4th Journal Reading

Ethnic Density of Neighborhoods and Incidence of

Psychotic Disorders Among Immigrants
 INTRODUCTION

• Interest in migration as a putative risk factor for

schizophrenia has accelerated in recent years:
– High incidence rates obtained for persons of African
Caribbean background in the United Kingdom
– High incidence rates of schizophrenia have also been found
for persons of Surinamese, Dutch Antillean, and Moroccan
background in the Netherlands
– An increased risk for developing schizophrenia has recently
been found for all migrants in Denmark, particularly those
from Australia, Africa, and Greenland
 INTRODUCTION

• A recent metaanalysis of 18 incidence studies of

schizophrenia and other psychotic disorders estimated
relative risks of 2.7 and 4.5 for first- and second-
generation immigrants, respectively, compared with
native populations
• In The Hague, the conditions were met to test
whether the relationship between immigration and
psychosis is dependent on or modified by ethnic
density
 SUMMARY

• Objective:
A high incidence of psychotic disorders has been reported
in immigrant ethnic groups in Western Europe.
Some studies suggest that ethnic density may influence
the incidence of schizophrenia.
The authors investigated whether this increased incidence
among immigrants depends on the ethnic density of the
neighborhoods in which they live.
 SUMMARY
• Method:
Over a 7-year period, individuals who made contact with a
physician for a suspected psychotic disorder underwent
diagnostic interviews and received DSM-IV diagnoses.
A comprehensive municipal registration system provided the
denominator for incidence rates
The ethnic density of a neighborhood was computed for each
immigrant group as the proportion of residents belonging to
that group.
Multilevel regression analyses predicted the incidence of
psychotic disorders as a function of individual ethnicity and
neighborhood ethnic density.
 SUMMARY

• Results:
A total of 226 native Dutch and 240 immigrants were
diagnosed as having a psychotic disorder
Compared with native Dutch, the adjusted incidence rate
ratio for immigrants was significantly increased in low-
ethnic-density neighborhoods (2.36) but not in high-
ethnic-density neighborhoods (1.25)
There was a strong interaction between individual
ethnicity and neighborhood ethnic density as predictors of
incidence of illness
 DISCUSSION

• It should be observed that significant heterogeneity

was found across studies, indicating that the different
migrant groups cannot be regarded as coming from
one population having a common effect size
• However, an overall effect size of this magnitude
indicates that there can be little doubt about the
existence of an association between migration and
schizophrenia.
 DISCUSSION

• Some researchers have argued that migrants

preferentially receive schizophrenia diagnoses be-
cause of cultural misunderstanding and/or language
difficulties
• Aspects of reproduction may be affected by migration
• It may be argued that aspects other than discri-
mination could contribute to the observed skin color
effect
 DISCUSSION

• Such a common mechanism might be the long-term

experience of social defeat, i.e., the chronic stressful
experience of outsider status
• Although the effect of social defeat on the human
brain would require further exploration with
neuroimaging techniques, accumulating evidence
suggests that stress can be responsible for anatomical
changes in the human brain, including hippocampal
(26) and gray matter (27) volume reductions
 CONCLUSION

• The size of the risk for developing schizophrenia

associated with migration is considerable and cannot
solely be explained by selection. The aspects of the
environment that may contribute to this risk are still
poorly understood, but perceptions of social
inequality may be important.
• Further investigations in this area may make a
substantial contribution to understanding the etiology
of schizophrenia.