title: Psychosis: clinical insight and beliefs in immigrants in their first episode.
abstract: Lack of insight into illness is frequent in psychotic disorders and seen as part of their primary pathology. The recognition of symptoms as psychotic, and beliefs about treatment alternatives, is also influenced by socio-cultural factors. Here we examined clinical insight into illness and beliefs about psychosis in immigrants in their first episode of psychosis compared with a reference group.
  
  
  
  A total of 277 first-episode psychosis participants were recruited to this cross-sectional study; 40 first- and 40 second-generation immigrants from Europe, Americas and Oceania (n = 37), Asia including Turkey (n = 28) or Africa (n = 15). The Birchwood Insight Scale was used to measure clinical insight and 'The Attitudes and Beliefs about Mental Health Problems' schizophrenia version to assess socio-cultural beliefs.
  
  
  
  Immigrants did not differ from the reference sample in clinical insight. After controlling for education level, first-generation immigrants were less likely to recognize psychotic symptoms (odds ratio (OR) 2.9; Wald = 8.977, degrees of freedom (d.f.) 1, P = 0.003) and viewed hospitalization (OR 5.2; Wald = 20.388, d.f. 1, P = 0.001) and treatment by a psychiatrist (OR 4.9; Wald = 6.609, d.f. 1, P = 0.01)) as less beneficial than the reference group. Immigrants from Asia held more alternative explanations (OR 0.3; Wald = 6.567, d.f. 1, P = 0.010). There were significantly stronger associations between clinical insight and socio-cultural beliefs in the reference group.
  
  
  
  Socio-cultural beliefs about psychosis in immigrants in first-episode psychosis call for more tailored information to this group, and emphasize the importance of treatment interventions involving both a cultural and personal perspective of insight.
authors.affiliation: NORMENT, K.G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.|Oslo University Hospital, Oslo, Norway.
authors.forename: Akiah Ottesen
authors.initials: AO
authors.lastname: Berg
authors.affiliation: NORMENT, K.G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.|Oslo University Hospital, Oslo, Norway.|Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
authors.forename: Elizabeth Ann
authors.initials: EA
authors.lastname: Barrett
authors.affiliation: NORMENT, K.G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.|Oslo University Hospital, Oslo, Norway.
authors.forename: Mari
authors.initials: M
authors.lastname: Nerhus
authors.affiliation: NORMENT, K.G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.|Oslo University Hospital, Oslo, Norway.
authors.forename: Camilla
authors.initials: C
authors.lastname: Büchman
authors.affiliation: NORMENT, K.G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.|Oslo University Hospital, Oslo, Norway.|Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
authors.forename: Carmen
authors.initials: C
authors.lastname: Simonsen
authors.affiliation: Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
authors.forename: Ann
authors.initials: A
authors.lastname: Faerden
authors.affiliation: NORMENT, K.G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.|Oslo University Hospital, Oslo, Norway.
authors.forename: Ole A
authors.initials: OA
authors.lastname: Andreassen
authors.affiliation: NORMENT, K.G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.|Oslo University Hospital, Oslo, Norway.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Melle
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa / Q000208:ethnology; D000368:Aged; D001208:Asia / Q000208:ethnology; D016022:Case-Control Studies; D002489:Central America / Q000208:ethnology; D003430:Cross-Sectional Studies; D054242:Emigrants and Immigrants / Q000523:psychology*; D005060:Europe / Q000208:ethnology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D044349:Oceania / Q000208:ethnology; D011618:Psychotic Disorders / Q000208:ethnology* / Q000523:psychology*; D013020:South America / Q000208:ethnology; D055815:Young Adult
keywords: bipolar disorder; emigrant and immigrant; psychotic disorder; schizophrenia