Refugees at Much Greater Risk of Psychotic Disorders

Refugees are at much greater risk of developing a psychotic disorder, such as schizophrenia, compared to non-refugee migrants from the same regions, according to a new study by a team of researchers at Karolinska Institutet in Sweden and the University College London (UCL).

Since World War II, the world has not seen so many displaced people, asylum seekers, and refugees as there are today. While it is well-known that refugees are at an increased risk of mental health problems, such as post traumatic stress disorder (PTSD), anxiety, and depression, little is known about their risk of psychosis.

For the study, the researchers set out to compare the risk of schizophrenia and other non-affective psychotic disorders in refugees to people in two other groups: the general Swedish population (those born to two Swedish parents) and non-refugee migrants from four major refugee generating regions (the Middle East and north Africa, sub-Saharan Africa, Asia, Eastern Europe, and Russia).

Using national register data, the investigators examined more than 1.3 million people in Sweden, and tracked diagnoses of non-affective psychotic disorders among the population. On a per capita basis, Sweden has granted more refugee applications than any other well-developed country, and in 2011, 12 percent of the total immigrant population were refugees.

The findings revealed that refugees granted asylum were on average 66 percent more likely to develop schizophrenia or another non-affective psychotic disorder than non-refugee migrants. In addition, they were up to 3.6 times more likely to do so than the Swedish-born population.

The increased rates of psychosis in refugees was significant for all areas of origin except sub-Saharan Africa, for whom rates in refugees and migrants were similarly high.

One possible explanation is “that a larger proportion of sub-Saharan Africa immigrants will have been exposed to deleterious psychosocial adversities before emigration, irrespective of refugee status,” suggest the authors. It’s also possible that “post-migratory factors, such as discrimination, racism, and social exclusion” may explain these high rates.

Overall, they say “our findings are consistent with the hypothesis that increased risk of non-affective psychotic disorders among immigrants is due to a higher frequency of exposure to social adversity before migration, including the effects of war, violence, or persecution.”

The researchers add that the findings emphasize “the need to take the early signs and symptoms of psychosis into account in refugee populations, as part of any clinical mental health service responses to the current global humanitarian crises.”

The study is published in The BMJ.

Source: BMJ