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CMAJ. 2015 Jun 16;187(9):E279-E286. doi: 10.1503/cmaj.141420. Epub 2015 May 11.

Incidence of psychotic disorders among first-generation immigrants and refugees in Ontario.

Author information

1
Departments of Epidemiology and Biostatistics, and Psychiatry (Anderson), Western University, London Ont.; Institute for Clinical Evaluative Sciences (Anderson, Cheng, Kurdyak), Toronto, Ont.; Centre for Addiction and Mental Health (Cheng, McKenzie, Kurdyak), Toronto, Ont.; Mailman School of Public Health (Susser), Columbia University, New York, NY; Department of Psychiatry (McKenzie, Kurdyak), University of Toronto, Toronto, Ont. kelly.anderson@schulich.uwo.ca.
2
Departments of Epidemiology and Biostatistics, and Psychiatry (Anderson), Western University, London Ont.; Institute for Clinical Evaluative Sciences (Anderson, Cheng, Kurdyak), Toronto, Ont.; Centre for Addiction and Mental Health (Cheng, McKenzie, Kurdyak), Toronto, Ont.; Mailman School of Public Health (Susser), Columbia University, New York, NY; Department of Psychiatry (McKenzie, Kurdyak), University of Toronto, Toronto, Ont.

Abstract

BACKGROUND:

Evidence suggests that migrant groups have an increased risk of psychotic disorders and that the level of risk varies by country of origin and host country. Canadian evidence is lacking on the incidence of psychotic disorders among migrants. We sought to examine the incidence of schizophrenia and schizoaffective disorders in first-generation immigrants and refugees in the province of Ontario, relative to the general population.

METHODS:

We constructed a retrospective cohort that included people aged 14-40 years residing in Ontario as of Apr. 1, 1999. Population-based administrative data from physician billings and hospital admissions were linked to data from Citizenship and Immigration Canada. We used Poisson regression models to calculate age- and sex-adjusted incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for immigrant and refugee groups over a 10-year period.

RESULTS:

In our cohort (n = 4,284,694), we found higher rates of psychotic disorders among immigrants from the Caribbean and Bermuda (IRR 1.60, 95% CI 1.29-1.98). Lower rates were found among immigrants from northern Europe (IRR 0.50, 95% CI 0.28-0.91), southern Europe (IRR 0.60, 95% CI 0.41-0.90) and East Asia (IRR 0.56, 95% CI 0.41-0.78). Refugee status was an independent predictor of risk among all migrants (IRR 1.27, 95% CI 1.04-1.56), and higher rates were found specifically for refugees from East Africa (IRR 1.95, 95% CI 1.44-2.65) and South Asia (IRR 1.51, 95% CI 1.08-2.12).

INTERPRETATION:

The differential pattern of risk across ethnic subgroups in Ontario suggests that psychosocial and cultural factors associated with migration may contribute to the risk of psychotic disorders. Some groups may be more at risk, whereas others are protected.

PMID:
25964387
PMCID:
PMC4467956
DOI:
10.1503/cmaj.141420
[Indexed for MEDLINE]
Free PMC Article

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