Schizophrenia Bulletin
Volume 43, Issue 6, 2017, Pages 1251-1261

Ethnic Minority Status, Age-at-Immigration and Psychosis Risk in Rural Environments: Evidence from the SEPEA Study (Article) (Open Access)

Kirkbride J.B.* , Hameed Y. , Ioannidis K. , Ankireddypalli G. , Crane C.M. , Nasir M. , Kabacs N. , Metastasio A. , Jenkins O. , Espandian A. , Spyridi S. , Ralevic D. , Siddabattuni S. , Walden B. , Adeoye A. , Perez J. , Jones P.B.
  • a PsyLife Group, Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, United Kingdom, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
  • b Norfolk and Suffolk Foundation Trust, Norwich, United Kingdom
  • c Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom, Cambridgeshire and Peterborough Foundation Trust, NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, United Kingdom
  • d North Essex Partnership NHS Foundation Trust, Chelmsford, United Kingdom
  • e Cambridgeshire and Peterborough Foundation Trust, NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, United Kingdom
  • f Norfolk and Suffolk Foundation Trust, Norwich, United Kingdom
  • g Cambridgeshire and Peterborough Foundation Trust, NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, United Kingdom
  • h Norfolk and Suffolk Foundation Trust, Norwich, United Kingdom
  • i Norfolk and Suffolk Foundation Trust, Norwich, United Kingdom
  • j Cambridgeshire and Peterborough Foundation Trust, NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, United Kingdom
  • k Cambridgeshire and Peterborough Foundation Trust, NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, United Kingdom
  • l Norfolk and Suffolk Foundation Trust, Norwich, United Kingdom
  • m Cambridgeshire and Peterborough Foundation Trust, NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, United Kingdom
  • n Norfolk and Suffolk Foundation Trust, Norwich, United Kingdom
  • o Norfolk and Suffolk Foundation Trust, Norwich, United Kingdom
  • p Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom, Cambridgeshire and Peterborough Foundation Trust, NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, United Kingdom
  • q Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom, Cambridgeshire and Peterborough Foundation Trust, NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, United Kingdom

Abstract

Objective Several ethnic minority groups experience elevated rates of first-episode psychosis (FEP), but most studies have been conducted in urban settings. We investigated whether incidence varied by ethnicity, generation status, and age-at-immigration in a diverse, mixed rural, and urban setting. Method We identified 687 people, 16-35 years, with an ICD-10 diagnosis of FEP, presenting to Early Intervention Psychosis services in the East of England over 2 million person-years. We used multilevel Poisson regression to examine incidence variation by ethnicity, rural-urban setting, generation status, and age-at-immigration, adjusting for several confounders including age, sex, socioeconomic status, population density, and deprivation. Results People of black African (incidence rate ratio: 4.06; 95% confidence interval [CI]: 2.63-6.25), black Caribbean (4.63; 95% CI: 2.38-8.98) and Pakistani (2.31; 95% CI: 1.35-3.94) origins were at greatest FEP risk relative to the white British population, after multivariable adjustment. Non-British white migrants were not at increased FEP risk (1.00; 95% CI: 0.77-1.32). These patterns were independently present in rural and urban settings. For first-generation migrants, migration during childhood conferred greatest risk of psychotic disorders (2.20; 95% CI: 1.33-3.62). Conclusions Elevated psychosis risk in several visible minority groups could not be explained by differences in postmigratory socioeconomic disadvantage. These patterns were observed across rural and urban areas of our catchment, suggesting that elevated psychosis risk for some ethnic minority groups is not a result of selection processes influencing rural-urban living. Timing of exposure to migration during childhood, an important social and neurodevelopmental window, may also elevate risk. © The Author 2017. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.

Author Keywords

Early intervention Social determinants Migration Ethnicity Epidemiology Incidence Urbanicity

Index Keywords

urban population Pakistan Pakistani urban area prospective study rural area schizophrenia India Caucasian risk population density minority group human immigration psychosis statistics and numerical data rural population ethnic group priority journal African Caribbean ethnology bipolar disorder Young Adult social status migrant mental patient Humans Adolescent Minority Groups male Emigrants and Immigrants England female patient referral Psychotic Disorders risk factor African Continental Ancestry Group Caribbean Region Caribbean Incidence Article major clinical study adult age European Continental Ancestry Group Age Factors outcome assessment Bangladesh ICD-10 secondary health care Black person
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85029534164&doi=10.1093%2fschbul%2fsbx010&partnerID=40&md5=5f1d69705f40e3b3eebb7b03c6864a26
DOI: 10.1093/schbul/sbx010
ISSN: 05867614
Cited by: 23
Original Language: English