Migration in adversity is a potential factor of functional impairment in early psychosis, and patients who migrate in the context of adversity have specific needs, as they are more likely to have experienced past trauma, according to a study published in Psychiatry Research.
Study researchers sought to explore the differences in patient outcomes according to migration within a subset of migration in psychosocial adversity profiles and sought to disentangle the impact of migration status vs psychosocial adversity on these outcomes. The investigators further sought to address particular treatment needs of early psychosis patients based on these differences.
The study included 257 early psychosis patients, aged 18 to 35 years, from the Treatment and Early Intervention in Psychosis Program in Switzerland who were categorized by
- migration (17.9%),
- migration in adversity (29.6%), and
- Swiss-born (52.2%).
The participants reported past medical history, demographic information, and exposure to adverse life events at baseline and were assessed for functioning outcomes and evolution of symptoms after 2, 6, 12, 18, 24, 30, and 36 months of treatment.
The migration in adversity group had poorer functioning across all domains (childhood, early adolescence, social, and academic) and higher symptom intensity scores at baseline. The group also reported higher rates of past exposure to trauma. After 36 months of treatment, migration without adversity patients reported similar symptomatic and functional outcomes compared with Swiss-born patients, but the migration in adversity group was lower functioning, more likely to relapse, and less likely to experience symptomatic remission (P =.022).
Limitations to the study included lack of data on the ethnic origin and birth location of migrant patients as well as data on the timing of when these patients migrated. Furthermore, the patients included in this study all migrated to Switzerland and not somewhere else, which potentially limits the generalizability of the results. Finally, potential confounding exists in which some patients may have had psychotic illness before migrating.
Migration in the context of adversity should receive special attention in populations of early psychosis patients as their migration profile suggests they are less integrated and more likely to have been exposed to past trauma. The investigators suggest that clinicians offer adapted treatment to help migrants in adversity cope with previous trauma and maintain treatment benefits to prevent risk for relapse.
Golay P, Baumann PS, Jaton L, et al. Migration in patients with early psychosis: a 3-year prospective follow-up study. Psychiatry Res. 2019;275:108-114.