Migration and schizophrenia: the challenges for European psychiatry and implications for the future.
BACKGROUND
The last decade of the twentieth century has seen an unprecedented increase in the number of reports in the psychiatric literature documenting increased rates of psychotic illness among migrants in a range of European countries. In countries where high rates of immigration have been long-standing such as Britain and the Netherlands, these increased rates have also been seen in the second generation of migrants. This has impacted on psychiatry significantly with regard to the aetiology, diagnosis, and treatment of schizophrenia.


METHODS
We reviewed the literature to summarise the available evidence about the phenomenon across the European countries where these findings have been reported. Comparisons of the findings between countries were highlighted to establish their impact on psychiatry and to identify areas and implications for future research.


RESULTS
The history of this kind of research is longest in Britain and has established increased risk for non-white migrants, with Caribbean and African patients being especially vulnerable. Caribbean migrants to the Netherlands have also been found to be at increased risk, but they are predominantly of Indo-Caribbean ethnicity. In the other European countries, East and West African migrants have been implicated in some countries, while European migrants have been implicated in other countries. Social inequalities, family fragmentation and urbanicity seem to be the main hypotheses proposed for these increased rates, though, in some countries where asylum seekers and refugees form the largest group of migrants, the stress of the migratory process itself may be implicated. These may all interact with genetic vulnerability and substance abuse.


CONCLUSIONS
Ethnicity and differences in dominant language emerge as major structural references in this new epistemology of psychosis and both the causes and the effects on psychopathology may be filtered through an experience of social disadvantage in an urban environment.
Hutchinson
Gerard
G
Psychiatry Unit, Faculty of Medical Sciences, University of West Indies, Trinidad, Trinidad & Tobago.
Haasen
Christian
C
D017691:Caribbean Region / Q000208:ethnology; D004641:Emigration and Immigration; D005060:Europe / Q000453:epidemiology; D006801:Humans; D011570:Psychiatry / Q000639:trends*; D012307:Risk Factors; D012559:Schizophrenia / Q000453:epidemiology / Q000208:ethnology*; D012565:Schizophrenic Psychology; D012931:Social Environment