Some immigrants and refugees are at higher risk of psychotic disorders compared to the general Ontario population: study

Immigrants from the Caribbean and Bermuda, as well as refugees from East Africa and South Asia, have a 1.5 to 2 times higher risk of psychotic disorders compared to the general population of Ontario, according to a new study by researchers at the Institute for Clinical Evaluative Sciences (ICES) and the Centre for Addiction and Mental Health (CAMH). The study also found that immigrants from Northern Europe, Southern Europe and East Asia had about half the risk of psychotic disorders compared to the general population.

The study published today in the CMAJ is one of the largest studies of its kind to date.

Ontario is home to the largest number of migrants in Canada, with nearly 30 per cent of the population being a first-generation migrant.

The study linked data from ICES and Citizenship and Immigration Canada to examine nearly four million people between 14 and 40 years of age, following them for 10 years beginning in 1999 to see whether the incidence of psychotic disorders (schizophrenia and schizoaffective disorder) differed between particular migrant groups.

The incidence rate of psychotic disorder was 55.6 per 100,000 person years among the general population, 51.7 per 100,000 person years among immigrants, and 72.8 per 100,000 person years among refugees.

“We found that refugees had about a 25 per cent greater risk of psychotic disorders compared to immigrants. We also found that neighbourhood-level income acted as a protective factor, with migrants who were living in the wealthiest neighbourhoods in the province having half the risk of psychotic disorders  compared to migrants living in the poorest neighbourhoods in the province,” said Kelly Anderson, lead author and post-doctoral research fellow at ICES Western.

There is substantial evidence from numerous countries to suggest that international migrants are at a higher risk of developing a psychotic disorder compared to the host population, and this risk persists into the second generation. This suggests that something inherent to the migratory or post-migration experience may play a role in the cause of psychotic disorders among these groups.

“The patterns we observe suggest that psychosocial factors associated with the migratory experience and integration into Canada may contribute to the risk of psychotic disorders,” said Dr. Paul Kurdyak, senior author of the study, lead of the Mental Health and Addictions Research Program at ICES and director of CAMH’s Health Outcomes and Performance Evaluation Research Unit.

"We need to understand why some immigrant groups have lower rates of psychosis. If we know what protects them it will help us develop prevention strategies for all,” said Dr. Kwame McKenzie, one of the study’s authors and medical director of CAMH’s Underserved Populations Program.

The study was funded in part by the Canadian Institutes of Health Research (CIHR).

“Incidence of psychotic disorders among first-generation immigrants and refugees in Ontario,” was published today in the CMAJ.

Author block: Kelly K. Anderson, Joyce Cheng, Ezra Susser, Kwame J. McKenzie and Paul Kurdyak.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

For the latest ICES news, follow us on Twitter: @ICESOntario

The Centre for Addiction and Mental Health (CAMH) is Canada's largest mental health and addiction teaching hospital, as well as one of the world's leading research centres in the area of addiction and mental health. CAMH combines clinical care, research, education, policy development and health promotion to help transform the lives of people affected by mental health and addiction issues. CAMH is fully affiliated with the University of Toronto, and is a Pan American Health Organization/World Health Organization Collaborating Centre. For more information, please visit www.camh.ca or follow us on Twitter @CAMHnews.

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