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Differences in clinical presentation at first hospitalization and the impact on involuntary admissions among first-generation migrant groups with non-affective psychotic disorders

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Abstract

Background

Some migrant and ethnic minority groups have a higher risk of coercive pathways to care; however, it is unclear whether differences in clinical presentation contribute to this risk. We sought to assess: (i) whether there were differences in clinician-rated symptoms and behaviours across first-generation immigrant and refugee groups at the first psychiatric hospitalization after psychosis diagnosis, and (ii) whether these differences accounted for disparities in involuntary admission.

Methods

Using population-based health administrative data from Ontario, Canada, we constructed a sample (2009–2013) of incident cases of non-affective psychotic disorder followed for two years to identify first psychiatric hospitalization. We compared clinician-rated symptoms and behaviours at admission between first-generation immigrants and refugees and the general population, and adjusted for these variables to ascertain whether the elevated prevalence of involuntary admission persisted.

Results

Immigrants and refugee groups tended to have lower ratings for affective symptoms, self-harm behaviours, and substance use, as well as higher levels of medication nonadherence and poor insight. Immigrant groups were more likely to be perceived as aggressive and a risk of harm to others, and both groups were perceived as having self-care issues. Adjustment for perceived differences in clinical presentation at admission did not attenuate the higher prevalence of involuntary admission for immigrant and refugee groups.

Conclusions

First-generation migrant groups may differ in clinical presentation during the early course of psychotic illness, although these perceived differences did not explain the elevated rates of involuntary admission. Further research using outpatient samples and tools with established cross-cultural validity are warranted.

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Data Availability

The dataset from this study is held securely in coded form at ICES and the analyst (RR) had full access to study data. While data sharing agreements prohibit ICES from making the data set publicly available, access can be granted to those who meet pre-specified criteria for confidential access, available at https://www.ices.on.ca/DAS. The full dataset creation plan is available from the authors upon request.

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Acknowledgements

Kelly Anderson is supported by a Canada Research Chair in Public Mental Health Research. This study was funded by a New Investigator Fellowship from the Ontario Mental Health Association (KKA). This study was conducted at ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). Parts of this material are based on data and information compiled and provided by the MOH and the Canadian Institute for Health Information (CIHI). The analyses, conclusions, opinions, and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred. Parts or whole of this material is based on data and/or information compiled and provided by Immigration, Refugees and Citizenship Canada (IRCC). However, the analyses, conclusions, opinions, and statements expressed in the material are those of the author(s), and not necessarily those of IRCC.

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Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, 1465 Richmond Street, PHFM 3135, London, ON, N6G 2M1, Canada

    Kelly K. Anderson & Rebecca Rodrigues

  2. Department of Psychiatry, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada

    Kelly K. Anderson

  3. ICES, London, ON, Canada

    Kelly K. Anderson

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Correspondence to Kelly K. Anderson.

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Anderson, K.K., Rodrigues, R. Differences in clinical presentation at first hospitalization and the impact on involuntary admissions among first-generation migrant groups with non-affective psychotic disorders. Soc Psychiatry Psychiatr Epidemiol 58, 1329–1341 (2023). https://doi.org/10.1007/s00127-023-02465-5

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