People who migrate in adolescence have an increased risk of psychosis, researchers have found, and note the link is particularly strong among black and North African people.
While research has previously suggested migration may play a role in the increased risk of psychosis among people from ethnic minorities, the study suggests that age may be an important factor.
James Kirkbride, a professor of psychiatric and social epidemiology at University College London (UCL) and co-author of the study, said adolescence was a time when individuals form a sense of identity and experience social, cognitive and neurological development .
He said: “Thus migrating during adolescence, which interrupts the formation of social networks, may require teenage migrants to learn a new language, navigate new social and cultural norms and customs, and manage new social environments – including potential exposure to racism and discrimination known to be associated with psychosis risk – may all play a role in making adolescent migration a particularly vulnerable period to increase future psychosis risk.”
Writing in the journal PLOS Mental HealthKirkbride and colleagues report how they analyzed data from 2,132 people aged 18-64 in England, France, Italy, Spain and the Netherlands who were part of a larger research study. Of this group, 937 people experienced a first episode of a psychotic disorder, with this occurring after migration in those who migrated.
Most of those who migrated, Kirkbride said, did so for economic reasons, rather than seeking asylum, for example.
After taking into account factors such as ethnicity, markers of social disadvantage and parental history of psychosis, the team found that those who migrated between the ages of 11 and 17 had almost twice the risk of developing psychosis compared to whites people who have not migrated. However, there was no increased risk for people who migrated in infancy, earlier childhood or adulthood.
In a further analysis, the team found that the increased risk of psychosis in adolescents was only significant among black and North African migrants. While Kirkbride noted that the exact association was difficult to ascertain due to the small size of the latter group in the study, the risk of psychosis was at least two to three times higher for these groups than for white people who did not migrate.
The analysis also revealed that North African adults, black people of all ages and non-migrants who were black or of mixed ethnic backgrounds were at greater risk of psychosis compared to white non-migrants. There was no such increase for white or Asian migrants.
Humma Andleeb, the first author of the study, also from UCL, said white people are not visible minorities in Europemeaning they have not experienced the same disadvantages or may be able to adapt more easily. “They may also be more likely to migrate within Europe and not experience the same disadvantages pre-migration or post-migration,” she said.
The study has limitations, including that it cannot show cause and effect, does not track people over time, and the sample sizes for some groups are small. Further work is also needed to find out why adolescents who migrate have an increased risk of psychosis.
Kirkbride said: “What we need to focus on for that group is ways to help them manage their mental health and help them integrate into society so they are armed with the social skills they need to navigate new environments. navigate and avoid the development of serious mental health problems.”
Dr Adam Coutts, from the University of Cambridge, who was not involved in the work, said the health impacts on asylum seekers would be worse given the uncertainty and lack of access to services and work they face. “The key issue is that the plight of economic migrants, refugees and asylum seekers has exposed the fragile nature of government frontline services such as mental health services. It needs to be improved for everyone, including local residents and migrants.”
Dr Gracia Fellmeth, from the University of Oxford, agreed. She said: “[These] findings highlight the urgent need to ensure that young migrants are given the care and support they need to thrive in their new environments.”
