Comparing Risk Factors for Non-affective Psychotic Disorders With Common Mental Disorders Among Migrant Groups: A 25-Year Retrospective Cohort Study of 2 Million Migrants
Comparing Risk Factors for Non-affective Psychotic Disorders With Common Mental Disorders Among Migrant Groups: A 25-Year Retrospective Cohort Study of 2 Million Migrants
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DOI：
10.1093/schbul/sbac021
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发表时间：
2022-03-04
影响因子：
6.6
通讯作者：
Edwards, Jordan
中科院分区：
文献类型：
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作者：
Anderson, Kelly K.;Le, Britney;Edwards, Jordan
背景和假设虽然移民是精神障碍的一个公认的危险因素，但对移民群体中改变风险的因素知之甚少。我们试图评估社会人口统计学、移民相关和移民后因素是否与第一代移民中非情感性精神障碍（NAPD）的风险相关，并与常见精神障碍（CMD）的估计值进行比较，以探讨其影响的特异性。研究设计我们使用基于人口的相关卫生管理数据（1992-2011年; n = 1 964 884），构建了一个回顾性队列，研究对象为加拿大安大略的第一代移民。我们使用标准化算法识别NAPD和CMD。我们使用改良的泊松回归模型来估计每个因素的发病率比（IRR），以评估其对每个结局风险的影响。近75%的NAPD病例在首次诊断精神病之前符合CMD的病例定义。我们的研究结果表明，年轻的移民年龄，男性，非洲裔，不熟练的民族语言有一个特定的影响，NAPD的风险较高。在登陆时年龄超过19岁的移民中，移民前教育程度较高和登陆时已婚/同居显示出对NAPD风险较低的影响特异性。移民阶层，农村的居住后登陆，和移民后的邻里水平的收入表现出类似的影响，跨疾病。结论：我们的研究结果有助于识别高危人群进行干预。识别对精神障碍而不是更广泛的精神障碍有特定影响的因素，对于预防和早期干预工作很重要。
Background and Hypothesis Although migration is a well-established risk factor for psychotic disorders, less is known about factors that modify risk within migrant groups. We sought to assess whether socio-demographic, migration-related, and post-migration factors were associated with the risk of non-affective psychotic disorders (NAPD) among first-generation migrants, and to compare with estimates for common mental disorders (CMD) to explore specificity of the effect. Study Design We constructed a retrospective cohort of first-generation migrants to Ontario, Canada using linked population-based health administrative data (1992-2011; n = 1 964 884). We identified NAPD and CMD using standardized algorithms. We used modified Poisson regression models to estimate incidence rate ratios (IRR) for each factor to assess its effect on the risk of each outcome. Study Results Nearly 75% of cases of NAPD met the case definition for a CMD prior to the first diagnosis of psychosis. Our findings suggest that younger age at migration, male sex, being of African-origin, and not having proficiency in national languages had a specificity of effect for a higher risk of NAPD. Among migrants who were over 19 years of age at landing, higher pre-migratory education and being married/common-law at landing showed specificity of effect for a lower risk of NAPD. Migrant class, rurality of residence after landing, and post-migration neighborhood-level income showed similar effects across disorders. Conclusions Our findings help identify high-risk groups to target for intervention. Identifying factors that show specific effects for psychotic disorder, rather than mental disorders more broadly, are important for informing prevention and early intervention efforts.