Minority and Immigration Status Associated with Psychosis Risk

Ethnic minorities and those who migrated during childhood have an elevated risk for psychosis, study finds


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.



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)

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Bernalyn Ruiz
MIA Research News Team: Bernalyn Ruiz-Yu is a Postdoctoral Fellow in the Department of Psychiatry and Biobehavioral Sciences at the University of California, Los Angeles. She completed her Ph.D. in Counseling Psychology from the University of Massachusetts Boston. Dr. Ruiz-Yu has diverse clinical expertise working with individuals, families, children, and groups with a special focus on youth at risk for psychosis. Her research focuses on adolescent serious mental illness, psychosis, stigma, and the use of sport and physical activity in our mental health treatments.


  1. Yes. but who’s mostly doing the diagnosing in the USA? white clinicians. i wish Mad in America would address American racism for real. race is also a whole different ball of wax in the UK. i brought up race for real with the mad in america staff awhile ago, and i was censored by Robert Whitaker. i’ve given up on this site when it comes to looking at racial disparities from the angle of racial justice. i do appreciate your article though. thanks.

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  2. Q. If there exists a high rate of “Caribbean mental illness” in the UK, then why doesn’t there exist a high rate of “Mental Illness” in the Caribbean?

    A. Because the Caribbean are not prepared to pay for “non existent Mental Illness”.

    The expression of emotional distress is not Mental Illness.

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  3. I live in San Antonio Texas, an area where many illegal immigrants have shown up over the last 30 years. Here lately, illegal immigrants have started to skip over our city, and I think I know why.

    Most illegals who come in and overstay their visas tend to blend into the ethnic community which they come from. Hispanics in this case, do take advantage of other hispanics by using them as domestic servants, and / or prostitutes while they are hidden from authorities. To prevent the migrants from going to authorities they are often given sedatives and other medications, easily obtained from the same trafficking network which brought them here. During amnesty, reporting a migrant in order to obtain Federal Aid for those the person was living with was a money maker. A migrant wasn’t told about their freedom in many cases; and if they became aware, oversedation was used in order to break memory formation and recall while simultaneously gaslighting the person in order to keep them close.

    It was right to end amnesty for these reasons. Sadly, this form of domestic abuse is now cultural in San Antonio and effects us at all levels. While Psychiatric offices for drug treatment are showing up all over the city, domestic abuse in San Antonio has continued to rise into violence as well as apparently rising psychiatric rates. Simultaneously, SAPD has refused to assist ICE and other immigration officials in deporting illegals, leaving them further at risk for exploitation by their own community. Yet, local hispanics as well as the country of Mexico continue to advocate for unrestrained illegal immigration on the pretense of human rights.

    Ultimately, it’s just going to get worse here. Since SAPD is enforcing things less and less (and community resentment of the Police is rising) and relying on psychiatrists to handle domestic abuse, people are left with a far worse sense of fairness. All the victims are left with is a bottle of pills, while the abusers which have better control over the situation walk free and find other people to use once they’ve totally used someone up.

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  4. Sex traffickers are the lowest. For those reasons I back the fact that Trump closed off the border and is trying to shut down the entire network of South America / Central American drug, human, and weapons smuggling. It has created a million problems for us.

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