Treatment seeking for alcohol and drug use disorders by immigrants to the Netherlands: retrospective, population-based, cohort study

Mental disorders among young adults of immigrant background: a nationwide register study in Norway

PURPOSE

Previous research indicates increased risk of various mental disorders in immigrant populations, particularly for schizophrenia and PTSD. However, findings are inconclusive due to variations in contextual factors, characteristics of immigrant groups and study design. Our study aims to investigate prevalence differences of receiving an ICD-10 psychiatric diagnosis between 2008 and 2016 among four first-generation immigrant groups and one second-generation immigrant group compared to ethnic Norwegians.

METHODS

Linked register data from the Norwegian Patient Registry and Statistics Norway were utilised. The sample (age 18-35) comprises 758,774 ethnic Norwegians, 61,124 immigrants originating from Poland, Somalia, Iran and Pakistan and 4630 s-generation Pakistani immigrants. Age- and gender-adjusted binary logistic regression models were applied.

RESULTS

The odds of schizophrenia were significantly elevated for all groups except for Poles. The highest odds were observed for second-generation Pakistani immigrants (adjusted OR 2.72, 95% CI 2.21-3.35). For PTSD, the odds were significantly increased for Somalis (aOR 1.31, 95% CI 1.11-1.54), second-generation Pakistani immigrants (aOR 1.37, 95% CI 1.11-1.70), and in particular for Iranians (aOR 3.99, 95% CI 3.51-4.54). While Iranians showed similar or higher odds of receiving the vast majority of psychiatric diagnoses, the remaining groups showed lower or similar odds compared to ethnic Norwegians.

CONCLUSION

Our findings suggest considerable prevalence differences in receiving a psychiatric diagnosis according to country of origin and generational status compared to ethnic Norwegian controls. The general pattern was lower prevalence of most ICD-10 mental disorders for the majority of immigrant groups compared to ethnic Norwegians, except for schizophrenia and PTSD.

Incidence and prevalence of mental disorders among immigrants and native Finns: a register-based study

PURPOSE

Migrants appear to have a higher risk of mental disorders, but findings vary across country settings and migrant groups. We aimed to assess incidence and prevalence of mental disorders among immigrants and Finnish-born controls in a register-based cohort study.

METHODS

A register-based cohort study of 184.806 immigrants and 185.184 Finnish-born controls (1.412.117 person-years) was conducted. Information on mental disorders according to ICD-10 was retrieved from the Hospital Discharge Register, which covers all public health care use.

RESULTS

The incidence of any mental disorder was lower among male (adjusted HR 0.82, 95% CI 0.77-0.87) and female (aHR 0.76, 95% CI 0.72-0.81) immigrants, being lowest among Asian and highest among North African and Middle Eastern immigrants. The incidence of bipolar, depressive and alcohol use disorders was lower among immigrants. Incidence of psychotic disorders was lower among female and not higher among male immigrants, compared with native Finns. Incidence of PTSD was higher among male immigrants (aHR 4.88, 95% CI 3.38-7.05).

CONCLUSIONS

The risk of mental disorders varies significantly across migrant groups and disorders and is generally lower among immigrants than native Finns.

Evidence of an excessive gender gap in the risk of psychotic disorder among North African immigrants in Europe: a systematic review and meta-analysis

PURPOSE

Epidemiological studies in the Netherlands have reported an excessive gender gap in the risk for non-affective psychotic disorder (NAPD) among immigrants from Morocco with a higher risk elevation in males compared to females. We examined the consistency of these findings and their generalizability to immigrants from the Maghreb (Mauritania, Morocco, Algeria, Tunisia and Libya) in other European countries.

METHODS

Systematic review and meta-analysis. Medline, PsychINFO and EMBASE databases were searched for publications in the period from January 1970 to April 2014. We included incidence and prevalence studies of non-affective psychotic disorder (NAPD) among migrants from the Maghreb in Europe and studies of subclinical psychotic symptoms (SPS) in representative samples. A meta-analysis was performed on the subgroup of incidence studies.

RESULTS

Five incidence and three prevalence studies of NAPD, and two prevalence studies of SPS, conducted in the Netherlands (n=7), Belgium (n=1), France (n=1) and Italy (n=1) met our inclusion criteria. Across all research designs, the risks of NAPD and SPS were consistently increased among male, not female immigrants from the Maghreb. The meta-analysis of incidence studies of NAPD yielded male-to-female risk ratios of 5.1 [95 % confidence interval (CI) 3.1-8.4] for migrants from the Maghreb, 2.0 (95 % CI 1.6-2.5) for other migrant groups, and 1.8 (95 % CI 1.3-2.5) for non-migrant Europeans.

CONCLUSIONS

The marked gender gap in psychosis risk among migrants from the Maghreb appears a consistent finding, foremost among the Moroccan-Dutch. The small number of studies limits the strength of conclusions that can be drawn about countries other than the Netherlands. Achievement-expectation mismatch, social marginalization and an increased prevalence of illicit drug use are possible explanations.

Alcohol problems among migrants in substance use treatment: the role of drinking patterns in countries of birth

Migrants’ beliefs about when to seek help for alcohol problems may differ from host-country norms. We undertook an audit of 393 cases of screening in specialist alcohol and other drug services in Victoria, Australia, to examine whether alcohol problem severity at the time of help-seeking was influenced by drinking norms in countries of birth. Alcohol problem severity was measured using the Alcohol Use Disorders Identification Test, and World Health Organization per capita alcohol consumption data was used to form three categories of clients relative to Australian consumption: (1) Australian born; (2) born in low alcohol consumption countries; and (3) born in high alcohol consumption countries. Clients born in high consumption countries such as those in Europe and the UK had significantly higher levels of alcohol problem severity at intake compared with Australian-born clients and clients born in low consumption countries. This suggests that clients from high consumption countries might have delayed seeking help in line with the alcohol norms in their country of origin. Screening this group for alcohol problems in primary health care might avoid significant cumulative harm.

Differences in prevalence and treatment of bipolar disorder among immigrants: results from an epidemiologic survey

OBJECTIVE

To add to the limited data on the prevalence, clinical characteristics, and treatment of bipolar disorder (BD) among immigrants.

METHOD

Data were obtained from a large epidemiologic survey, the Canadian Community Health Survey-Mental Health and Well-Being (CCHS 1.2). Lifetime prevalence rates of BD were compared between immigrant and nonimmigrant respondents. Among BD subjects (n = 831), sociodemographic, clinical, and mental health treatment use variables were compared based on immigrant status. Logistic regression was used to determine the correlates of lifetime contact with a mental health professional and 12-month psychotropic medication use.

RESULTS

Lifetime prevalence rate of CCHS 1.2-defined BD was significantly lower among immigrant, compared with nonimmigrant, participants (1.50% and 2.27%, P = 0.01). There were few sociodemographic or clinical differences, yet immigrants with BD were significantly less likely to report any lifetime contact with mental health professionals (OR = 0.25, 95% CI 0.13 to 0.50, P < 0.001). Past-year psychotropic medication use was numerically lower among immigrants with BD (24.5% and 41.0%); however, this did not reach statistical significance when controlling for other factors (OR = 0.49, 95% CI 0.24 to 1.01, P = 0.05).

CONCLUSIONS

Based on the results of this study, there are in the range of 56 000 to 104 000 immigrants with BD in Canada. Further efforts are needed to better understand and address the barriers to mental health treatment use among immigrants who have BD.

Case registers in psychiatry: do they still have a role for research and service monitoring?

PURPOSE OF REVIEW

To follow up on reviews of case register research. Literature searches over a 2-year period were conducted to determine whether psychiatric case registers still have a role for research and service monitoring.

RECENT FINDINGS

Case register research covers a wide range of topics, and is most often found in Denmark where national databases support all kinds of record linkage studies. Typically, case registers are used in studies of treated prevalence and incidence of psychiatric disorders, in research on patterns of care, as sampling frames in epidemiological studies, and in studies on risk factors and treatment outcome.

SUMMARY

Despite a wide range of research based on administrative data, stakeholders in most countries are probably not well served by current priorities. Few studies investigate longitudinal patterns of service use to evaluate healthcare policies. There is a lack of comparative record linkage studies to inform local authorities on the cooperation between mental healthcare and public services. Implementing standard tools and procedures for routine outcome assessment seems still to be in an early phase in most register areas. When case register staff can capitalize on new opportunities, old and new case registers will continue to be important for research and service monitoring.

Hypothesis: social defeat is a risk factor for schizophrenia?

The increased schizophrenia risks for residents of cities with high levels of competition and for members of disadvantaged groups (for example migrants from low- and middle-income countries, people with low IQ, hearing impairments or a history of abuse) suggest that social factors are important for aetiology. Dopaminergic dysfunctioning is a key mechanism in pathogenesis. This editorial is a selective literature review to delineate a mechanism whereby social factors can disturb dopamine function in the brain. Experiments with rodents have shown that social defeat leads to dopaminergic hyperactivity and to behavioural sensitisation, whereby the animal displays an enhanced behavioural and dopamine response to dopamine agonists. Neuroreceptor imaging studies have demonstrated the same phenomena in patients with schizophrenia who had never received antipsychotics. In humans, the chronic experience of social defeat may lead to sensitisation (and/or increased baseline activity) of the mesolimbic dopamine system and thereby increase the risk for schizophrenia.