Abstract
ObjectiveThe determinants of increased psychosis risk among immigrants remain unclear. Given ethnic density may be protective, we investigated whether the presence of immediate family, or “family networks”, at time of immigration was associated with risk of non-affective psychosis. MethodsWe followed a cohort of migrants (n = 838,717) to Sweden, born 1968–1997, from their 14th birthday, or earliest immigration thereafter, until diagnosis of non-affective psychosis (ICD-9/ICD-10), emigration, death, or 2011. Using record linkage, we measured family network as the presence of adult first-degree relatives immigrating with the cohort participant or already residing in Sweden. We used Cox proportional hazards regression to examine whether risk varied between those migrating with family, migrating to join family, or migrating alone. ResultsMigrating with immediate family was associated with increased psychosis risk amongst males compared to males who did not migrate with family (adjusted Hazard Ratio [aHR]: 1.16, 95% CI: 1.00–1.34). Migrating with family did not increase risk among females (aHR: 0.91, 95% CI: 0.78–1.07); similar observations were observed for males who immigrated to join family (aHR: 1.35, 95% CI: 1.21–1.51). In contrast, females who migrated alone were at increased risk compared to females who did not migrate alone (aHR: 1.31, 95% CI: 1.11–1.54). ConclusionFamily networks at the time of immigration were associated with differential patterns of non-affective psychotic disorders for males and females. These results suggest sex-specific differences in the perceived role of family networks during the migration process.
Highlights
There is robust evidence that several migrants groups and their children are at increased risk of psychotic disorders (Bourque et al, 2011; Cantor-Graae and Pedersen, 2013) with exact risk varying by country of origin, ethnicity, and reason for migration (Hollander et al, 2016)
We reported unadjusted and adjusted hazard ratios, with 95% confidence intervals, adjusting for a priori confounders and mutual adjustment for the other family network variables in each analysis
We observed strong effect modification by sex in the relationship between non-affective psychosis risk and family network exposures, so presented stratified results (Supplemental Table 1). Those who immigrated to join family were at higher risk of psychosis compared with those who did not join family members after multivariable adjustment (Table 2, Fig. 2)
Summary
There is robust evidence that several migrants groups and their children are at increased risk of psychotic disorders (Bourque et al, 2011; Cantor-Graae and Pedersen, 2013) with exact risk varying by country of origin, ethnicity, and reason for migration (Hollander et al, 2016). The availability of social networks may buffer stressors experienced before, during, and after migration (Cohen and Wills, 1985), consistent with observations that risk is modified amongst migrant who live in communities with a. Social networks may help buffer stressors experienced before, during, and after migration (Cohen and Wills, 1985), and mitigate risk of subsequent disorder. Social networks are regarded as important sources of social capital, and are at times used synonymously in the literature (Ryan et al, 2008) In his seminal work, Putnam described social capital as ‘social networks and the associated norms of reciprocity and trust’ (Putnam, 2007, 2000). Social networks have been associated with numerous physical and mental health benefits, such as fewer health complaints among children (Eriksson et al, 2012), fewer behavioural and mental health problems among adolescents (McPherson et al, 2014), and lower rates of schizophrenia (Kirkbride et al, 2008a, 2008b), and suicide (Congdon, 2012; Kelly et al, 2009)
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