First admission rates for schizophrenia in immigrants to the Netherlands

Data from the Dutch national register were examined in order to determine first admission rates for schizophrenia in the four largest immigrant groups to the Netherlands (from the countries of Surinam, the Netherlands Antilles, Turkey and Morocco). Rates for immigrants from Surinam and the Netherlands Antilles exceeded by far those of the antive-born population. Differences in proportions of compulsory first admissions between young male immigrants from these countries and their native-born counterparts were small and statistically not significant. Rates of first admissions for young male immigrants from Morocco were also much higher than those for the native-born population, but rates for female immigrants from Morocco and for immigrants from Turkey were not increased. These results support British studies reporting an increased incidence of schizophrenia in Caribbean immigrants to the United Kingdom.Published in part by the Nederlands Tijdschrift voor Geneeskunde (in Dutch): 1994, 138: 345–350     

The frequency of multiple sclerosis in jewish and arab populations in greater jerusalem

A comparison of the incidence rate (IR) and the prevalence rate (PR) of multiple sclerosis (MS) in subgroups of the same ethnic origin, but born and living in different geographical areas, may delineate the relationship between environmental and genetic risk factors for MS. Previous epidemiological studies of MS in Israel did not include the Arab population and used diagnostic criteria that did not include MRI findings. Therefore, we studied the age-adjusted IR and PR of MS in a more recent sample in different population groups, including Arabs, of Greater Jerusalem. We found that the PR of MS in Israeli Jews is higher than previously described. Furthermore, the PR was significantly lower among immigrant Jews from Asia/Africa (A/A) than among native-born Jews of Asian/African origin (I-A/A). Since these groups have similar genetic susceptibilities to MS, the higher PR in the latter is probably due to environmental factors. Our study does not support the effect of latitude on the risk of developing MS since no difference in the PR was found between immigrant Jews from Europe/America (E/A) and native-born Jews of European/American origin (I-E/A). Among Arabs, the PR was similar to that among A/A. Therefore, we hypothesized similarity in environmental etiologic factors for MS between the countries of origin of A/A immigrants and of Arabs communities in Greater Jerusalem. The IR of I-E/A was higher than that of I-A/A and Arabs, although this difference did not reach statistical significance.     

Incidence of schizophrenia among second-generation immigrants in the jerusalem perinatal cohort

Objective: Increased incidence of schizophrenia is observed among some immigrant groups in Europe, with the offspring of immigrants, ie “second-generation” immigrants particularly vulnerable. Few contemporary studies have evaluated the risk of schizophrenia among second-generation immigrants in other parts of the world. Methods: We studied the incidence of schizophrenia in relation to parental immigrant status in a population-based cohort of 88 829 offspring born in Jerusalem in 1964–1976. Parental countries of birth were obtained from birth certificates and grouped together as (1) Israel, (2) Other West Asia, (3) North Africa, and (4) Europe and industrialized countries. Cox proportional hazards methods were used in adjusting for sex, parents’ ages, maternal education, social class, and birth order. Results: Linkage with Israel''s Psychiatric Registry identified 637 people admitted to psychiatric care facilities with schizophrenia-related diagnoses, before 1998. Incidence of schizophrenia was not increased among second-generation immigrants in this birth cohort, neither overall nor by specific group. Conclusions: The difference in risk of schizophrenia among second-generation immigrants in Europe and in this Israeli birth cohort suggests that the nature of the immigration experience may be relevant to risk, including reasons for migration, the nature of entry, and subsequent position in the host country for immigrants and their offspring. Minority status may be of importance as, in later studies, immigrants to Israel from Ethiopia had increased risk of schizophrenia.     

Comparison of Immigrant and Native-Born Population Adherence to Antipsychotic Treatment in a Spanish Health Region

Previous studies report that immigrants underuse psychiatric hospitalization services and are less exposed to antipsychotic medication. The objective of this study is to determine whether immigrant and Spanish native groups with psychotic disorder adhere differently to antipsychotic drugs. Retrospective study including two matched samples of 47 immigrants and 47 native-born patients with psychotic disorder admitted to a psychiatric Unit (2006–2007). Adherence was measured after one-year follow-up. Only 30 % of patients adhered to treatment (40.4 % of native-born, and 19.1 % of immigrants). The lowest rate of adherence was found in sub-Saharans. Fifty per cent of non-adherents were readmitted after 12 months, compared with 21.4 % of adherents, the effect was observed in both native and immigrants. This alarmingly poor adherence in immigrant patients with psychosis underlines the need for preventive strategies to minimize the negative clinical, social and economic outcomes.     

The generational gap: Mental disorder prevalence and disability amongst first and second generation immigrants in Australia

Despite unprecedented numbers of migrants internationally, little is known about the mental health needs of immigrant groups residing in common countries of resettlement. The majority of studies support the ‘healthy migrant hypothesis’, but few studies have examined: 1) shifts in prevalence patterns across generations; 2) how prevalence relates to disability in immigrant groups. Our study examined the prevalence of common mental disorders and disability in first and second generation migrants to Australia. Twelve-month and lifetime prevalence rates of affective, anxiety, and substance use disorders were obtained from the Australian National Survey of Mental Health and Wellbeing (N = 8841). First generation immigrants (born overseas) and second generation immigrants (both parents overseas) from non-English and English speaking backgrounds were compared to an Australian-born cohort. Disability was indexed by days out of role and the WHO Disability Assessment Schedule (WHODAS12). First generation immigrants with non-English speaking (1G-NE) backgrounds evidenced reduced prevalence of common mental disorders relative to the Australian-born population (adjusted odds ratio 0.5 [95% CI 0.38–0.66]). This lower prevalence was not observed in second generation immigrant cohorts. While overall levels of disability were equal between all groups (p > 0.05), mental health-related disability was elevated in the 1G-NE group relative to the Australian-born group (p = 0.012). The findings challenge the overarching notion of the “healthy migrant” and suggest a dissociation between reduced prevalence and elevated mental health-related disability amongst first generation immigrants with non-English speaking backgrounds. These findings highlight the heterogeneous psychiatric needs of first and second generation immigrants.     

Multiple sclerosis: genetic versus environmental aetiology: epidemiology in Israel updated

The incidence and prevalence of multiple sclerosis (MS) were compared, controlling for age, in native-born Israelis of different origins and in immigrants to Israel. This comparison was carried out in two populations, countrywide and in Jerusalem. In the countrywide population, ascertainment was based mainly on hospitalizations; it included 252 patients who were native-born and 150 who had immigrated from Africa-Asia (AA immigrants). The 89 MS patients of Jerusalem also included patients diagnosed in outpatient clinics. In native-born Israelis whose father was born in Europe-America (I-EA), the incidence and prevalence of MS were found to be as high as or even higher than that found previously in immigrants from Europe-America. Among native-born Israelis whose father was born in Africa or Asia (I-AA), the yearly age-adjusted incidence and prevalence rates were found to be 1.4- to 1.8-fold higher than among AA immigrants, pointing to environmental factors. The incidence and prevalence rates in the I-EA were 1.2- to 1.6-fold higher than in the I-AA, pointing to genetic factors. These results seem to point to both environmental and genetic factors in the aetiology of MS. Further research is needed, however, to disentangle the genetic factors from possible environmental differences in the two ethnic groups.     

Patterns and correlates of psychiatric hospitalization in a nationwide sample

Summary A nationwide random sample of psychiatric patients (n=832) admitted for hospitalization in Israel in 1980 was followed up until the end of 1984. A multivariate analysis was performed, where the dependent variables were: the cumulative length of all hospitalizations, the mean duration of hospitalization and the mean length of stay out of hospital. The independent variables were: age, sex, marital status, ethnic origin, diagnosis, and various indices of previous hospitalizations. For patients whose hospitalization in 1980 (index hospitalization) was the first in their life, older age and male gender predicted a low probability of readmission, and the diagnosis of schizophrenia a long cumulative stay. For patients whose index hospitalization was not the first in their life, the main variables predictive of long cumulative stay were: old age, being single, long duration and high frequency of previous hospitalizations. Patients tended to maintain the same relative length of inpatients stay and the same frequency of readmission from the beginning of their hospitalization history.     

Immigration and neurological diseases: a longitudinal study in an acute neurological care

Very few data exist on causes and outcomes of hospitalization of immigrants in Italy. Even though immigration is a real challenge for the western countries, we are still unaware of how it reflects on the costs and the management of an acute care department. This study was aimed to compare the patterns of hospital use by immigrants incoming to the Acute Care Department of Neurology in Brescia, Italy, with those of the resident Italian people. The study was based on the hospital discharge data. Discharges of immigrants were compared to those of a random selection of Italian patients matched by age and sex. The length of the study period was of 2.5?years. A similar pattern of hospital use by age was observed between foreigners and Italian patients; however, average length of hospitalization was significantly longer in immigrant population.     

Amyotrophic lateral sclerosis a population study

Summary A country-wide study of the frequency of amyotrophic lateral sclerosis (ALS) was undertaken in Israel for the period 1960–1970. Israel was chosen for this study because of its excellent medical facilities and detailed demographic information. Moreover, the population includes representative groups from all parts of the world for comparison of frequency. A wide variety of motor system disease was screened in all hospitals, clinics, and chronic care facilities in the country, death certificates were reviewed and physicians with a neurological practice were contacted to derive a tentative list of cases. Only those who fit strict clinical diagnostic criteria or had autopsy confirmation were included in estimates of prevalence and incidence.On January 1, 1965, the mid-point of the study, 62 patients with ALS were living in Israel. The age-adjusted prevalence of ALS on that date was 3 per 100000 population. The average annual age-adjusted incidence for the period 1960–1970 was 0.78 per 100000 population (0.86 in males, 0.46 in females; ratio 1.9:1). There was no appreciable change in trend of incidence over the study interval. Age-specific incidence rates were similar in native-born inhabitants of Israel, immigrants from Europe and immigrants from Afro-Asian countries. The range in age-adjusted incidence among subgroups of immigrants to Israel from various countries was 0.25 to 1.20 per 100000 population but small numbers precluded testing the statistical significance of these rather narrow differences.Mean age at onset was 55.4 years for males and 52.4 years for females. The mean age at death was 60.2 for males and 58.0 for females. The average annual mortality from ALS was 0.58 per 100000 population. There were no familial aggregates of ALS in Israel and autopsy data showed no neurofibrillary changes, granulovacuolar or inclusion bodies.There are only a few other population studies of ALS in different regions of the world. The average annual incidence in these other studies ranged from 0.4 to 1.4 per 100000 population. Thus, the incidence in Israel falls within this narrow range. The present study lends further support to the impression that ALS has a remarkably uniform geographic distribution with Guam and the Kii peninsula of Japan being the only known areas with significantly high rates. If an environmental factor contributes to the pathogenesis of ALS, the factor must also have a uniform geographic distribution.Supported in part by the Minneapolis Veterans Administration Hospital.     

Point prevalence of schizophrenia in immigrant groups in Rotterdam: data from outpatient facilities.

OBJECTIVE: Reports of an increased incidence of schizophrenia in some immigrant groups to The Netherlands are based exclusively on hospital data. The aims of our study were: 1) to determine the treated point prevalence of schizophrenia at outpatient mental health services in Rotterdam and to compare the results for immigrants to those for natives; and 2) to compare groups born in The Netherlands and immigrant groups in terms of the proportions of patients with a previous hospital admission. METHOD: We included all patients aged between 20 and 64 who were treated for a non-affective psychosis at any of the outpatient mental health services in Rotterdam on October 1, 1994. The mental health professionals responsible reported on the socio-demographic and clinical characteristics of each patient. RESULTS: Seven hundred and thirteen patients with a diagnosis of schizophrenia (DSM-III-R) were identified (rate: 2.1 per 1000). The (treated) prevalence of schizophrenia in male immigrants from Surinam and Morocco and in female immigrants from Surinam, the Netherlands Antilles and Cape Verde was significantly higher than that in their native-born counterparts (odds ratios between 2 and 3). The (treated) prevalence was not significantly higher in immigrants from Turkey, female immigrants from Morocco or male immigrants from the Antilles. Proportions of patients with a previous hospital admission were similar in each ethnic group (81-93%). CONCLUSION: These findings are generally in line with earlier studies, based on the Dutch psychiatric registry, which has reported an increase in the (treated) incidence of schizophrenia in immigrants from Surinam and the Netherlands Antilles and in male immigrants from Morocco, and no increase in the (treated) incidence in immigrants from Turkey or female immigrants from Morocco.     

Risk factors for violence among long-stay psychiatric patients: national study.

This study identified risk factors for violence among long-stay (1 year or more) psychiatric patients in Israel (n = 2946) using data from a national reevaluation of such patients. Patients were rated as being violent if hospital staff or patient charts indicated an incident of physical violence at least every few months. The relationship between violence and patients' functioning, living conditions, treatment, background and hospitalization history was studied. In total, 22.8% of patients were violent. Based on logistic regression analysis, the risk factors for being violent were younger age, younger age at first hospitalization, poorer self-care, having more frequent visitors, and the patient not having his or her own clothing. The data for age and lack of gender differences confirm previous findings. However, the results regarding clothing, visitors, poor self-care and age of onset are unique. The results of this study suggest that the violent behaviour of in-patients is related to both individual and environmental variables.     

Immigrants and refugees: the psychiatric perspective

Psychiatric studies of immigrants have yielded contradictory findings regarding rates of mental illness. Current evidence suggests that rates of schizophrenia (and probably other disorders) among immigrant groups are low compared with native-born populations when sending and receiving countries are socially and culturally similar. The rates for immigrants are higher when sending and receiving countries are dissimilar, probably because of multiple social problems faced by immigrants in the receiving country. Refugees who flee their own country because of fears of violence or starvation often have had extremely traumatic experiences, which may result in PTSD and sometimes chronic impairment. Asylum seekers who arrive illegally to seek refuge in a foreign country also may have multiple traumas and experience further distress from their uncertain residency and legal status. Although much is known about the effects of migration, competent culturally sensitive services for migrants remain inadequate to meet the need.     

Age differences in stress process of recent immigrants

In the present study we sought to examine whether age affects the relationship between stress/social support and psychological distress in community residents in Israel who recently emigrated from the former Soviet Union (FSU). A cross-sectional and partly longitudinal design was used to compare emotional distress, stressor, and social support measures in three age groups (18 to 29, 30 to 59, and 60 to 86 years) of adult immigrants (N = 563). Age-related differences in the parameters of interest and their changes over time were examined with analysis of variance (ANOVA), t tests, and multiple regression analyses. We found that older immigrants reported higher levels of health-related stressors, but did not differ on total social support from younger immigrants. Specific predictors of elevated distress differed by age. For the youngest cohort, these included climate changes and anxiety for the future. For the middle-aged immigrants, these included female gender, lower education, unemployment, and longer time in Israel. For the oldest immigrants, predictors of distress included being divorced, separated, or widowed, and perceiving long-time residents of Israel as hostile. Only the middle-aged cohort showed a significant decline in levels of perceived stressors and distress during a 1-year follow-up. Thus, age differences in the stress process of recent immigrants are associated with age-specific perceived adjustment difficulties and demographic characteristics.     

A prevalence estimate of pervasive developmental disorder among Immigrants to Israel and Israeli natives

BACKGROUND: The prevalence rates of pervasive developmental disorder (PDD) have risen in the West over the last 10 years. There is argument over the etiology of this change in rates. Social and cultural processes including migration have been hypothesized. Israel, as a country of ongoing immigration with a national registry of children diagnosed with PDD, offers an opportunity to compare rates of PDD among immigrants from developing countries and native Israelis. METHOD: A Social Security national registry of 1004 children diagnosed with PDD was reviewed and rates were calculated using data extracted from the Israel National Bureau of Statistics. Of all Jewish children that were born in the years 1983-1997 and who are currently living in Israel, we defined four groups: (1). native Israelis of non-Ethiopian extraction (N = 1198, 300), (2). native Israelis of Ethiopian extraction (N = 15600), (3). immigrants of non-Ethiopian extraction (N = 110300) and (4). children born in Ethiopia (N = 11800). A further breakdown of groups 1 and 3 by well-characterized ethnic or geographical origins was not possible. RESULTS: The rate of PDD was significantly elevated in native Israelis as compared to all immigrant children. Among immigrants, the rate of PDD in Ethiopian-born children was lower than that of those born in other countries. The rate of PDD in immigrant Ethiopian children was much lower than in native Israeli children of Ethiopian extraction. CONCLUSIONS: Birth in Israel, an industrialized country, is a marker for an environmental risk factor for PDD. This may indicate that gestation, birth or infancy in industrialized countries exposes children to environmental insults that increase the risk for contracting PDD.     

Factors associated with problem behaviors in Turkish immigrant children in the Netherlands

Background: The objective of this study was to examine the relationship between child, parent, family/support, and stress variables and problem behaviors in Turkish immigrant children in the Netherlands. Methods: Parents of 833 children were interviewed and administered a Turkish version of the Child Behavior Checklist for ages 4 through 18 and a Turkish immigrant assessment questionnaire. Results: Increased integration (i.e., children belonging to a second generation of immigrants, older children) generally reduced the risk for problem behaviors, while frequent arguments, divorce, psychological problems, and convictions/incarcerations increased the risk for problem behaviors. Conclusions: Results indicate that problem behaviors are associated with the high level of separation faced by Turkish immigrant families and that more integration leads to lower levels of problem behavior. Additionally, migration history alone does not contribute to problem behavior. Factors in the family (e.g., quarrels, divorce, conviction) associated with problem behaviors in Turkish immigrants are similar to those found in Dutch and American populations. Future studies could examine predictors of problem behaviors in other culturally separated immigrant groups in the Netherlands, and in Turkish immigrant groups in other countries. Accepted: 11 January 2000     

Demoralization in Soviet-Jewish immigrants to the United States and Israel

Two hundred seventy-two recent Soviet-Jewish immigrants to the United States were compared with 412 Soviet-Jewish immigrants to Israel for the purpose of determining which country was more likely to lead to the development of demoralization. Even when differences in age and marital state were accounted for, the immigrants to the United States were significantly more demoralized. Individuals with low social support, older immigrants, women, and divorced or widowed individuals were more likely to be demoralized in both countries. Self-selection and host reception factors are explored to explain the differences between the two groups of immigrants.     

The significance of age of onset for schizophrenia.

Age of onset is the single most important characteristic of schizophrenia that could yield clues to its origin. To identify the age of onset, however, the onset of the pathological process must be determined. This process may have more than one component occurring at distinctly different times in the life of an individual. Nevertheless, many studies, using either the first appearance of psychosis or the age of first hospitalization, have found gender, familial, and other "age of onset" differences among patients with schizophrenia. These differences may aid in examining genetic mechanisms for schizophrenia.     

Mental disorders among English-speaking Mexican immigrants to the US compared to a national sample of Mexicans

Our understanding of the relationship between immigration and mental health can be advanced by comparing immigrants pre- and post-immigration with residents of the immigrants' home countries. DSM-IV anxiety and mood disorders were assessed using identical methods in representative samples of English-speaking Mexican immigrants to the US, a subsample of the US National Comorbidity Survey Replication (NCSR), and Mexicans, the Mexican National Comorbidity Survey (MNCS). Retrospective reports of age of onset of disorders and, in the immigrant sample, age of immigration were analyzed to study the associations of pre-existing mental disorders with immigration and of immigration with the subsequent onset and persistence of mental disorders. Pre-existing anxiety disorders predicted immigration (OR=3.0; 95% CI 1.2-7.4). Immigration predicted subsequent onset of anxiety (OR=1.9; 95% CI 0.9-3.9) and mood (OR=2.3; 95% CI 1.3-4.0) disorders and persistence of anxiety (OR=3.7 95% CI 1.2-11.2) disorders. The results are inconsistent with the "healthy immigrant" hypothesis (that mentally healthy people immigrate) and partly consistent with the "acculturation stress" hypothesis (i.e., that stresses of living in a foreign culture promote mental disorder). Replication and extension of these results in a larger bi-national sample using a single field staff are needed.     

Cross-cultural adaptation and mental disorders]

Recently, it has not been rare for psychiatrists to treatment disorders and provide consultation on mental health problems for people from different cultures. The following is a brief outline of mental disorders and mental health problems of the people who immigrated in culturally different societies. In reviewing the literature, most of the reports demonstrate that the admission rate for schizophrenia is higher among immigrants than among people remaining in their original countries or among native-born people of the host countries. Furthermore the prevalence of mood disorders in community surveys is reported to be higher among immigrants than among native-born people of the host countries. In regard to gender difference of vulnerability to cross-cultural immigration, the prevalence rate for mental disorders is reported to be higher in female immigrants than male immigrants. Psychological adaptation of Japanese war orphans returned from Mainland China four decades after WWII revealed that psychological problems became exacerbated three months after resettlement in Japan and took three years to recover. Three major psychological symptoms that manifested in resettlement were obsession, somatization and depression. It is hypothesized that the acculturation process can be divided into four layers: the behavioral level, intellectual level, representative level and emotional level. The study of the acculturation process of Japanese war orphans demonstrated that it gradually proceeded from a surface level to deeper levels, namely from the behavioral level-->intellectual level-->representative level-->emotional level. The relationship of psychological adaptation and acculturation process is reported to be complicated. The acculturation process does not necessarily accompany psychological adaptation and vice versa. Impact of immigration on psychological manifestation revealed the following vicissitude: the asymptomatic phase for two months after resettlement-->hypochondriacal phase-->depressive phase-->paranoid phase. The vicissitude of psychological manifestations of the impact of immigration may be a reflection of the four layers of adaptive mechanisms (G. Vaillant).