Incidence of schizophrenia among ethnic minorities in the Netherlands: A four-year first-contact study
Introduction
Studies from the United Kingdom and Scandinavia have reported a very high incidence of schizophrenia among several immigrant groups (Cantor-Graae and Selten, 2005, Kirkbride et al., 2006). A two-year first-contact study in The Hague, the Netherlands, found an increased incidence of schizophrenia among immigrants from Surinam and among male immigrants from Morocco (Selten et al., 2001). The risks were not significantly increased for Moroccan or Turkish women, or for immigrants from Western countries. However, these results were difficult to interpret, because the number of cases was small, particularly for the second generation.
As the high schizophrenia incidence rates among immigrants are still poorly understood (Sharpley et al., 2001) and have been questioned (Strakowski et al., 1996, Fernando, 2003, Arnold et al., 2004), it is important to clarify which immigrant groups are at higher risk, and to what extent second generation immigrants are affected. We therefore conducted a second two-year first-contact incidence study in The Hague and combined the results of both studies. We compared the risks of schizophrenic disorders (DSM IV: schizophrenia, schizophreniform disorder, schizoaffective disorder) in immigrants with those in native Dutch persons.
Section snippets
Classification of ethnicity
The municipality of The Hague classifies ethnicity according to citizens' country of birth and to that of their parents. Immigrants include both those who are foreign-born (first generation) and those who have at least one foreign-born parent (second generation). Seven categories of ethnicity are used: (1) Morocco, (2) Surinam, (3) Turkey, (4) the Netherlands Antilles, (5) other non-Western countries, (6) Western or westernised countries (Western or Northern Europe, the former Yugoslavia, the
First period, 1997–1999
The results of the first period have been reported previously (Selten et al., 2001).
Second period, 2000–2002
One hundred ninety-seven subjects made first contact during this two-year period. Diagnostic interviews were conducted in 155 cases (78.7%) and interviews with key informants in 132 cases (67.0%). A consensus DSM-IV diagnosis could be made for all but one subject. One hundred nineteen subjects (87 men, 32 women) were diagnosed with a schizophrenic disorder. Among these 119 subjects, the mean age at first contact
Discussion
The risk of schizophrenic disorders was increased for first and second generation immigrants from Morocco, Surinam, and other non-Western countries. Second generation immigrants from these groups had higher risks than those of the first generation.
Remarkably, whereas the risk was very high for first and second generation Moroccan males, the risk for Moroccan females, first or second generation, was not significantly increased. We have no ready explanation for the low number of Moroccan women
Acknowledgments
This study was supported in part by the Theodore and Vada Stanley Foundation.
References (16)
- et al.
Ethnicity and first-rank symptoms in patients with psychosis
Schizophr. Res.
(2004) - et al.
IRAOS: an instrument for the assessment of onset and early course of schizophrenia
Schizophr. Res.
(1992) - et al.
Racial differences in the diagnosis of psychosis
Schizophr. Res.
(1996) - et al.
The Comprehensive Assessment of Symptoms and History (CASH). An instrument for assessing diagnosis and psychopathology
Arch. Gen. Psychiatry
(1992) - et al.
Acculturation and intercultural relations
- et al.
Schizophrenia and migration: a meta-analysis and review
Am. J. Psychiatry
(2005) - et al.
Mental health care and immigrants. Developments in service uptake in greater Rotterdam, 1990–1998
Cited by (142)
Gender differences in the association between environment and psychosis
2022, Schizophrenia ResearchCitation Excerpt :An investigation of the association between urbanicity and schizotypy traits in non-clinical young population (age: 17 to 22 years) showed that urbanicity might be associated with magical thinking and unusual experiences in women, whereas no significant association between schizotypy and urbanicity was detected in men (Mimarakis et al., 2018). Six studies investigated the effect of migration by sex with PSD (Cantor-Graae and Pedersen, 2013; Dykxhoorn et al., 2019; Hollander et al., 2016; Kirkbride et al., 2017; Mimarakis et al., 2018; Veling et al., 2006) (See Table 5). In a large Danish birth-cohort study, both the first and the second-generation immigrant men were more likely to develop PSD than immigrant women.
International incidence of psychotic disorders, 2002–17: a systematic review and meta-analysis
2019, The Lancet Public HealthThe impact of ethnic density on dispensing of antipsychotic and antidepressant medication among immigrants in the Netherlands
2018, Social Science and MedicineCitation Excerpt :To exclude a diagnosis of dementia as reason for dispensing antipsychotics, analyses were also done separately for young persons (<40 years). Furthermore, earlier studies showed high relative risks of psychosis (Selten et al., 2001; Veling et al., 2006) and of dispensed antipsychotics (Termorshuizen et al., 2017) among Moroccan males aged <40 years. For antidepressants, high relative risks of dispensing were found among Moroccan females aged <40 and males aged ≥40 years (Termorshuizen et al., 2017).
Internal migration and mental health of the second generation. The case of Turin in the age of the Italian economic miracle
2018, Social Science and MedicineCitation Excerpt :It is reasonable to suppose that discrimination processes take on greater force when the supposed différance between native and immigrants is underpinned on features like skin colour or other somatic traits, which are more easily stigmatized. In fact, psychosis risk was particularly high in these ethnic groups, whereas it appears lower in the few studies that evaluated it among white people who migrated from other European countries (Veling et al., 2006; Leão et al., 2006; Coid et al., 2008). Due the nature of the empirical material analysed, the main alternative hypothesis that is worthwhile considering is that the observed over-morbidity for psychosis is nothing more than an artefact, attributable to physicians’ greater propensity to diagnose this disorder among Southern offspring, resulting in higher misdiagnosis among migrants than natives.
Comparison between a morocco and a native-born population, in a sample of first episode psychosis
2020, Revista de Psiquiatria y Salud Mental