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People who migrate as adolescents have a higher risk of psychosis, study finds

Research from UCL has identified a link between the age at which people migrate and their risk of developing psychosis

3rd October 2024 about a 3 minute read
“Migrating during adolescence, which interrupts social network formation, and may require teenage migrants to learn a new language, navigate new social and cultural norms and customs, and manage new social environments – including potential exposure to racism and discrimination known to be associated with psychosis risk – could all play a part in making adolescent migration a particularly vulnerable period for increasing future psychosis risk.” James Kirkbride, professor of psychiatric and social epidemiology, UCL

People who migrate to another country as adolescents have an increased risk of psychosis, according to a new study.

The study, carried out by University College London (UCL) researchers, involved analysing data from 2,132 people aged 18-64 in England, France, Italy, Spain and the Netherlands who were part of a larger research study. Of this group, 937 people had experienced a first episode of a psychotic disorder – and in people who had migrated, the episode occurred after migration. The research was published in the journal PLOS Mental Health.

James Kirkbride, professor of psychiatric and social epidemiology at UCL and co-author of the study, said that most of those who migrated had done so for economic reasons, rather than seeking asylum.

After taking into account factors such as ethnicity, markers of social disadvantage and parental history of psychosis, the researchers found that those who migrated between the ages of 11 and 17 had almost twice the risk of developing psychosis as white people who had not migrated. This increased risk, however, was significant only among black and north African migrants. There was no increased risk for people who migrated in infancy, earlier childhood or adulthood.

Although previous research has suggested that migration could play a part in increasing psychosis risk among people from ethnic minorities, this study is new in highlighting age as an important factor. “Adolescent migrants may have accumulated exposure to socioeconomic disadvantage and traumatic life events (parental separation, economic instability violence, interpersonal or civil conflict, persecution) prior to migration that increase psychosis risk,” the researchers write.

Kirkbride told the Guardian that adolescence was a time when individuals were forming a sense of identity and experiencing social, cognitive and neurological development: “Migrating during adolescence, which interrupts social network formation, and may require teenage migrants to learn a new language, navigate new social and cultural norms and customs, and manage new social environments – including potential exposure to racism and discrimination known to be associated with psychosis risk – could all play a part in making adolescent migration a particularly vulnerable period for increasing future psychosis risk.”

North African adults at greater risk of psychosis

Among black and north African people who had migrated as adolescents, the risk of psychosis was at least two to three times higher than for white people who had not migrated. Kirkbride said the exact association was hard to pin down because of the small size of this group in the study.

The analysis also found that north African adults, black people of all ages and non-migrants who were black or from mixed ethnic backgrounds were at greater risk of psychosis compared with white non-migrants. There was no such increase for white or Asian migrants.

Humma Andleeb, the first author of the study, also from UCL, said that because white people were not visible minorities they might be able to adapt more easily: “They may also be more likely to migrate within Europe and not experience the same disadvantages pre-migration or post-migration.”

The study’s limitations are that it does not track people over time, it cannot show cause and effect and the sample sizes for some groups are small. Further work is also needed to unpick why adolescents who migrate have an increased risk of psychosis.

Kirkbride said: “What we should be focusing on for that group is ways to help them manage their mental health and help them integrate into society so that they’re armed with the social skills they need to navigate new environments and avoid developing serious mental health problems.”

FCC Insight

The finding that among people who migrated to a new country as adolescents have a significantly increased risk of developing psychosis as adults is both new and interesting. The risk is only significant amongst black and north African migrants, however, and there is no increased risk for those who migrated either as adults or in early childhood. The sample size is small, so we must be cautious about over-interpreting the findings, but it does raise questions that would benefit from further research: what is the causal mechanism? What is it about this particular interplay of ethnicity and age that increases risk? And how do we address and mitigate the risk for this particular group? We look forward to seeing studies that delve into these questions.