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Sturm ET, Thomas ML, Sares AG, Dave S, Baron D, Compton MT, Palmer BW, Jester DJ, Jeste DV. Review of Major Social Determinants of Health in Schizophrenia-Spectrum Disorders: II. Assessments. Schizophr Bull 2023; 49:851-866. [PMID: 37022911 PMCID: PMC10318889 DOI: 10.1093/schbul/sbad024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
BACKGROUND AND AIMS Social determinants of health (SDoHs) impact the development and course of schizophrenia-spectrum psychotic disorders (SSPDs). Yet, we found no published scholarly reviews of psychometric properties and pragmatic utility of SDoH assessments among people with SSPDs. We aim to review those aspects of SDoH assessments. STUDY DESIGN PsychInfo, PubMed, and Google Scholar databases were examined to obtain data on reliability, validity, administration process, strengths, and limitations of the measures for SDoHs identified in a paired scoping review. STUDY RESULTS SDoHs were assessed using different approaches including self-reports, interviews, rating scales, and review of public databases. Of the major SDoHs, early-life adversities, social disconnection, racism, social fragmentation, and food insecurity had measures with satisfactory psychometric properties. Internal consistency reliabilities-evaluated in the general population for 13 measures of early-life adversities, social disconnection, racism, social fragmentation, and food insecurity-ranged from poor to excellent (0.68-0.96). The number of items varied from 1 to more than 100 and administration time ranged from less than 5 minutes to over an hour. Measures of urbanicity, low socioeconomic status, immigration status, homelessness/housing instability, and incarceration were based on public records or targeted sampling. CONCLUSIONS Although the reported assessments of SDoHs show promise, there is a need to develop and test brief but validated screening measures suitable for clinical application. Novel assessment tools, including objective assessments at individual and community levels utilizing new technology, and sophisticated psychometric evaluations for reliability, validity, and sensitivity to change with effective interventions are recommended, and suggestions for training curricula are offered.
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Affiliation(s)
- Emily T Sturm
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | - Michael L Thomas
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | - Anastasia G Sares
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | | | - David Baron
- Western University of Health Sciences, CA, USA
| | - Michael T Compton
- Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, and New York State Psychiatric Institute, New York, NY, USA
| | - Barton W Palmer
- Department of Psychiatry, University of California, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, Mental Illness Research, Education, and Clinical Center, San Diego, CA, USA
| | - Dylan J Jester
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Dilip V Jeste
- Department of Psychiatry, University of California, San Diego, CA, USA (Retired)
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Zhang D, Guo Q, Xu L, Liu X, Zhang T, Liu X, Chen H, Li G, Wang J. The impact of COVID-19 pandemic on individuals at clinical high-risk for psychosis: Evidence from eye-tracking measures. Prog Neuropsychopharmacol Biol Psychiatry 2022; 118:110578. [PMID: 35618148 PMCID: PMC9126616 DOI: 10.1016/j.pnpbp.2022.110578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 11/19/2022]
Abstract
Emerging evidence suggested that people with severe mental disorders were more vulnerable to the negative effects of the COVID-19 pandemic. However, few researches investigated the influence of global pandemics on people at clinical high risk (CHR) for psychosis. This study aimed to investigate the impact of the COVID-19 pandemic on clinical symptoms, psychological distress, and eye-tracking characteristics in CHR individuals and healthy participants. Forty-nine CHR individuals and 50 healthy controls (HC) were assessed by PTSD Checklist for DSM-5 (PCL-5), Perceived Stress Scale, 10-item version (PSS-10), and Coronavirus Impact Scale (CIS). Eye movement performances were measured by the tests of fixation stability, free-viewing, and anti-saccade. According to the mean score of CIS, participants were stratified into high-impact (n = 35) and low-impact (n = 64) subgroups. Compared with the HC group, CHR participants reported significantly higher levels of post-traumatic symptoms caused by the COVID-19 pandemic and showed abnormalities in most of the eye movement indexes. Among the altered indexes, the saccade amplitude of fixation stability test (far distractor), the scan path length of free-viewing test, and the accuracy of anti-saccade test were negatively affected by the severity of impact level in the CHR group. Moreover, the altered eye movement indexes were significantly associated with the total scores of CIS, PCL-5, and subscales of the Scale of Prodromal Syndromes (SOPS) among CHR individuals. Overall, our findings suggested the negative impact of the COVID-19 pandemic on the eye movement characteristics of CHR individuals. The present study provides valuable information on physiological distress related to the COVID-19 pandemic and sensitive neuropsychological biomarkers that interacted with social and environment stress in the CHR population.
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Affiliation(s)
- Dan Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China
| | - Qian Guo
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China; Department of Early Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China.
| | - Lihua Xu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China
| | - Xu Liu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China
| | - TianHong Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China
| | - Xiaohua Liu
- Department of Early Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China
| | - Haiying Chen
- Department of Early Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China
| | - Guanjun Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China.
| | - Jijun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China; CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai 201203, PR China; Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai 200030, PR China.
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3
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O'Donoghue B, Downey L, Eaton S, Mifsud N, Kirkbride JB, McGorry P. Risk of psychotic disorders in migrants to Australia. Psychol Med 2021; 51:1192-1200. [PMID: 31996272 DOI: 10.1017/s0033291719004100] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Certain migrant groups are at an increased risk of psychotic disorders compared to the native-born population; however, research to date has mainly been conducted in Europe. Less is known about whether migrants to other countries, with different histories and patterns of migration, such as Australia, are at an increased risk for developing a psychotic disorder. We tested this for first-generation migrants in Melbourne, Victoria. METHODS This study included all young people aged 15-24 years, residing in a geographically-defined catchment area of north western Melbourne who presented with a first episode of psychosis (FEP) to the Early Psychosis Prevention and Intervention Centre (EPPIC) between 1 January 2011 and 31 December 2016. Data pertaining to the at-risk population were obtained from the Australian 2011 Census and incidence rate ratios were calculated and adjusted for age, sex and social deprivation. RESULTS In total, 1220 young people presented with an FEP during the 6-year study period, of whom 24.5% were first-generation migrants. We found an increased risk for developing psychotic disorder in migrants from the following regions: Central and West Africa (adjusted incidence rate ratio [aIRR] = 3.53, 95% CI 1.58-7.92), Southern and Eastern Africa (aIRR = 3.06, 95% CI 1.99-4.70) and North Africa (aIRR = 5.03, 95% CI 3.26-7.76). Migrants from maritime South East Asia (aIRR = 0.39, 95% CI 0.23-0.65), China (aIRR = 0.25, 95% CI 0.13-0.48) and Southern Asia (aIRR = 0.44, 95% CI 0.26-0.76) had a decreased risk for developing a psychotic disorder. CONCLUSION This clear health inequality needs to be addressed by sufficient funding and accessible mental health services for more vulnerable groups. Further research is needed to determine why migrants have an increased risk for developing psychotic disorders.
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Affiliation(s)
- Brian O'Donoghue
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Orygen Youth Health, Melbourne, Australia
| | - Linglee Downey
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Scott Eaton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Nathan Mifsud
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - James B Kirkbride
- Psylife Group, Division of Psychiatry, University College London, London, England
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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4
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Tarricone I, D'Andrea G, Storbini V, Braca M, Ferrari S, Reggianini C, Rigatelli M, Gramaglia C, Zeppegno P, Gambaro E, Luciano M, Ceregato A, Altamura M, Barrasso G, Primavera D, Carpiniello B, Todarello O, Berlincioni V, Podavini F, Morgan C, Murray RM, Di Forti M, Muratori R, Berardi D. First-episode Psychosis and Migration in Italy: Results from a Study in the Italian Mental Health Services (Pep-Ita Study). J Immigr Minor Health 2021; 23:519-527. [PMID: 33689115 PMCID: PMC8068695 DOI: 10.1007/s10903-021-01168-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 11/29/2022]
Abstract
Background: Migrants present high rates of psychosis. A better understanding of this phenomenon is needed. Methods: We conducted a multicentre First-Episode Psychosis (FEP) prospective study over two years (January 2012–December 2013) to evaluate first-generation migrants presenting with FEP at the participating Community Mental Health Centers (CMHCs). Results: 109 FEP migrants were identified. Almost half of them were highly educated, employed and in a stable affective relationship. The average age was 32.8 (± 9.8) years, and the average length of stay in Italy was 8.6 (± 8.8) years. About 2/3 of patients were referred to CMHCs following Emergency Department access or psychiatric admission. Conclusions: Our finding of a “high functioning portrait” of FEP migrants allow us to hypothesize that a high burden of negative psychosocial factors is likely to be needed for the FEP onset. Furtherly, mental health services should implement more appropriate resources and organizational methods to respond to migrants’ health needs.
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Affiliation(s)
- Ilaria Tarricone
- Department of Medical and Surgical Sciences, Bologna Transcultural Psychosomatic Team (BoTPT), University of Bologna, Viale C. Pepoli 5, 40123, Bologna, Italy. .,Department of Mental Health and Pathological Addiction, Local Health Authority, Bologna, Italy.
| | - Giuseppe D'Andrea
- Department of Medical and Surgical Sciences, Bologna Transcultural Psychosomatic Team (BoTPT), University of Bologna, Viale C. Pepoli 5, 40123, Bologna, Italy.,Department of Biomedical and NeuroMotor Sciences, Psychiatry Unit, University of Bologna, Bologna, Italy
| | - Viviana Storbini
- Department of Biomedical and NeuroMotor Sciences, Psychiatry Unit, University of Bologna, Bologna, Italy
| | - Mauro Braca
- Department of Biomedical and NeuroMotor Sciences, Psychiatry Unit, University of Bologna, Bologna, Italy
| | - Silvia Ferrari
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
| | - Corinna Reggianini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
| | - Marco Rigatelli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
| | - Carla Gramaglia
- Department of Translational Medicine, Institute of Psychiatry, Università del Piemonte Orientale, Novara, Italy
| | - Patrizia Zeppegno
- Department of Translational Medicine, Institute of Psychiatry, Università del Piemonte Orientale, Novara, Italy
| | - Eleonora Gambaro
- Department of Translational Medicine, Institute of Psychiatry, Università del Piemonte Orientale, Novara, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Alessio Ceregato
- Mental Health Department A.S.L. TO4, Community Mental Health Service, Chivasso, TO, Italy
| | - Mario Altamura
- Department of Clinical and Experimental Medicine, Section of Psychiatry and Clinical Psychology, University of Foggia, Foggia, Italy
| | | | - Diego Primavera
- Department of Medical Science and Public Health-Section of Psychiatry, University of Cagliari, Cagliari, Italy
| | - Bernardo Carpiniello
- Department of Medical Science and Public Health-Section of Psychiatry, University of Cagliari, Cagliari, Italy
| | - Orlando Todarello
- U.O. di Psichiatria - Azienda Ospedaliero-Universitaria "Consorziale Policlinico" Bari; Dipartimento Di Scienze Mediche Di Base, Neuroscienze Ed Organi Di Senso, Università Degli Studi Aldo Moro Di Bari, Bari BA, Italy
| | - Vanna Berlincioni
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Francesca Podavini
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Craig Morgan
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Robin M Murray
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Marta Di Forti
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Roberto Muratori
- Department of Mental Health and Pathological Addiction, Local Health Authority, Bologna, Italy
| | - Domenico Berardi
- Department of Mental Health and Pathological Addiction, Local Health Authority, Bologna, Italy.,Department of Biomedical and NeuroMotor Sciences, Psychiatry Unit, University of Bologna, Bologna, Italy
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5
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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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6
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Oduola S, Das-Munshi J, Bourque F, Gayer-Anderson C, Tsang J, Murray RM, Craig TKJ, Morgan C. Change in incidence rates for psychosis in different ethnic groups in south London: findings from the Clinical Record Interactive Search-First Episode Psychosis (CRIS-FEP) study. Psychol Med 2021; 51:300-309. [PMID: 31739818 PMCID: PMC7893508 DOI: 10.1017/s0033291719003234] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/08/2019] [Accepted: 10/22/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND A higher incidence of psychotic disorders has been consistently reported among black and other minority ethnic groups, particularly in northern Europe. It is unclear whether these rates have changed over time. METHODS We identified all individuals with a first episode psychosis who presented to adult mental health services between 1 May 2010 and 30 April 2012 and who were resident in London boroughs of Lambeth and Southwark. We estimated age-and-gender standardised incidence rates overall and by ethnic group, then compared our findings to those reported in the Aetiology and Ethnicity of Schizophrenia and Other Psychoses (ÆSOP) study that we carried out in the same catchment area around 10 years earlier. RESULTS From 9109 clinical records we identified 558 patients with first episode psychosis. Compared with ÆSOP, the overall incidence rates of psychotic disorder in southeast London have increased from 49.4 (95% confidence interval (CI) 43.6-55.3) to 63.1 (95% CI 57.3-69.0) per 100 000 person-years at risk. However, the overall incidence rate ratios (IRR) were reduced in some ethnic groups: for example, IRR (95% CI) for the black Caribbean group reduced from 6.7 (5.4-8.3) to 2.8 (2.1-3.6) and the 'mixed' group from 2.7 (1.8-4.2) to 1.4 (0.9-2.1). In the black African group, there was a negligible difference from 4.1 (3.2-5.3) to 3.5 (2.8-4.5). CONCLUSIONS We found that incidence rates of psychosis have increased over time, and the IRR varied by the ethnic group. Future studies are needed to investigate more changes over time and determinants of change.
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Affiliation(s)
- Sherifat Oduola
- School of Health Sciences, University of East Anglia, Norwich Research Park, NorwichNR4 7TJ, UK
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, Denmark Hill, LondonSE5 8AF, UK
- South London & Maudsley NHS Foundation Trust, Denmark Hill, LondonSE5 8AZ, UK
| | - Jayati Das-Munshi
- South London & Maudsley NHS Foundation Trust, Denmark Hill, LondonSE5 8AZ, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, Denmark Hill, LondonSE5 8AF, UK
| | - Francois Bourque
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, Denmark Hill, LondonSE5 8AF, UK
- Division of Social and Cultural Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal (Quebec), H4H 1R3, Canada
| | - Charlotte Gayer-Anderson
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, Denmark Hill, LondonSE5 8AF, UK
| | - Jason Tsang
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, Denmark Hill, LondonSE5 8AF, UK
| | - Robin M. Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, Denmark Hill, LondonSE5 8AF, UK
| | - Tom K. J Craig
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, Denmark Hill, LondonSE5 8AF, UK
| | - Craig Morgan
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, Denmark Hill, LondonSE5 8AF, UK
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7
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Webb R, Bartl G, James B, Skan R, Peters E, Jones AM, Garety P, Kuipers E, Hayward M, Greenwood K. Exploring the Development, Validity, and Utility of the Short-Form Version of the CHoice of Outcome In Cbt for PsychosEs: A Patient-Reported Outcome Measure of Psychological Recovery. Schizophr Bull 2020; 47:653-661. [PMID: 33215190 PMCID: PMC8084424 DOI: 10.1093/schbul/sbaa173] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The original CHoice of Outcome In Cbt for psychosEs (CHOICE) measure was designed in collaboration with experts by experience as a patient-reported "Psychological Recovery" outcome measure for cognitive-behavioral therapy for psychosis (CBTp). A short version (CHOICE-SF) was developed to use as a brief outcome measure, with a focus on sensitivity to change, for use in future research and practice. CHOICE-SF was developed and validated using 3 separate samples, comprising 640 service users attending 1 of 2 transdiagnostic clinics for (1) CBTp or (2) therapies for voice hearing or (3) who took part in the treatment as usual arm of a trial. In the initial subsample of 69 participants, items from the original CHOICE measure with medium to large effect sizes for change pre- to post-CBTp were retained to form the CHOICE-SF. Internal consistency, construct validity, and sensitivity to change were confirmed, and the factor structure was examined in 242 participants. Specificity was confirmed by comparison with 44 participants who completed CHOICE at 2 time points but did not receive therapy. Validation of CHOICE-SF was carried out by confirming factor structure and sensitivity to change in a new sample of 354 and a subsample of 51 participants, respectively. The CHOICE-SF comprised 11 items and 1 additional personal goal item. A single-factor structure was confirmed, with high internal consistency, construct validity, and sensitivity to change. The CHOICE-SF is a brief, psychometrically robust measure to assess change following psychological therapies in research and clinical practice for people with psychosis and severe mental illness.
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Affiliation(s)
- Rebecca Webb
- School of Psychology, University of Sussex, Pevensey, Falmer, Brighton, UK
| | - Gergely Bartl
- School of Psychology, University of Sussex, Pevensey, Falmer, Brighton, UK
| | - Bryony James
- School of Psychology, University of Sussex, Pevensey, Falmer, Brighton, UK
| | - Rosie Skan
- School of Psychology, University of Sussex, Pevensey, Falmer, Brighton, UK
| | - Emmanuelle Peters
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, King’s College London, London, UK,Psychological Interventions Clinic for Outpatients With Psychosis, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK
| | - Anna-Marie Jones
- R&D Department, Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Philippa Garety
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, King’s College London, London, UK,National Institute for Health Research Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King’s College London, London, UK
| | - Elizabeth Kuipers
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, King’s College London, London, UK,Psychological Interventions Clinic for Outpatients With Psychosis, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK,National Institute for Health Research Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King’s College London, London, UK
| | - Mark Hayward
- School of Psychology, University of Sussex, Pevensey, Falmer, Brighton, UK,R&D Department, Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Kathryn Greenwood
- School of Psychology, University of Sussex, Pevensey, Falmer, Brighton, UK,R&D Department, Sussex Partnership NHS Foundation Trust, Brighton, UK,To whom correspondence should be addressed; tel: +44 1273 678409, fax: +44 1273 678058, e-mail:
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8
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Neill E, Tan EJ, Toh WL, Selvendra A, Morgan VA, Rossell SL, Castle DJ. Examining which factors influence age of onset in males and females with schizophrenia. Schizophr Res 2020; 223:265-270. [PMID: 32883558 DOI: 10.1016/j.schres.2020.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/14/2020] [Accepted: 08/15/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Data from the 2010 Australian National Survey of High Impact Psychosis (SHIP) was used to examine (1) what variables influence age of onset (AOO) for males and females, and (2) whether influencing variables were different between the sexes. METHOD Data from 622 schizophrenia patients in the SHIP sample was used. These included early life factors, encompassing family psychiatric history, childhood development, trauma and parental loss. Factors occurring within 12 months of diagnosis were also used, including drug/alcohol abuse and premorbid work and social adjustment. Based on the recognised differences in symptom profiles and AOO between the sexes, these factors were regressed separately for males and females. RESULTS Stepwise linear regressions showed that a family history of psychiatric disorders was significantly associated with earlier AOO in both sexes. Other variables differed between males and females. Specifically, for females, an earlier AOO was associated with poor premorbid social adjustment and the loss of a family member in childhood. Older AOO was associated with immigrant status. For males, a younger AOO was associated with unemployment at onset, poor premorbid work adjustment, parental divorce in childhood, and lifetime cannabis use. A higher premorbid IQ was associated with an older AOO. CONCLUSION Familial predisposition to psychiatric illness is related to earlier AOO of schizophrenia independent of sex. Males appear to have more individual-based predictive factors while females seem to have more community/social-based influences. Future directions for research in schizophrenia are suggested.
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Affiliation(s)
- Erica Neill
- Department of Psychiatry, St. Vincent's Hospital, Melbourne, VIC, Australia; Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia; Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia.
| | - Eric J Tan
- Department of Psychiatry, St. Vincent's Hospital, Melbourne, VIC, Australia; Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Wei Lin Toh
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Ajit Selvendra
- Department of Psychiatry, St. Vincent's Hospital, Melbourne, VIC, Australia
| | - Vera A Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, University of Western Australia, Perth, WA, Australia; Centre for Clinical Research in Neuropsychiatry, Medical School, University of Western Australia, Perth, WA, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
| | - David J Castle
- Department of Psychiatry, St. Vincent's Hospital, Melbourne, VIC, Australia; Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
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Westman J, Johansson LM, Sundquist K. Country of birth and hospital admission rates for mental disorders: a cohort study of 4.5 million men and women in Sweden. Eur Psychiatry 2020; 21:307-14. [PMID: 16675206 DOI: 10.1016/j.eurpsy.2006.02.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2006] [Accepted: 02/08/2006] [Indexed: 11/16/2022] Open
Abstract
AbstractThis study analysed the association between country of birth and psychotic, affective, and neurotic disorders in seven immigrant categories, after adjustment for demographic and socioeconomic factors. A 2-year national cohort study of 4.5 million individuals in the age group 25–64 years was performed. Swedish national registers including individual demographic and socioeconomic data were linked to the hospital discharge register. Cox regression was used in the analysis. Several groups of immigrants, both men and women, had risks of hospital admission for psychotic, affective, or neurotic disorders compared to the Swedish-born reference group. The impact of demographic and socioeconomic factors on these risks seemed to be larger for men than for women. For foreign-born men, several of the risks no longer remained significant after adjustment for income and marital status. In contrast, most of the risks for foreign-born women remained significant after adjustment for income and marital status. Low income and being single were associated with an increased risk of psychiatric hospital admission. These results represent important knowledge for clinicians and public health planners who are involved in treatment and prevention of mental disorders among certain groups of immigrants, and among low income men and women irrespective of immigrant status.
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Affiliation(s)
- J Westman
- Centre for Family Medicine, Karolinska Institute, MigraMed, Alfred-Nobels allé 12, Huddinge, Sweden.
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10
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Fossion P, Servais L, Rejas MC, Ledoux Y, Pelc I, Minner P. Psychosis, migration and social environment: an age-and-gender controlled study. Eur Psychiatry 2020; 19:338-43. [PMID: 15363471 DOI: 10.1016/j.eurpsy.2004.04.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
AbstractPurposeAdverse social experiences are frequently invoked to explain the higher rate of psychosis among migrant groups. The aim of the present study was to establish the socio-environmental factors distinguishing migrant psychotic patients from autochthonous patients.Subjects and methodWe conducted a cross-sectional survey involving 341 migrant psychotic patients matched for age and gender with 341 autochthonous psychotic patients.ResultsMigrant patients lived more often with their parental family, were less often enrolled with a referral psychiatrist, presented a lower rate of employment, a lower percentage of alcohol misuse and of suicide attempts.DiscussionOur findings add to the growing body of results showing that more attention needs to be focused on socio-environmental variables in psychosis research. However, several limitations have to be taken into account, particularly with regard to selection biases and age of onset of the psychotic illness.ConclusionOur results are compatible with the hypothesis that unemployment is a contributing factor in the risk for psychosis among migrant groups. Migrants’ families are an important keystone in the mental health care process of their sick relatives. Our service models need to be adapted with the aim to make the treatment easier for migrant patients.
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Affiliation(s)
- P Fossion
- Department of Psychiatry, Brugmann University Hospital, CHU Brugmann, 4, place Van Gehuchten, 1020 Brussels, Belgium.
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11
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Claassen D, Ascoli M, Berhe T, Priebe S. Research on mental disorders and their care in immigrant populations: a review of publications from Germany, Italy and the UK. Eur Psychiatry 2020; 20:540-9. [PMID: 15963698 DOI: 10.1016/j.eurpsy.2005.02.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2004] [Accepted: 02/15/2005] [Indexed: 11/28/2022] Open
Abstract
AbstractObjectiveThe review aims to identify the extent and nature of research on mental disorders and their care in immigrant populations in three major European countries with high levels of immigration, i.e. Germany, Italy, United Kingdom (UK).MethodsPeer-reviewed publications on the subject from the three countries between 1996 and 2004 were analyzed. The research questions addressed, the methods used, and the results obtained were assessed.ResultsThirteen papers reporting empirical studies were found from Germany, four from Italy and 95 from the UK. Studies addressed a range of research questions and most frequently assessed rates of service utilization in different immigrant groups. The most consistent finding is a higher rate of hospital admissions for Afro-Caribbean patients in the UK. Many studies had serious methodological shortcomings with low sample sizes and unspecified inclusion criteria.DiscussionDespite large scale immigration in each of the three studied countries, the numbers of relevant research publications vary greatly with a relatively high level of empirical research in the UK. Possible reasons for this are a generally stronger culture of mental health service research and a higher number of researchers who are themselves from immigrant backgrounds in the UK.ConclusionOverall the evidence base to guide the development of mental health services for immigrant populations appears limited. Future research requires appropriate funding, should be of sufficient methodological quality and may benefit from collaboration across Europe.
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Affiliation(s)
- Dirk Claassen
- Unit for Social and Community Psychiatry, Queen Mary (University of London), Newham Centre for Mental Health, Glen Road, Plaistow, London E13 8SP, UK.
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12
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Selten JP, van der Ven E, Termorshuizen F. Migration and psychosis: a meta-analysis of incidence studies. Psychol Med 2020; 50:303-313. [PMID: 30722795 PMCID: PMC7083571 DOI: 10.1017/s0033291719000035] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 11/15/2018] [Accepted: 01/04/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND The aims of this meta-analysis are (i) to estimate the pooled relative risk (RR) of developing non-affective psychotic disorder (NAPD) and affective psychotic disorder (APD) among migrants and their children; (ii) to adjust these results for socioeconomic status (SES); (iii) to examine the sources of heterogeneity that underlie the risk of NAPD. METHODS We included population-based incidence studies that reported an age-adjusted RR with 95% confidence interval (CI) published 1 January 1977-12 October 2017 and used a random-effects model. RESULTS We retrieved studies performed in Europe (n = 43), Israel (n = 3), Canada (n = 2) and Australia (n = 1). The meta-analysis yielded a RR, adjusted for age and sex, of 2.13 (95% CI 1.99-2.27) for NAPD and 2.94 (95% CI 2.28-3.79) for APD. The RRs diminished, but persisted after adjustment for SES. With reference to NAPD: a personal or parental history of migration to Europe from countries outside Europe was associated with a higher RR (RR = 2.94, 95% CI 2.63-3.29) than migration within Europe (RR = 1.88, 95% 1.62-2.18). The corresponding RR was lower in Israel (RR = 1.22; 0.99-1.50) and Canada (RR = 1.21; 0.85-1.74). The RR was highest among individuals with a black skin colour (RR = 4.19, 95% CI 3.42-5.14). The evidence of a difference in risk between first and second generation was insufficient. CONCLUSIONS Positive selection may explain the low risk in Canada, while the change from exclusion to inclusion may do the same in Israel. Given the high risks among migrants from developing countries in Europe, social exclusion may have a pathogenic role.
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Affiliation(s)
- Jean-Paul Selten
- School for Mental Health and Neuroscience, University of Maastricht, Maastricht, The Netherlands
- GGZ Rivierduinen, Institute for Mental Health, Leiden, The Netherlands
| | - Els van der Ven
- School for Mental Health and Neuroscience, University of Maastricht, Maastricht, The Netherlands
- GGZ Rivierduinen, Institute for Mental Health, Leiden, The Netherlands
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13
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Ethnic inequalities in the incidence of diagnosis of severe mental illness in England: a systematic review and new meta-analyses for non-affective and affective psychoses. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1311-1323. [PMID: 31482194 DOI: 10.1007/s00127-019-01758-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 08/20/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Although excess risks particularly for a diagnosis of schizophrenia have been identified for ethnic minority people in England and other contexts, we sought to identify and synthesise up-to-date evidence (2018) for affective in addition to non-affective psychoses by specific ethnic groups in England. METHODS Systematic review and meta-analysis of ethnic differences in diagnosed incidence of psychoses in England, searching nine databases for reviews (citing relevant studies up to 2009) and an updated search in three databases for studies between 2010 and 2018. Studies from both searches were combined in meta-analyses allowing coverage of more specific ethnic groups than previously. RESULTS We included 28 primary studies. Relative to the majority population, significantly higher risks of diagnosed schizophrenia were found in Black African (Relative risk, RR 5.72, 95% CI 3.87-8.46, n = 9); Black Caribbean (RR 5.20, 95% CI 4.33-6.24, n = 21); South Asian (RR 2.27, 95% CI 1.63-3.16, n = 14); White Other (RR 2.24, 95% CI 1.59-3.14, n = 9); and Mixed Ethnicity people (RR 2.24, 95% CI 1.32-3.80, n = 4). Significantly higher risks for diagnosed affective psychoses were also revealed: Black African (RR 4.07, 95% CI 2.27-7.28, n = 5); Black Caribbean (RR 2.91, 95% CI 1.78-4.74, n = 16); South Asian (RR 1.71, 95% CI 1.07-2.72, n = 8); White Other (RR 1.55, 95% CI 1.32-1.83, n = 5); Mixed Ethnicity (RR 6.16, 95% CI 3.99-9.52, n = 4). CONCLUSIONS The risk for a diagnosis of non-affective and affective psychoses is particularly elevated for Black ethnic groups, but is higher for all ethnic minority groups including those previously not assessed through meta-analyses (White Other, Mixed Ethnicity). This calls for further research on broader disadvantages affecting ethnic minority people.
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Abstract
A hypothesis offering diglossia as a potential risk factor for schizophrenia is presented. This is supported primarily by an account of the numerous co-occurrences between the diglossic phenomenon and the established risk factors and features of schizophrenia, such as language impairment, working memory dysfunction, social adversity, urbanicity, migration, and ethnicity, as well as some of the broader educational elements including illiteracy, reading deficits, and poor academic attainment. With an emphasis on the inherent role of language in schizophrenia and the demand for elucidating a mechanism behind its risk factors, we propose that a diglossic environment in childhood may constitute a neurodevelopmental insult predisposing to the development of the disorder. This relationship may be mediated by the reduced lateralization of language in the brain, which has been observed in relation to schizophrenia.
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15
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Byrne M, Codjoe L, Morgan C, Stahl D, Day F, Fearon P, Fusar-Poli P, Power P, McGuire P, Valmaggia L. The relationship between ethnicity and service access, treatment uptake and the incidence of psychosis among people at ultra high risk for psychosis. Psychiatry Res 2019; 272:618-627. [PMID: 30616132 DOI: 10.1016/j.psychres.2018.12.111] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 12/20/2018] [Accepted: 12/20/2018] [Indexed: 11/29/2022]
Abstract
Black ethnicity is associated with increased risk for psychosis in South London. This study explored the distribution of ethnicity among services users at ultra high risk for psychosis (UHR) and examined the influence of ethnicity on service access, treatment uptake and incidence of psychosis. The ethnic distribution of 228 people at UHR for psychosis, seen in an early detection clinical service over 10 years, was compared with 146 people with first episode psychosis from the same geographic region and census figures for the local population. Black service users were significantly over-represented in the UHR group compared to the background population (34% vs 21%; p < 0.05); but less so than in the first episode sample (58% vs 19%; p < 0.05). Within the UHR sample, there was no strong evidence of differences between ethnic groups in the types of treatment provided, nor in the rate of transition to psychosis over 2 years. The absence of differences between ethnic groups in rates of transition to psychosis raises the possibility that access to mental health care at the high risk stage might have reduced the influence of ethnicity on the incidence of psychosis in this sample. This would need to be replicated in a larger sample.
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Affiliation(s)
- Majella Byrne
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, United Kingdom; South London and Maudsley NHS Foundation Trust, United Kingdom.
| | - Louisa Codjoe
- South London and Maudsley NHS Foundation Trust, United Kingdom; Health Service and Population Research, King's College London, Institute of Psychiatry, Psychology and Neuroscience, United Kingdom
| | - Craig Morgan
- Health Service and Population Research, King's College London, Institute of Psychiatry, Psychology and Neuroscience, United Kingdom
| | - Daniel Stahl
- Biostatistics & Health Informatics, King's College London, Institute of Psychiatry, Psychology and Neuroscience, United Kingdom
| | - Fern Day
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, United Kingdom
| | - Paul Fearon
- St Patrick University Hospital and Trinity College Dublin, Ireland
| | - Paolo Fusar-Poli
- South London and Maudsley NHS Foundation Trust, United Kingdom; Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, United Kingdom
| | - Paddy Power
- St Patrick University Hospital and Trinity College Dublin, Ireland
| | - Philip McGuire
- South London and Maudsley NHS Foundation Trust, United Kingdom; Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, United Kingdom
| | - Lucia Valmaggia
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, United Kingdom; South London and Maudsley NHS Foundation Trust, United Kingdom
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16
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Abstract
PURPOSE OF REVIEW We review recent developments on risk factors in schizophrenia. RECENT FINDINGS The way we think about schizophrenia today is profoundly different from the way this illness was seen in the twentieth century. We now know that the etiology of schizophrenia is multifactorial and reflects an interaction between genetic vulnerability and environmental contributors. Environmental risk factors such as pregnancy and birth complications, childhood trauma, migration, social isolation, urbanicity, and substance abuse, alone and in combination, acting at a number of levels over time, influence the individual's likelihood to develop the disorder. Environmental risk factors together with the identification of a polygenic risk score for schizophrenia, research on gene-environment interaction and environment-environment interaction have hugely increased our knowledge of the disorder.
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Affiliation(s)
- Simona A Stilo
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK.
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
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17
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Maraj A, Iyer SN, Shah JL. Enhancing the Engagement of Immigrant and Ethnocultural Minority Clients in Canadian Early Intervention Services for Psychosis. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:740-747. [PMID: 30067385 PMCID: PMC6299191 DOI: 10.1177/0706743718773752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Anika Maraj
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montréal, Quebec
- Department of Psychiatry, McGill University, Montreal, Quebec
| | - Srividya N. Iyer
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montréal, Quebec
- Department of Psychiatry, McGill University, Montreal, Quebec
- ACCESS Open Minds (Pan-Canadian youth mental health services research network), Douglas Mental Health University Institute, Montreal, Quebec
- Frayme, Networks for Centres of Excellence focused on youth mental health and substance use, Canada
- These authors contributed equally to this work
| | - Jai L. Shah
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montréal, Quebec
- Department of Psychiatry, McGill University, Montreal, Quebec
- ACCESS Open Minds (Pan-Canadian youth mental health services research network), Douglas Mental Health University Institute, Montreal, Quebec
- These authors contributed equally to this work
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18
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Abstract
The epidemiology and management of schizophrenia have been well studied over the past few decades. In the UK, key findings that have emerged time and again are the excess prevalence and incidence rates of schizophrenia among people of African–Caribbean origin. The reasons for this excess and the implications of this finding are many. The findings may reflect a true excess or a methodological artefact related to errors in the estimation of numerator and denominator data. The findings have been increasingly accepted as better designed studies have emerged, but these still do not fully address concerns about the nature of schizophrenia in other cultural groups and in societies in which industrialisation and economic productivity of the individual are not considered to be as crucial for an individual's sense of belonging in a community.
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19
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Abstract
Human beings have moved from place to place since time immemorial. The reasons for and the duration of these migrations put extraordinary stress on individuals and their families. Such stress may not be related to an increase in mental illness for all conditions or to the same extent across all migrant groups. In this paper, we provide an overview of some observations in the field of migration and mental health, hypothesise why some individuals and groups are more vulnerable to psychiatric conditions, and consider the impact of migration experiences on provision of services and care.
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20
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21
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Gomes FV, Grace AA. Adolescent Stress as a Driving Factor for Schizophrenia Development-A Basic Science Perspective. Schizophr Bull 2017; 43:486-489. [PMID: 28419390 PMCID: PMC5464111 DOI: 10.1093/schbul/sbx033] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Schizophrenia has been associated with heightened stress responsivity in adolescence that precedes onset of psychosis. We now report that multiple stressors during adolescence in normal rats leads to deficits in adults analogous to that seen in schizophrenia patients. Moreover, impairment of stress control by lesion of the prelimbic prefontal cortex in adolescence caused previously subthreshold levels of stress to induce these deficit states when tested as adults. Thus, predisposition to stress hyper-responsivity, or exposure to substantial stressors, during adolescence can trigger a cascade of events that result in a schizophrenia-like profile in adults. This data can provide crucial information with respect to identifying markers for schizophrenia vulnerability early in life and, by mitigating the impact of stressors, prevent the transition to psychosis.
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Affiliation(s)
- Felipe V. Gomes
- Departments of Neuroscience, Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA
| | - Anthony A. Grace
- Departments of Neuroscience, Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA
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22
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Abstract
Purpose of review While the experience of migration and resettlement in a new country is associated with mental health risks, immigrants generally demonstrate better mental health than expected. This review describes patterns in mental health outcomes among immigrants. We discuss a conceptual model of the potential underlying mechanisms that could buffer the stress and disadvantage experienced by this substantial and growing population. Recent findings While epidemiological studies have established a general pattern of lower risk for mental health disorders among first-generation (foreign-born) immigrants in the U.S., recent studies highlight how this pattern varies substantially by the intersection of race, ethnicity, national origin, gender, and socioeconomic status. Contextual factors including the family and neighborhood context; an immigrant's social position; experiences of social support and social exclusion; language competency and ability; and exposure to discrimination and acculturative stress further influence the relationship between immigration and mental health. Summary We conclude with an emphasis on social resilience processes, with a focus on how immigrants develop social relations, social capital and social networks. We recommend future directions for research that prioritize identifying and understanding social adaptation strategies adopted by immigrant groups to cope with immigration stressors.
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23
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Egerton A, Howes OD, Houle S, McKenzie K, Valmaggia LR, Bagby MR, Tseng HH, Bloomfield MAP, Kenk M, Bhattacharyya S, Suridjan I, Chaddock CA, Winton-Brown TT, Allen P, Rusjan P, Remington G, Meyer-Lindenberg A, McGuire PK, Mizrahi R. Elevated Striatal Dopamine Function in Immigrants and Their Children: A Risk Mechanism for Psychosis. Schizophr Bull 2017; 43:293-301. [PMID: 28057720 PMCID: PMC5605255 DOI: 10.1093/schbul/sbw181] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Migration is a major risk factor for schizophrenia but the neurochemical processes involved are unknown. One candidate mechanism is through elevations in striatal dopamine synthesis and release. The objective of this research was to determine whether striatal dopamine function is elevated in immigrants compared to nonimmigrants and the relationship with psychosis. Two complementary case-control studies of in vivo dopamine function (stress-induced dopamine release and dopamine synthesis capacity) in immigrants compared to nonimmigrants were performed in Canada and the United Kingdom. The Canadian dopamine release study included 25 immigrant and 31 nonmigrant Canadians. These groups included 23 clinical high risk (CHR) subjects, 9 antipsychotic naïve patients with schizophrenia, and 24 healthy volunteers. The UK dopamine synthesis study included 32 immigrants and 44 nonimmigrant British. These groups included 50 CHR subjects and 26 healthy volunteers. Both striatal stress-induced dopamine release and dopamine synthesis capacity were significantly elevated in immigrants compared to nonimmigrants, independent of clinical status. These data provide the first evidence that the effect of migration on the risk of developing psychosis may be mediated by an elevation in brain dopamine function.
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Affiliation(s)
- Alice Egerton
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK;,These authors are joint first authors
| | - Oliver D. Howes
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK;,These authors are joint first authors
| | - Sylvain Houle
- Research Imaging Center, CAMH, PET Centre, Toronto, ON, Canada;,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada;,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada;,These authors are joint first authors
| | - Kwame McKenzie
- Research Imaging Center, CAMH, PET Centre, Toronto, ON, Canada;,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Lucia R. Valmaggia
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Michael R. Bagby
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada;,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada;,Department of Psychology, University of Toronto
| | - Huai-Hsuan Tseng
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK;,Research Imaging Center, CAMH, PET Centre, Toronto, ON, Canada
| | - Michael A. P. Bloomfield
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK;,Division of Psychiatry, University College London, London, UK;,Psychiatric Imaging Group, MRC Clinical Sciences Centre, Hammersmith Hospital, London, UK
| | - Miran Kenk
- Research Imaging Center, CAMH, PET Centre, Toronto, ON, Canada
| | - Sagnik Bhattacharyya
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Ivonne Suridjan
- Research Imaging Center, CAMH, PET Centre, Toronto, ON, Canada
| | | | - Toby T. Winton-Brown
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Paul Allen
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK;,Department of Psychology, Whitelands College, University of Roehampton, London, UK
| | - Pablo Rusjan
- Research Imaging Center, CAMH, PET Centre, Toronto, ON, Canada;,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Gary Remington
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada;,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Andreas Meyer-Lindenberg
- Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, Mannheim, Germany
| | - Philip K. McGuire
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK;,These authors are joint last authors
| | - Romina Mizrahi
- Research Imaging Center, CAMH, PET Centre, Toronto, ON, Canada;,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada;,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada;,These authors are joint last authors
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24
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Abstract
OBJECTIVE We investigated the role of biological and psychosocial risk factors in the development of psychotic disorders with regards to immigrant status. Our hypothesis was that biological risk factors are more predictive of psychosis in non-immigrants, whereas psychosocial risk factors play a bigger role in immigrants. METHOD A retrospective audit of admissions between December 2013 and June 2014 in an Australian adult inpatient unit was conducted, focussing on patients with psychotic disorders. We analysed the association between immigrant status, and biological and psychosocial variables. RESULTS For biological risk factors, non-immigrants had significantly more family history of psychotic disorders (p = 0.021), illicit drug use (p = < 0.001) and alcohol use (p = < 0.001). For psychosocial risk factors, immigrants were more likely to have experienced a traumatic event (p = 0.022). With regards to age of index presentation, age at onset of psychotic disorder, proportion of males and dysfunctional family background, there was no significant difference. CONCLUSION Retrospective data in this report suggests that the development of psychotic disorders in immigrants and non-immigrants may be different.
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Affiliation(s)
- Grace Yx Lim
- Medical Student, School of Psychology and Psychiatry, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Michael Th Wong
- Adjunct Clinical Associate Professor of Psychiatry, School of Psychology and Psychiatry, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
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Zandi T, Havenaar JM, Laan W, Kahn RS, Brink WVD. Effects of a culturally sensitive assessment on symptom profiles in native Dutch and Moroccan patients with a first psychosis referral. Transcult Psychiatry 2016; 53:45-59. [PMID: 25851336 DOI: 10.1177/1363461515577288] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Previous studies have reported a higher incidence of psychosis in Moroccan immigrants in the Netherlands than among native-born residents. However, this disparity was substantially attenuated when cultural differences in symptom presentation were taken into account. To better understand the impact of different diagnostic procedures on incidence rates, we examined the effects of the use of a culturally sensitive diagnostic interview, compared to a standard semi-structured diagnostic interview, on symptom profiles among Moroccan immigrant and native Dutch patients in the Netherlands. A total of 26 Dutch and 26 Moroccan patients referred with a possible first psychosis diagnosis were interviewed twice: once with the standard version and once with a culturally adapted version of the Comprehensive Assessment of Symptoms and History questionnaire (CASH and CASH-CS, respectively). Among native Dutch patients, symptoms profiles based on CASH and CASH-CS interviews were very similar. By contrast, among Moroccan immigrant patients, symptom profiles based on CASH and CASH-CS interviews differed substantially, with more mania symptoms (+30%; p < .05) and fewer delusions (-31%; p < .05) reported when using the CASH-CS. These results suggest that the over-diagnosis of schizophrenia in Moroccan immigrants with a first psychosis referral may be related to a tendency to under-detect mood symptoms and over-detect positive psychotic symptoms when a standard diagnostic procedure is used. This bias may be corrected, at least in part, by the use of a culturally sensitive interview instrument such as the CASH- CS.
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26
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Alderman T, Addington J, Bearden C, Cannon TD, Cornblatt BA, McGlashan TH, Perkins DO, Seidman LJ, Tsuang MT, Walker EF, Woods SW, Cadenhead KS. Negative symptoms and impaired social functioning predict later psychosis in Latino youth at clinical high risk in the North American prodromal longitudinal studies consortium. Early Interv Psychiatry 2015; 9:467-75. [PMID: 24576057 PMCID: PMC4362746 DOI: 10.1111/eip.12128] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 12/20/2013] [Indexed: 01/30/2023]
Abstract
AIM Examining ethnically related variables in evaluating those at risk for psychosis is critical. This study investigated sociodemographic and clinical characteristics of Latino versus non-Latino clinical high-risk (CHR) subjects and healthy control (HC) subjects in the first North American Prodrome Longitudinal Study. METHODS Fifty-six Latino CHR subjects were compared to 25 Latino HC and 423 non-Latino CHR subjects across clinical and demographic variables. Thirty-nine of the 56 CHR subjects completed at least one subsequent clinical evaluation over the 2.5-year period with 39% developing a psychotic illness. Characteristics of Latino CHR subjects who later converted to psychosis ('converters') were compared to those who did not ('non-converters'). RESULTS Latino CHR subjects were younger than non-Latino CHR subjects and had less education than Latino HC subjects and non-Latino CHR counterparts. Latino CHR converters had higher scores than Latino non-converters on the Structured Interview for Prodromal Syndromes total negative symptoms that were accounted for by decreased expression of emotion and personal hygiene/social attentiveness subsections. Latino CHR converters scored lower on the global functioning:social scale, indicating worse social functioning than Latino non-converters. CONCLUSION Based on this sample, Latino CHR subjects may seek treatment earlier and have less education than non-Latino CHR subjects. Deficits in social functioning and impaired personal hygiene/social attentiveness among Latino CHR subjects predicted later psychosis and may represent important areas for future study. Larger sample sizes are needed to more thoroughly investigate the observed ethnic differences and risk factors for psychosis in Latino youth.
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Affiliation(s)
- Tracy Alderman
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Carrie Bearden
- Department of Psychology and Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Tyrone D Cannon
- Department of Psychology and Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA.,Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Barbara A Cornblatt
- Department of Psychiatry, Zucker Hillside Hospital, Long Island, New York, USA
| | | | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Larry J Seidman
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ming T Tsuang
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Elaine F Walker
- Department of Psychology and Psychiatry, Emory University, Atlanta, Georgia, USA
| | - Scott W Woods
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Kristin S Cadenhead
- Department of Psychiatry, University of California, San Diego, California, USA.,San Diego Veterans Affairs Medical Center, San Diego, California, USA
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Singh SP, Brown L, Winsper C, Gajwani R, Islam Z, Jasani R, Parsons H, Rabbie-Khan F, Birchwood M. Ethnicity and pathways to care during first episode psychosis: the role of cultural illness attributions. BMC Psychiatry 2015; 15:287. [PMID: 26573297 PMCID: PMC4647639 DOI: 10.1186/s12888-015-0665-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/28/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies demonstrate ethnic variations in pathways to care during first episode psychosis (FEP). There are no extant studies, however, that have statistically examined the influence of culturally mediated illness attributions on these variations. METHODS We conducted an observational study of 123 (45 White; 35 Black; 43 Asian) patients recruited over a two-year period from an Early Intervention Service (EIS) in Birmingham, UK. Sociodemographic factors (age; sex; education; country of birth; religious practice; marital status; living alone), duration of untreated psychosis (DUP), service contacts (general practitioner; emergency services; faith-based; compulsory detention; criminal justice) and illness attributions ("individual;" "natural;" "social;" "supernatural;" "no attribution") were assessed. RESULTS Ethnic groups did not differ in DUP (p = 0.86). Asian patients were more likely to report supernatural illness attributions in comparison to White (Odds Ratio: 4.02; 95 % Confidence Intervals: 1.52, 10.62) and Black (OR: 3.48; 95 % CI: 1.25, 9.67) patients. In logistic regressions controlling for confounders and illness attributions, Black (OR: 14.00; 95 % CI: 1.30, 151.11) and Asian (OR: 13.29; 95 % CI: 1.26, 140.47) patients were more likely to consult faith-based institutions than White patients. Black patients were more likely to be compulsorily detained than White patients (OR: 4.56; 95 % CI: 1.40, 14.85). CONCLUSION Illness attributions and sociodemographic confounders do not fully explain the ethnic tendency to seek out faith-based institutions. While Asian and Black patients are more likely to seek help from faith-based organisations, this does not appear to lead to a delay in contact with mental health services.
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Affiliation(s)
- Swaran P. Singh
- Mental Health and Well Being, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Luke Brown
- Mental Health and Well Being, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
| | - Catherine Winsper
- Mental Health and Well Being, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
| | - Ruchika Gajwani
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
| | - Zoebia Islam
- LOROS, Hospice Care for Leicester, Leicestershire and Rutland, Leicester, UK. .,De Montfort University, Leicester, UK.
| | | | - Helen Parsons
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
| | - Fatemeh Rabbie-Khan
- Faculty of Health, Education & Life Sciences, Birmingham City University, Birmingham, UK.
| | - Max Birchwood
- Mental Health and Well Being, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
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29
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Schizophrenia and other psychotic disorders in Caribbean-born migrants and their descendants in England: systematic review and meta-analysis of incidence rates, 1950-2013. Soc Psychiatry Psychiatr Epidemiol 2015; 50:1039-55. [PMID: 25660551 PMCID: PMC4464051 DOI: 10.1007/s00127-015-1021-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 01/29/2015] [Indexed: 01/14/2023]
Abstract
PURPOSE Increased risk of schizophrenia and other psychotic disorders among black Caribbean migrants and their descendants have been described since the 1960s. It remains unclear whether this risk varies over time, between rural and urban areas, or according to methodological artefact. METHODS We conducted a systematic review of the incidence of adult-onset psychotic disorders in black Caribbean groups relative to the baseline population in England, published 1950-2013. Subject to sufficient data (N ≥ 5) we used random effects meta-analyses to estimate pooled incidence rates (IR) and rate ratios (IRR) of seven psychotic disorder outcomes, and meta-regression to inspect whether any variation was attributable to study-level methodological features, including case ascertainment, denominator reliability, choice of baseline population and study quality. RESULTS Eighteen studies met inclusion for review. Sixteen demonstrated statistically significant elevated incidence rates in the black Caribbean group, present across all major psychotic disorders, including schizophrenia and bipolar disorder. Methodological quality increased over time (p = 0.01), but was not associated with estimated IR or IRR. For schizophrenia (N = 11 studies) the pooled IRR in the black Caribbean group was 4.7 (95 % CI 3.9-5.7) relative to the baseline; no evidence of publication bias was observed. We found weak evidence to suggest schizophrenia IRRs were smaller from studies in more urban settings (odds ratio 0.98; 95 % CI 0.96-1.00; p = 0.06). CONCLUSIONS Higher incidence rates of psychotic disorders have been present for more than 60 years amongst black Caribbean ethnic groups in England, despite improved study methodologies over time. Aetiological explanations appear to more parsimoniously account for this excess than methodological biases.
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Kelly BD, Emechebe A, Anamdi C, Duffy R, Murphy N, Rock C. Custody, care and country of origin: demographic and diagnostic admission statistics at an inner-city adult psychiatry unit. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2015; 38:1-7. [PMID: 25634112 DOI: 10.1016/j.ijlp.2015.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Involuntary detention is a feature of psychiatric care in many countries. We previously reported an involuntary admission rate of 67.7 per 100,000 population per year in inner-city Dublin (January 2008-December 2010), which was higher than Ireland's national rate (38.5). We also found that the proportion of admissions that was involuntary was higher among individuals born outside Ireland (33.9%) compared to those from Ireland (12.0%), apparently owing to increased diagnoses of schizophrenia in the former group. In the present study (January 2011-June 2013) we again found that the proportion of admissions that was involuntary was higher among individuals from outside Ireland (32.5%) compared to individuals from Ireland (9.9%) (p<0.001), but this is primarily attributable to a lower rate of voluntary admission among individuals born outside Ireland (206.1 voluntary admissions per 100,000 population per year; deprivation-adjusted rate: 158.5) compared to individuals from Ireland (775.1; deprivation-adjusted rate: 596.2). Overall, admission rates in our deprived, inner-city catchment area remain higher than national rates and this may be attributable to differential effects of Ireland's recent economic problems on different areas within Ireland. The relatively low rate of voluntary admission among individuals born outside Ireland may be attributable to different patterns of help-seeking which mental health services in Ireland need to take into account in future service-planning. Other jurisdictions could also usefully focus attention not just on rates on involuntary admission among individuals born elsewhere, but also rates of voluntary admission which may provide useful insights for service-planning and delivery.
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Affiliation(s)
- Brendan D Kelly
- Department of Adult Psychiatry, University College Dublin, Mater Misericordiae University Hospital, 62/63 Eccles Street, Dublin 7, Ireland.
| | - Afam Emechebe
- Department of Adult Psychiatry, University College Dublin, Mater Misericordiae University Hospital, 62/63 Eccles Street, Dublin 7, Ireland.
| | - Chike Anamdi
- Department of Adult Psychiatry, University College Dublin, Mater Misericordiae University Hospital, 62/63 Eccles Street, Dublin 7, Ireland.
| | - Richard Duffy
- Department of Adult Psychiatry, University College Dublin, Mater Misericordiae University Hospital, 62/63 Eccles Street, Dublin 7, Ireland.
| | - Niamh Murphy
- School of Medicine, Clinical Sciences Institute, National University of Ireland Galway, Newcastle Road, Galway, Ireland.
| | - Catherine Rock
- Department of Adult Psychiatry, University College Dublin, Mater Misericordiae University Hospital, 62/63 Eccles Street, Dublin 7, Ireland.
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Abstract
After over 100 years of research without clarifying the aetiology of schizophrenia, a look at the current state of knowledge in epidemiology, genetics, precursors, psychopathology, and outcome seems worthwhile. The disease concept, created by Kraepelin and modified by Bleuler, has a varied history. Today, schizophrenia is considered a polygenic disorder with onset in early adulthood, characterized by irregular psychotic episodes and functional impairment, but incident cases occur at all ages with marked differences in symptoms and social outcome. Men’s and women’s lifetime risk is nearly the same. At young age, women fall ill a few years later and less severely than men, men more rarely and less severely later in life. The underlying protective effect of oestrogen is antagonized by genetic load. The illness course is heterogeneous and depressive mood the most frequent symptom. Depression and schizophrenia are functionally associated, and affective and nonaffective psychoses do not split neatly. Most social consequences occur at the prodromal stage. Neither schizophrenia as such nor its main symptom dimensions regularly show pronounced deterioration over time. Schizophrenia is neither a residual state of a neurodevelopmental disorder nor a progressing neurodegenerative process. It reflects multifactorial CNS instability, which leads to cognitive deficits and symptom exacerbations.
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Lasalvia A, Bonetto C, Tosato S, Zanatta G, Cristofalo D, Salazzari D, Lazzarotto L, Bertani M, Bissoli S, De Santi K, Cremonese C, De Rossi M, Gardellin F, Ramon L, Zucchetto M, Amaddeo F, Tansella M, Ruggeri M. First-contact incidence of psychosis in north-eastern Italy: influence of age, gender, immigration and socioeconomic deprivation. Br J Psychiatry 2014; 205:127-34. [PMID: 24723631 DOI: 10.1192/bjp.bp.113.134445] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Considerable variations in the incidence of psychosis have been observed across countries, in terms of age, gender, immigration status, urbanicity and socioeconomic deprivation. AIMS To evaluate the incidence rate of first-episode psychosis in a large area of north-eastern Italy and the distribution of the above-mentioned risk factors in individuals with psychoses. METHOD Epidemiologically based survey. Over a 3-year period individuals with psychosis on first contact with services were identified and diagnosed according to ICD-10 criteria. RESULTS In total, 558 individuals with first-episode psychosis were identified during 3,077,555 person-years at risk. The annual incidence rate per 100,000 was 18.1 for all psychoses, 14.3 for non-affective psychoses and 3.8 for affective psychoses. The rate for all psychoses was higher in young people aged 20-29 (incidence rate ratio (IRR) = 4.18, 95% CI 2.77-6.30), immigrants (IRR = 2.26, 95% CI 1.85-2.75) and those living in the most deprived areas (IRR = 2.09, 95% CI 1.54-2.85). CONCLUSIONS The incidence rate in our study area was lower than that found in other European and North American studies and provides new insights into the factors that may increase and/or decrease risk for developing psychosis.
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Affiliation(s)
- Antonio Lasalvia
- Antonio Lasalvia, MD, PhD, Chiara Bonetto, PhD, Sarah Tosato, MD, PhD, Gioia Zanatta, DClinPsy, Doriana Cristofalo, Edu Sci, Damiano Salazzari, Lorenza Lazzarotto, DClinPsy, Mariaelena Bertani, PhD, Sarah Bissoli, PhD, Katia De Santi, MD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona; Carla Cremonese, MD, Psychiatric Clinic, Department of Neuroscience, University of Padua, Padua; Moreno De Rossi, MD, Department of Mental Health, NHS, Local Health Authority Adria, Rovigo; Francesco Gardellin, MD, Department of Mental Health, NHS, Local Health Authority Vicenza; Luana Ramon, MD, Department of Mental Health, NHS, Local Health Authority Portogruaro, Venezia; Maria Zucchetto, MD, Department of Mental Health, NHS, Local Health Authority Padua; Francesco Amaddeo, MD, PhD, Michele Tansella, MD, Mirella Ruggeri, MD, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy
| | - Chiara Bonetto
- Antonio Lasalvia, MD, PhD, Chiara Bonetto, PhD, Sarah Tosato, MD, PhD, Gioia Zanatta, DClinPsy, Doriana Cristofalo, Edu Sci, Damiano Salazzari, Lorenza Lazzarotto, DClinPsy, Mariaelena Bertani, PhD, Sarah Bissoli, PhD, Katia De Santi, MD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona; Carla Cremonese, MD, Psychiatric Clinic, Department of Neuroscience, University of Padua, Padua; Moreno De Rossi, MD, Department of Mental Health, NHS, Local Health Authority Adria, Rovigo; Francesco Gardellin, MD, Department of Mental Health, NHS, Local Health Authority Vicenza; Luana Ramon, MD, Department of Mental Health, NHS, Local Health Authority Portogruaro, Venezia; Maria Zucchetto, MD, Department of Mental Health, NHS, Local Health Authority Padua; Francesco Amaddeo, MD, PhD, Michele Tansella, MD, Mirella Ruggeri, MD, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy
| | - Sarah Tosato
- Antonio Lasalvia, MD, PhD, Chiara Bonetto, PhD, Sarah Tosato, MD, PhD, Gioia Zanatta, DClinPsy, Doriana Cristofalo, Edu Sci, Damiano Salazzari, Lorenza Lazzarotto, DClinPsy, Mariaelena Bertani, PhD, Sarah Bissoli, PhD, Katia De Santi, MD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona; Carla Cremonese, MD, Psychiatric Clinic, Department of Neuroscience, University of Padua, Padua; Moreno De Rossi, MD, Department of Mental Health, NHS, Local Health Authority Adria, Rovigo; Francesco Gardellin, MD, Department of Mental Health, NHS, Local Health Authority Vicenza; Luana Ramon, MD, Department of Mental Health, NHS, Local Health Authority Portogruaro, Venezia; Maria Zucchetto, MD, Department of Mental Health, NHS, Local Health Authority Padua; Francesco Amaddeo, MD, PhD, Michele Tansella, MD, Mirella Ruggeri, MD, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy
| | - Gioia Zanatta
- Antonio Lasalvia, MD, PhD, Chiara Bonetto, PhD, Sarah Tosato, MD, PhD, Gioia Zanatta, DClinPsy, Doriana Cristofalo, Edu Sci, Damiano Salazzari, Lorenza Lazzarotto, DClinPsy, Mariaelena Bertani, PhD, Sarah Bissoli, PhD, Katia De Santi, MD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona; Carla Cremonese, MD, Psychiatric Clinic, Department of Neuroscience, University of Padua, Padua; Moreno De Rossi, MD, Department of Mental Health, NHS, Local Health Authority Adria, Rovigo; Francesco Gardellin, MD, Department of Mental Health, NHS, Local Health Authority Vicenza; Luana Ramon, MD, Department of Mental Health, NHS, Local Health Authority Portogruaro, Venezia; Maria Zucchetto, MD, Department of Mental Health, NHS, Local Health Authority Padua; Francesco Amaddeo, MD, PhD, Michele Tansella, MD, Mirella Ruggeri, MD, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy
| | - Doriana Cristofalo
- Antonio Lasalvia, MD, PhD, Chiara Bonetto, PhD, Sarah Tosato, MD, PhD, Gioia Zanatta, DClinPsy, Doriana Cristofalo, Edu Sci, Damiano Salazzari, Lorenza Lazzarotto, DClinPsy, Mariaelena Bertani, PhD, Sarah Bissoli, PhD, Katia De Santi, MD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona; Carla Cremonese, MD, Psychiatric Clinic, Department of Neuroscience, University of Padua, Padua; Moreno De Rossi, MD, Department of Mental Health, NHS, Local Health Authority Adria, Rovigo; Francesco Gardellin, MD, Department of Mental Health, NHS, Local Health Authority Vicenza; Luana Ramon, MD, Department of Mental Health, NHS, Local Health Authority Portogruaro, Venezia; Maria Zucchetto, MD, Department of Mental Health, NHS, Local Health Authority Padua; Francesco Amaddeo, MD, PhD, Michele Tansella, MD, Mirella Ruggeri, MD, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy
| | - Damiano Salazzari
- Antonio Lasalvia, MD, PhD, Chiara Bonetto, PhD, Sarah Tosato, MD, PhD, Gioia Zanatta, DClinPsy, Doriana Cristofalo, Edu Sci, Damiano Salazzari, Lorenza Lazzarotto, DClinPsy, Mariaelena Bertani, PhD, Sarah Bissoli, PhD, Katia De Santi, MD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona; Carla Cremonese, MD, Psychiatric Clinic, Department of Neuroscience, University of Padua, Padua; Moreno De Rossi, MD, Department of Mental Health, NHS, Local Health Authority Adria, Rovigo; Francesco Gardellin, MD, Department of Mental Health, NHS, Local Health Authority Vicenza; Luana Ramon, MD, Department of Mental Health, NHS, Local Health Authority Portogruaro, Venezia; Maria Zucchetto, MD, Department of Mental Health, NHS, Local Health Authority Padua; Francesco Amaddeo, MD, PhD, Michele Tansella, MD, Mirella Ruggeri, MD, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy
| | - Lorenza Lazzarotto
- Antonio Lasalvia, MD, PhD, Chiara Bonetto, PhD, Sarah Tosato, MD, PhD, Gioia Zanatta, DClinPsy, Doriana Cristofalo, Edu Sci, Damiano Salazzari, Lorenza Lazzarotto, DClinPsy, Mariaelena Bertani, PhD, Sarah Bissoli, PhD, Katia De Santi, MD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona; Carla Cremonese, MD, Psychiatric Clinic, Department of Neuroscience, University of Padua, Padua; Moreno De Rossi, MD, Department of Mental Health, NHS, Local Health Authority Adria, Rovigo; Francesco Gardellin, MD, Department of Mental Health, NHS, Local Health Authority Vicenza; Luana Ramon, MD, Department of Mental Health, NHS, Local Health Authority Portogruaro, Venezia; Maria Zucchetto, MD, Department of Mental Health, NHS, Local Health Authority Padua; Francesco Amaddeo, MD, PhD, Michele Tansella, MD, Mirella Ruggeri, MD, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy
| | - Mariaelena Bertani
- Antonio Lasalvia, MD, PhD, Chiara Bonetto, PhD, Sarah Tosato, MD, PhD, Gioia Zanatta, DClinPsy, Doriana Cristofalo, Edu Sci, Damiano Salazzari, Lorenza Lazzarotto, DClinPsy, Mariaelena Bertani, PhD, Sarah Bissoli, PhD, Katia De Santi, MD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona; Carla Cremonese, MD, Psychiatric Clinic, Department of Neuroscience, University of Padua, Padua; Moreno De Rossi, MD, Department of Mental Health, NHS, Local Health Authority Adria, Rovigo; Francesco Gardellin, MD, Department of Mental Health, NHS, Local Health Authority Vicenza; Luana Ramon, MD, Department of Mental Health, NHS, Local Health Authority Portogruaro, Venezia; Maria Zucchetto, MD, Department of Mental Health, NHS, Local Health Authority Padua; Francesco Amaddeo, MD, PhD, Michele Tansella, MD, Mirella Ruggeri, MD, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy
| | - Sarah Bissoli
- Antonio Lasalvia, MD, PhD, Chiara Bonetto, PhD, Sarah Tosato, MD, PhD, Gioia Zanatta, DClinPsy, Doriana Cristofalo, Edu Sci, Damiano Salazzari, Lorenza Lazzarotto, DClinPsy, Mariaelena Bertani, PhD, Sarah Bissoli, PhD, Katia De Santi, MD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona; Carla Cremonese, MD, Psychiatric Clinic, Department of Neuroscience, University of Padua, Padua; Moreno De Rossi, MD, Department of Mental Health, NHS, Local Health Authority Adria, Rovigo; Francesco Gardellin, MD, Department of Mental Health, NHS, Local Health Authority Vicenza; Luana Ramon, MD, Department of Mental Health, NHS, Local Health Authority Portogruaro, Venezia; Maria Zucchetto, MD, Department of Mental Health, NHS, Local Health Authority Padua; Francesco Amaddeo, MD, PhD, Michele Tansella, MD, Mirella Ruggeri, MD, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy
| | - Katia De Santi
- Antonio Lasalvia, MD, PhD, Chiara Bonetto, PhD, Sarah Tosato, MD, PhD, Gioia Zanatta, DClinPsy, Doriana Cristofalo, Edu Sci, Damiano Salazzari, Lorenza Lazzarotto, DClinPsy, Mariaelena Bertani, PhD, Sarah Bissoli, PhD, Katia De Santi, MD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona; Carla Cremonese, MD, Psychiatric Clinic, Department of Neuroscience, University of Padua, Padua; Moreno De Rossi, MD, Department of Mental Health, NHS, Local Health Authority Adria, Rovigo; Francesco Gardellin, MD, Department of Mental Health, NHS, Local Health Authority Vicenza; Luana Ramon, MD, Department of Mental Health, NHS, Local Health Authority Portogruaro, Venezia; Maria Zucchetto, MD, Department of Mental Health, NHS, Local Health Authority Padua; Francesco Amaddeo, MD, PhD, Michele Tansella, MD, Mirella Ruggeri, MD, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy
| | - Carla Cremonese
- Antonio Lasalvia, MD, PhD, Chiara Bonetto, PhD, Sarah Tosato, MD, PhD, Gioia Zanatta, DClinPsy, Doriana Cristofalo, Edu Sci, Damiano Salazzari, Lorenza Lazzarotto, DClinPsy, Mariaelena Bertani, PhD, Sarah Bissoli, PhD, Katia De Santi, MD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona; Carla Cremonese, MD, Psychiatric Clinic, Department of Neuroscience, University of Padua, Padua; Moreno De Rossi, MD, Department of Mental Health, NHS, Local Health Authority Adria, Rovigo; Francesco Gardellin, MD, Department of Mental Health, NHS, Local Health Authority Vicenza; Luana Ramon, MD, Department of Mental Health, NHS, Local Health Authority Portogruaro, Venezia; Maria Zucchetto, MD, Department of Mental Health, NHS, Local Health Authority Padua; Francesco Amaddeo, MD, PhD, Michele Tansella, MD, Mirella Ruggeri, MD, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy
| | - Moreno De Rossi
- Antonio Lasalvia, MD, PhD, Chiara Bonetto, PhD, Sarah Tosato, MD, PhD, Gioia Zanatta, DClinPsy, Doriana Cristofalo, Edu Sci, Damiano Salazzari, Lorenza Lazzarotto, DClinPsy, Mariaelena Bertani, PhD, Sarah Bissoli, PhD, Katia De Santi, MD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona; Carla Cremonese, MD, Psychiatric Clinic, Department of Neuroscience, University of Padua, Padua; Moreno De Rossi, MD, Department of Mental Health, NHS, Local Health Authority Adria, Rovigo; Francesco Gardellin, MD, Department of Mental Health, NHS, Local Health Authority Vicenza; Luana Ramon, MD, Department of Mental Health, NHS, Local Health Authority Portogruaro, Venezia; Maria Zucchetto, MD, Department of Mental Health, NHS, Local Health Authority Padua; Francesco Amaddeo, MD, PhD, Michele Tansella, MD, Mirella Ruggeri, MD, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy
| | - Francesco Gardellin
- Antonio Lasalvia, MD, PhD, Chiara Bonetto, PhD, Sarah Tosato, MD, PhD, Gioia Zanatta, DClinPsy, Doriana Cristofalo, Edu Sci, Damiano Salazzari, Lorenza Lazzarotto, DClinPsy, Mariaelena Bertani, PhD, Sarah Bissoli, PhD, Katia De Santi, MD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona; Carla Cremonese, MD, Psychiatric Clinic, Department of Neuroscience, University of Padua, Padua; Moreno De Rossi, MD, Department of Mental Health, NHS, Local Health Authority Adria, Rovigo; Francesco Gardellin, MD, Department of Mental Health, NHS, Local Health Authority Vicenza; Luana Ramon, MD, Department of Mental Health, NHS, Local Health Authority Portogruaro, Venezia; Maria Zucchetto, MD, Department of Mental Health, NHS, Local Health Authority Padua; Francesco Amaddeo, MD, PhD, Michele Tansella, MD, Mirella Ruggeri, MD, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy
| | - Luana Ramon
- Antonio Lasalvia, MD, PhD, Chiara Bonetto, PhD, Sarah Tosato, MD, PhD, Gioia Zanatta, DClinPsy, Doriana Cristofalo, Edu Sci, Damiano Salazzari, Lorenza Lazzarotto, DClinPsy, Mariaelena Bertani, PhD, Sarah Bissoli, PhD, Katia De Santi, MD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona; Carla Cremonese, MD, Psychiatric Clinic, Department of Neuroscience, University of Padua, Padua; Moreno De Rossi, MD, Department of Mental Health, NHS, Local Health Authority Adria, Rovigo; Francesco Gardellin, MD, Department of Mental Health, NHS, Local Health Authority Vicenza; Luana Ramon, MD, Department of Mental Health, NHS, Local Health Authority Portogruaro, Venezia; Maria Zucchetto, MD, Department of Mental Health, NHS, Local Health Authority Padua; Francesco Amaddeo, MD, PhD, Michele Tansella, MD, Mirella Ruggeri, MD, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy
| | - Maria Zucchetto
- Antonio Lasalvia, MD, PhD, Chiara Bonetto, PhD, Sarah Tosato, MD, PhD, Gioia Zanatta, DClinPsy, Doriana Cristofalo, Edu Sci, Damiano Salazzari, Lorenza Lazzarotto, DClinPsy, Mariaelena Bertani, PhD, Sarah Bissoli, PhD, Katia De Santi, MD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona; Carla Cremonese, MD, Psychiatric Clinic, Department of Neuroscience, University of Padua, Padua; Moreno De Rossi, MD, Department of Mental Health, NHS, Local Health Authority Adria, Rovigo; Francesco Gardellin, MD, Department of Mental Health, NHS, Local Health Authority Vicenza; Luana Ramon, MD, Department of Mental Health, NHS, Local Health Authority Portogruaro, Venezia; Maria Zucchetto, MD, Department of Mental Health, NHS, Local Health Authority Padua; Francesco Amaddeo, MD, PhD, Michele Tansella, MD, Mirella Ruggeri, MD, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy
| | - Francesco Amaddeo
- Antonio Lasalvia, MD, PhD, Chiara Bonetto, PhD, Sarah Tosato, MD, PhD, Gioia Zanatta, DClinPsy, Doriana Cristofalo, Edu Sci, Damiano Salazzari, Lorenza Lazzarotto, DClinPsy, Mariaelena Bertani, PhD, Sarah Bissoli, PhD, Katia De Santi, MD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona; Carla Cremonese, MD, Psychiatric Clinic, Department of Neuroscience, University of Padua, Padua; Moreno De Rossi, MD, Department of Mental Health, NHS, Local Health Authority Adria, Rovigo; Francesco Gardellin, MD, Department of Mental Health, NHS, Local Health Authority Vicenza; Luana Ramon, MD, Department of Mental Health, NHS, Local Health Authority Portogruaro, Venezia; Maria Zucchetto, MD, Department of Mental Health, NHS, Local Health Authority Padua; Francesco Amaddeo, MD, PhD, Michele Tansella, MD, Mirella Ruggeri, MD, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy
| | - Michele Tansella
- Antonio Lasalvia, MD, PhD, Chiara Bonetto, PhD, Sarah Tosato, MD, PhD, Gioia Zanatta, DClinPsy, Doriana Cristofalo, Edu Sci, Damiano Salazzari, Lorenza Lazzarotto, DClinPsy, Mariaelena Bertani, PhD, Sarah Bissoli, PhD, Katia De Santi, MD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona; Carla Cremonese, MD, Psychiatric Clinic, Department of Neuroscience, University of Padua, Padua; Moreno De Rossi, MD, Department of Mental Health, NHS, Local Health Authority Adria, Rovigo; Francesco Gardellin, MD, Department of Mental Health, NHS, Local Health Authority Vicenza; Luana Ramon, MD, Department of Mental Health, NHS, Local Health Authority Portogruaro, Venezia; Maria Zucchetto, MD, Department of Mental Health, NHS, Local Health Authority Padua; Francesco Amaddeo, MD, PhD, Michele Tansella, MD, Mirella Ruggeri, MD, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy
| | - Mirella Ruggeri
- Antonio Lasalvia, MD, PhD, Chiara Bonetto, PhD, Sarah Tosato, MD, PhD, Gioia Zanatta, DClinPsy, Doriana Cristofalo, Edu Sci, Damiano Salazzari, Lorenza Lazzarotto, DClinPsy, Mariaelena Bertani, PhD, Sarah Bissoli, PhD, Katia De Santi, MD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona; Carla Cremonese, MD, Psychiatric Clinic, Department of Neuroscience, University of Padua, Padua; Moreno De Rossi, MD, Department of Mental Health, NHS, Local Health Authority Adria, Rovigo; Francesco Gardellin, MD, Department of Mental Health, NHS, Local Health Authority Vicenza; Luana Ramon, MD, Department of Mental Health, NHS, Local Health Authority Portogruaro, Venezia; Maria Zucchetto, MD, Department of Mental Health, NHS, Local Health Authority Padua; Francesco Amaddeo, MD, PhD, Michele Tansella, MD, Mirella Ruggeri, MD, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy
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Tarricone I, Braca M, Allegri F, Barrasso G, Bellomo A, Berlincioni V, Carpiniello B, Ceregato A, Conforti Donati M, Defilippi S, Del Vecchio V, De Rosa C, Ferrannini L, Ferrari S, Furio MA, Gramaglia C, La Cascia C, Luciano M, Mulè A, Nardini M, Podavini F, Primavera D, Reggianini C, Rigatelli M, Todarello O, Turella E, Ventriglio A, Zeppegno P, Fiorillo A, Berardi D. First-episode psychosis and migration in Italy (PEP-Ita migration): a study in the Italian mental health services. BMC Psychiatry 2014; 14:186. [PMID: 24957972 PMCID: PMC4079180 DOI: 10.1186/1471-244x-14-186] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 05/28/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND It has been frequently reported a higher incidence of psychotic disorders in immigrants than in native populations. There is, however, a lack of knowledge about risk factors which may explain this phenomenon. A better understanding of the causes of psychosis among first-generation migrants is highly needed, particularly in Italy, a country with a recent massive migration. METHODS/DESIGN The "Italian study on first-episode psychosis and migration (PEP-Ita)" is a prospective observational study over a two-year period (1 January 2012-31 December 2013) which will be carried out in 11 Italian mental health centres. All participating centres will collect data about all new cases of migrants with first-episode psychosis. The general purpose ("core") of the PEP-Ita study is to explore the socio-demographic and clinical characteristics, and the pathways to care of a population of first-episode psychosis migrants in Italy. Secondary aims of the study will be: 1) to understand risk and protective factors for the development of psychotic disorders in migrants; 2) to evaluate the correlations between psychopathology of psychotic disorders in migrants and socio-demographic characteristics, migration history, life experiences; 3) to evaluate the clinical and social outcomes of first-episode psychoses in migrants. DISCUSSION The results of the PEP-Ita study will allow a better understanding of risk factors for psychosis in first-generation migrants in Italy. Moreover, our results will contribute to the development of prevention programmes for psychosis and to the improvement of early intervention treatments for the migrant population in Italy.
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Affiliation(s)
- Ilaria Tarricone
- Department of Medical and Surgical Sciences, Bologna University, Bologna, Italy,Department of Mental Health and Pathological Addictions, Local Health Trust, Bologna, Italy
| | - Mauro Braca
- Department of Medical and Surgical Sciences, Bologna University, Bologna, Italy.
| | - Fabio Allegri
- Department of Medical and Surgical Sciences, Bologna University, Bologna, Italy
| | | | - Antonello Bellomo
- Department of Clinical and Experimental Sciences, Section of Psychiatry and Clinical Psychology, University of Foggia, Foggia, Italy
| | - Vanna Berlincioni
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | | | | | | | | | - Corrado De Rosa
- Department of Psychiatry, University of Naples SUN, Napoli, Italy
| | | | - Silvia Ferrari
- U.O. Psichiatria Ospedaliero-Universitaria Modena Centro, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Antonietta Furio
- Dipartimento di Scienze Mediche di Base, Neuroscienze ed Organi di Senso, Università degli Studi Aldo Moro di Bari, Bari, Italy
| | - Carla Gramaglia
- SC Psichiatria, AOU Ospedale Maggiore della Carità, Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale Amedeo Avogadro, Novara, Italy
| | - Caterina La Cascia
- Psychiatric Unit, Azienda Ospedaliera Universitaria Policlinico “P. Giaccone” Palermo, Palermo, Italy,Department of Experimental Biomedicine and Clinical Neuroscience, Section of Psychiatry, University of Palermo, Palermo, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Naples SUN, Napoli, Italy
| | - Alice Mulè
- Psychiatric Unit, Azienda Ospedaliera Universitaria Policlinico “P. Giaccone” Palermo, Palermo, Italy,Department of Experimental Biomedicine and Clinical Neuroscience, Section of Psychiatry, University of Palermo, Palermo, Italy
| | - Marcello Nardini
- U.O. di Psichiatria - Azienda Ospedaliero Universitaria “Consorziale Policlinico” Bari, Bari, Italy,Dipartimento di Scienze Mediche di Base, Neuroscienze ed Organi di Senso, Università degli Studi Aldo Moro di Bari, Bari, Italy
| | - Francesca Podavini
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Diego Primavera
- Clinica Psichiatrica - Università degli Studi di Cagliari, Cagliari, Italy
| | - Corinna Reggianini
- U.O. Psichiatria Ospedaliero-Universitaria Modena Centro, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Rigatelli
- U.O. Psichiatria Ospedaliero-Universitaria Modena Centro, University of Modena and Reggio Emilia, Modena, Italy
| | - Orlando Todarello
- U.O. di Psichiatria - Azienda Ospedaliero Universitaria “Consorziale Policlinico” Bari, Bari, Italy,Dipartimento di Scienze Mediche di Base, Neuroscienze ed Organi di Senso, Università degli Studi Aldo Moro di Bari, Bari, Italy
| | - Elena Turella
- U.O.A. di Psichiatria di Camposampiero (PD), Camposampiero, PD, Italy
| | - Antonio Ventriglio
- Department of Clinical and Experimental Sciences, Section of Psychiatry and Clinical Psychology, University of Foggia, Foggia, Italy
| | - Patrizia Zeppegno
- SC Psichiatria, AOU Ospedale Maggiore della Carità, Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale Amedeo Avogadro, Novara, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Naples SUN, Napoli, Italy
| | - Domenico Berardi
- Department of Medical and Surgical Sciences, Bologna University, Bologna, Italy,Department of Mental Health and Pathological Addictions, Local Health Trust, Bologna, Italy
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Abstract
AbstractWe describe the case of a 30 year old Chinese woman who presented to an Irish psychiatric service with a five-month history of somatic delusions, auditory hallucinations and denial of lineage. We utilise this case to illustrate the significant cultural influences on psychopathology. We discuss the increasingly frequent diagnostic and therapeutic challenges presented by migrants with mental illness.
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Bhugra D, Gupta S, Schouler-Ocak M, Graeff-Calliess I, Deakin N, Qureshi A, Dales J, Moussaoui D, Kastrup M, Tarricone I, Till A, Bassi M, Carta M. EPA Guidance Mental Health Care of Migrants. Eur Psychiatry 2014; 29:107-15. [DOI: 10.1016/j.eurpsy.2014.01.003] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 01/08/2014] [Accepted: 01/12/2014] [Indexed: 11/28/2022] Open
Abstract
AbstractMigration is an increasingly commonplace phenomenon for a number of reasons. People migrate from rural to urban areas or across borders for reasons including economic, educational or political. There is increasing recent research evidence from many countries in Europe that indicates that migrants are more prone to certain psychiatric disorders. Because of their experiences of migration and settling down in the new countries, they may also have special needs such as lack of linguistic abilities which must be taken into account using a number of strategies at individual, local and national policy levels. In this guidance document, we briefly present the evidence and propose that specific measures must be taken to improve and manage psychiatric disorders experienced by migrants and their descendants. This improvement requires involvement at the highest level in governments. This is a guidance document and not a systematic review.
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Allegri F, Belvederi Murri M, Paparelli A, Marcacci T, Braca M, Menchetti M, Michetti R, Berardi D, Tarricone I. Current cannabis use and age of psychosis onset: a gender-mediated relationship? Results from an 8-year FEP incidence study in Bologna. Psychiatry Res 2013; 210:368-70. [PMID: 23919899 DOI: 10.1016/j.psychres.2013.06.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 06/04/2013] [Accepted: 06/12/2013] [Indexed: 11/29/2022]
Abstract
This study examined the relationship between gender, illicit drug use and age of onset of psychosis. We analysed data from an epidemiologically based cohort of 160 subjects with first-episode psychosis from community mental health centers. Cannabis was associated with an earlier onset of psychosis compared to other drugs, especially among women.
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Affiliation(s)
- Fabio Allegri
- Department of Medical and Surgical Science, Section of Psychiatry, University of Bologna, Bologna, Italy
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Bansal N, Bhopal R, Netto G, Lyons D, Steiner MFC, Sashidharan SP. Disparate patterns of hospitalisation reflect unmet needs and persistent ethnic inequalities in mental health care: the Scottish health and ethnicity linkage study. ETHNICITY & HEALTH 2013; 19:217-239. [PMID: 23844602 DOI: 10.1080/13557858.2013.814764] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES The presence and extent of mental health inequalities in Scotland is unclear. We investigated ethnic variations in psychiatric hospitalisations and compulsory treatment in relation to socioeconomic indicators. DESIGN In a retrospective cohort study design, using data linkage methods, we examined ethnic variations in psychiatric [any psychiatric, mood (affective), and psychotic disorders) hospitalisations and use of the Mental Health (Care and Treatment) (Scotland) Act 2003 (Emergency Detentions (ED), Short-Term Detentions (STD) and Compulsory Treatment Orders (CTO)] using age (and sex for compulsory treatment), car ownership, and housing tenure adjusted risk ratios (RR). 95% CIs for the data below exclude the reference White Scottish group value (100). RESULTS Compared to the White Scottish population, Other White British men and women had lower hospitalisation from any psychiatric disorder (RR = 77.8, 95% CI: 71.0-85.2 and 85.8, 95% CI: 79.3-92.9), mood disorder (91.2, 95% CI: 86.9-95.8 and 83.6, 95% CI: 75.1-93.1), psychotic disorder (67.1, 95% CI: 59.9-75.2 and 78.5, 95% CI: 67.6-91.1), CTO (84.6, 95% CI: 72.4-98.9) and STD (88.2, 95% CI: 78.6-99.0). Any Mixed Background women had higher hospitalisation from any psychiatric disorder (137.2, 95% CI: 110.9-169.6) and men and women had a higher risk of psychotic disorder (200.6, 95% CI: 105.7-380.7 and 175.5, 95% CI: 102.3-301.2), CTO (263.0, 95% CI: 105.4-656.3), ED (245.6, 95% CI: 141.6-426.1) and STD (311.7, 95% CI: 190.2-510.7). Indian women had lower risk of any psychiatric disorder (43.2, 95% CI: 28.0-66.7). Pakistani men had lower risk of any psychiatric disorder (78.7, 95% CI: 69.3-89.3), and higher risk of mood disorders (117.5, 95% CI: 100.2-137.9). Pakistani women had similar risk of any psychiatric and mood disorder however, a twofold excess risk of psychotic disorder (227.3, 95% CI: 195.8-263.8). Risk of STD was higher in South Asians (136.9, 95% CI: 109.0-171.9). Chinese men and women had the lowest risk of hospitalisation for any psychiatric disorder (35.3, 95% CI: 23.2-53.7 and 44.5, 95% CI: 30.3-65.5) and mood disorder (51.5, 95% CI: 31.0-85.4 and 47.5, 95% CI: 23.2-97.4) but not psychotic disorders and higher risk for CTO (181.4, 95% CI: 121.0-271.0). African women had higher risk of any psychiatric disorder (139.4, 95% CI: 119.0-163.2). African men and women had the highest risk for psychotic disorders (230.8, 95% CI: 177.8-299.5 and 240.7, 95% CI: 163.8-353.9) and were also overrepresented in STD (214.3, 95% CI: 122.4-375.0) and CTO (486.6, 95% CI: 231.9-1021.1). Differences in hospitalisations were not fully attenuated when adjusted for car ownership and housing tenure and the effect of these adjustments varied by ethnic group. CONCLUSION Our data show disparate patterns of psychiatric hospitalisations by ethnic group in Scotland providing new observations concerning the mental health care experience of Chinese, Mixed background and White subgroups not fully explained by socioeconomic indicators. For South Asian and Chinese groups in particular, our data indicate under and late utilisation of mental health services. These data call for monitoring and review of services.
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Affiliation(s)
- Narinder Bansal
- a Centre for Population Health Sciences , University of Edinburgh , Edinburgh , UK
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Miller CL. Evidence for phenotypic plasticity in response to photic cues and the connection with genes of risk in schizophrenia. Front Behav Neurosci 2013; 7:82. [PMID: 23847488 PMCID: PMC3705146 DOI: 10.3389/fnbeh.2013.00082] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Accepted: 06/20/2013] [Indexed: 01/28/2023] Open
Abstract
Numerous environmental factors have been identified as influential in the development of schizophrenia. Some are byproducts of modern life, yet others were present in our evolutionary past and persist to a lesser degree in the current era. The present study brings together published epidemiological data for schizophrenia and data on variables related to photic input for places of residence across geographical regions, using rainfall as an inverse, proxy measure for light levels. Data were gathered from the literature for two countries, the former Yugoslavia and Ireland, during a time in the early 20th century when mobility was relatively limited. The data for Yugoslavia showed a strong correlation between hospital census rates for schizophrenia (by place of birth) and annual rain (r = 0.96, p = 0.008). In Ireland, the hospital census rates and first admissions for schizophrenia (by place of permanent residence) showed a trend for correlation with annual rain, reaching significance for 1st admissions when the rainfall data was weighted by the underlying population distribution (r = 0.71, p = 0.047). In addition, across the years 1921-1945, birth-year variations in a spring quarter season-of-birth effect for schizophrenia in Ireland showed a trend for correlation with January-March rainfall (r = 0.80, p ≤ 0.10). The data are discussed in terms of the effect of photoperiod on the gestation and behavior of offspring in animals, and the premise is put forth that vestigial phenotypic plasticity for such photic cues still exists in humans. Moreover, genetic polymorphisms of risk identified for psychotic disorders include genes modulated by photoperiod and sunlight intensity. Such a relationship between phenotypic plasticity in response to a particular environmental regime and subsequent natural selection for fixed changes in the environmentally responsive genes, has been well studied in animals and should not be discounted when considering human disease.
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Gonidakis F, Lembesi E, Kontaxakis VP, Havaki-Kontaxaki BJ, Ploumpidis D, Madianos M, Papadimitriou GN. A study of acculturation in psychotic and non-psychotic immigrants living in Athens. Int J Soc Psychiatry 2013; 59:157-64. [PMID: 22166256 DOI: 10.1177/0020764011430031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Acculturation is the phenomenon that results when a group with one culture comes into continuous contact with a host culture. AIMS To investigate the correlation between acculturation and psychotic symptomatology in a group of immigrants suffering from psychosis and to explore differences in demographic factors related with the acculturation process between individuals with and without psychosis. METHODS Sixty-five patients and 317 non-psychotic immigrants were interviewed using the Immigrant Acculturation Scale (IAS) and a structured questionnaire for demographic data. The Positive and Negative Syndrome Scale (PANSS), the Calgary Depression Scale for Schizophrenia (CDSS) and the Global Assessment of Functioning (GAF) were also administered to all immigrants suffering from psychosis. RESULTS Total IAS scores, as well as IAS everyday life scores, were positively correlated with GAF scores. IAS everyday life score in the patient group related with religion, marital status, gender and years in Greece, while in the non-psychosis group it was related with gender and years in Greece. IAS wishful orientation/nostos (the strong desire for one's homeland) related with religion in both groups. The IAS identity in the psychosis group did not show any significant relation with any of the variables, while in the non-patient group, it was related with marital status, gender and years in Greece. Age, duration of residence in Greece and higher adoption of Greek ethnic identity were the variables that differentiated the two groups of immigrants. CONCLUSION Acculturation in immigrants suffering from psychosis could be seen as a process that does not correlate strongly with the severity of the symptomatology but is probably influenced by different set of factors.
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Affiliation(s)
- F Gonidakis
- 1st Department of Psychiatry, Athens University, Eginition Hospital, Athens, Greece.
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Abstract
Over the past 50 years, schizophrenia as a disorder has been widely studied across cultures throughout the world. There are differences not only in the symptoms and presentation but also in outcome and prognosis. Various authors have tried to explore and explain such variation but the reasons for this are not always clear. In this paper, we review some of the cultural aspects of schizophrenia.
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Affiliation(s)
- Gurvinder Kalra
- Department of Psychiatry, Lokmanya Tilak Medical College and Sion Hospital, Sion, Mumbai, India
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Chorlton E, McKenzie K, Morgan C, Doody G. Course and outcome of psychosis in black Caribbean populations and other ethnic groups living in the UK: a systematic review. Int J Soc Psychiatry 2012; 58:400-8. [PMID: 21628358 DOI: 10.1177/0020764011403070] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND A higher incidence of psychosis has repeatedly been reported in black Caribbean populations in the UK. This has been attributed to a number of biological, psychological and sociocultural causes, including black Caribbean populations having a different illness course and outcome compared to other ethnic populations living in the UK. AIMS A systematic review of UK-based quantitative studies, which compared at least two aspects of outcome in black Caribbean populations and other ethnic populations living in the UK, was conducted to assess whether the current body of research suggests that there are differences in the course and outcome of psychoses for these populations. METHOD A wide variety of databases were searched using MeSH terms and keywords. Studies were evaluated according to specified inclusion criteria and analysed using predefined scoring criteria. RESULTS Searches yielded a heterogeneous collection of studies. Large variances in methodological approaches and the quality of studies were reported. Many studies reported little or no difference between black Caribbean and other ethnic populations living in the UK. CONCLUSIONS Emphasis is placed on the unreliability of these findings given the methodological limitations of the studies, and the need for higher-quality research in this area is highlighted.
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Ng XT, Kelly BD. Voluntary and involuntary care: three-year study of demographic and diagnostic admission statistics at an inner-city adult psychiatry unit. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2012; 35:317-326. [PMID: 22560406 DOI: 10.1016/j.ijlp.2012.04.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Individuals with mental disorders can, under specific circumstances, be detained and treated against their wishes. In 2009, there were 1633 involuntary admissions in Ireland, accounting for 8.1% of all psychiatric admissions. We examined demographic and diagnostic factors associated with involuntary admission in a general adult psychiatry service in Dublin's north inner-city over a retrospective three-year period. The overall admission rate was 450.5 admissions per 100,000 population per year (deprivation-adjusted rate: 345.7), which is lower than the national rate (476.3). The involuntary admission rate was 67.7 (deprivation-adjusted rate: 51.9), which is higher than the national rate (38.5). Fifteen per cent of admissions were involuntary (for all or part of the admission), which is higher than the national proportion (8.1%) but the same as that reported in another inner-city psychiatry service (15.7%). The proportion of admissions that was involuntary was higher amongst individuals from outside Ireland (33.9%) compared to those from Ireland (12.0%) (p<0.001). Country of origin was, however, related to diagnosis: 53.2% of admissions of individuals from outside Ireland were with schizophrenia, compared to 18.5% of admissions of individuals from Ireland (p<0.001). Diagnosis was, in turn, related to admission status: 37.5% of admissions with schizophrenia were involuntary compared to 15% overall (p<0.001). On multi-variable testing, diagnosis was the only independent predictor of admission status (p=0.01) (R(2)=35.2%); country of origin was not an independent predictor of admission status. Deprivation accounts for part, but not all, of the high rate of involuntary admission in Dublin's inner-city. Diagnosis accounts for one third of the variance in admission status between individuals. Further study is required to determine what factors account for the remaining two thirds (e.g. symptoms, insight) and to clarify better the relationships between admission status, diagnosis and country of origin. There is a strong need for enhanced focus on the mental health needs of individuals from outside of Ireland, especially in Dublin's north inner-city.
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Affiliation(s)
- Xiao Ting Ng
- Department of Adult Psychiatry, University College Dublin, Mater Misericordiae University Hospital, 62/63 Eccles Street, Dublin 7, Ireland.
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Kirkbride JB, Errazuriz A, Croudace TJ, Morgan C, Jackson D, Boydell J, Murray RM, Jones PB. Incidence of schizophrenia and other psychoses in England, 1950-2009: a systematic review and meta-analyses. PLoS One 2012; 7:e31660. [PMID: 22457710 PMCID: PMC3310436 DOI: 10.1371/journal.pone.0031660] [Citation(s) in RCA: 330] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 01/17/2012] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND We conducted a systematic review of incidence rates in England over a sixty-year period to determine the extent to which rates varied along accepted (age, sex) and less-accepted epidemiological gradients (ethnicity, migration and place of birth and upbringing, time). OBJECTIVES To determine variation in incidence of several psychotic disorders as above. DATA SOURCES Published and grey literature searches (MEDLINE, PSycINFO, EMBASE, CINAHL, ASSIA, HMIC), and identification of unpublished data through bibliographic searches and author communication. STUDY ELIGIBILITY CRITERIA Published 1950-2009; conducted wholly or partially in England; original data on incidence of non-organic adult-onset psychosis or one or more factor(s) pertaining to incidence. PARTICIPANTS People, 16-64 years, with first -onset psychosis, including non-affective psychoses, schizophrenia, bipolar disorder, psychotic depression and substance-induced psychosis. STUDY APPRAISAL AND SYNTHESIS METHODS Title, abstract and full-text review by two independent raters to identify suitable citations. Data were extracted to a standardized extraction form. Descriptive appraisals of variation in rates, including tables and forest plots, and where suitable, random-effects meta-analyses and meta-regressions to test specific hypotheses; rate heterogeneity was assessed by the I²-statistic. RESULTS 83 citations met inclusion. Pooled incidence of all psychoses (N = 9) was 31.7 per 100,000 person-years (95%CI: 24.6-40.9), 23.2 (95%CI: 18.3-29.5) for non-affective psychoses (N = 8), 15.2 (95%CI: 11.9-19.5) for schizophrenia (N = 15) and 12.4 (95%CI: 9.0-17.1) for affective psychoses (N = 7). This masked rate heterogeneity (I²: 0.54-0.97), possibly explained by socio-environmental factors; our review confirmed (via meta-regression) the typical age-sex interaction in psychosis risk, including secondary peak onset in women after 45 years. Rates of most disorders were elevated in several ethnic minority groups compared with the white (British) population. For example, for schizophrenia: black Caribbean (pooled RR: 5.6; 95%CI: 3.4-9.2; N = 5), black African (pooled RR: 4.7; 95%CI: 3.3-6.8; N = 5) and South Asian groups in England (pooled RR: 2.4; 95%CI: 1.3-4.5; N = 3). We found no evidence to support an overall change in the incidence of psychotic disorder over time, though diagnostic shifts (away from schizophrenia) were reported. LIMITATIONS Incidence studies were predominantly cross-sectional, limiting causal inference. Heterogeneity, while evidencing important variation, suggested pooled estimates require interpretation alongside our descriptive systematic results. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Incidence of psychotic disorders varied markedly by age, sex, place and migration status/ethnicity. Stable incidence over time, together with a robust socio-environmental epidemiology, provides a platform for developing prediction models for health service planning.
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Affiliation(s)
- James B Kirkbride
- Department of Psychiatry, Herchel Smith Building for Brain and Mind Sciences, University of Cambridge, Cambridge, United Kingdom.
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Tarricone I, Stivanello E, Poggi F, Castorini V, Marseglia MV, Fantini MP, Berardi D. Ethnic variation in the prevalence of depression and anxiety in primary care: a systematic review and meta-analysis. Psychiatry Res 2012; 195:91-106. [PMID: 21705094 DOI: 10.1016/j.psychres.2011.05.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Revised: 04/12/2011] [Accepted: 05/18/2011] [Indexed: 10/18/2022]
Abstract
Primary care plays a key role in the detection and management of depression and anxiety. At present it is not clear if the prevalence of depression and anxiety in primary care differs between migrants and ethnic minorities (MI) and natives and ethnic majorities (MA). A systematic review and a meta-analysis of studies comparing the prevalence of depression and anxiety in MI and MA in primary care were performed. Studies were identified by searching MEDLINE, PsychINFO, EMBASE and through hand-search. We included 25 studies, most of which had a relatively small sample size. Significant variations were found in the prevalence of anxiety and depression across studies. Pooled analyses were carried out for 23 studies, based on random-effects models. Pooled RR of depression and anxiety in MI were 1.21 (95% CI 1.04-1.40, p=0.012) and 1.01 (95% CI 0.76-1.32, p=0.971), with high heterogeneity (I²=87.2% and I²=73%). Differences in prevalence rates among studies can be accounted for by inclusion criteria, sampling methods, diagnostic instruments and study design. Further research on larger samples and with culturally adapted instruments is needed to estimate the prevalence of depression and anxiety in MI seeking help for these disorders.
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Elaboration on the association between immigration and schizophrenia: a population-based national study disaggregating annual trends, country of origin and sex over 15 years. Soc Psychiatry Psychiatr Epidemiol 2012; 47:303-11. [PMID: 21286683 DOI: 10.1007/s00127-011-0342-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Accepted: 01/06/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Generally, immigrant status and male sex are separately documented to increase the risk of schizophrenia; although population-based risk trends by sex and immigration over time have not been examined. This study aims to examine the extent to which immigration acts as a risk factor for schizophrenia, delineated by origin, sex and year, using national population-based data over 15 years. METHOD Data on all first psychiatric admissions from 1978 to 1992 (n = 10,892) from the National Psychiatric Hospitalization Case Registry of the State of Israel were merged with aggregate national data from the Israeli Central Bureau of Statistics. RESULTS Compared to native-born Israelis, people who migrated prior to the age of 15 (n = 2,335) were at a greater risk of schizophrenia (n = 8,557; RR = 1.6, 95% CI = 1.53; 1.68), particularly those from Far Eastern (RR = 2.43, 95% CI = 1.91; 3.1) and Caribbean and South American (RR = 1.94, 95% CI = 1.51; 2.51) countries. Aggregate risk was higher among female than male immigrants and over the 15-year study immigration-related risk declined across the sexes. CONCLUSION The current findings replicate past research showing that immigrants, particularly from a social minority, as suggested by the social defeat-hypothesis, are at an increased risk of schizophrenia, and extend past findings to show that risk at least in Israel has decreased with time irrespective of sex.
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Ethnic differences in risk of acute compulsory admission in Amsterdam, 1996-2005. Soc Psychiatry Psychiatr Epidemiol 2012; 47:111-8. [PMID: 21076912 DOI: 10.1007/s00127-010-0312-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 10/18/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE Several European studies have shown that migrants from non-western countries are at increased risk of psychotic disorders. This study examines how this is reflected in the risk of acute compulsory admission (ACA). METHODS Information on all patients with an ACA in Amsterdam from 1996 to 2005 was linked to the Amsterdam municipal register. RESULTS The incidence of first ACA in Amsterdam was 4.5 per 10,000 person years. The incidence risk of ACA for any psychiatric disorders and for psychotic disorders in particular showed a 2- to 3-fold increase in almost all migrant groups from non-western countries, and especially for second-generation migrants. In addition, all non-western migrant groups were at increased risk of being assessed as posing a danger to others. CONCLUSIONS The relative risk of ACA for psychotic disorders was similar to that for the incidence of psychotic disorders in most ethnic groups from other studies, suggesting that the increased risk of ACA in non-western migrants can mainly be explained by the increased incidence of psychotic disorders in these groups. However, the relative risk of ACA for psychotic disorders among Moroccan migrants was lower than expected on the basis of incidence studies, which suggests that additional factors are relevant, such as illness-related expression and access to and quality of care.
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Zandi T, Havenaar JM, Laan W, Kahn RS, van den Brink W. Predictive validity of a culturally informed diagnosis of schizophrenia: a 30 month follow-up study with first episode psychosis. Schizophr Res 2011; 133:29-35. [PMID: 22019074 DOI: 10.1016/j.schres.2011.09.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 09/14/2011] [Accepted: 09/18/2011] [Indexed: 11/29/2022]
Abstract
UNLABELLED Previous research has shown discrepancies between a standard diagnostic interview for schizophrenia (CASH) and a culture sensitive version of this instrument (CASH-CS) in Moroccan patients. More specifically we showed that among Moroccan immigrants the CASH-CS resulted in fewer patients with a diagnosis of schizophrenia compared with diagnoses based on the CASH, whereas for Native Dutch patients there was no difference between the CASH and the CASH-CS. The aim of the current study was to compare the predictive validity of a diagnosis of schizophrenia according to the CASH and CASH-CS. METHOD Thirty months after referral, 26 Moroccan and 26 native Dutch patients with a suspected first psychotic episode were compared with regard to 30-month diagnostic stability, symptom development, psychosocial functioning, medication use and hospitalization using baseline diagnoses based on the two versions of the CASH. RESULTS Moroccan patients who were diagnosed with schizophrenia using the standard CASH at baseline had a significantly better 30-month prognosis than native Dutch patients with the same CASH diagnosis. Prognosis of schizophrenia according to the CASH-CS was similar for Moroccans and native Dutch patients. Diagnostic stability according to the CASH was high for native Dutch (92%), but low for Moroccan patients (27%), whereas diagnostic stability according to the CASH-CS was high for both groups (85% and 81%, respectively). CONCLUSION These data raise questions regarding the validity of the standard CASH in Moroccan immigrants in The Netherlands and support the validity of the CASH-CS. As a consequence, there are serious doubts about the validity of previous studies showing an increased incidence of schizophrenia in immigrants using standard diagnostic procedures.
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Affiliation(s)
- Tekleh Zandi
- Altrecht, Institute for Mental Health Care, Utrecht, The Netherlands.
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Abstract
SUMMARYBackground — By the mid-1960s, the importance of socio-economic status for schizophrenia had been demonstrated in terms of differences between social-class groups in prevalence and incidence rates, illness course and outcome, and treatment experience. In the causation – selection debate, however, opinion had swung in favour of the selection hypothesis. Aims — To reassess evidence on the social-class distribution of schizophrenia in Britain, and to compare this body of research with population-based studies of schizophrenia risk in socially disadvantaged ethnic minorities. Method — Systematic review of medical and psychological data-bases. Results — Epidemiological research, while confirming the importance of premorbid social decline, has also provided support for the environmental ‘breeder’ hypothesis. High psychosis rates have been confirmed in ethnic minori-ties; in particular among Afro-Caribbean and other Black immigrants whose low social status cannot be accounted for by selective downward social drift or segregation. Conclusions — There are striking parallels, both in the epidemiology of schizophrenia and in social characteristics, between the lower-class indigenous groups highlighted by earlier psychiatric surveys and African-Caribbean populations in Britain's inner cities today. These similarities underline the need for a broader perspective in the search for environmental risk factors.Declaration of Interest: none.
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Affiliation(s)
- Brian Cooper
- Section of Old Age Psychiatry, Institute of Psychiatry, London, United Kingdom.
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Durbin A, Lin E, Taylor L, Callaghan RC. First-generation immigrants and hospital admission rates for psychosis and affective disorders: an ecological study in Ontario. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2011; 56:418-26. [PMID: 21835105 DOI: 10.1177/070674371105600705] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The immigrant population in Canada, and particularly in Ontario, is increasing. Our ecological study first assessed if there was an association between areas with proportions of first-generation immigrations and admissions rates for psychotic and affective disorders. Second, this study examined if area-level risks would persist after controlling for area socioeconomic factors in census-derived geographical areas-Forward Sortation Areas (FSAs)-in Ontario. METHODS Ontario's inpatient admission records from 1996 to 2005 and census data from 2001 were analyzed to derive FSA rates of first admissions for psychotic disorders and affective disorders per 100 000 person-years. Negative binomial regression models were adjusted, first, for FSA age and sex and, second, also for FSA population density and average income. RESULTS Using age- and sex-adjusted models, admission rates for psychotic disorders were higher in areas with greater proportions of immigrants. These areas were associated with lower admission rates for affective disorders. When FSA average income and population density were added to the models, the influence of immigrants was attenuated to nonsignificant levels in models predicting psychotic disorders admission rates. However, greater proportions of immigrants remained significantly protective when predicting rates of affective disorders. DISCUSSION Our study provides insight about the influence of area-level variables on risk of admission for psychotic and affective disorders in high immigrant areas. There is a dearth of current Canadian research on immigrant admission for psychotic disorders at the individual or area level. Future area- and individual-level studies may better identify groups at risk and possible explanations.
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Affiliation(s)
- Anna Durbin
- Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.
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Abstract
The incidence of psychotic disorders is extremely high in several immigrant groups in Europe. This article describes the epidemiological evidence for increased incidence rates among immigrants compared with nonimmigrant populations and explores possible explanations for this excess risk. Potential causes not only involve factors acting at the level of the individual, but encompass the broader social context of neighborhoods and ethnic groups. Growing up and living in a disadvantaged ethnic minority position, characterized by a low social status, high degree of discrimination against the group and low neighborhood ethnic density, may lead to an increased risk of psychotic disorders, especially when individuals reject their minority status and when their social resources are insufficient to buffer the impact of adverse social experiences. Future research should refine measures of the social context, adopt a life-course perspective and should integrate social and neurobiological pathways.
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Affiliation(s)
- Wim Veling
- Center for Early Psychosis, Parnassia Psychiatric Institute, The Hague, The Netherlands
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