Wednesday, August 14, 2019

Refugees at Greater Risk of Developing Psychotic Disorders, Meta-Analysis Finds

The risk for schizophrenia and other psychotic disorders is higher among refugees than native populations and nonrefugee migrants, suggests a report published today in JAMA Psychiatry.

“Refugees do not migrate deliberately but are forced to migrate and have possibly faced traumatic experiences before and during migration,” wrote Lasse Brandt, M.D., of Charité-University Medicine Berlin and colleagues. Migration combined with separation from social networks, social exclusion and discrimination, limited access to medical care, poverty, and more may make refugees especially vulnerable to developing mental illness, they added.

Previous studies have pointed to migration as a risk factor for developing nonaffective psychoses, such as schizophrenia, schizoaffective disorder, and schizophreniform disorders. Brandt and colleagues wanted to know how the incidence of these mental illnesses in refugee migrants compared with incidence in both nonrefugee migrants and native groups in a host country.

Based on an analysis of nine studies published between 2004 and 2018, which included 540,000 refugees in Canada, Denmark, Norway, and Sweden, the researchers found that refugee migrants were 40% more likely to have a first diagnosis of nonaffective psychoses than nonrefugee migrants and 140% more likely than native populations of the host country.

“We believe that these findings highlight the need for psychiatric prevention strategies and outreach programs for refugees,” concluded Brandt and colleagues.

The researchers noted several study limitations; for example, eight of the nine studies were from Scandinavian countries, questioning whether the findings are applicable to other regions. Additionally, “despite the similarity in geographic location and study methods among included studies, their heterogeneity [across studies] was considerably high,” they wrote.

Nonetheless, in an accompanying editorial, Kristina Sundquist, M.D., Ph.D., of Lund University in Sweden noted, “because the risk of nonaffective psychoses in refugees was significantly increased (both compared with nonrefugee migrants and the native population) in countries with a generous welfare system and almost universal health care coverage, … refugees in other parts of the world may have even higher relative risks for several psychiatric disorders, including nonaffective psychoses.” She added, “The observed risk increases of nonaffective psychoses in refugees highlight the need for extended support, which may include psychiatric care specifically tailored for this vulnerable subgroup in the population. Support to refugees may also encompass other health-promoting efforts to prevent psychiatric disorders from occurring.”

For related information, see the Psychiatric News article “GWU Group Helps Train Refugee Aid Workers.”

(Image: iStock/Steve Debenport)


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