Abstract
BackgroundRates of psychotic disorder are raised for many migrant groups. Understanding the role played by the social context in which they live may help explain why. This study investigates the effect of both neighbourhood ethnic density and urbanicity on the incidence of non-affective psychosis for migrant groups. MethodPopulation based cohort of all those born 1965 or later followed from their 15th birthday (2,224,464 people) to 1st July 2013 (37,335,812 person years). Neighbourhood exposures were measured at age 15. ResultsFor all groups incidence of non-affective psychosis was greater in lower ethnic density neighbourhoods. For migrants of African origin there was a 1.94-fold increase (95% CI, 1.17–3.23) comparing lowest and highest density quintiles; with similar effects for migrants from Europe (excluding Scandinavia): incidence rate ratio (IRR) 1.99 (95% CI, 1.56–2.54); Asia: IRR 1.63 (95% CI, 1.02–2.59); and the Middle East: IRR 1.68 (95% CI, 1.19–2.38). This initial analysis found no evidence for an urbanicity effect for migrant groups. Adjusting for ethnic density revealed a positive association between level of urbanicity and psychosis for two groups, with a statistically significant linear trend (average effect of a one quintile increase) for migrants from Europe: IRR 1.09 (95% CI, 1.02–1.16) and the Middle East: IRR 1.12 (95% CI, 1.01–1.23). ConclusionsIn this first nationwide population-based study of ethnic density, urbanicity and psychosis we show that lower ethnic density is associated with increased incidence of non-affective psychosis for different migrant groups; masking urban/rural differences in psychosis for some groups.
Highlights
An elevated risk of psychosis among some migrant groups is well documented and, in some instances, estimated to be greater than most other risk factors with the exception of family history of psychosis (Bourque et al, 2011; Cantor-Graae and Pedersen, 2013; Cantor-Graae and Selten, 2005; McGrath et al, 2004)
An ethnic density effect has been observed where psychosis incidence is reduced for members of minority ethnic groups who live in areas where their ethnic group is well represented (Becares et al, 2009; Boydell et al, 2001; Kirkbride et al, 2007b; Veling et al, 2008)
For each migrant group there was an elevated incidence of non-affective psychosis (Table 1) and this was most pronounced for the African group, with a 2.93 -fold increased incidence compared to Native Danes
Summary
An elevated risk of psychosis among some migrant groups is well documented and, in some instances, estimated to be greater than most other risk factors with the exception of family history of psychosis (Bourque et al, 2011; Cantor-Graae and Pedersen, 2013; Cantor-Graae and Selten, 2005; McGrath et al, 2004). This study investigates the effect of both neighbourhood ethnic density and urbanicity on the incidence of non-affective psychosis for migrant groups. For migrants of African origin there was a 1.94-fold increase (95% CI, 1.17–3.23) comparing lowest and highest density quintiles; with similar effects for migrants from Europe (excluding Scandinavia): incidence rate ratio (IRR) 1.99 (95% CI, 1.56–2.54); Asia: IRR 1.63 (95% CI, 1.02–2.59); and the Middle East: IRR 1.68 (95% CI, 1.19– 2.38). This initial analysis found no evidence for an urbanicity effect for migrant groups. Conclusions: In this first nationwide population-based study of ethnic density, urbanicity and psychosis we show that lower ethnic density is associated with increased incidence of non-affective psychosis for different migrant groups; masking urban/rural differences in psychosis for some groups
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