Although psychosis is rare, factors including stress related to migration and discrimination could contribute to increased risk, say researchers

People from ethnic minorities have up to a five times greater risk of psychotic disorders than the white British population, researchers say.

A new study reveals that the trend holds in both urban and rural settings, with first-generation migrants who arrive in the UK in childhood among those at increased risk.



The team behind the study say a number of factors could be at play, including stresses related to the migration process, discrimination and issues related to isolation and integration.



James Kirkbride, a psychiatric epidemiologist from University College London and co-author of the research, described the figures as shocking.

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“If this was any other disorder we would be horrified and up in arms and we would be campaigning from a public health perspective on how we could reduce this level of suffering,” he said. “There is a massive health inequality and it hasn’t got much attention.”

While psychosis is rare – rates in England stand at about 30 cases per 100,000 people per year – Kirkbride says more should be done to offer services to those in need and to unpick drivers behind raised risks.

“In the present climate when issues about migration are at the forefront of the public’s mind, people from ethnic minority backgrounds may face additional stresses that could potentially contribute to mental health problems,” he added.

Writing in the journal Schizophrenia Bulletin, Kirkbride and colleagues from the University of Cambridge and a collection of NHS foundation trusts describe how they looked at trends among 687 people in the east of England. All were aged between 16 and 35 years of age, had received a clinical diagnosis of a psychotic disorder, and had not previously had an episode of psychosis.

After taking into account of a host of factors including socioeconomic status, age and sex, the results reveal that compared to the risk of psychotic disorders in the white British population, people of black Caribbean origin had a 4.6 times greater risk. Those of Pakistani or black African origins, or of mixed ethnic backgrounds had risks 2.3 times, 4.1 times, and 1.7 times higher respectively. Non-British white individuals did not have an increased risk of psychotic disorders.

While overall there was no apparent increased risk of psychotic disorders among first-generation migrants, the team found that there was a higher risk for certain groups. Overall, the risk of psychotic disorders was higher for those who moved to Britain between the ages of five and 12, at more than twice the risk seen for the white British population.

“It is something to do with the migration process and the subsequent experiences that people have seem to increase people’s risk,” said Kirkbride. “It is not to do with higher rates in other countries.”

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The team also found an increased risk among later generations. Overall People from ethnic minority groups born in the UK were almost 2.6 times as likely to have a psychotic disorder as the UK-born white British population, with rates for UK born non-British white migrants also raised. “Second generation and later groups have to deal with a range of different pressures, and they might be to do with living in a country where they are brought up and born, and [are] citizens of that country but actually they still face barriers and things like discrimination because of their ethnic minority status,” said Kirkbride.

Rhiannon Corcoran, a professor of psychology at the University of Liverpool who was not involved in the research, welcomed the study, saying that while other research has highlighted a a link between increased risk of psychotic disorders and migration, the new work teases out the risk from city living – a factor also known to increase the risk of psychotic disorders.

But Corcoran said that it is important to unpick what is behind the link, particularly for children who migrate, pointing out that factors such as a sense of belonging, perceived threats in the new country and conflicting demands of fitting in with different cultures at home and with peers could all play a role.

Together with further research in the field, she said the new findings, “open up all sorts of possibilities for policy interventions aimed at making our communities more psychologically benign.”