institut Convergences Migrations, Aubervilliers, France
| | - Patrick Simon
- Institut Convergences Migrations, Aubervilliers, France.,Institut National d'Etudes Démographiques, Aubervilliers, France
| | | | - Norbert Skurnik
- Groupe Hospitalier Universitaire Paris Psychiatrie & Neurosciences, Paris, France
| | | | - Grégoire Baudin
- Laboratoire de Psychopathologie et Processus de Santé, Université de Paris, EA 4057, Boulogne-Billancourt, France
| | - Aziz Ferchiou
- INSERM U955 Translational Neuropsychiatry, Créteil, France.,AP-HP, DMU IMPACT, Hôpitaux Universitaires Henri-Mondor, Créteil, France
| | - Marion Leboyer
- INSERM U955 Translational Neuropsychiatry, Créteil, France.,AP-HP, DMU IMPACT, Hôpitaux Universitaires Henri-Mondor, Créteil, France.,Fondation FondaMental, Créteil, France.,UPEC, University Paris-Est, Créteil, France
| | - Franck Schürhoff
- INSERM U955 Translational Neuropsychiatry, Créteil, France.,AP-HP, DMU IMPACT, Hôpitaux Universitaires Henri-Mondor, Créteil, France.,Fondation FondaMental, Créteil, France.,UPEC, University Paris-Est, Créteil, France
| | - Andrei Szöke
- INSERM U955 Translational Neuropsychiatry, Créteil, France.,AP-HP, DMU IMPACT, Hôpitaux Universitaires Henri-Mondor, Créteil, France.,Fondation FondaMental, Créteil, France
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O'Donoghue B, Downey L, Eaton S, Mifsud N, Kirkbride JB, McGorry P. Risk of psychotic disorders in migrants to Australia. Psychol Med 2021; 51:1192-1200. [PMID: 31996272 DOI: 10.1017/s0033291719004100] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Certain migrant groups are at an increased risk of psychotic disorders compared to the native-born population; however, research to date has mainly been conducted in Europe. Less is known about whether migrants to other countries, with different histories and patterns of migration, such as Australia, are at an increased risk for developing a psychotic disorder. We tested this for first-generation migrants in Melbourne, Victoria. METHODS This study included all young people aged 15-24 years, residing in a geographically-defined catchment area of north western Melbourne who presented with a first episode of psychosis (FEP) to the Early Psychosis Prevention and Intervention Centre (EPPIC) between 1 January 2011 and 31 December 2016. Data pertaining to the at-risk population were obtained from the Australian 2011 Census and incidence rate ratios were calculated and adjusted for age, sex and social deprivation. RESULTS In total, 1220 young people presented with an FEP during the 6-year study period, of whom 24.5% were first-generation migrants. We found an increased risk for developing psychotic disorder in migrants from the following regions: Central and West Africa (adjusted incidence rate ratio [aIRR] = 3.53, 95% CI 1.58-7.92), Southern and Eastern Africa (aIRR = 3.06, 95% CI 1.99-4.70) and North Africa (aIRR = 5.03, 95% CI 3.26-7.76). Migrants from maritime South East Asia (aIRR = 0.39, 95% CI 0.23-0.65), China (aIRR = 0.25, 95% CI 0.13-0.48) and Southern Asia (aIRR = 0.44, 95% CI 0.26-0.76) had a decreased risk for developing a psychotic disorder. CONCLUSION This clear health inequality needs to be addressed by sufficient funding and accessible mental health services for more vulnerable groups. Further research is needed to determine why migrants have an increased risk for developing psychotic disorders.
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Affiliation(s)
- Brian O'Donoghue
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Orygen Youth Health, Melbourne, Australia
| | - Linglee Downey
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Scott Eaton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Nathan Mifsud
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - James B Kirkbride
- Psylife Group, Division of Psychiatry, University College London, London, England
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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Tarricone I, D'Andrea G, Storbini V, Braca M, Ferrari S, Reggianini C, Rigatelli M, Gramaglia C, Zeppegno P, Gambaro E, Luciano M, Ceregato A, Altamura M, Barrasso G, Primavera D, Carpiniello B, Todarello O, Berlincioni V, Podavini F, Morgan C, Murray RM, Di Forti M, Muratori R, Berardi D. First-episode Psychosis and Migration in Italy: Results from a Study in the Italian Mental Health Services (Pep-Ita Study). J Immigr Minor Health 2021; 23:519-527. [PMID: 33689115 PMCID: PMC8068695 DOI: 10.1007/s10903-021-01168-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 11/29/2022]
Abstract
Background: Migrants present high rates of psychosis. A better understanding of this phenomenon is needed. Methods: We conducted a multicentre First-Episode Psychosis (FEP) prospective study over two years (January 2012–December 2013) to evaluate first-generation migrants presenting with FEP at the participating Community Mental Health Centers (CMHCs). Results: 109 FEP migrants were identified. Almost half of them were highly educated, employed and in a stable affective relationship. The average age was 32.8 (± 9.8) years, and the average length of stay in Italy was 8.6 (± 8.8) years. About 2/3 of patients were referred to CMHCs following Emergency Department access or psychiatric admission. Conclusions: Our finding of a “high functioning portrait” of FEP migrants allow us to hypothesize that a high burden of negative psychosocial factors is likely to be needed for the FEP onset. Furtherly, mental health services should implement more appropriate resources and organizational methods to respond to migrants’ health needs.
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Affiliation(s)
- Ilaria Tarricone
- Department of Medical and Surgical Sciences, Bologna Transcultural Psychosomatic Team (BoTPT), University of Bologna, Viale C. Pepoli 5, 40123, Bologna, Italy. .,Department of Mental Health and Pathological Addiction, Local Health Authority, Bologna, Italy.
| | - Giuseppe D'Andrea
- Department of Medical and Surgical Sciences, Bologna Transcultural Psychosomatic Team (BoTPT), University of Bologna, Viale C. Pepoli 5, 40123, Bologna, Italy.,Department of Biomedical and NeuroMotor Sciences, Psychiatry Unit, University of Bologna, Bologna, Italy
| | - Viviana Storbini
- Department of Biomedical and NeuroMotor Sciences, Psychiatry Unit, University of Bologna, Bologna, Italy
| | - Mauro Braca
- Department of Biomedical and NeuroMotor Sciences, Psychiatry Unit, University of Bologna, Bologna, Italy
| | - Silvia Ferrari
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
| | - Corinna Reggianini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
| | - Marco Rigatelli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
| | - Carla Gramaglia
- Department of Translational Medicine, Institute of Psychiatry, Università del Piemonte Orientale, Novara, Italy
| | - Patrizia Zeppegno
- Department of Translational Medicine, Institute of Psychiatry, Università del Piemonte Orientale, Novara, Italy
| | - Eleonora Gambaro
- Department of Translational Medicine, Institute of Psychiatry, Università del Piemonte Orientale, Novara, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Alessio Ceregato
- Mental Health Department A.S.L. TO4, Community Mental Health Service, Chivasso, TO, Italy
| | - Mario Altamura
- Department of Clinical and Experimental Medicine, Section of Psychiatry and Clinical Psychology, University of Foggia, Foggia, Italy
| | | | - Diego Primavera
- Department of Medical Science and Public Health-Section of Psychiatry, University of Cagliari, Cagliari, Italy
| | - Bernardo Carpiniello
- Department of Medical Science and Public Health-Section of Psychiatry, University of Cagliari, Cagliari, Italy
| | - Orlando Todarello
- U.O. di Psichiatria - Azienda Ospedaliero-Universitaria "Consorziale Policlinico" Bari; Dipartimento Di Scienze Mediche Di Base, Neuroscienze Ed Organi Di Senso, Università Degli Studi Aldo Moro Di Bari, Bari BA, Italy
| | - Vanna Berlincioni
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Francesca Podavini
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Craig Morgan
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Robin M Murray
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Marta Di Forti
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Roberto Muratori
- Department of Mental Health and Pathological Addiction, Local Health Authority, Bologna, Italy
| | - Domenico Berardi
- Department of Mental Health and Pathological Addiction, Local Health Authority, Bologna, Italy.,Department of Biomedical and NeuroMotor Sciences, Psychiatry Unit, University of Bologna, Bologna, Italy
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50
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Misra S, Gelaye B, Williams DR, Koenen KC, Borba CPC, Quattrone D, Di Forti M, Tripoli G, La Cascia C, La Barbera D, Ferraro L, Tarricone I, Berardi D, Lasalvia A, Tosato S, Szöke A, Llorca PM, Arango C, Tortelli A, de Haan L, Velthorst E, Bobes J, Bernardo M, Sanjuán J, Santos JL, Arrojo M, Del-Ben CM, Menezes PR, Selten JP, Jones PB, Jongsma HE, Kirkbride JB, Rutten BPF, van Os J, Murray RM, Gayer-Anderson C, Morgan C. Perceived major experiences of discrimination, ethnic group, and risk of psychosis in a six-country case-control study. Psychol Med 2021; 52:1-9. [PMID: 33648622 DOI: 10.1017/s0033291721000453] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Perceived discrimination is associated with worse mental health. Few studies have assessed whether perceived discrimination (i) is associated with the risk of psychotic disorders and (ii) contributes to an increased risk among minority ethnic groups relative to the ethnic majority. METHODS We used data from the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions Work Package 2, a population-based case-control study of incident psychotic disorders in 17 catchment sites across six countries. We calculated odds ratios (OR) and 95% confidence intervals (95% CI) for the associations between perceived discrimination and psychosis using mixed-effects logistic regression models. We used stratified and mediation analyses to explore differences for minority ethnic groups. RESULTS Reporting any perceived experience of major discrimination (e.g. unfair treatment by police, not getting hired) was higher in cases than controls (41.8% v. 34.2%). Pervasive experiences of discrimination (≥3 types) were also higher in cases than controls (11.3% v. 5.5%). In fully adjusted models, the odds of psychosis were 1.20 (95% CI 0.91-1.59) for any discrimination and 1.79 (95% CI 1.19-1.59) for pervasive discrimination compared with no discrimination. In stratified analyses, the magnitude of association for pervasive experiences of discrimination appeared stronger for minority ethnic groups (OR = 1.73, 95% CI 1.12-2.68) than the ethnic majority (OR = 1.42, 95% CI 0.65-3.10). In exploratory mediation analysis, pervasive discrimination minimally explained excess risk among minority ethnic groups (5.1%). CONCLUSIONS Pervasive experiences of discrimination are associated with slightly increased odds of psychotic disorders and may minimally help explain excess risk for minority ethnic groups.
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Affiliation(s)
- Supriya Misra
- Department of Public Health, San Francisco State University, San Francisco, CA94132, USA
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA02115, USA
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA02115, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA02115, USA
| | - Christina P C Borba
- Department of Psychiatry, Boston Medical Center; Boston University School of Medicine, Boston, MA02118, USA
| | - Diego Quattrone
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, LondonSE5 8AE, UK
| | - Marta Di Forti
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, LondonSE5 8AE, UK
| | - Giada Tripoli
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, 90129Palermo, Italy
| | - Caterina La Cascia
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, 90129Palermo, Italy
| | - Daniele La Barbera
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, 90129Palermo, Italy
| | - Laura Ferraro
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, 90129Palermo, Italy
| | - Ilaria Tarricone
- Department of Medical and Surgical Science, Bologna Transcultural Psychosomatic Team, (BoTPT), Alma Mater Studiorum Università di Bologna, 40126Bologna, Italy
| | - Domenico Berardi
- Department of Biomedical and Neuro-motor Sciences, Psychiatry Unit, Alma Mater, Studiorum Università di Bologna, 40126Bologna, Italy
| | - Antonio Lasalvia
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134Verona, Italy
| | - Sarah Tosato
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134Verona, Italy
| | - Andrei Szöke
- INSERM U955, Equipe 15, Institut National de la Santé et de la Recherche Médicale, 94010Créteil, France
| | | | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad, Complutense, IiSGM, CIBERSAM, 28007Madrid, Spain
| | - Andrea Tortelli
- Etablissement Public de Santé Maison Blanche, 75020Paris, France
| | - Lieuwe de Haan
- Department of Psychiatry, Early Psychosis Section, Amsterdam UMC, Location: Academic, Medical Centre, University of Amsterdam, 1105AZAmsterdam, The Netherlands
| | - Eva Velthorst
- Department of Psychiatry, Early Psychosis Section, Amsterdam UMC, Location: Academic, Medical Centre, University of Amsterdam, 1105AZAmsterdam, The Netherlands
- Department of Psychiatry, Icahn School of Medicine, Mount Sinai, NY, USA
| | - Julio Bobes
- Faculty of Medicine and Health Sciences - Psychiatry, Universidad de Oviedo, ISPA, INEUROPA, CIBERSAM, 33006Oviedo, Spain
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, 08036Barcelona, Spain
| | - Julio Sanjuán
- Department of Psychiatry, School of Medicine, Universidad de Valencia, Centro de, Investigación Biomédica en Red de Salud Mental (CIBERSAM), 46010Valencia, Spain
| | - Jose Luis Santos
- Department of Psychiatry, Servicio de Psiquiatría Hospital "Virgen de la Luz,", 16002Cuenca, Spain
| | - Manuel Arrojo
- Department of Psychiatry, Psychiatry Genetic Group, Instituto de Investigación Sanitaria de, Santiago de Compostela, Complejo Hospitalario Universitario de Santiago de Compostela, 15706Santiago de Compostela, Spain
| | - Cristina Marta Del-Ben
- Division of Psychiatry, Department of Neuroscience and Behaviour, Ribeirão Preto Medical School, University of São Paulo, São Paulo14049-900, Brazil
| | - Paulo Rossi Menezes
- Department of Preventative Medicine, Faculdade de Medicina FMUSP, University of São Paulo, São Paulo01246-903, Brazil
| | - Jean-Paul Selten
- Rivierduinen Institute for Mental Health Care, 2333 ZZLeiden, The Netherlands
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, CambridgeCB2 0SZ, UK
| | - Hannah E Jongsma
- Psylife Group, Division of Psychiatry, University College London, LondonW1T 7NF, UK
| | - James B Kirkbride
- Psylife Group, Division of Psychiatry, University College London, LondonW1T 7NF, UK
| | - Bart P F Rutten
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, 6200MDMaastricht, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, 6200MDMaastricht, The Netherlands
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, LondonSE5 8AF, UK
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, LondonSE5 8AF, UK
| | - Charlotte Gayer-Anderson
- Department of Health Service and Population Research, Institute of Psychiatry, King's College London, LondonSE5 8AF, UK
| | - Craig Morgan
- Department of Health Service and Population Research, Institute of Psychiatry, King's College London, LondonSE5 8AF, UK
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