Migration, ethnicity, and psychosis: toward a sociodevelopmental model.
There is consistent and strong evidence that the incidence of all psychoses is higher in many migrant and minority ethnic populations in a number of countries. The reasons for this are, however, unclear and a wide range of explanations have been proposed, from genetic to neurodevelopmental to psychosocial. In this article, we describe and evaluate the available evidence for and against each of these. What this shows is that: (1) there are few studies that have directly investigated specific risk factors in migrant and minority ethnic populations, with often only 1 or 2 studies of any relevance to specific explanations and (2) what limited research there has been tends to implicate a diverse range of social factors (including childhood separation from parents, discrimination and, at an area level, ethnic density) as being of potential importance. In an attempt to synthesize these disparate findings and provide a basis for future research, we go on to propose an integrated model--of a sociodevelopmental pathway to psychosis--to account for the reported high rates in migrant and minority ethnic populations. Aspects of this model will be directly tested in a new Europe-wide incidence and case-control study that we will conduct over the next 3 years, as part of the European Network of National Schizophrenia Networks studying Gene-Environment Interactions programme.
Section of Society, Culture and Mental Health, Health Service and Population Research Department, Box 33, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. craig.morgan@kcl.ac.uk
Craig
C
Morgan
Monica
M
Charalambides
Gerard
G
Hutchinson
Robin M
RM
Murray
D015982:Bias; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D004641:Emigration and Immigration; D005006:Ethnicity / Q000523:psychology* / Q000706:statistics & numerical data*; D005060:Europe; D020022:Genetic Predisposition to Disease / Q000453:epidemiology / Q000208:ethnology / Q000235:genetics / Q000523:psychology; D006801:Humans; D015994:Incidence; D008016:Life Change Events; D008913:Minority Groups / Q000523:psychology* / Q000706:statistics & numerical data*; D008960:Models, Psychological; D011287:Prejudice; D011618:Psychotic Disorders / Q000453:epidemiology* / Q000208:ethnology* / Q000235:genetics / Q000523:psychology; D012307:Risk Factors; D012559:Schizophrenia / Q000453:epidemiology* / Q000208:ethnology* / Q000235:genetics; D012565:Schizophrenic Psychology; D012931:Social Environment