Understanding the Evolution of Psychotic Disorders and Related Outcomes Among First-Generation Migrant Groups

Psychotic disorders, such as schizophrenia and bipolar disorder, are increasingly recognized as an important public health issue. Migrant groups with psychotic disorders face disparities across the illness continuum from onset to outcomes, including a higher risk of psychotic disorder, greater difficulties accessing mental health care, a higher likelihood of service disengagement, and poorer outcomes from treatment. There has historically been a notable lack of evidence from Canada on psychotic disorder among migrants, which has a large migrant population and different migration patterns relative to other countries. Our team was the first to show an excess risk of psychosis among some first-generation migrant groups in Canada, and to identify subgroups of migrants who may be at higher risk, such as refugees and those who do not speak English. We’ve also highlighted significant disparities in access to psychiatric treatment, such as a higher likelihood of aversive service contacts. The availability of large population-based health administrative datasets that include migrants from a wide range of countries has enabled our team to produce some of the first Canadian evidence on psychosis among migrant groups. Our unique perspective gives us a window into aspects of etiology that might well generalize but may not be possible to study in other settings, which can inform international efforts to ameliorate known disparities for migrant groups with psychosis.

We are using a multi methods approach to conduct the most comprehensive Canadian study to date on disparities faced by migrant groups with psychotic disorders across the illness continuum from onset to outcomes – including psychosis risk, evolution of symptoms, and long-term outcomes, as well as the contribution of post-migration contextual effects. We will also incorporate the perspectives of migrants with psychotic disorders and the service providers who treat them.  

The excess rates of psychotic disorders among migrant groups have been called a “public health tragedy”, and these inequities have persisted for nearly a century with little progress toward prevention. This work will advance public health approaches to psychotic disorders by providing information to enable population health surveillance, identifying determinants of illness and disparities in outcomes, and supporting improvements to mental health services and systems of care.

Project participants

Funding: Canadian Institutes of Health Research – Project Grant; Western University Department of Psychiatry

Principal Investigator: Kelly Anderson

Co-Investigators: Maria Chiu, Jordan Edwards, Paul Kurdyak, Dan Lizotte, Lena Palaniyappan, Martin Rotenberg

Post-Doc: Tasneem Khan

Students: Jahin Khan, Emmanuel Akanbi