Migrant integration policies, regional social disadvantage, ethnicity and psychosis risk: Findings from the EU-GEI study

Background

Compared with individual-level factors, macro-level exposures have received less attention in research on the increased risk of psychosis among ethnic minorities. We aimed to investigate the impact of migrant integration policies and area-level social deprivation on higher incidence rates among ethnic minorities.

Methods

This study, conducted between 2010 and 2015, analysed incidence data from five countries from the EUropean network of national schizophrenia networks studying Gene-Environment Interactions [EU-GEI]. The total population was multiplied by the duration of case-ascertainment to estimate person-years. Cases with a non-organic psychotic disorder were included. Exposures included population group (based on self/parental region of origin/self-ascribed ethnicity) and area-level exposures including country-level migrant integration policies and regional-level proxies of social deprivation (percentages of unemployment, low education, owner-occupied houses, single person-households). Negative binomial mixed-effects regression models were fitted to calculate the association between individual and area-level exposures and incidence of psychotic disorders.

Results

The study included 1933 individuals. Supportive migrant policies (IRR: 0.71; 95 % CI 0.68–0.73) and higher percentages of owner-occupied houses (IRR: 0.97; 95 % CI 0.96–0.97) were associated with lower incidence of psychosis. Higher percentages of unemployment (IRR: 1.08; 95 % CI 1.07–1.09) and single person-households (IRR: 1.10; 95 % CI 1.05–1.14) were associated with higher incidence of psychosis. Accounting for policies and area-level social deprivation markers reduced risk estimates among all migrant/ethnic minority groups, compared to the majority population.

Conclusions

This is the first study on the impact of migrant integration policies on psychosis incidence. Migrant integration policies and area-level social deprivation influenced psychosis risk in the overall and minority populations. These findings can inform policies and social epidemiological approaches to studying multi-level exposures in psychosis.