Ethnic enclaves and risk of psychiatric disorders among first- and second-generation immigrants in Sweden

Abstract

Purpose Some non-Western immigrant groups in Europe have elevated risk of psychosis relative to native-born. It is hypothesized that neighborhood ethnic density moderates this risk. Immigration to Sweden has increased substantially recently, particularly from the Middle East. This study examined the relationship between neighborhood ethnic density (i.e., living in an immigrant enclave) and risk of psychotic and affective disorders among three groups: Iraqi immigrants, immigrants from other nations, and native-born Swedes. Methods Individuals aged 15 to 60, without prevalent psychopathology, were drawn from Swedish population-based registries and followed from 2005 to 2010 (N=1,442,931). Multi-level logistic regression was used to examine the association between neighborhood ethnic composition and incident psychopathology. Results Cumulative incidence of psychopathology was greater in Iraqi enclaves relative to predominantly Swedish neighborhoods (6.3% vs. 4.5%). Iraqis living in enclaves did not have significantly greater risk of psychosis (Odds Ratio (OR): 1.66, 95% Confidence Interval (CI): 0.92 – 2.97) or affective disorders (OR: 1.04, 95%CI: 0.85 – 1.27) relative to those in predominantly Swedish neighborhoods. There was no increased risk of psychosis (OR: 0.93, p>0.05) or affective disorders (OR: 0.93, p>0.05) for other immigrants living in an enclave. Swedes living in an enclave had elevated risk of both psychosis (OR: 1.37, p<0.05) and affective disorders (OR: 1.14, p<0.05) relative to those in predominantly Swedish neighborhoods. Second-generation Iraqis had higher risk of psychotic but not affective disorders relative to first-generation. Conclusions Neighborhood ethnic density does not moderate risk of psychopathology for immigrants in Sweden. Findings regarding Swedes are consistent with social drift.

Ethnic density, urbanicity and psychosis risk for migrant groups – A population cohort study

“…An advantage of our study was that we were able to investigate migrant groups otherwise overlooked in previous studies. Only one study to date has looked at this question in relation to migrants from the Middle East, covering Iraqi migrants in Sweden ( N = 19,975), and this found no evidence for the ethnic density hypothesis ( Mezuk et al, 2015 ). Few have looked at migrants from Europe; with these concentrating on the UK Irish population only ( Cochrane and Bal, 1988 , Das-Munshi et al, 2010 ).…”

A comprehensive systematic review and multilevel meta-analysis of the ethnic density effect in psychosis

“…Fourteen studies were conducted (45%) in the UK 9,11,[25][26][27][28][29][30][31][32][33][34][35][36] , eight (26%) in the Netherlands [37][38][39][40][41][42][43][44] , and four (13%) in Sweden [45][46][47][48] . Of the remaining five (16%), two were conducted in Denmark 49,50 , and one of each in the USA 51 , Canada 52 , and Australia 53 .…”

“…The majority were retrospective epidemiological studies (n=26, 84%) 9,11,[25][26][27][28][29][30][31][32][33][34][35][36][39][40][41][42][45][46][47][48][49][50]52,53 . Of these, most were cross-sectional and six (four datasets) used longitudinal methods 32,[46][47][48][49][50] .…”

“…Around half of the studies (n=15, 48%) examined first incident cases 9,[25][26][27]31,35,36,39,41,42,[45][46][47]49,50 and six (19%) used measures of subclinical psychosis 11,[28][29][30]33,51 . The others assessed symptomatic outcomes 37,38,43,44 , mortality rates 32 , inpatient days following admission 34 , compulsory admission 48 , individuals meeting ultra-high risk [UHR] criteria 53 , dispensed antipsychotic medication 40 , lifetime prevalence of psychosis 52 , psychophysiological outcomes 43 , and social distance 43,44 .…”

Why Do Some Nonnative People Who Migrate to Another Country Have Better Health Status Than Their Native-Born Counterparts?

“…20 In addition, immigrants with mental illnesses who live in areas that are densely populated by individuals (ethnic density hypothesis) from the same ethnic group have been shown to be associated with reduced illness severity. [21][22][23] Global migration is estimated at 200 million individuals per year. 19 With the recent migration of millions of individuals from war-torn Syria, Afghanistan, and Iraq, this number will surely continue to rise.…”