Migration and Psychosis

  • Samuel O. OkpakuEmail author
  • Ademola B. Adeponle
  • Robert Kohn
Living reference work entry
Part of the Mental Health and Illness Worldwide book series (MHIW)


This chapter reviews the literature on migration as a risk factor for psychosis dating from the work of Ødegaard. The earlier crude hospital counts have been replaced by more sophisticated population-based incidence studies. Research has identified several major trends:
  1. I.

    European studies indicate that the risk of psychosis is higher in all immigrant groups than in the host population.

  2. II.

    Meta-analytic studies have shown a high mean weighted relative risk for developing schizophrenia for first generation immigrants.

  3. III.

    Some studies have shown also that the increased risk persists for second generation immigrants.


Various explanations are given for the above findings. The chapter then considers issues of screening and assessment of immigrants and concludes with treatment approaches. The need for an anthropological and ethnographic approach is emphasized. The encounters between providers and migrants and their families are to be seen essentially as transcultural encounters.


Wars Political Unrest Extreme poverty Global migration 


  1. Abreu J (1999) Conscious and nonconscious African American stereotypes: impact on first impression and diagnostic ratings by therapists. J Consult Clin Psychol 67(3):387–393CrossRefPubMedGoogle Scholar
  2. Adeponle AB, Thombs BD, Groleau D, Jarvis E, Kirmayer LJ (2012) Using the cultural formulation to resolve uncertainty in diagnoses of psychosis among ethnoculturally diverse patients. Psychiatr Serv 63:147CrossRefPubMedGoogle Scholar
  3. Adeponle AB, Groleau D, Kirmayer LJ (2015) Clinician reasoning in the use of cultural formulation to resolve uncertainty in the diagnosis of psychosis. Cult Med Psychiatry 39(1):16–42CrossRefPubMedGoogle Scholar
  4. Ali GC, Ryan G, De Silva MJ (2016) Validated screening tools for common mental disorders in low and middle income countries: a systematic review. PLoS One 11:e0156939.
  5. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders (DSM-5). American Psychiatric Association, Washington, DCCrossRefGoogle Scholar
  6. Anderson KK, Cheng J, Susser E, McKenzie KJ, Kurdyak P (2015) Incidence of psychotic disorders among first-generation immigrants and refugees in Ontario. Can Med Assoc J 187(9):E279–E286CrossRefGoogle Scholar
  7. Berg AO, Melle I, Rossberg J, Romm K, Larsson S, Lagerberg TV, Andreassen OA, Hauff E (2011) Perceived discrimination is associated with severity of positive and depression/anxiety symptoms in immigrants with psychosis: a cross-sectional study. BMC Psychiatry 11(1):77CrossRefPubMedPubMedCentralGoogle Scholar
  8. Bourque F, Van der Ven E, Malla A (2011) A meta-analysis of the risk for psychotic disorders among first and second-generation immigrants. Psychol Med 41(5):897–910CrossRefPubMedGoogle Scholar
  9. Boydell J, van Os J, McKenzie K, Allardyce J, Goel R, McCreadie RG, Murray RM (2001) Incidence of schizophrenia in ethnic minorities in London: ecological study into interactions with environment. Br Med J 323:1336–1338CrossRefGoogle Scholar
  10. Cairmcross L (1989) Cultural interpreter training manual. Queen’s Printer for Ontario, OntarioGoogle Scholar
  11. Cantor-Graae E, Selten JP (2005) Schizophrenia and migration: a meta-analysis and review. Am J Psychiatr 162:12–12CrossRefPubMedGoogle Scholar
  12. CDCD (2010) Towards an Integrated Immigrant Services Delivery System in Durham Region. Research and Consideration for Moving Forward. Community Development Council Durham. August 2010 Vol. 2Google Scholar
  13. Corin E (1997) Playing with limits: Tobie Nathan’s evolving paradigm in Ethnopsychiatry. Transcult Psychiatry 34:345–358CrossRefGoogle Scholar
  14. DeVylder JE, Oh HY, Yang LH, Cabassa LJ, Chen FP, Lukens EP (2013) Acculturative stress and psychotic-like experiences among Asian and Latino immigrants to the United States. Schizophr Res 150(1):223–228CrossRefPubMedPubMedCentralGoogle Scholar
  15. Dinh MH, Groleau D, Kirmayer LJ, Rodriguez C, Bibeau G (2012) Influence of the DSM-IV outline for cultural formulation on multidisciplinary case conferences in mental health. Anthropol Med 19(2):261–276CrossRefPubMedGoogle Scholar
  16. Eichelbaum M, Gross AS (1990) The genetic polymorphism of debrisoquin/spartene metabolism. Clinical Aspects Pharmacol Ther 46(3):377–394PubMedGoogle Scholar
  17. Fearon P, Kirkbride JB, Morgan C, Dazzan P, Morgan K, Lloyd T, Mallett R (2006) Incidence of schizophrenia and other psychoses in ethnic minority groups: results from the MRC AESOP study. Psychol Med 36(11):1541–1550CrossRefPubMedGoogle Scholar
  18. Fernando S (2003) Cultural diversity, mental health and psychiatry: the struggle against racism. Brunner-Routledge, Hove/New YorkCrossRefGoogle Scholar
  19. Gara MA, Vega WA, Arndt S, Escamilla M, Fleck DE, Lawson WB, Strakowski SM (2012) Influence of patient race and ethnicity on clinical assessment in patients with affective disorders. Arch Gen Psychiatry 69(6):593–600CrossRefPubMedGoogle Scholar
  20. 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(Suppl 1):72–79CrossRefGoogle Scholar
  21. Gone JP, Kirmayer LJ (2010) On the wisdom of considering culture and context in psychopathology. In: Millon T, Krueger RF, Simonsen E (eds) Contemporary directions in psychopathology: scientific foundations of the DSM-V and ICD-11. Guilford Press, New YorkGoogle Scholar
  22. Guarnaccia PJ, Farias P (1988) The social meanings of nervios: a case study of a Central American woman. Soc Sci Med 26(12):1223–1231CrossRefPubMedGoogle Scholar
  23. Harrison G, Owens D, Holton A, Neilson D, Boot D (1988) A prospective study of severe mental disorder in AfroCaribbean patients. Psychol Med 18:643–657CrossRefPubMedGoogle Scholar
  24. Hashmi F (1968) Community psychiatric problems among Birmingham immigrants. Br J Soc Psychiatry 2:196–201Google Scholar
  25. Hemsi LK (1967) Psychiatric morbidity of West Indian immigrants: A study of first admissions in London. Soc Psychiatry 2(3):95–100CrossRefGoogle Scholar
  26. Hickling F, McKenzie K, Mullen R, Murray R (1999) A Jamaican psychiatrist evaluates diagnoses at a London psychiatric hospital. Br J Psychiatry 175(3):283–285CrossRefPubMedGoogle Scholar
  27. Jarvis E, Kirmayer L, Jarvis G, Whitley R (2005) The role of AfroCanadian status in police or ambulance referral to emergency psychiatric services. Psychiatr Serv 56(6):705–771CrossRefPubMedGoogle Scholar
  28. Kalow W (1982) Ethnic differences in drug metabolism. Clin Pharmacokinet 7(5):373–400CrossRefPubMedGoogle Scholar
  29. Karlsen S, Nazroo JY (2002) Relation between racial discrimination, social class, and health among ethnic minority groups. Am J Public Health 92(4):624–631CrossRefPubMedPubMedCentralGoogle Scholar
  30. King M, Coker E, Leavey G, Hoare A, Johnson-Sabine E (1994) Incidence of psychotic illness in London: comparison of ethnic groups. BMJ 309(6962):1115–1119CrossRefPubMedPubMedCentralGoogle Scholar
  31. Kirkbride JB, Lunn DJ, Morgan C, Lappin JM, Paola D, Morgan K, Fearon P, Murray RM, Jones PB (2010) Examining evidence for neighbourhood variation in the duration of untreated psychosis. Health Place 16(2):219–225CrossRefPubMedPubMedCentralGoogle Scholar
  32. Kirmayer LJ, Bhugra D (2009) Culture and mental illness: social context and explanatory models. Psychiatric diagnosis: patterns and prospects. Wiley, New York, pp 29–37Google Scholar
  33. Kirmayer LJ, Nasrasiah L, Muñoz M, Rashid M, Ryder AG, Guzder J, Hassan G, Rousseau C, Pottie K (2011) Common mental health problems in immigrants and refugees: general approach in primary care. Can Med Assoc J 183(12):E959–E967CrossRefGoogle Scholar
  34. Kirmayer LJ, Guzder J, Rosseau C (eds) (2014) Cultural consultation:encountering the other in mental health care. Springer, New York. Scholar
  35. Kleinman A (1980) Patients and healers in the context of culture. In: An exploration of the botherland between anthropology, medicine and psychiatry. University of California Press, BerkeleyGoogle Scholar
  36. Kleinman AM (1997) Depression, somatization and the “new cross-cultural psychiatry”. Soc Sci Med 11(1):3–9CrossRefGoogle Scholar
  37. Kohrt BA, Hruschka DJ (2010) Nepali concepts of psychological trauma: the role of idioms of distress, ethnopsychology and ethnophysiology in alleviating suffering and preventing stigma. Cult Med Psychiatry 34(2):322–352CrossRefPubMedGoogle Scholar
  38. Krupinski J, Stoller A, Wallace L (1973) Psychiatric disorders in East European refugees now in Australia. Soc Sci Med 7(1):31–49CrossRefPubMedGoogle Scholar
  39. Lasalvia A, Bonetto C, Tosato S, Zanatta G, Cristofalo D, Salazzari D, Cremonese C (2014) First-contact incidence of psychosis ii north eastern Italy: influence of age, gender, immigration and socioeconomic deprivation. Br J Psychiatry 205(2):127–134CrossRefPubMedGoogle Scholar
  40. Lee E (1997) Working with Asian Americans: a guide for clinicians. The Guilford press, New YorkGoogle Scholar
  41. Lin K (1996) Cultural influences on the diagnosis of psychotic and organic disorders: I. In: Mezzich JE, Kleinman A, Fabrega H, Parron DL (eds) Culture and psychiatric diagnosis. A DSM-IV perspective. American Psychiatric Association, Washington, DC, pp 49–62Google Scholar
  42. Lin K-M, Chang W-H, Poland HE et al (1992) Ethnicity and psychopharmacology. Cult Med Psychiatry 10:151–165CrossRefGoogle Scholar
  43. Littlewood R, Lipsedge M (1981) Some social and phenomenological characteristics of psychotic immigrants. Psychol Med 11(02):289–302CrossRefPubMedGoogle Scholar
  44. Lopez S (1989) Patient variable biases in clinical judgment: conceptual overview and methodological considerations. Psychol Bull 106(2):184–120CrossRefPubMedGoogle Scholar
  45. McGovern D, Cope RV (1987) First psychiatric admission rates of first and second generation Afro Caribbeans. Soc Psychiatry 22(3):139–149CrossRefPubMedGoogle Scholar
  46. Metzl JM (2009) The protest psychosis. How schizophrenia became a black disease. Beacon Press, BostonGoogle Scholar
  47. Morgan C, Mallett R, Hutchinson G, Leff J (2004) Negative pathways to psychiatric care and ethnicity: the bridge between social science and psychiatry. Soc Sci Med 58(4):739–752CrossRefPubMedGoogle Scholar
  48. Neighbors H, Trierweiler S, Ford B et al (2003) Racial differences in DSM diagnosis using a semi-structured instrument: the importance of clinical judgment in the diagnosis of African Americans. J Health Soc Behav 43:237–256CrossRefGoogle Scholar
  49. Nichter M (1981) Idioms of distress: alternatives in the expression of psychosocial distress: a case study from South India. Cult Med Psychiatry 5(4):379–408CrossRefPubMedGoogle Scholar
  50. Ödegaard Ö (1932) Emigration and insanity. Acta Psychiatr Neurol Scand 4(Suppl):1–206Google Scholar
  51. Oh H, Abe J, Negi N, DeVylder J (2015) Immigration and psychotic experiences in the United States:another example of the epidemiological paradox? Psychiatry Res 229(3):784–790CrossRefPubMedGoogle Scholar
  52. Okpaku S (1998) Introduction and background. Clinical Methods in Transcultural. In: Okpaku S (ed) Psychiatry. American Psychiatric Press, Inc, Washington, DC, p xxiiGoogle Scholar
  53. Okpaku S, Frazer A, Mendels J (1980) A pilot study of racial differences in erythrocyte lithium transport. Am J Psychiatr 137:120–121CrossRefPubMedGoogle Scholar
  54. Pedersen CB, Cantor-Graae E (2012) Age at migration and risk of schizophrenia among immigrants in Denmark: a 25-year incidence study. Am J Psychiatr 169(10):1117–1118CrossRefPubMedGoogle Scholar
  55. Rogler LH (1993) Culture in psychiatric diagnosis and issue of scientific accuracy. Psychiatry 56(4):324–327CrossRefPubMedGoogle Scholar
  56. Rohlof et al (2009) Use of the Cultural Formulation with Refugees. Transcult Psychiatry 46(3):487–505. Scholar
  57. Rosso MS, Baarnheilm S (2012) Use of the Cultural Formulation in Stockholm: A qualitative study of mental illness experience among migrants. Transcult Psychiatry 49(2):283–301CrossRefGoogle Scholar
  58. Rudmin F (2009) Constructs, measurements and models of acculturation and acculturative stress. Int J Intercult Relat 33(2):106–123CrossRefGoogle Scholar
  59. Rwegellera GGC (1977) Psychiatric morbidity among West Africans and West Indians living in London. Psychol Med 7(2):317–329CrossRefPubMedGoogle Scholar
  60. Sanua VD (1970) Immigration, migration and mental illlness: a review of the literature with special emphasis on schizophrenia. In: Brody EB (ed) Behavior in new environments, adaptation of migrant populations. Sage, Beverly HillsGoogle Scholar
  61. Selten JP, van der Ven E, Rutten BP, Cantor-Graae E (2013) The social defeat hypothesis of schizophrenia: an update. Schizophr Bull 39(6):1180–1186CrossRefPubMedPubMedCentralGoogle Scholar
  62. Sharpley M, Hutchinson G, Murray R, McKenzie K (2001) Understanding the excess of psychosis among the African-Caribbean population in England: review of current hypotheses. Br J Psychiatry 178(40):s60–s66CrossRefGoogle Scholar
  63. Strakowski M, Keck P, Arnold L et al (2003) Ethnicity and diagnosis in patients with affective disorders. J Clin Psychiatry 64(7):747–754CrossRefPubMedGoogle Scholar
  64. Tandon R, Keshavan MS, Nasrallah HA (2008) Schizophrenia, ‘just the facts’ what we know in 2008. 2. Epidemiology and etiology. Schizophr Res 102:1–18CrossRefPubMedGoogle Scholar
  65. The Royal Children’s Hospital, Melbourne (2016) Working with interpreters. Web:
  66. Van Moffaert MMMP (1995) Chapter 15: somatization patterns in Mediterranean migrants. In: Clinical method in transcultural psychiatry. American Psychiatric Press, Inc, Washington, DC, pp 301–320Google Scholar
  67. Vanheusden K, Mulder CL, Van Der Ende J, Selten JP, Van Lenthe FJ, Verhulst FC, Mackenbach JP (2008) Associations between ethnicity and self-reported hallucinations in a population sample of young adults in the Netherlands. Psychol Med 38(8):1095–1102CrossRefPubMedGoogle Scholar
  68. Veling W, Selten JP, Mackenbach JP, Hoek HW (2007) Symptoms at first contact for psychotic disorder: comparison between native Dutch and ethnic minorities. Schizophr Res 95:30CrossRefPubMedGoogle Scholar
  69. Veling W, Hoek HW, Selten J-P, Susser E (2011) Age at migration and future risk of psychotic disorders among immigrants in the Netherlands: a 7-year incidence study. Am J Psychiatry 168(12):1278–1285CrossRefPubMedGoogle Scholar
  70. Westermeyer J (1987) Cultural factors in clinical assessment. J Consult Clin Psychol 55(4):471–478CrossRefPubMedGoogle Scholar
  71. Whaley AL (1997) Ethnicity/race, paranoia, and psychiatric diagnoses:clinician bias versus sociocultural differences. J Psychopathol Behav Assess 19(1):1–20CrossRefGoogle Scholar
  72. World Health Organization, UNHRC (2012) Assessing mental health and psychological needs and resources. Toolkit for major humanitarian settings. WHO Press, World Health Organization, GenevaGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  • Samuel O. Okpaku
    • 1
    Email author
  • Ademola B. Adeponle
    • 2
    • 3
  • Robert Kohn
    • 4
  1. 1.Center for Health, Culture and SocietySouth NashvilleUSA
  2. 2.Department of PsychiatryMcGill UniversityMontrealCanada
  3. 3.Culture and Mental Health Research UnitJewish General HospitalMontrealCanada
  4. 4.Department of Psychiatry and Human BehaviorWarren Alpert Medical School of Brown University, The Miriam HospitalProvidenceUSA

Personalised recommendations