Studies of psychosis risk have most often explored risk for psychosis within urban populations. Researchers led by Dr. James B. Kirkbride from the University College London, examined if rates of first-episode psychosis (FEP) varied by ethnicity, generation status, and age-at-immigration in diverse, mixed rural, and urban settings. The authors found that differences in psychosis risk among minority groups were explained by postmigratory socioeconomic disadvantage across both rural and urban areas.
Increased psychosis risk has been associated with childhood victimization along with numerous other environmental risk factors. Most epidemiological studies of FEP risk have been conducted in urban settings. Authors of this study argue that rural black and minority ethnic (BME) groups could potentially differ from BME groups in urban areas for reasons including differential exposure in SES, deprivation, increased exposure to visible minority position or social isolation.
Data from the Social Epidemiology of Psychoses in East Anglia (SEPEA) study of 687 individuals age 16-35 with ICD diagnosis of FEP was utilized. Individuals included in early intervention in psychosis (EIP) services were followed up to 3-years or until discharge from services.
Two-thirds of FEP participants were men, younger age. Lower SES groups were over-represented within the sample. Twenty-five percent of participants self-ascribed as members of a BME group vs. 19.7% of those at-risk. Ten percent of FEP participants came from a non-British white background, 4.1% were mixed, 3.3% were black African, and 2.5% were Pakistani. More FEP participants were second or later-generation than those in the at-risk groups. Median age-at-immigration in FEP participants was 20.1 years and negatively correlated with years in the United Kingdom.
Rates by Ethnic Group
FEP rates were elevated across most ethnic minority groups relative to the white British populating. Rates were significantly raised among people of black African, black Caribbean, Pakistani, and mixed ethnic backgrounds.
For schizophrenia, elevated rates were seen across several ethnic groups including Bangladeshi and Arabic groups. People of Pakistani, black Caribbean and mixed ethnic backgrounds also had substantially high rates of affective psychoses.
Rates by Ethnic Group and Rural-Urban Status
No difference in FEP risk between rural and urban populations was found. Rates for black, Pakistani, and Bangladeshi groups were raised in both rural and urban regions. Some ethnic minority groups in rural areas had elevated risk for affective psychoses.
Rates by Generation Status
When compared to the white British population in the UK, second- and later-generation BME groups had higher FEP risk. Incidence rates were elevated for first- and later-generation black and Pakistani and Bangladeshi groups when compared to UK-born white British population.
Rates by Age-at-immigration
Regarding age-at–immigration, only those who immigrated to the UK during childhood (5-12 years old), had elevated rates of psychotic disorder compared with the UK-born white British population. No evidence that immigration at other ages was associated with FEP risk. The study found an excess risk associated with childhood immigration for first-generation black individuals and Pakistani and Bangladeshi migrants. Black, Pakistani, and Bangladeshi migrants who immigrated to the UK in adulthood remained at increased psychosis risk.
Overall this study found that elevated risk for psychosis exists in people of black Caribbean, black African, and Pakistani origin. Interestingly, risk across rural and urban populations was similar for black and minority ethnic groups. For first generation migrants, higher risk was observed in those who migrated during childhood.
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Kirkbride, J. B., Hameed, Y., Ioannidis, K., Ankireddypalli, G., Crane, C. M., Nasir, M., … & Spyridi, S. (2017). Ethnic Minority Status, Age-at-Immigration and Psychosis Risk in Rural Environments: Evidence From the SEPEA Study. Schizophrenia Bulletin, sbx010. (Link)
