I was recently listening to a podcast about global mental health. The guest speaker mentioned that
This set off one of my more intense google binges.
As I wrote about before, I am interested in the experiences of migrants. These are often innocent people who are often fleeing their country of origin because conditions have become, somehow, unsuitable. (Economic reasons, natural disasters, conflict, persecution—that’s a whole other blog post.)
They risk their lives to stay, and they risk their lives to leave. What happens when they resettle? What are the hardships they face, and what interventions can help?
So now I’m reading all about migrants and psychosis. Things quickly got overwhelming. People dedicate whole careers to figuring out what causes psychosis. And every piece of research seems to make the answer more complicated.
Mix in these slippery variables:
- Perceived discrimination. Is this a manifestation of paranoia due to psychosis or hypervigilance due to past trauma? Is the discrimination due to ethnicity or mental health stigma? How do you measure something that is not readily measurable and is reported retroactively?
- Migrant populations. These groups are under-researched in every way. Is there misdiagnosis? Is the risk factor related to past or present experiences? There is such a diversity within this population. People from countries all over the world migrate, and sometimes the migrant group is a minority within the originating country who fled discrimination there.
To be clear: I am not at all attempting to explain why people develop schizophrenia with a blog post (or even a series of blog posts). I’m just trying to think flexibly and in terms of systems.
Just as I was about to give up this google-fest, I found this article:
The article is a meta-analysis of research in this area. They consider each proposed causal factor and examine the evidence. Here are the interesting parts:
- There is evidence that there is a higher rate of psychosis in migrant populations. The data comes from studies in the UK, Netherlands, and the US. (Though as I wrote before, most migrants end up in countries neighboring the one they fled, i.e. Africa or Middle East.)
- Within migrant populations, the rate of psychosis is highest among second generation migrants, migrants from developing countries, and migrants from countries where a majority of the population is black.
- Misdiagnosis has been ruled out though migrants with psychosis do sometimes present differently.
- Selective migration has been ruled out, and it’s unlikely that sometimes who is symptomatic would be able to manage the trip. (This makes me wonder: what happens to people with disabilities when there is a mass migration?)
- Genetics are an unlikely cause because the rate is higher among migrants from all over the world. Also, the rate among migrants is higher than the rate among people living in the originating country.
- Neurodevelopmental factors could be related. There is evidence for and against this.
- Psychosocial risk factors like trauma history, long standing disadvantage, isolation are more often and more intensely experienced by migrant groups. Some of these risk factors have been associated with a later diagnosis of psychosis in other populations.
- There is a higher incidence of psychosis where there is a lower density of that migrant group. It could be that social isolation is a risk factor and that isolated migrants have fewer opportunities in their new home.
I’ll definitely be writing more about the research concerning perceived discrimination. Though, for the Syrian refugees, we can just delete the word perceived.
Yes, there are many who are advocating for them. There is also shocking hostility that is expressed so frequently and by so many that it’s commonplace. It’s hate speech.
It can inform what supports and services are in place, and how refugees should be resettled. I’m also interested in research about the impact of pressure to acculturate and assimilate. When migrants are pressured to “fit in,” what’s the result? Is that benefiting anyone? Does that help them have a better quality of life or does it strip them of the protective factors of cultural identity?
Thanks for reading!