Urban birth and migrant status as risk factors for psychosis: an Australian case-control study

McGrath, John J.; El-Saadi, O.; Cardy, Sue; Chapple, Ben; Chant, David; Mowry, Bryan

doi:10.1007/s001270170003

Cited by 32 publications

(22 citation statements)

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“…Such observations are not new [87], [153], [154], are not a phenomenon limited to the UK or even Europe [153], [154], [155], [156], and are not limited to people of black ethnicity [10], [153], [154], [157]. Nevertheless, not all migrant groups in England [52], [73] or elsewhere [158], [159] exhibit the same risk profile, with considerable variation by ethnicity, sex and other socio-environmental factors. Such heterogeneity is likely to reveal clues to the possible determinants of psychosis incidence according to ethnicity.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Schizophrenia and Other Psychoses in England, 1950–2009: A Systematic Review and Meta-Analyses

et al. 2012

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BackgroundWe conducted a systematic review of incidence rates in England over a sixty-year period to determine the extent to which rates varied along accepted (age, sex) and less-accepted epidemiological gradients (ethnicity, migration and place of birth and upbringing, time).ObjectivesTo determine variation in incidence of several psychotic disorders as above.Data SourcesPublished and grey literature searches (MEDLINE, PSycINFO, EMBASE, CINAHL, ASSIA, HMIC), and identification of unpublished data through bibliographic searches and author communication.Study Eligibility CriteriaPublished 1950–2009; conducted wholly or partially in England; original data on incidence of non-organic adult-onset psychosis or one or more factor(s) pertaining to incidence.ParticipantsPeople, 16–64 years, with first -onset psychosis, including non-affective psychoses, schizophrenia, bipolar disorder, psychotic depression and substance-induced psychosis.Study Appraisal and Synthesis MethodsTitle, abstract and full-text review by two independent raters to identify suitable citations. Data were extracted to a standardized extraction form. Descriptive appraisals of variation in rates, including tables and forest plots, and where suitable, random-effects meta-analyses and meta-regressions to test specific hypotheses; rate heterogeneity was assessed by the I2-statistic.Results83 citations met inclusion. Pooled incidence of all psychoses (N = 9) was 31.7 per 100,000 person-years (95%CI: 24.6–40.9), 23.2 (95%CI: 18.3–29.5) for non-affective psychoses (N = 8), 15.2 (95%CI: 11.9–19.5) for schizophrenia (N = 15) and 12.4 (95%CI: 9.0–17.1) for affective psychoses (N = 7). This masked rate heterogeneity (I2: 0.54–0.97), possibly explained by socio-environmental factors; our review confirmed (via meta-regression) the typical age-sex interaction in psychosis risk, including secondary peak onset in women after 45 years. Rates of most disorders were elevated in several ethnic minority groups compared with the white (British) population. For example, for schizophrenia: black Caribbean (pooled RR: 5.6; 95%CI: 3.4–9.2; N = 5), black African (pooled RR: 4.7; 95%CI: 3.3–6.8; N = 5) and South Asian groups in England (pooled RR: 2.4; 95%CI: 1.3–4.5; N = 3). We found no evidence to support an overall change in the incidence of psychotic disorder over time, though diagnostic shifts (away from schizophrenia) were reported.LimitationsIncidence studies were predominantly cross-sectional, limiting causal inference. Heterogeneity, while evidencing important variation, suggested pooled estimates require interpretation alongside our descriptive systematic results.Conclusions and Implications of Key FindingsIncidence of psychotic disorders varied markedly by age, sex, place and migration status/ethnicity. Stable incidence over time, together with a robust socio-environmental epidemiology, provides a platform for developing prediction models for health service planning.

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Section: Discussionmentioning

confidence: 99%

Incidence of Schizophrenia and Other Psychoses in England, 1950–2009: A Systematic Review and Meta-Analyses

et al. 2012

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“…In a casecontrol study, McGrath et al (2001) found that first and second generation migrants in Australia had a reduced risk of a psychotic disorder compared to those born in Australia (McGrath et al, 2001). Similarly, Nielssen et al (2013) examined the psychiatric admission rate for psychotic disorders in New South Wales (Australia) over a ten-year period and found no difference in the admission rates between migrants and the Australian born population (Nielssen et al, 2013).…”

Section: Migration Status and Risk Of Psychosismentioning

confidence: 94%

Social environmental risk factors for transition to psychosis in an Ultra-High Risk population

O’Donoghue

Nelson

Yuen

et al. 2015

Schizophrenia Research

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“…This study also failed to find an increased risk of schizophrenia in second-generation migrants to Australia. 76 More recent studies in Denmark also cast doubt on whether urban findings should be interpreted solely in terms of social factors. A cohort study in Denmark that included over 5 million people found no evidence of time trends in the urban-rural differences in schizophrenia risk during the period 1910 to 1986, 77 in contrast to previous findings from Finland 78 and The Netherlands 79 that showed an increase in the urban effect over time.…”

Section: Does the Urban Effect In Schizophrenia Lend Support To The Smentioning

confidence: 99%

The Contribution of Social Factors to the Development of Schizophrenia: A Review of Recent Findings

Cantor‐Graae

2007

Can J Psychiatry

169

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Objective: To investigate recent evidence suggesting that social factors are causally related to the development of schizophrenia.Method: I conducted a sytematic review of MEDLINE to identify possibly relevant studies. The search was limited to peer-reviewed studies and review articles appearing in English-language journals since 1996. Studies were included if they used standardized diagnostic criteria for schizophrenia or standardized assessment instruments for psychotic symptoms.Results: Studies of migrants to western Europe provide compelling support for the notion that social factors contribute to the development of schizophrenia. Findings such as excessively high risk for schizophrenia in second-generation immigrants are difficult to explain solely in terms of biological or genetic factors. A growing number of studies implicate childhood exposure to social adversity as a risk factor for schizophrenia, although few studies have used prospective designs. The increased incidence of schizophrenia risk associated with urban birth and (or) urban upbringing suggests possible social causation, but these findings are more ambiguous. Thus far, no studies have explored actual mechanisms by which exposure to social factors might generate psychotic symptoms, although animal experiments suggest that social defeat or social exclusion may cause dopamine dysregulation or sensitization. Conclusions:The accumulating evidence suggesting a role for social factors in the development of schizophrenia arises primarily from studies of migrants conducted in Europe. The mechanisms by which social factors exert their influence remain unknown. Future investigations of social causation should clarify the temporal relation between exposure to social defeat and (or) social adversity and the development of psychotic symptoms.(Can J Psychiatry 2007;52:277-286) Information on funding and support and author affiliations appears at the end of the article. Clinical Implications· Social factors may play an etiologic role in the development of schizophrenia. · A common denominator may be chronic experiences of social defeat and (or) exclusion, resulting in dopamine dysregulation or sensitization. · The implementation of interventions and preventive strategies may reduce the risk associated with social factors. Limitations· Thus far, few prospective studies specifically target social factors. · Animal models of social defeat may not be satisfactory analogues for the migrant experience. · The role of substance abuse in individuals exposed to social adversity cannot be excluded.

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Urban birth and migrant status as risk factors for psychosis: an Australian case-control study

Abstract: The lack of effect for urban birth and second-generation migrant status may help generate candidate environmental risk factors that operate in Europe but not in Australia.

Cited by 32 publications

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Incidence of Schizophrenia and Other Psychoses in England, 1950–2009: A Systematic Review and Meta-Analyses

Incidence of Schizophrenia and Other Psychoses in England, 1950–2009: A Systematic Review and Meta-Analyses

Social environmental risk factors for transition to psychosis in an Ultra-High Risk population

The Contribution of Social Factors to the Development of Schizophrenia: A Review of Recent Findings

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