This article is more than 5 years old. Information may no longer be current.

Refugees at increased risk for nonaffective psychosis

Refugees were at a greater risk for nonaffective psychoses compared with the native population and nonrefugee migrants in Western host countries, according to findings published in JAMA Psychiatry.

“Migration is an established risk factor in the development of schizophrenia and other nonaffective psychoses,” Jonathan Henssler, MD, from the department of psychiatry and psychotherapy, Charité–Universitätsmedizin Berlin, and colleagues wrote. “The need for further investigation of mental health problems among refugees is highlighted by the increasing numbers of refugees not only in Europe but also worldwide.”

Researchers conducted a systematic review and meta-analysis to determine the relative risk for nonaffective psychoses in refugees compared with the risk in the native population and nonrefugee migrants.

Henssler and colleagues searched clinical databases and selected studies conducted in Denmark, Sweden, Norway and Canada that reported refugee history, assessed effect size and spread, adjusted for sex, defined nonaffective psychosis based on standardized criteria and included nonrefugee migrants or the native population as comparators. Using a random-effects model, they pooled relative risk estimates in refugees compared with the nonrefugee population.

Overall, nine studies including 540,000 refugees were included in analyses.

The results showed that the risk for nonaffective psychoses was higher in refugees (RR = 1.43; 95% CI, 1-2.05; I² = 96.3%) than in nonrefugee migrants.

When including only studies with low risk of bias, analyses indicated that the relative risk was 1.39 (95% CI, 1.23-1.58; I² = 0%) for refugees compared with nonrefugee migrants and 2.41 (95% CI, 1.51-3.85; I² = 96.3%) for refugees compared with the native population. When excluding studies that defined refugee status by country of origin, analyses indicated a relative risk of 2.24 (95% CI, 1.12-4.49; I² = 96.8%) for refugee compared with nonrefugee migrants and a risk of 3.26 (95% CI, 1.87-5.7; I² = 97.6%) for refugees compared with the native population.

In addition, the risk for nonaffective psychosis was higher in migrants, regardless of refugee status, compared with the native population, according to Henssler and colleagues.

“We believe that these findings highlight the need for psychiatric prevention strategies and outreach programs for refugees,” the researchers wrote. “More register-based studies from countries with different social, economic, and political characteristics appear to be needed to further assess the generalizability of the findings from the present study.”

These findings emphasis the need for extended support for refugees, Kristina Sundquist, MD, PhD, from Lund University Clinical Research Centre in Sweden, wrote in a related editorial.

“Several previous studies have shown that economic and social factors, such as having a job and knowing the language in the new country, promote integration and good psychiatric health in migrants,” she wrote. “A better integration is therefore essential to reach good psychiatric health in first-generation and second-generation refugees and avoid the creation and firm establishment of new minority groups that will be alienated from the society, experience psychological distress, and develop psychiatric disorders, including severe ones, such as nonaffective psychoses.” – by Savannah Demko

Disclosure: Henssler reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures. Sundquist reports no relevant financial disclosures.