Social Psychiatry and Psychiatric Epidemiology

, Volume 50, Issue 11, pp 1713–1722 | Cite as

Ethnic enclaves and risk of psychiatric disorders among first- and second-generation immigrants in Sweden

  • Briana MezukEmail author
  • Xinjun Li
  • Klas Cederin
  • Jeannie Concha
  • Kenneth S. Kendler
  • Jan Sundquist
  • Kristina Sundquist
Original Paper



Some non-Western immigrant groups in Europe have elevated risk of psychosis relative to native-born. It is hypothesized that neighborhood ethnic density moderates this risk. Immigration to Sweden has increased substantially recently, particularly from the Middle East. This study examined the relationship between neighborhood ethnic density (i.e., living in an immigrant enclave) and risk of psychotic and affective disorders among three groups: Iraqi immigrants, immigrants from other nations, and native-born Swedes.


Individuals aged 15–60, without prevalent psychopathology, were drawn from Swedish population-based registries and followed from 2005 to 2010 (N = 950,979). Multi-level logistic regression was used to examine the association between neighborhood ethnic composition and incident psychopathology.


Cumulative incidence of psychopathology was greater in Iraqi enclaves relative to predominantly Swedish neighborhoods (6.3 vs. 4.5 %). Iraqis living in enclaves did not have significantly greater risk of psychosis (Odds Ratio (OR): 1.66, 95 % Confidence Interval (CI) 0.92–2.97) or affective disorders (OR: 1.04, 95 %CI 0.85–1.27) relative to those in predominantly Swedish neighborhoods. There was no increased risk of psychosis (OR: 0.93, p > 0.05) or affective disorders (OR: 0.93, p > 0.05) for other immigrants living in an enclave. Swedes living in an enclave had elevated risk of both psychosis (OR: 1.37, p < 0.05) and affective disorders (OR: 1.14, p < 0.05) relative to those in predominantly Swedish neighborhoods. Second-generation Iraqis had higher risk of psychotic but not affective disorders relative to first-generation.


Neighborhood ethnic density does not moderate risk of psychopathology for immigrants in Sweden. Findings regarding Swedes are consistent with social drift.


Immigrants Neighborhood Psychosis Depression Multi-level 



This work was supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases (R21-DK8356430) and National Institute of Mental Health (K01-MH093642) to Briana Mezuk, the Swedish Research Council to Kristina Sundquist (2011-3340), the Swedish Research Council to Jan Sundquist (2012-2378), the Swedish Research Council for Health, Working Life and Welfare to Kristina Sundquist and Jan Sundquist (In Swedish: Forte). The sponsors had no role in the design, interpretation, or publication of this manuscript. Research reported in this publication was also supported by the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number R01HL116381. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors would also like to acknowledge Kristen Rice, MPH for her contributions to this project.

Supplementary material

127_2015_1107_MOESM1_ESM.docx (470 kb)
Supplementary material 1 (DOCX 469 kb)


  1. 1.
    Alegria M, Mulvaney-Day N, Torres M, Polo A, Cao Z, Canino G (2007) Prevalence of psychiatric disorders across Latino subgroups in the United States. Am J Public Health 97:68–75PubMedCentralCrossRefPubMedGoogle Scholar
  2. 2.
    Anselin L (1995) Local indicators of spatial association—LISA. Geographical Analysis 27:93–115CrossRefGoogle Scholar
  3. 3.
    Becares L, Nazroo J, Stafford M (2009) The buffering effects of ethnic density on experienced racism and health. Health Place 15:700–708CrossRefGoogle Scholar
  4. 4.
    Bhurgra D, Arya P (2005) Ethnic density, cultural congruity and mental illness in migrants. Int Rev Psychiat 17:133–134CrossRefGoogle Scholar
  5. 5.
    Borjas GJ (1998) To ghetto or not to ghetto: ethnicity and residential segregation. J Urban Economics 44:228–253CrossRefGoogle Scholar
  6. 6.
    Bosqui TJ, Hoy K, Shannon C (2014) A systematic review and meta-analysis of the ethnic density effect in psychotic disorders. Soc Psychiatry Psychiatr Epidemiol 49:519–529CrossRefPubMedGoogle Scholar
  7. 7.
    Bryk AS, Raudenbush SW (1992) Hierarchical linear models: applications and data analysis methods. Sage Publications, Thousand OaksGoogle Scholar
  8. 8.
    Chakraborty A, McKenzie K (2002) Does racial discrimination cause mental illness? Br J Psychiatry 180:475–477CrossRefPubMedGoogle Scholar
  9. 9.
    Edin P, Fredricksson P, Aslund O (2003) Ethnic enclaves and the economic success of immigrants—evidence from a natural experiment. Q J Econ 118:329–357CrossRefGoogle Scholar
  10. 10.
    Faris REL, Dunham HW (1939) Mental disorders in urban areas: an ecological study of schizophrenia and other psychoses. Chicago Press, OxfordGoogle Scholar
  11. 11.
    Fredlund-Blomst S (2014). Assessing immigrant integration in sweden after the May 2013 Riots. Migration Policy Institute. ( Accessed 21 November 2014
  12. 12.
    Gilliver SC, Sundquist J, Li X, Sundquist K (2014) Recent research on the mental health of immigrants to Sweden: a literature review. Eur J Pub Health 24:72–79CrossRefGoogle Scholar
  13. 13.
    Halpern D (1993) Minorities and mental health. Soc Sci Med 36:597–607CrossRefPubMedGoogle Scholar
  14. 14.
    Halpern D, Nazroo J (2000) The ethnic density effect: results from a national community survey of England and Wales. Int J Soc Psychiat 46:34–46CrossRefPubMedGoogle Scholar
  15. 15.
    Higgins A (2013). In Sweden, riots put an identity in question. New York Times. ( Accessed 21 November 2014
  16. 16.
    Iceland J, Scopilliti M (2008) Immigrant residential segregation in US metropolitan areas: 1990–2000. Demography 45:79–94PubMedCentralCrossRefPubMedGoogle Scholar
  17. 17.
    Kawakami N, Li X, Sundquist K (2011) Health-promoting and health-damaging neighbourhood resources and coronary heart disease: a follow-up study of 2,165,000 people. J Epidemiol Community Health 65:866–872CrossRefPubMedGoogle Scholar
  18. 18.
    Kim D (2008) Blues from the neighborhood? Neighborhood characteristics and depression. Epidemiol Rev 30:101–117CrossRefPubMedGoogle Scholar
  19. 19.
    Kirkbride JB, Boydel J, Ploubidis GB, Morgan C, Dazzan P, McKenzie K, Murray RM, Jones PB (2008) Testing the association between the incidence of schizophrenia and social capital in an urban area. Psychol Med 38:1038–1094CrossRefGoogle Scholar
  20. 20.
    Kirkbride JB, Morgan C, Fearon P, Dazzon P, Murray RM, Jones PB (2007) Neighbourhood-level effects on psychoses: re-examining the role of context. Psychol Med 37:1413–1425CrossRefPubMedGoogle Scholar
  21. 21.
    Lofors J, Sundquist K (2007) Low-linking social capital as a predictor of mental disorders: a cohort study of 4.5 million Swedes. Soc Sci Med 64:21–34CrossRefPubMedGoogle Scholar
  22. 22.
    Logan J, Zhang Alba R (2002) Immigrant enclaves and ethnic communities in New York and Los Angeles. Am Sociol Rev 62:299–322CrossRefGoogle Scholar
  23. 23.
    Ludvigsson JF, Andersson E, Ekbom A, Feychting M, Kim JL, Reuterwall C, Heurgren M, Olausson PO (2011) External review and validation of the Swedish national inpatient register. BMC Public Health 11:450PubMedCentralCrossRefPubMedGoogle Scholar
  24. 24.
    Mair C, Diez Roux AV, Osypuk TL, Rapp SR, Seeman T, Watson KE (2010) Is neighborhood racial/ethnic composition associated with depressive symptoms? The multi-ethnic study of atherosclerosis. Soc Sci Med 71:541–550PubMedCentralCrossRefPubMedGoogle Scholar
  25. 25.
    Massey DS, Denton NA (1993) American apartheid: segregation and the making of the underclass. Harvard University Press, CambridgeGoogle Scholar
  26. 26.
    McGrath J, Saha S, Welham J, El SO, MacCauley C, Chant D (2004) A systematic review of the incidence of schizophrenia: the distribution of rates and the influence of sex, urbanicity, migrant status and methodology. BMC Med 2:13PubMedCentralCrossRefPubMedGoogle Scholar
  27. 27.
    Mezuk B, Chaikiat A, Li X, Sundquist J, Kendler KS, Sundquist K (2013) Depression, neighborhood deprivation and risk of type 2 diabetes. Health Place 23:63–69PubMedCentralCrossRefPubMedGoogle Scholar
  28. 28.
    Migrationsverket, Sweden Migration Board (2014). Applications for asylum received 1984–2012. ( Accessed 21 November 2014
  29. 29.
    Moran PAP (1948) The interpretation of statistical maps. J Royal Stat Soc Ser B Stat Methodol 10:243–251Google Scholar
  30. 30.
    Organization for Economic Co-operation and Development (OECD) (2011). Divided we stand: why inequality keeps rising. ( Accessed 21 November 2014
  31. 31.
    Schofield P, Ashworth M, Jones R (2011) Ethnic isolation and psychosis: re-examining the ethnic density effect. Psychol Med 41:1263–1269CrossRefPubMedGoogle Scholar
  32. 32.
    Shaw RJ, Atkin K, Becares L, Albor CM, Stafford M, Kiernan KE, Nazroo JY, Wilkinson RG, Pickett KE (2012) Impact of ethnic density on adult mental disorders: narrative review. Br J Psychiat 201:11–19CrossRefGoogle Scholar
  33. 33.
    Snijders TAB, Bosker R (1999) Multilevel analysis: an introduction to basic and advanced multilevel modeling. Sage Publications, Thousand OaksGoogle Scholar
  34. 34.
    South SJ, Crowder K, Chavez E (2005) Migration and spatial assimilation among US Latinos: classical versus segmented trajectories. Demography 42:497–521CrossRefPubMedGoogle Scholar
  35. 35.
    Statistics Sweden (2009). Description of the Population in Sweden 2008. ( Accessed 21 November 2014
  36. 36.
    Sundquist K, Malmström M, Johansson SE (2004) Neighbourhood deprivation and incidence of coronary heart disease: a multilevel study of 2.6 million women and men in Sweden. J Epidemiol Community Health 58:71–77PubMedCentralCrossRefPubMedGoogle Scholar
  37. 37.
    Termorshuizen F, Smeets HM, Braam AW, Veling W (2014) Neighborhood ethnic density and psychotic disorders among ethnic minorities in Utrecht City. Soc Psychiatry Psychiatr Epidemiol 49:1093–1102CrossRefPubMedGoogle Scholar
  38. 38.
    Tinghög P, Al-Saffar S, Carstensen J, Nordenfelt L (2010) The association of immigrant- and non-immigrant-specific factors with mental ill health among immigrants in Sweden. Int J Soc Psychiat 56:74–93CrossRefPubMedGoogle Scholar
  39. 39.
    Tinghög P, Hemmingsson T, Lundberg I (2007) To what extent may the association between immigrant status and mental health be explained by socioeconomic factors? Soc Psychiatry Psychiatr Epidemiol 42:990–996CrossRefPubMedGoogle Scholar
  40. 40.
    Veling W, Susser E (2011) Migration and psychotic disorders. Expert Rev Neurother 11:65–76CrossRefPubMedGoogle Scholar
  41. 41.
    Veling W, Susser E, van Os J, Mackenbach JP, Selten JP, Hoek HW (2008) Ethnic density of neighborhoods and incidence of psychotic disorders among immigrants. Am J Psychiat 165:66–73CrossRefPubMedGoogle Scholar
  42. 42.
    Verkuyten M, Martinovic B (2012) Social identity complexity and immigrants’ attitude toward the host nation: the intersection of ethnic and religious group identification. Pers Soc Psychol Bull 38:1165–1177CrossRefPubMedGoogle Scholar
  43. 43.
    Xie Y, Gough M (2011) Ethnic enclaves and the earnings of immigrants. Demography 48(1293–1315):12Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Briana Mezuk
    • 1
    • 3
    • 4
    Email author
  • Xinjun Li
    • 2
  • Klas Cederin
    • 2
  • Jeannie Concha
    • 1
  • Kenneth S. Kendler
    • 3
  • Jan Sundquist
    • 2
    • 5
  • Kristina Sundquist
    • 2
    • 5
  1. 1.Division of Epidemiology, Department of Family Medicine and Population HealthVirginia Commonwealth University School of MedicineRichmondUSA
  2. 2.Center for Primary Health Care ResearchLund UniversityMalmöSweden
  3. 3.Virginia Institute for Psychiatric and Behavioral GeneticsVirginia Commonwealth University School of MedicineRichmondUSA
  4. 4.Institute for Social ResearchUniversity of MichiganAnn ArborUSA
  5. 5.Stanford Prevention Research CenterStanford University School of MedicineStanfordUSA

Personalised recommendations