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Jiang W, Shi G, Li Y, Lu C, Guo L, Zhang W. Dynamic contributions of socioeconomic status to mental health with the resettlement process among refugees. Psychiatry Res 2023; 324:115197. [PMID: 37058795 DOI: 10.1016/j.psychres.2023.115197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/31/2023] [Accepted: 04/09/2023] [Indexed: 04/16/2023]
Abstract
Socioeconomic status (SES) is shown to be associated with refugees' mental health, but few studies have considered that these associations may vary over time. This study aimed to examine the dynamic contributions of SES to refugees' mental health during resettlement. We used five waves of data from a cohort study in Australia; 2399 refugees completed the interview in Wave 1, and the remaining waves had 2009, 1894, 1929, and 1881 participants, respectively. SES, high risk of severe mental illness (HR-SMI), and post-traumatic stress disorder (PTSD) were assessed in each wave. Weighted multilevel regression models were performed, and analyses were stratified by sex. For both sexes, financial hardships were consistently positively associated with HR-SMI and PTSD across all five waves. However, time or sex differences were more pronounced for associations between other SES factors and mental health. For males, there were negative associations of current paid jobs with HR-SMI and PTSD in Waves 3-5. For females, the current paid job was negatively associated with HR-SMI only in Wave 5. Our findings highlight the dynamic associations and sex differences between SES and refugees' mental health. We recommend interventions focusing on increasing employment opportunities, particularly for male refugees in the later resettlement stages.
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Affiliation(s)
- Weiqing Jiang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, China
| | - Guangduoji Shi
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, China
| | - Yanzhi Li
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, China
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, China
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, China.
| | - Weihong Zhang
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Belgium
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2
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Dunlavy A, Gauffin K, Berg L, De Montgomery CJ, Europa R, Eide K, Ascher H, Hjern A. Health outcomes in young adulthood among former child refugees in Denmark, Norway and Sweden: A cross-country comparative study. Scand J Public Health 2021:14034948211031408. [PMID: 34304618 DOI: 10.1177/14034948211031408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS This study aimed at comparing several health outcomes in young adulthood among child refugees who settled in the different immigration and integration policy contexts of Denmark, Norway and Sweden. METHODS The study population included refugees born between 1972 and 1997 who immigrated before the age of 18 and settled in the three Nordic countries during 1986-2005. This population was followed up in national registers during 2006-2015 at ages 18-43 years and was compared with native-born majority populations in the same birth cohorts using sex-stratified and age-adjusted regression analyses. RESULTS Refugee men in Denmark stood out with a consistent pattern of higher risks for mortality, disability/illness pension, psychiatric care and substance misuse relative to native-born majority Danish men, with risk estimates being higher than comparable estimates observed among refugee men in Norway and Sweden. Refugee men in Sweden and Norway also demonstrated increased risks relative to native-born majority population men for inpatient psychiatric care, and in Sweden also for disability/illness pension. With the exception of increased risk for psychotic disorders, outcomes among refugee women were largely similar to or better than those of native-born majority women in all countries. CONCLUSIONS The observed cross-country differences in health indicators among refugees, and the poorer health outcomes of refugee men in Denmark in particular, may be understood in terms of marked differences in Nordic integration policies. However, female refugees in all three countries had better relative health outcomes than refugee men did, suggesting possible sex differentials that warrant further investigation.
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Affiliation(s)
- Andrea Dunlavy
- Centre for Health Equity Studies (CHESS), Department of Public Health Sciences, Stockholm University, Sweden
| | - Karl Gauffin
- Centre for Health Equity Studies (CHESS), Department of Public Health Sciences, Stockholm University, Sweden
| | - Lisa Berg
- Centre for Health Equity Studies (CHESS), Department of Public Health Sciences, Stockholm University, Sweden
| | - Christopher Jamil De Montgomery
- Danish Research Centre for Migration, Ethnicity and Health (MESU), Department of Public Health, University of Copenhagen, Denmark
| | - Ryan Europa
- Faculty of Health and Social Sciences, Department of Health, Social and Welfare Studies, University of South-Eastern Norway, Norway
| | - Ketil Eide
- Faculty of Health and Social Sciences, Department of Health, Social and Welfare Studies, University of South-Eastern Norway, Norway
| | - Henry Ascher
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Research Department, Angered Hospital, Sweden
| | - Anders Hjern
- Centre for Health Equity Studies (CHESS), Department of Public Health Sciences, Stockholm University, Sweden.,Department of Medicine, Clinical Epidemiology, Karolinska Institutet, Sweden
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3
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Vinkers DJ, Van de Vorst M, Hoek HW, Van Os J. Social Defeat, Psychotic Symptoms, and Crime in Young Caribbean Immigrants to Rotterdam. Front Psychiatry 2021; 12:498096. [PMID: 33897475 PMCID: PMC8058196 DOI: 10.3389/fpsyt.2021.498096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 02/22/2021] [Indexed: 11/29/2022] Open
Abstract
Background: The negative experience of being excluded from the majority group (social defeat) may be associated with psychosis in immigrants. The social defeat hypothesis is supported by the high frequency of perceived discrimination and acculturation problems in psychotic immigrants. In addition, social defeat may lead to crime through social problems such as unemployment, school dropout, a broken family structure, or psychotic symptoms. Methods: We assessed the association between social defeat and acculturation on the one hand and broadly defined psychotic symptoms and crime on the other in Caribbean immigrants to Rotterdam who are aged 18-24 years. The municipality of Rotterdam provided data about Caribbean immigrants to Rotterdam. Acculturation, social defeat (perceived discrimination, sense of control, and evaluation of self and others), psychotic symptoms, and crime were assessed using online questionnaires. Results: Social defeat was associated with psychotic symptoms in women (β = 0.614, p < 0.001). This relation applied particularly to the negative self-perception domain of social defeat. Acculturation was associated with neither social defeat nor psychotic symptoms or crime and did not mediate the association between social defeat and psychosis. Conclusion: The social defeat hypothesis of psychosis may be gender-specific valid but does not extend to crime.
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Affiliation(s)
- David J Vinkers
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | | | - Hans W Hoek
- Parnassia Psychiatric Institute, The Hague, Netherlands.,Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.,Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Jim Van Os
- Department of Psychiatry, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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4
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Ventriglio A, Bellomo A, Petito A, Pascucci M, Cuozzo E, Vitrani G, Stella E, Borraccino L, Varlese MP, Bhugra D. Factors Associated to the Onset of Mental Illness Among Hospitalized Migrants to Italy: A Chart Review. J Immigr Minor Health 2020; 23:425-433. [PMID: 33030664 DOI: 10.1007/s10903-020-01105-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 11/25/2022]
Abstract
Migration is a complex phenomenon and mental illness among immigrants remains a major matter of concern in Italy and worldwide. 243 medical and pharmacy records of patients admitted to University of Foggia hospital between 2004 and 2018 were retrospectively screened and included in the study. Socio-demographic data and clinical characteristics of inpatients were compared in those with and without first-episode of mental illness (FEMI). Subjects (140 men, 103 women; aged 34.4 ± 10.2 years) represented 6.66 ± 3.73% of all hospitalizations in 15 years. Nearly half of them (48.5%) had emigrated from other European countries. 30.8% were diagnosed with a DSM-IV TR unspecified psychosis. 103 patients (42.3%) were in first-lifetime episodes of mental illness. Factors significantly associated with FEMI were: younger age, sex (men), immigrating from Africa, poor language proficiency, lower amount of prescribed psychotropics. Mental health among immigrants is of major concern in Italy. Our findings report on factors possibly associated to the onset of mental illness among immigrant psychiatric inpatients.
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Affiliation(s)
- Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, presso Policlinico "Riuniti" di Foggia, Foggia, 71121, Italy.
| | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, University of Foggia, presso Policlinico "Riuniti" di Foggia, Foggia, 71121, Italy
| | - Annamaria Petito
- Department of Clinical and Experimental Medicine, University of Foggia, presso Policlinico "Riuniti" di Foggia, Foggia, 71121, Italy
| | - Marco Pascucci
- Department of Clinical and Experimental Medicine, University of Foggia, presso Policlinico "Riuniti" di Foggia, Foggia, 71121, Italy
| | - Edwige Cuozzo
- Department of Clinical and Experimental Medicine, University of Foggia, presso Policlinico "Riuniti" di Foggia, Foggia, 71121, Italy
| | - Giovanna Vitrani
- Department of Clinical and Experimental Medicine, University of Foggia, presso Policlinico "Riuniti" di Foggia, Foggia, 71121, Italy
| | - Eleonora Stella
- Department of Clinical and Experimental Medicine, University of Foggia, presso Policlinico "Riuniti" di Foggia, Foggia, 71121, Italy
| | - Luisa Borraccino
- Department of Clinical and Experimental Medicine, University of Foggia, presso Policlinico "Riuniti" di Foggia, Foggia, 71121, Italy
| | - Maria Pia Varlese
- Department of Clinical and Experimental Medicine, University of Foggia, presso Policlinico "Riuniti" di Foggia, Foggia, 71121, Italy
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Abstract
A first step towards personalized medicine is to consider whether, for some disorders, the safest and most effective treatment of women needs to differ from standard guideline recommendations developed on the basis of clinical trials conducted, for the most part, in men. A second step is to consider how women’s reproductive stages—pre-pubertal years, menstrual phases, pregnancy trimesters, lactation and postpartum periods, menopausal and postmenopausal/aging status—affect the optimal choice of treatment. This review focuses on these two steps in the treatment of psychosis, specifically schizophrenia. It discusses genetics, precursors and symptoms of schizophrenia, reproductive and associated ethical issues, antipsychotic drug response and adverse effects, substance abuse, victimization and perpetration of violence, and issues of immigration and of co-morbidity. The conclusions, while often based on clinical experience and theoretical considerations rather than strictly on the evidence of randomized controlled trials, are that clinical recommendations need to consider clinical and role differences that exist between men and women and make appropriate correction for age and reproductive status.
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Rosen M, Haidl TK, Ruhrmann S, Vogeley K, Schultze-Lutter F. Sex differences in symptomatology of psychosis-risk patients and in prediction of psychosis. Arch Womens Ment Health 2020; 23:339-349. [PMID: 31485796 DOI: 10.1007/s00737-019-01000-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 08/12/2019] [Indexed: 02/06/2023]
Abstract
Sex differences may be important for understanding underlying pathophysiological mechanisms and developing effective preventions and treatments of mental disorders. Despite sex differences in the onset of psychosis, patients at clinical high risk for psychosis (CHR) are underinvestigated for sex effects, especially with respect to models for prediction of conversion to psychosis. We studied psychopathological sex differences in referrals to a German early detection service and in its subgroup of converters and examined sex-specific psychopathological prediction models. In 152 male and 90 female referrals (88% at CHR; 35% converters), symptoms assessed with the Structured Interview for Psychosis-Risk Syndromes were investigated for sex differences using effect sizes. Sex-specific prediction models of psychosis were separately generated using Cox regressions with a LASSO operator. We found different small sex effects (0.10 < Rosenthal's r < 0.30) in the referral and in the converter sample. In the referral sample, exclusively, males showed more pronounced symptoms (all negative symptoms incl. reduced stress tolerance, grandiosity, and disorganized communication); in converters, females experienced more pronounced perceptual abnormalities, bizarre thinking, and odd behaviors, while males expressed and experienced emotions to a lower degree. Furthermore, sexes differed in psychosis-predictive symptoms: "suspiciousness" and "disorganized communication" were prominent in prediction of psychosis in males, whereas "trouble with focus and attention" was so in females. While most sex differences in patients attending an early detection service seem to reflect general differences that are not specifically related to psychosis, others might be psychosis-specific. These results can inform the development of more individualized and effective interventions for CHR patients based on more precise sex-specific prediction models.
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Affiliation(s)
- Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Theresa Katharina Haidl
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Kai Vogeley
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Bergische Landstraße 2, 40629, Düsseldorf, Germany
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7
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Schultze-Lutter F, Schimmelmann BG, Flückiger R, Michel C. Effects of age and sex on clinical high-risk for psychosis in the community. World J Psychiatry 2020; 10:101-124. [PMID: 32477906 PMCID: PMC7243619 DOI: 10.5498/wjp.v10.i5.101] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 03/23/2020] [Accepted: 03/30/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Recent reports of both heightened prevalence rates and limited clinical relevance of clinical high-risk (CHR) criteria and their relevant symptoms in children and adolescents indicate an important role of neurodevelopment in the early detection of psychoses. Furthermore, sex effects in CHR symptoms have been reported, though studies were inconclusive. As sex also impacts on neurodevelopment, we expected that sex might have an additional contribution to age in the prevalence and clinical relevance of CHR symptoms and criteria.
AIM To investigate age and sex effects on CHR criteria and symptoms and their association with psychosocial impairment and mental disorder.
METHODS In this cross-sectional cohort study, n = 2916 8- to 40-year-olds, randomly drawn from the population register of the Swiss canton Bern, were assessed in semi-structured interviews by phone or face-to-face for CHR symptoms and criteria using the Structured Interview for Psychosis-Risk Syndromes and the Schizophrenia Proneness Instrument in its child and youth, and adult version, respectively. Furthermore, social and occupational functioning and DSM-IV axis I disorders were assessed. Simple and interaction effects of age and sex on CHR symptoms and criteria, and interaction effects of age, sex, and CHR symptoms and criteria on presentation of functional impairment and of non-psychotic disorder were investigated using logistic regression analyses.
RESULTS Altogether, 542 (18.6%) participants reported any CHR symptom; of these, 261 (9.0%) participants reported any one of the 11 criteria relevant cognitive and perceptual basic symptoms, and 381 (13.1%) any one of the five attenuated or transient psychotic symptoms (attenuated psychotic symptoms/brief intermittent psychotic symptoms). Fewer participants met any one of the CHR criteria (n = 82, 2.8%) or any one of the three recently recommended CHR criteria (n = 38, 1.3%). Both age and sex were significantly (P < 0.05) associated with CHR symptoms and criteria, mostly by younger age and female sex. Though slightly differing between symptom groups, age thresholds were detected around the turn from adolescence to adulthood; they were highest for cognitive basic symptoms and CHR criteria. With the exception of the infrequent speech disorganization attenuated psychotic symptom, the interaction of age with CHR symptoms and criteria predicted functional impairment; whereas, independent of each other, sex and CHR symptoms mostly predicted mental disorders.
CONCLUSION Age and sex differentially impact on CHR symptoms and criteria; these differences may support better understanding of causal pathways. Thus, future CHR studies should consider effects of sex and age.
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Affiliation(s)
- Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf 40692, Germany
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern 3000, Switzerland
- University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Rahel Flückiger
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern 3000, Switzerland
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern 3000, Switzerland
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8
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Abstract
Since its earliest conceptualization, schizophrenia has been considered a disorder of "young men." Contemporary research suggests that there are sex differences in schizophrenia that are both transdiagnostic and representative of general sex/gender differences across the psychopathology spectrum. This chapter selectively summarizes representative sex/gender differences in clinical expression, epidemiology, risk factors, treatment, as well as course and outcome in schizophrenia. The consistent sex differences found, such as onset age, generic brain anomalies, and hormonal involvement, are not specific to schizophrenia or necessarily to psychopathology. It is suggested that in working with those diagnosed as meeting the current criteria for schizophrenia, clinicians adopt a transdiagnostic framework informed by sex and gender role processes.
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Affiliation(s)
- Richard Lewine
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, United States.
| | - Mara Hart
- Department of Psychiatry, Worcester Recovery Center and Hospital, Worcester, MA, United States
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9
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Morgan C, Knowles G, Hutchinson G. Migration, ethnicity and psychoses: evidence, models and future directions. World Psychiatry 2019; 18:247-258. [PMID: 31496097 PMCID: PMC6732691 DOI: 10.1002/wps.20655] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
There is a large body of research reporting high rates of psychotic disorders among many migrant and minority ethnic groups, particularly in Northern Europe. In the context of increasing migration and consequent cultural diversity in many places worldwide, these findings are a major social and public health concern. In this paper, we take stock of the current state of the art, reviewing evidence on variations in rates of psychoses and putative explanations, including relevant theories and models. We discuss in particular: a) the wide variation in reported rates of psychotic disorders by ethnic group, and b) the evidence implicating social risks to explain this variation, at ecological and individual levels. We go on to set out our proposed socio-developmental model, that posits greater exposure to systemic social risks over the life course, particularly those involving threat, hostility and violence, to explain high rates of psychoses in some migrant and minority ethnic groups. Based on this analysis, the challenge of addressing this social and public health issue needs to be met at multiple levels, including social policy, community initiatives, and mental health service reform.
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Affiliation(s)
- Craig Morgan
- Economic and Social Research Council (ESRC) Centre for Society and Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Gemma Knowles
- Economic and Social Research Council (ESRC) Centre for Society and Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
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10
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Arranz S, Camacho J, Andrés C, Niubó I, Sanchez Gistau V. Comparison between a morocco and a native-born population, in a sample of first episode psychosis. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2019; 13:73-79. [PMID: 31109904 DOI: 10.1016/j.rpsm.2019.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 02/20/2019] [Accepted: 03/11/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Ethnic differences have been studied previously in schizophrenia and first episodes of psychosis (FEP). Previous studies in Netherlands have reported a higher incidence of psychosis in male Moroccan immigrants and more clinical severity. However there is lack of studies in Spain with morocco population and FEP. OBJECTIVES This study aims to determine the clinical differences in a sample of FEP between Morocco and Spanish population, recruited in a hospitalisation unit. MATERIAL AND METHODS Descriptive and cross-sectional study of 83 inpatients (FEP). Functionality and symptomatology were evaluated at entry and discharge, the pattern of use of cannabis was evaluated at entry, the dose of antipsychotic and the pattern of side-effects at discharge. Comparisons between native-born population and Morocco population was made with univariate analysis and logistic regression was made for evaluating the independence of the associations. RESULTS The 28.9% of the sample was Morocco group. No significance differences were found in clinical characteristics between groups at entry or at discharge. Compared with native-born, the Morocco group were more male, with less years of education, worse functionality, reported less use of cannabis, a better pattern of side effects and a tendency of more prescription of LAis. After the multivariate analysis, just remains a lower functionality (OR 0.93; IC 95%: 0.88-0.99, P=0.02) and lower years of education (OR 0.75; IC 95%: 0.56-1.01, P=0.05), remain significative with being related with Morocco origin. CONCLUSIONS Our study provides evidence for ethnic differences in Morocco population with FEP. Patients with Morocco ethnicity have more probability of being males, less years of educations. Have lower functionality and a better profile of side effects.
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Affiliation(s)
- Sara Arranz
- Parc Sanitari Sant Joan de Déu, Barcelona, España; Hospital Universitario Instituto Pere Mata, Universitat Rovira Virgili, Reus, España.
| | - Julia Camacho
- Parc Sanitari Sant Joan de Déu, Barcelona, España; Hospital Universitario Instituto Pere Mata, Universitat Rovira Virgili, Reus, España
| | - Claudia Andrés
- Parc Sanitari Sant Joan de Déu, Barcelona, España; Hospital Universitario Instituto Pere Mata, Universitat Rovira Virgili, Reus, España
| | - Inés Niubó
- Parc Sanitari Sant Joan de Déu, Barcelona, España; Hospital Universitario Instituto Pere Mata, Universitat Rovira Virgili, Reus, España
| | - Vanessa Sanchez Gistau
- Parc Sanitari Sant Joan de Déu, Barcelona, España; Hospital Universitario Instituto Pere Mata, Universitat Rovira Virgili, Reus, España
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11
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Abstract
PURPOSE OF REVIEW Arguably, the strongest evidence of an environmental contribution to the cause of psychosis is the increased risk for certain groups of migrants and ethnic minorities. This article summarizes findings published since 2016. RECENT FINDINGS Two studies suggested that migration or minority status are proxies for exposure to an inferior social status. A study from Bologna, Italy, showed that the psychosis risk for internal migrants from Southern Italy was as much increased as that for international migrants. A report from New Zealand reported a higher risk for Maoris than for the remainder of the population.Furthermore, a Danish investigation showed that own-group ethnic density of the neighbourhood at age 15 strongly modified the psychosis risk at adult age. This rules out differential mobility during the prodromal phase as an explanation for the ethnic density effect. Preliminary evidence suggests that the psychotogenic effect of migration may be mediated by elevated dopamine in the striatum. SUMMARY An increasing body of evidence suggests that the higher psychosis risk for certain migrant or ethnic minority groups is due to an inferior social status. Neuroimaging of the dopamine system appears to be a promising avenue for research into pathogenesis.
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12
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Belbasis L, Köhler CA, Stefanis N, Stubbs B, van Os J, Vieta E, Seeman MV, Arango C, Carvalho AF, Evangelou E. Risk factors and peripheral biomarkers for schizophrenia spectrum disorders: an umbrella review of meta-analyses. Acta Psychiatr Scand 2018; 137:88-97. [PMID: 29288491 DOI: 10.1111/acps.12847] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/04/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study aimed to systematically appraise the meta-analyses of observational studies on risk factors and peripheral biomarkers for schizophrenia spectrum disorders. METHODS We conducted an umbrella review to capture all meta-analyses and Mendelian randomization studies that examined associations between non-genetic risk factors and schizophrenia spectrum disorders. For each eligible meta-analysis, we estimated the summary effect size estimate, its 95% confidence and prediction intervals and the I2 metric. Additionally, evidence for small-study effects and excess significance bias was assessed. RESULTS Overall, we found 41 eligible papers including 98 associations. Sixty-two associations had a nominally significant (P-value <0.05) effect. Seventy-two of the associations exhibited large or very large between-study heterogeneity, while 13 associations had evidence for small-study effects. Excess significance bias was found in 18 associations. Only five factors (childhood adversities, cannabis use, history of obstetric complications, stressful events during adulthood, and serum folate level) showed robust evidence. CONCLUSION Despite identifying 98 associations, there is only robust evidence to suggest that cannabis use, exposure to stressful events during childhood and adulthood, history of obstetric complications, and low serum folate level confer a higher risk for developing schizophrenia spectrum disorders. The evidence on peripheral biomarkers for schizophrenia spectrum disorders remains limited.
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Affiliation(s)
- L Belbasis
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - C A Köhler
- Translational Psychiatry Research Group, Department of Clinical Medicine, Federal University of Ceará Medical School, Fortaleza, Brazil
| | - N Stefanis
- Department of Psychiatry, Eginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - B Stubbs
- Department of Physiotherapy, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Health Service and Population Research, Institute of Psychiatry, King's College London, London, UK
| | - J van Os
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - E Vieta
- Bipolar Disorder Unit, Institute of Neuroscience, University of Barcelona, IDIBAPS and CIBERSAM, Barcelona, Spain
| | - M V Seeman
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - C Arango
- Department of Child and Adolescent Psychiatry, University Hospital Gregorio Marañón, Complutense University of Madrid Medical School, CIBERSAM, Madrid, Spain
| | - A F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction & Mental Health (CAMH), Toronto, ON, Canada
| | - E Evangelou
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
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13
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Radua J, Ramella-Cravaro V, Ioannidis JPA, Reichenberg A, Phiphopthatsanee N, Amir T, Yenn Thoo H, Oliver D, Davies C, Morgan C, McGuire P, Murray RM, Fusar-Poli P. What causes psychosis? An umbrella review of risk and protective factors. World Psychiatry 2018; 17:49-66. [PMID: 29352556 PMCID: PMC5775150 DOI: 10.1002/wps.20490] [Citation(s) in RCA: 377] [Impact Index Per Article: 53.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Psychosis is a heterogeneous psychiatric condition for which a multitude of risk and protective factors have been suggested. This umbrella review aimed to classify the strength of evidence for the associations between each factor and psychotic disorders whilst controlling for several biases. The Web of Knowledge database was searched to identify systematic reviews and meta-analyses of observational studies which examined associations between socio-demographic, parental, perinatal, later factors or antecedents and psychotic disorders, and which included a comparison group of healthy controls, published from 1965 to January 31, 2017. The literature search and data extraction followed PRISMA and MOOSE guidelines. The association between each factor and ICD or DSM diagnoses of non-organic psychotic disorders was graded into convincing, highly suggestive, suggestive, weak, or non-significant according to a standardized classification based on: number of psychotic cases, random-effects p value, largest study 95% confidence interval, heterogeneity between studies, 95% prediction interval, small study effect, and excess significance bias. In order to assess evidence for temporality of association, we also conducted sensitivity analyses restricted to data from prospective studies. Fifty-five meta-analyses or systematic reviews were included in the umbrella review, corresponding to 683 individual studies and 170 putative risk or protective factors for psychotic disorders. Only the ultra-high-risk state for psychosis (odds ratio, OR=9.32, 95% CI: 4.91-17.72) and Black-Caribbean ethnicity in England (OR=4.87, 95% CI: 3.96-6.00) showed convincing evidence of association. Six factors were highly suggestive (ethnic minority in low ethnic density area, second generation immigrants, trait anhedonia, premorbid IQ, minor physical anomalies, and olfactory identification ability), and nine were suggestive (urbanicity, ethnic minority in high ethnic density area, first generation immigrants, North-African immigrants in Europe, winter/spring season of birth in Northern hemisphere, childhood social withdrawal, childhood trauma, Toxoplasma gondii IgG, and non-right handedness). When only prospective studies were considered, the evidence was convincing for ultra-high-risk state and suggestive for urbanicity only. In summary, this umbrella review found several factors to be associated with psychotic disorders with different levels of evidence. These risk or protective factors represent a starting point for further etiopathological research and for the improvement of the prediction of psychosis.
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Affiliation(s)
- Joaquim Radua
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- FIDMAG Germanes Hospitalàries, CIBERSAM, Sant Boi de Llobregat, Spain
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Valentina Ramella-Cravaro
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - John P A Ioannidis
- Department of Medicine, Stanford Prevention Research Center, Stanford, CA, USA
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA
- Meta-Research Innovation Center at Stanford, Stanford University, Stanford, CA, USA
- Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA, USA
| | - Abraham Reichenberg
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Frieman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nacharin Phiphopthatsanee
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Taha Amir
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Hyi Yenn Thoo
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Dominic Oliver
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Cathy Davies
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Craig Morgan
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research (NIHR) Maudsley Biomedical Research Center, London, UK
| | - Philip McGuire
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research (NIHR) Maudsley Biomedical Research Center, London, UK
| | - Robin M Murray
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research (NIHR) Maudsley Biomedical Research Center, London, UK
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research (NIHR) Maudsley Biomedical Research Center, London, UK
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
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14
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van de Beek MH, van der Krieke L, Schoevers RA, Veling W. Social exclusion and psychopathology in an online cohort of Moroccan-Dutch migrants: Results of the MEDINA-study. PLoS One 2017; 12:e0179827. [PMID: 28692653 PMCID: PMC5503196 DOI: 10.1371/journal.pone.0179827] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 06/05/2017] [Indexed: 12/02/2022] Open
Abstract
Introduction Migration is seen as a risk factor for developing psychiatric symptoms and experiencing social exclusion. In the Netherlands, the Moroccan-Dutch population is the second largest migrant group. 70% of all young Moroccan-Dutch people meet each other in the online community www.marokko.nl. Within this community, we investigated the association between experiences of social exclusion and self-reported depressive symptoms and psychotic experiences. Materials and methods Participants were recruited via the website www.marokko.nl. They completed an online survey, with screening instruments for depressive symptoms (K10) and psychotic experiences (PQ-16), measures of social exclusion (perceived discrimination, social defeat and social support), and questions about demographical information. With regression analysis the association between social exclusion and psychiatric symptoms was investigated. Results We included 267 participants; 87% were female. 27% of the sample has received mental healthcare in the past. Over 50% of these people screened positive for depressive symptoms and psychotic experiences. Perceived discrimination and social defeat were significantly associated with psychotic experiences and social defeat was associated with depressive symptoms. Social support and higher education were associated with less depressive symptoms and psychotic experiences. Discussion Our findings suggest that the online environment allows for epidemiological research and early symptom detection. Levels of psychopathology were high in our sample. This suggests that a part of this young ethnic minority population might not get adequate mental healthcare. Since this population can be reached through Internet, the online environment may therefore also offer an appropriate setting for intervention, to increase resilience towards social exclusion.
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Affiliation(s)
- Madelien H. van de Beek
- Dimence Institute for Mental Health, Dimence Group, Zwolle, the Netherlands
- University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- * E-mail:
| | - Lian van der Krieke
- University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Robert A. Schoevers
- University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Wim Veling
- University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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15
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Akdeniz C, Schäfer A, Streit F, Haller L, Wüst S, Kirsch P, Tost H, Meyer-Lindenberg A. Sex-Dependent Association of Perigenual Anterior Cingulate Cortex Volume and Migration Background, an Environmental Risk Factor for Schizophrenia. Schizophr Bull 2017; 43:925-934. [PMID: 28969352 PMCID: PMC5472165 DOI: 10.1093/schbul/sbw138] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Migration status is one of the best-established risk factors for schizophrenia. An increase in risk is observed in both first- and second-generation immigrants, with a varying magnitude depending on the ethnic background of the individuals. The underlying mechanisms for the increased risk are only recently coming into focus. A causal role for social stress has been widely proposed, and recent work indicated altered neural stress processing in the perigenual anterior cingulate cortex (pACC) in migrants. Since previous work shows that social stress may lead to enduring changes in the gray matter volume of vulnerable brain regions, we investigated the impact of migration background on brain structure. We studied healthy young adults (N = 124), native Germans and second-generation migrants, using whole-brain structural magnetic resonance imaging. Groups were matched for a broad range of sociodemographic characteristics including age, gender, urban exposure, and education. We found a significant group by sex interaction effect in pACC gray matter volume, which was reduced in males with migration background only. This mirrors previous findings in urban upbringing, another risk factor for schizophrenia. Our results provide convergent evidence for an impact of environmental risk factors linked to schizophrenia on gray matter volume and extend prior data by highlighting the possibility that the pACC structure may be particularly sensitive to the convergent risk factors linked to schizophrenia.
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Affiliation(s)
- Ceren Akdeniz
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany,These authors contributed equally
| | - Axel Schäfer
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany,These authors contributed equally
| | - Fabian Streit
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Leila Haller
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Stefan Wüst
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany,Present address: Institute of Experimental Psychology, University of Regensburg, Regensburg, Germany
| | - Peter Kirsch
- Department of Clinical Psychology, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Heike Tost
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
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16
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Termorshuizen F, Selten JP, Heerdink ER. Dispensing of psychotropic medication among 400,000 immigrants in The Netherlands. Soc Psychiatry Psychiatr Epidemiol 2017; 52:963-977. [PMID: 28616632 PMCID: PMC5534199 DOI: 10.1007/s00127-017-1405-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 06/03/2017] [Indexed: 11/15/2022]
Abstract
PURPOSE Previously, a high prevalence of certain psychiatric disorders was shown among non-Western immigrants. This study explores whether this results in more prescriptions for psychotropic medication. METHODS Data on dispensing of medication among adults living in the four largest Dutch cities in 2013 were linked to demographic data from Statistics Netherlands. Incident (i.e., following no dispensing in 2010-2012) and prevalent dispensing among immigrants was compared to that among native Dutch (N = 1,043,732) and analyzed using multivariable Poisson and logistic regression. RESULTS High adjusted Odds Ratios (ORadj) of prevalent and high Incidence Rate Ratios (IRRadj) of incident dispensing of antipsychotics were found among Moroccan (N = 115,455) and Turkish individuals (N = 105,460), especially among young Moroccan males (ORadj = 3.22 [2.99-3.47]). Among Surinamese (N = 147,123) and Antillean individuals (N = 41,430), slightly higher rates of dispensed antipsychotics were found and the estimates decreased after adjustment. The estimates for antipsychotic dispensing among the Moroccan and Turkish increased, following adjustment for household composition. Rates for antidepressant dispensing among Turkish and Moroccan subjects were high (Moroccans: ORadj = 1.74 [1.70-1.78]). Among Surinamese and Antillean subjects, the rates for antidepressant dispensing were low and the ORadj lagged behind the IRRadj (Surinamese: 0.69 [0.67-0.71] vs. 1.06 [1.00-1.13]). Similar results were found for anxiolytics. For ADHD medication, lower dispensing rates were found among all migrant groups. CONCLUSIONS The findings agree with earlier reports of more mental health problems among Moroccan and Turkish individuals. Surinamese/Antillean individuals did not use psychotropic drugs at excess and discontinued antidepressants and anxiolytics earlier. The data strongly suggest under-treatment for ADHD in all ethnic minority groups.
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Affiliation(s)
- Fabian Termorshuizen
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, P.O. Box 80082, 3508 TB, Utrecht, The Netherlands. .,Rivierduinen, Institute for Mental Health Care, Sandifortdreef 19, 2333 ZZ, Leiden, The Netherlands.
| | - Jean-Paul Selten
- Rivierduinen, Institute for Mental Health Care, Sandifortdreef 19, 2333 ZZ Leiden, The Netherlands ,0000 0001 0481 6099grid.5012.6Department of Psychiatry and Psychology, School for Mental Health and Neuroscience MHeNS, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - Eibert R. Heerdink
- 0000000120346234grid.5477.1Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, P.O. Box 80082, 3508 TB Utrecht, The Netherlands ,0000000090126352grid.7692.aDepartment of Clinical Pharmacy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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17
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Reactivity to social stress in ethnic minority men. Psychiatry Res 2016; 246:629-636. [PMID: 27884461 DOI: 10.1016/j.psychres.2016.10.076] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 09/02/2016] [Accepted: 10/30/2016] [Indexed: 01/22/2023]
Abstract
Repeated exposures to social exclusion, through a process of sensitization, may result in larger responses to experiences of social stress. The current study tested the hypothesis that healthy Moroccan-Dutch men respond stronger to social stress than Dutch controls 1) in daily life, and 2) in an experimental set-up. A general population sample of 50 Moroccan-Dutch and 50 Dutch young adult males were tested with 1) the Experience Sampling Method, a structured diary technique, assessing reactivity to social stress in daily life, and 2) an experimental exposure to social peer evaluation. No group differences were found in affective or psychotic reactivity to daily social stress. When exposed to a negative social evaluation in the lab, a blunted affective response was found in the Moroccan-Dutch compared to the Dutch group, whereas the psychotic response did not differ significantly between groups. In conclusion, healthy Moroccan-Dutch men are not more sensitive to social stress than healthy Dutch men. Instead, the blunted affective response of Moroccan-Dutch men to peer evaluation may signify habituation rather than sensitization.
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