Increased prevalence of psychotic disorders among third-generation migrants: Results from the French Mental Health in General Population survey

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Abstract

There is very strong evidence that the prevalence of psychosis is elevated in migrant populations and that this risk persists into the second generation. However, these results have not been replicated in France, and the prevalence of psychotic disorders in the third generation of migrants remains unknown. Based on the Mental Health in General Population survey (n = 37 063), we report for the first time the increased prevalence of psychotic disorders in migrants in France, which persists into the second generation for a single psychotic episode (SPE) (OR = 1.43, 95% CI [1.02–2.03], p < 0.03) and into the third generation for recurrent psychotic disorder (RPD) (OR = 1.78, 95% CI [1.45–2.18], p < 0.0001) after adjustment for age, sex, level of education and cannabis use. Complementary statistical analyses of our sample showed a significantly higher risk of SPE in migrants from the French West Indies and Africa (χ2 = 17.70, p < 0.01). These results are consistent with the socio-developmental model and the psychosis continuum hypothesis.

Introduction

There is strong evidence that the prevalence of psychosis is higher in migrant populations in many countries (McGrath et al., 2004). Meta-analyses have consistently shown that a personal or family history of migration is an important risk factor for psychosis (RR = 2.9, 95% CI [2.5–3.4]) (Cantor-Graae and Selten, 2005). Furthermore, this risk clearly persists into the second generation, with an incidence ratio of 2.3 (95% CI [1.8–2.5]) (Bourque et al., 2011). These results are well known in several European countries, but they have never been replicated in France. Furthermore, the prevalence of psychotic disorders in the third generation remains unknown.

In this paper, we report for the first time the prevalence of psychotic disorders in migrant populations in France, and we present findings concerning third-generation migrants.

Section snippets

Method

Between 1999 and 2003, the French Mental Health in General Population (MHGP) survey, conducted by the World Health Organization Collaborating Centre (WHO-CC), was used to interview 37 063 people. The subjects interviewed were selected by a quota sampling method and, thus, were representative of the general population in the 47 study sites in France. This method develops a sample of subjects with the same characteristics as the general population on predefined issues, such as age, sex,

Results

Of the 37 063 individuals interviewed, 9821 were migrants. Characteristics of the subjects are summarized in Table 1.

There was missing information about migrant status for 266 subjects in the total sample, and for only 7 subjects with a psychotic disorder. The most frequently observed birthplaces of migrants are summarized in Table 2.

Psychotic disorders were diagnosed in 1014 subjects (2.7%), comprising 271 (0.7%) with SPE and 743 (2.0%) with RPD. After adjustment for age, sex, level of

Discussion

The current study reports, for the first time, a high prevalence of psychotic disorders in the migrants in France, which persists into the second generation for SPE and into the third generation for the RPD, after adjustment for age, sex, level of education and cannabis use.

Several explanations have been proposed to account for the increase of psychosis among migrants. One explanation corresponds to the hypothesis of an increased prevalence of psychosis in the country of origin. In line with

Role of funding source

The authors of this study received no funds for this research.

Contributions

All the authors designed the study; A.A. and J.S. performed the analyses; A.A. and D.G. wrote the first draft; all the authors contributed to the manuscript writing and approved the final version.

Conflict of interest

The authors report no financial disclosures or conflicts of interest.

Acknowledgements

The authors gratefully acknowledge the contributions of Anne Vandeborre to this study.

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