Abstract
Background
Previous studies have reported a very high incidence of schizophrenia for immigrant ethnic groups in Western Europe. The explanation of these findings is unknown, but is likely to involve social stress inherent to the migrant condition. A previous study reported that the incidence of schizophrenia in ethnic groups was higher when these groups perceived more discrimination. We conducted a case-control study of first-episode schizophrenia, and investigated whether perceived discrimination at the individual level is a risk factor for schizophrenia.
Methods
Cases included all non-western immigrants who made first contact with a physician for a psychotic disorder in The Hague, the Netherlands, between October 2000 and July 2005, and received a diagnosis of a schizophrenia spectrum disorder (DSM IV: schizophrenia, schizophreniform disorder, schizoaffective disorder) (N = 100). Two matched control groups were recruited, one among immigrants who made contact with non-psychiatric secondary health care services (N = 100), and one among siblings of the cases (N = 63). Perceived discrimination in the year before illness onset was measured with structured interviews, assessing experiences of prejudice, racist insults or attacks, and perception of discrimination against one’s ethnic group. Conditional logistic regression analyses were used to predict schizophrenia as a function of perceived discrimination.
Results
Cases reported somewhat higher rates of perceived discrimination in the year prior to illness onset than their siblings and the general-hospital controls, but these differences were not statistically significant; 52% of the cases and 42% of both control groups had perceived any discrimination. Perceived discrimination at the individual level was not a risk factor for schizophrenia in these data. Perceived discrimination was positively correlated with cultural distance and cannabis use, and negatively with ethnic identity, self-esteem, and mastery.
Conclusions
The relationship between racial discrimination and psychosis may vary with the aspect of discrimination that is studied, and may also depend upon the social context in which discrimination takes place.
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References
Berry JW, Phinney JS, Sam DL, Vedder PE (2006) Immigrant youth in cultural transition. Acculturation, identity, and adaptation across national contexts. Lawrence Erlbaum Associates, Mahwah
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 323:1336–1338
Cannon TD, Zorrilla LE, Shtasel D, Gur RE, Gur RC, Marco EJ, Moberg P, Price RA (1994) Neuropsychological functioning in siblings discordant for schizophrenia and healthy volunteers. Arch Gen Psychiatry 51:651–661
Cantor-Graae E, Selten JP (2005) Schizophrenia and migration: a meta-analysis and review. Am J Psychiatry 162:12–24
Chakraborty A, McKenzie K (2002) Does racial discrimination cause mental illness? Br J Psychiatry 180:475–477
Clark R, Anderson NB, Clark VR, Williams DR (1999) Racism as a stressor for African Americans. Am Psychol 54:805–816
Cooper C, Morgan C, Byrne M, Dazzan P, Morgan K, Hutchinson G, Doody GA, Harrison G, Leff J, Jones P, Ismail K, Murray R, Bebbington PE, Fearon P (2008) Perceptions of disadvantage, ethnicity and psychosis. Br J Psychiatry 192:185–190
Dagevos J (2001) Perspective on integration. The socio-cultural and structural integration of ethnic minorities in the Netherlands. The Netherlands Scientific Council for Government Policy, WRR, The Hague
Eaton W, Harrison G (2001) Life chances, life planning, and schizophrenia. A review and interpretation of research on social deprivation. Int J Mental Health 30:58–81
Fischer AR, Shaw CM (1999) African Americans’ mental health and perceptions of racist discrimination: the moderating effects of racial socioalization experiences and self-esteem. J Couns Psychol 46:395–407
Gilvarry CM, Walsh E, Samele C, Hutchinson G, Mallett R, Rabe-Hesketh S, Fahy T, van Os J, Murray RM (1999) Life events, ethnicity and perceptions of discrimination in patients with severe mental illness. Soc Psychiatry Psychiatr Epidemiol 34:600–608
Halpern D (1993) Minorities and mental health. Soc Sci Med 36:597–607
Henquet C, Krabbendam L, Spauwen J, Kaplan C, Lieb R, Wittchen HU, van Os J (2005) Prospective cohort study of cannabis use, predisposition for psychosis, and psychotic symptoms in young people. Br Med J 330:11
Hjern A, Wicks S, Dalman C (2004) Social adversity contributes to high morbidity in psychoses in immigrants—a national cohort study in two generations of Swedish residents. Psychol Med 34:1025–1033
Hutchinson G, Haasen C (2004) Migration and schizophrenia; the challenges for European psychiatry and implications for the future. Soc Psychiatry Psychiatr Epidemiol 39:350–357
Janssen I, Hanssen M, Bak M, Bijl RV, de Graaf R, Vollebergh W, McKenzie K, van Os J (2003) Discrimination and delusional ideation. Br J Psychiatry 182:71–76
Karlsen S, Nazroo JY (2004) Fear of racism and health. J Epidemiol Commun Health 58:1017–1018
Karlsen S, Nazroo JY (2002) Relation between racial discrimination, social class, and health among ethnic minority groups. Am J Public Health 92:624–631
Karlsen S, Nazroo JY, McKenzie K, Bhui K, Weich S (2005) Racism, psychosis and common mental disorder among ethnic minority groups in England. Psychol Med 35:1–9
Kirkbride JB, Fearon P, Morgan C, Dazzan P, Morgan K, Murray RM, Jones PB (2007) Neighbourhood variation in the incidence of psychotic disorders in Southeast London. Soc Psychiatry Psychiatr Epidemiol 42:438–445
Kirkbride JB, Morgan C, Fearon P, Dazzan P, Murray RM, Jones PB (2007) Neighbourhood-level effects on psychoses: re-examining the role of context. Psychol Med 37:1413–1425
Kleiner RJ, Parker S (1963) Goal-striving, social status, and mental disorder: a research review. Am Sociol Rev 28:189–203
Meyer IH (2003) Prejudice and stress: conceptual and measurement problems. Am J Public Health 93:262–265
Miller P, Lawrie SM, Hodges A, Clafferty R, Cosway R, Johnstone EC (2001) Genetic liability, illicit drug use, life stress and psychotic symptoms: preliminary findings from the Edinburgh study of people at high risk for schizophrenia. Soc Psychiatry Psychiatr Epidemiol 36:338–342
Noh S, Kaspar V (2003) Perceived discrimination and depression: moderating effects of coping, acculturation, and ethnic support. Am J Public Health 93:232–238
Phinney JS (2003) Ethnic identity and acculturation. In: Chun KM, Balls Organista P, Marin G (eds) Acculturation: advances in theory, measurement and applied research. American Psychological Association, Washington, DC, pp 63–82
Rosenberg M (1965) Society and the adolescent self-image. Princeton University Press, Princeton
Selten JP, Cantor-Graae E (2005) Social defeat: risk factor for schizophrenia? Br J Psychiatry 187:101–102
Sharpley MS, Hutchinson G, Murray RM, McKenzie K (2001) Understanding the excess of psychosis among the African–Caribbean population in England: review of current hypotheses. Br J Psychiatry 178:S60–68
Smitten MH, Smeets RMW, Van den Brink W (1998) Composite international diagnostic interview (CIDI), Version 2.1. World Health Organization, Amsterdam
Steele CM (1997) A threat in the air. How stereotypes shape intellectual identity and performance. Am Psychol 52:613–629
Van de Vijver FJR, Leung K (1997) Methods and data analysis for cross-cultural research. Sage, Thousand Oaks
Van Eijk LM, van Kempen GIJM, van Sonderen FLP (1994) A short scale for measuring social support in the elderly: the SSL12-I. Tijdschr Gerontol Geriatr 25:192–196
Van Mastrigt S, Addington J, Addington D (2004) Substance misuse at presentation to an early psychosis program. Soc Psychiatry Psychiatr Epidemiol 39:69–72
Veling W, Mackenbach JP, Van Os J, Hoek HW (2008) Cannabis use and genetic predisposition for schizophrenia: a case-control study. Psychol Med. doi:10.1017/s00332g1708003474
Veling W, Selten JP, Susser E, Laan W, Mackenbach JP, Hoek HW (2007) Discrimination and the incidence of psychotic disorders among ethnic minorities in the Netherlands. Int J Epidemiol 36:761–768
Veling W, Selten JP, Veen N, Laan W, Blom JD, Hoek HW (2006) Incidence of schizophrenia among ethnic minorities in the Netherlands: a 4-year first-contact study. Schizophr Res 86:189–193
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 Psychiatry 165:66–73
Williams DR, Neighbors HW, Jackson JS (2003) Racial/ethnic discrimination and health: findings from community studies. Am J Public Health 93:200–208
Williams DR, Williams-Morris R (2000) Racism and mental health: the African American experience. Ethn Health 5:243–268
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Veling, W., Hoek, H.W. & Mackenbach, J.P. Perceived discrimination and the risk of schizophrenia in ethnic minorities. Soc Psychiat Epidemiol 43, 953–959 (2008). https://doi.org/10.1007/s00127-008-0381-6
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DOI: https://doi.org/10.1007/s00127-008-0381-6