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The association between migrant status and transition in an ultra-high risk for psychosis population

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Abstract

Purpose

Migrant status is one of the most replicated and robust risk factors for developing a psychotic disorder. This study aimed to determine whether migrant status in people identified as Ultra-High Risk for Psychosis (UHR) was associated with risk of transitioning to a full-threshold psychotic disorder.

Methods

Hazard ratios for the risk of transition were calculated from five large UHR cohorts (n = 2166) and were used to conduct a meta-analysis using the generic inverse-variance method using a random-effects model.

Results

2166 UHR young people, with a mean age of 19.1 years (SD ± 4.5) were included, of whom 221 (10.7%) were first-generation migrants. A total of 357 young people transitioned to psychosis over a median follow-up time of 417 days (I.Q.R.147–756 days), representing 17.0% of the cohort. The risk of transition to a full-threshold disorder was not increased for first-generation migrants, (HR = 1.08, 95% CI 0.62–1.89); however, there was a high level of heterogeneity between studies The hazard ratio for second-generation migrants to transition to a full-threshold psychotic disorder compared to the remainder of the native-born population was 1.03 (95% CI 0.70–1.51).

Conclusions

This meta-analysis did not find a statistically significant association between migrant status and an increased risk for transition to a full-threshold psychotic disorder; however, several methodological issues could explain this finding. Further research should focus on examining the risk of specific migrant groups and also ensuring that migrant populations are adequately represented within UHR clinics.

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References

  1. Cantor-Graae E, Selten J-P (2005) Schizophrenia and migration: a meta-analysis and review. Am J Psychiatry 162(1):12–24. https://doi.org/10.1176/appi.ajp.162.1.12

    Article  PubMed  Google Scholar 

  2. Selten JP, van der Ven E, Termorshuizen F (2020) Migration and psychosis: a meta-analysis of incidence studies. Psychol Med 50(2):303–313. https://doi.org/10.1017/S0033291719000035

    Article  PubMed  Google Scholar 

  3. Odegaard O (1932) Emigration and insanity: a study of mental disorders among Norwegian-born population in Minnesota. Acta Psychiatr Neurol Scand 4:1–206

    Google Scholar 

  4. Cantor Graae E, Pedersen C, McNeil T, Mortensen P (2003) Migration as a risk factor for schizophrenia: a Danish population-based cohort study. Br J Psychiatry 182:117–122

    Article  Google Scholar 

  5. Selten JP, Slaets JP, Kahn RS (1997) Schizophrenia in Surinamese and Dutch Antillean immigrants to The Netherlands: evidence of an increased incidence. Psychol Med 27(4):807–811

    Article  CAS  Google Scholar 

  6. Smith GN, Boydell J, Murray RM, Flynn S, McKay K, Sherwood M, Honer WG (2006) The incidence of schizophrenia in European immigrants to Canada. Schizophr Res 87(1–3):205–211. https://doi.org/10.1016/j.schres.2006.06.024

    Article  CAS  PubMed  Google Scholar 

  7. Tortelli A, Errazuriz A, Croudace T, Morgan C, Murray RM, Jones PB, Szoke A, Kirkbride JB (2015) 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 50(7):1039–1055. https://doi.org/10.1007/s00127-015-1021-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. O’Donoghue B, Downey L, Eaton S, Mifsud N, Kirkbride JB, McGorry P (2020) Risk of psychotic disorders in migrants to Australia. Psychol Med. https://doi.org/10.1017/S0033291719004100

    Article  PubMed  Google Scholar 

  9. Dykxhoorn J, Kirkbride JB (2019) Psychoses sans Frontieres: towards an interdisciplinary understanding of psychosis risk amongst migrants and their descendants. Epidemiol Psychiatr Sci 28(2):146–152. https://doi.org/10.1017/S2045796018000501

    Article  CAS  PubMed  Google Scholar 

  10. Anderson KK, Edwards J (2020) Age at migration and the risk of psychotic disorders: a systematic review and meta-analysis. Acta Psychiatr Scand 141(5):410–420. https://doi.org/10.1111/acps.13147

    Article  CAS  PubMed  Google Scholar 

  11. Yung AR, Nelson B (2013) The ultra-high risk concept-a review. Can J Psychiatry 58(1):5–12. https://doi.org/10.1177/070674371305800103

    Article  PubMed  Google Scholar 

  12. Yung AR, McGorry PD, McFarlane CA, Jackson HJ, Patton GC, Rakkar A (1996) Monitoring and care of young people at incipient risk of psychosis. Schizophr Bull 22(2):283–303

    Article  CAS  Google Scholar 

  13. Yung ARPL, Yuen HP, Francey SM, McFarlane CA, Hallgren M, McGorry PD (2003) Psychosis prediction: 12-month follow up of a high-risk (“prodromal”) group. Schizophr Res 60(1):21–32

    Article  Google Scholar 

  14. Yung ARPL, Yuen HP, McGorry PD (2003) Risk factors for psychosis in an ultra high-risk group: psychopathology and clinical features. Schizophr Res 67(2):131–142

    Google Scholar 

  15. Fusar-Poli P, Bonoldi I, Yung AR, Borgwardt S, Kempton MJ, Valmaggia L, Barale F, Caverzasi E, McGuire P (2012) Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk. Arch Gen Psychiatry 69(3):220–229. https://doi.org/10.1001/archgenpsychiatry.2011.1472

    Article  PubMed  Google Scholar 

  16. Addington J, Farris M, Stowkowy J, Santesteban-Echarri O, Metzak P, Kalathil MS (2019) Predictors of transition to psychosis in individuals at clinical high risk. Curr Psychiatry Rep 21(6):39. https://doi.org/10.1007/s11920-019-1027-y

    Article  PubMed  Google Scholar 

  17. Geros H, Sizer H, Mifsud N, Reynolds S, Kim DJ, Eaton S, McGorry P, Nelson B, O’Donoghue B (2020) Migrant status and identification as ultra-high risk for psychosis and transitioning to a psychotic disorder. Acta Psychiatr Scand 141(1):52–59. https://doi.org/10.1111/acps.13099

    Article  CAS  PubMed  Google Scholar 

  18. O’Donoghue B, Nelson B, Yuen HP, Lane A, Wood S, Thompson A, Lin A, McGorry P, Yung AR (2015) Social environmental risk factors for transition to psychosis in an ultra-high risk population. Schizophr Res 161(2–3):150–155. https://doi.org/10.1016/j.schres.2014.10.050

    Article  PubMed  Google Scholar 

  19. Ising HK, Kraan TC, Rietdijk J, Dragt S, Klaassen RM, Boonstra N, Nieman DH, Willebrands-Mendrik M, van den Berg DP, Linszen DH, Wunderink L, Veling W, Smit F, van der Gaag M (2016) Four-year follow-up of cognitive behavioral therapy in persons at ultra-high risk for developing psychosis: the dutch early detection intervention evaluation (EDIE-NL) trial. Schizophr Bull 42(5):1243–1252. https://doi.org/10.1093/schbul/sbw018

    Article  PubMed  PubMed Central  Google Scholar 

  20. Addington J, Liu L, Buchy L, Cadenhead KS, Cannon TD, Cornblatt BA, Perkins DO, Seidman LJ, Tsuang MT, Walker EF, Woods SW, Bearden CE, Mathalon DH, McGlashan TH (2015) North American prodrome longitudinal study (NAPLS 2): the prodromal symptoms. J Nerv Ment Dis 203(5):328–335. https://doi.org/10.1097/NMD.0000000000000290

    Article  PubMed  PubMed Central  Google Scholar 

  21. McGorry PD, Nelson B, Markulev C, Yuen HP, Schafer MR, Mossaheb N, Schlogelhofer M, Smesny S, Hickie IB, Berger GE, Chen EY, de Haan L, Nieman DH, Nordentoft M, Riecher-Rossler A, Verma S, Thompson A, Yung AR, Amminger GP (2017) Effect of omega-3 polyunsaturated fatty acids in young people at ultrahigh risk for psychotic disorders: the NEURAPRO randomized clinical trial. JAMA Psychiatry 74(1):19–27. https://doi.org/10.1001/jamapsychiatry.2016.2902

    Article  PubMed  Google Scholar 

  22. Nelson B, Yuen HP, Wood SJ, Lin A, Spiliotacopoulos D, Bruxner A, Broussard C, Simmons M, Foley DL, Brewer WJ, Francey SM, Amminger GP, Thompson A, McGorry PD, Yung AR (2013) Long-term follow-up of a group at ultra high risk (“prodromal”) for psychosis: the PACE 400 study. JAMA Psychiatry 70(8):793–802. https://doi.org/10.1001/jamapsychiatry.2013.1270

    Article  PubMed  Google Scholar 

  23. Yung AR, Yuen HP, McGorry PD, Phillips LJ, Kelly D, Dell’Olio M, Francey SM, Cosgrave EM, Killackey E, Stanford C, Godfrey K, Buckby J (2005) Mapping the onset of psychosis: the comprehensive assessment of at-risk mental states. Aust N Z J Psychiatry 39(11–12):964–971. https://doi.org/10.1080/j.1440-1614.2005.01714.x

    Article  PubMed  Google Scholar 

  24. MacGlashan TW, Walsh BC, Woods SW (2010) The psychosis risk syndrome: handbook for diagnosis and follow-up. Oxford University Press, New York

    Google Scholar 

  25. Miller TJ, McGlashan TH, Rosen JL, Cadenhead K, Cannon T, Ventura J, McFarlane W, Perkins DO, Pearlson GD, Woods SW (2003) Prodromal assessment with the structured interview for prodromal syndromes and the scale of prodromal symptoms: predictive validity, interrater reliability, and training to reliability. Schizophr Bull 29(4):703–715. https://doi.org/10.1093/oxfordjournals.schbul.a007040

    Article  PubMed  Google Scholar 

  26. IBM Corporation (2019) IBM SPSS Statistics for Windows Version 26.0. Armonk, NY

  27. The_Cochrane-Collaboration (2020) Review Manager (Rev Man) 5.4 edn

  28. Boonstra N, Sterk B, Wunderink L, Sytema S, De Haan L, Wiersma D (2012) Association of treatment delay, migration and urbanicity in psychosis. Eur Psychiatry J Assoc Eur Psychiatr 27(7):500–505. https://doi.org/10.1016/j.eurpsy.2011.05.001

    Article  CAS  Google Scholar 

  29. Dapunt J, Kluge U, Heinz A (2017) Risk of psychosis in refugees: a literature review. Translational psychiatry 7(6):e1149–e1149. https://doi.org/10.1038/tp.2017.119

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. van Os J, Linscott RJ, Myin-Germeys I, Delespaul P, Krabbendam L (2009) A systematic review and meta-analysis of the psychosis continuum: evidence for a psychosis proneness-persistence-impairment model of psychotic disorder. Psychol Med 39(2):179–195. https://doi.org/10.1017/S0033291708003814

    Article  PubMed  Google Scholar 

  31. Scott J, Chant D, Andrews G, McGrath J (2006) Psychotic-like experiences in the general community: the correlates of CIDI psychosis screen items in an Australian sample. Psychol Med 36(2):231–238. https://doi.org/10.1017/S0033291705006392

    Article  PubMed  Google Scholar 

  32. Tarricone I, Atti AR, Salvatori F, Braca M, Ferrari S, Malmusi D, Berardi D (2009) Psychotic symptoms and general health in a socially disadvantaged migrant community in Bologna. Int J Soc Psychiatry 55(3):203–213. https://doi.org/10.1177/0020764008093445

    Article  PubMed  Google Scholar 

  33. King M, Nazroo J, Weich S, McKenzie K, Bhui K, Karlsen S, Stansfeld S, Tyrer P, Blanchard M, Lloyd K, McManus S, Sproston K, Erens B (2005) Psychotic symptoms in the general population of England–a comparison of ethnic groups (The EMPIRIC study). Soc Psychiatry Psychiatr Epidemiol 40(5):375–381

    Article  Google Scholar 

  34. Nelson B, Yuen K, Yung AR (2011) Ultra high risk (UHR) for psychosis criteria: Are there different levels of risk for transition to psychosis? Schizophr Res 125(1):62–68. https://doi.org/10.1016/j.schres.2010.10.017

    Article  CAS  PubMed  Google Scholar 

  35. Larsen TK, McGlashan TH, Moe LC (1996) First-episode schizophrenia: I. Early course parameters. Schizophr Bull 22(2):241–256

    Article  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Orygen, Melbourne, Australia

    Brian O’Donoghue, Hellen Geros, Holly Sizer, G. Paul Amminger, Jessica A. Hartmann, Suzie Lavoie, Connie Markulev, Nathan G. Mifsud, Miriam R. Schäfer, Andrew Thompson, Stephen J. Wood, Hok Pan Yuen, Alison Ruth Yung, Patrick D. McGorry & Barnaby Nelson

  2. Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia

    Brian O’Donoghue, Hellen Geros, Holly Sizer, G. Paul Amminger, Jessica A. Hartmann, Suzie Lavoie, Connie Markulev, Nathan G. Mifsud, Miriam R. Schäfer, Andrew Thompson, Stephen J. Wood, Hok Pan Yuen, Alison Ruth Yung, Patrick D. McGorry & Barnaby Nelson

  3. Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada

    Jean Addington

  4. Department of Psychiatry, Medical University of Vienna, Vienna, Austria

    G. Paul Amminger, Nilufar Mossaheb & Monika Schlögelhofer

  5. Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA

    Carrie E. Beaden

  6. Department of Psychiatry, UCSD, San Diego, CA, USA

    Kristin S. Cadenhead & Ming T. Tsuang

  7. Department of Psychology, Yale University, New Haven, CT, USA

    Tyrone D. Cannon

  8. Department of Psychiatry, Zucker Hillside Hospital, Long Island, NY, USA

    Barbara A. Cornblatt

  9. Child and Adolescent Psychiatric Service of the Canton of Zurich, Zürich, Switzerland

    Gregor Emanuel Berger

  10. Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong

    Eric Y. H. Chen

  11. Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands

    Lieuwe de Haan & Dorien H. Nieman

  12. Brain and Mind Research Institute, University of Sydney, Sydney, Australia

    Ian B. Hickie

  13. Department of Psychosis Research, Parnassia Psychiatric Institute, The Hague, The Netherlands

    Helga K. Ising & Mark van der Gaag

  14. Telethon Kids Institute, Perth, Australia

    Ashleigh Lin

  15. Department of Psychiatry, UCSF, San Francisco, CA, USA

    Daniel H. Mathalon

  16. SFVA Medical Center, San Francisco, CA, USA

    Daniel H. Mathalon

  17. Department of Psychiatry, Yale University, New Haven, CT, USA

    Thomas H. McGlashan & Scott W. Woods

  18. Psychiatric Centre Bispebjerg, Copenhagen, Denmark

    Merete Nordentoft

  19. Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA

    Diana O. Perkins

  20. Psychiatric University Clinics Basel, Basel, Switzerland

    Anita Riecher-Rössler

  21. Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, MA, USA

    Larry J. Seidman

  22. Massachusetts General Hospital, Boston, MA, USA

    Larry J. Seidman

  23. Department of Psychiatry, University Hospital Jena, Jena, Germany

    Stephan Smesny

  24. Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit , Amsterdam, The Netherlands

    Mark van der Gaag

  25. Institute of Mental Health, Singapore, Singapore

    Swapna Verma

  26. Department of Psychology, Emory University, Atlanta, GA, USA

    Elaine F. Walker

  27. Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, England

    Alison Ruth Yung

Authors
  1. Brian O’Donoghue
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  2. Hellen Geros
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  3. Holly Sizer
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  4. Jean Addington
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  5. G. Paul Amminger
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  6. Carrie E. Beaden
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  7. Kristin S. Cadenhead
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  8. Tyrone D. Cannon
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  9. Barbara A. Cornblatt
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  10. Gregor Emanuel Berger
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  11. Eric Y. H. Chen
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  12. Lieuwe de Haan
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  13. Jessica A. Hartmann
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  14. Ian B. Hickie
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  15. Helga K. Ising
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  16. Suzie Lavoie
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  17. Ashleigh Lin
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  18. Connie Markulev
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  19. Daniel H. Mathalon
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  20. Thomas H. McGlashan
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  21. Nathan G. Mifsud
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  22. Nilufar Mossaheb
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  23. Dorien H. Nieman
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  24. Merete Nordentoft
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  25. Diana O. Perkins
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  26. Anita Riecher-Rössler
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  27. Miriam R. Schäfer
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  28. Monika Schlögelhofer
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  29. Larry J. Seidman
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  30. Stephan Smesny
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  31. Andrew Thompson
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  32. Ming T. Tsuang
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  33. Mark van der Gaag
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  34. Swapna Verma
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  35. Elaine F. Walker
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  36. Stephen J. Wood
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  37. Scott W. Woods
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  38. Hok Pan Yuen
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  39. Alison Ruth Yung
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  40. Patrick D. McGorry
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  41. Barnaby Nelson
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Corresponding author

Correspondence to Brian O’Donoghue.

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The authors have no conflicts of interest to declare.

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O’Donoghue, B., Geros, H., Sizer, H. et al. The association between migrant status and transition in an ultra-high risk for psychosis population. Soc Psychiatry Psychiatr Epidemiol 56, 943–952 (2021). https://doi.org/10.1007/s00127-020-02012-6

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  • DOI: https://doi.org/10.1007/s00127-020-02012-6

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