Psychological Medicine
Volume 49, Issue 14, 2019, Pages 2354-2363

Risk of schizophrenia, schizoaffective, and bipolar disorders by migrant status, region of origin, and age-at-migration: a national cohort study of 1.8 million people (Article) (Open Access)

Dykxhoorn J.* , Hollander A.-C. , Lewis G. , Magnusson C. , Dalman C. , Kirkbride J.B.
  • a Division of Psychiatry, UCL, London, United Kingdom
  • b Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
  • c Division of Psychiatry, UCL, London, United Kingdom
  • d Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden, Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
  • e Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden, Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
  • f Division of Psychiatry, UCL, London, United Kingdom

Abstract

Background We assessed whether the risk of various psychotic disorders and non-psychotic bipolar disorder (including mania) varied by migrant status, a region of origin, or age-at-migration, hypothesizing that risk would only be elevated for psychotic disorders.Methods We established a prospective cohort of 1 796 257 Swedish residents born between 1982 and 1996, followed from their 15th birthday, or immigration to Sweden after age 15, until diagnosis, emigration, death, or end of 2011. Cox proportional hazards models were used to model hazard ratios by migration-related factors, adjusted for covariates.Results All psychotic disorders were elevated among migrants and their children compared with Swedish-born individuals, including schizophrenia and schizoaffective disorder (adjusted hazard ratio [aHR]migrants: 2.20, 95% CI 1.96-2.47; aHRchildren : 2.00, 95% CI 1.79-2.25), affective psychotic disorders (aHRmigrant1.42, 95% CI 1.25-1.63; aHRchildren: 1.22 95% CI 1.07-1.40), and other non-affective psychotic disorders (aHRmigrant: 1.97, 95% CI 1.81-2.14; aHRchildren: 1.68, 95% CI 1.54-1.83). For all psychotic disorders, risks were generally highest in migrants from Africa (i.e. aHRschizophrenia: 5.24, 95% CI 4.26-6.45) and elevated at most ages-of-migration. By contrast, risk of non-psychotic bipolar disorders was lower for migrants (aHR: 0.58, 95% CI 0.52-0.64) overall, and across all ages-of-migration except infancy (aHR: 1.20; 95% CI 1.01-1.42), while risk for their children was similar to the Swedish-born population (aHR: 1.00, 95% CI 0.93-1.08).Conclusions Increased risk of psychiatric disorders associated with migration and minority status may be specific to psychotic disorders, with exact risk dependent on the region of origin. © Cambridge University Press 2018.

Author Keywords

Migration psychotic disorders mania schizophrenia bipolar disorder Epidemiology

Index Keywords

[No Keywords available]
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85057971739&doi=10.1017%2fS0033291718003227&partnerID=40&md5=25da1ad1742a834a19aa85517c89ad88
DOI: 10.1017/S0033291718003227
ISSN: 00332917
Cited by: 3
Original Language: English