Compared with native populations and non-refugee migrants in a host country, refugees have a particular risk of developing non-affective psychosis, according to study results published in JAMA Psychiatry.

Researchers conducted a systematic review and meta-analysis of 9 studies conducted in Denmark, Sweden, Norway, and Canada from PubMed, PsycINFO, and Embase databases. Each study included observation of refugee history in patients, assessment of effect size and spread, adjustment for sex, definition of non-affective psychosis, and comparisons with either non-refugee migrants or native population.

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To assess the relative risk for non-affective psychosis in refugees, researchers utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and followed guidelines from the Meta-analysis of Observational Studies in Epidemiology. The primary outcome was the pooled relative risk in refugees compared with the non-refugee population. In the 540,000 refugees included in the data, researchers found that refugee experience was an independent risk factor of developing non-affective psychosis. The relative risk increased statistically significantly to 1.39 for refugees compared with non-refugee migrants and to 2.41 for refugees compared with the native population in studies with low risk bias.

The study was limited to the refugee experience in Scandinavian countries and Canada. Applying these findings to other countries may be limited and ought to consider the characteristics of the native society and its interaction with refugee populations. Social, economic, and political factors should also be considered in association with immigration and mental health and may differ significantly in different regions.

To date, this systematic review and meta-analysis is the most comprehensive to focus on the incidence of non-affective psychosis in refugees. Researchers concluded, “We believe that these findings highlight the need for psychiatric prevention strategies and outreach programs for refugees.”

Reference

Brandt L, Henssler J, Müller M, Wall S, Gabel D, Heinz A. Risk of psychosis among refugees: a systematic review and meta-analysis [published online August 14, 2019]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2019.1937