title: Psychosis and suicide risk by ethnic origin and history of migration in the Netherlands.
abstract: BACKGROUND
  There is an increased incidence of non-affective psychotic disorders (NAPD) among first- and second-generation migrants in Europe. The purpose of this population-based study was to compare the risk of suicide in Dutch natives and immigrants with or without NAPD.
  
  
  METHODS
  Cases of NAPD (n=12 580) from three Dutch psychiatric registers were linked to the cause of death register of Statistics Netherlands and were compared to matched controls (n=244 792) from the population register, who had no such diagnosis. Hazard ratios (HRs) of suicide were estimated and adjusted for age and gender by Cox regression analysis.
  
  
  RESULTS
  The presence of NAPD was strongly associated with suicide risk in each ethnic group. However, for all ethnic minority groups the HRs were somewhat lower than among Dutch natives, for whom the HR was 23.4 (95%-CI; 18.5-29.7). A closer examination revealed that suicide risk was influenced by the history of migration. While the risk for immigrants of the first generation, diagnosed with NAPD, was significantly lower than that for native Dutch patients (HR=0.45; 95%-CI: 0.28-0.73), the risk for those of the second generation was more similar to that for the Dutch (HR=0.85; 95%-CI: 0.51-1.40) (P value of history of migration=0.005).
  
  
  CONCLUSIONS
  Immigrants diagnosed with NAPD of the first generation appear to be protected against suicide, whereas this protection is waning among those of the second generation. This is the first study worldwide on suicide in migrants with NAPD and the first study of suicide in patients with NAPD in the Netherlands.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands. F.Termorshuizen@umcutrecht.nl
authors.forename: Fabian
authors.initials: F
authors.lastname: Termorshuizen
authors.forename: André I
authors.initials: AI
authors.lastname: Wierdsma
authors.forename: Ellen
authors.initials: E
authors.lastname: Visser
authors.forename: Marjan
authors.initials: M
authors.lastname: Drukker
authors.forename: Sjoerd
authors.initials: S
authors.lastname: Sytema
authors.forename: Wijnand
authors.initials: W
authors.lastname: Laan
authors.forename: Hugo M
authors.initials: HM
authors.lastname: Smeets
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Selten
mesh_terms: D000328:Adult; D015331:Cohort Studies; D054242:Emigrants and Immigrants / Q000523:psychology*; D005006:Ethnicity / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009018:Morocco / Q000208:ethnology; D009426:Netherlands / Q000453:epidemiology; D009427:Netherlands Antilles / Q000208:ethnology; D016016:Proportional Hazards Models; D011618:Psychotic Disorders / Q000453:epidemiology* / Q000208:ethnology; D012042:Registries; D012189:Retrospective Studies; D013405:Suicide / Q000208:ethnology / Q000706:statistics & numerical data*; D013532:Suriname / Q000208:ethnology; D014421:Turkey / Q000208:ethnology