Refugees Have Much Higher Risk of Psychosis, Schizophrenia

Refugees' increased risk relative to their geographic peers was particularly high among males.

Refugees have a greater risk of schizophrenia and other non-affective psychotic disorders than migrants from similar geographic regions, found new research in the BMJ. Refugees’ psychosis risk was triple that of native-born Swedes and 1.7 times greater than non-refugee migrants, researchers found.

Anna-Clara Hollander, MD, of the Karolinska Institutet in Stockholm, Sweden, and her colleagues used national registry data to follow more than 1.3 million Swedish residents born after January 1984. Among the cohort, 88.4% were born in Sweden to Swedish-born parents, and 9.8% were non-refugee migrants from the Middle East and north Africa, sub-Saharan Africa, Asia and Eastern Europe and Russia. The remaining 1.8% were refugees from the same four regions.

The researchers tracked individuals from their 14th birthday or arrival in Sweden through December 2011 and identified 3704 cases of non-affective psychotic disorder. Disorders occurred at a crude rate 38.5 cases per 100 000 Swedish-born people per year, 80.4 cases per 100 000 non-refugee migrants, and 126.4 cases per 100 000 refugees.

Refugees had 2.9 times greater risk of non-affective psychotic disorders than native-born Swedes after accounting for disposable income, age, sex and population density when individuals entered the cohort. Non-refugee migrants’ risk was 1.75 times greater than that of native Swedes.

Except among those from sub-Saharan Africa, refugees’ psychosis risk exceeded that of non-refugee migrants by 1.66 times. Rates among all migrants combined from sub-Saharan Africa were more than 4 times greater than those of native Swedes after adjustment.

Refugees’ increased risk relative to their geographic peers was particularly high among males, especially those from Eastern Europe and Russia. Refugees received their diagnosis a median 1.1 years sooner after arrival than non-refugee migrants.

“Clinicians and service planners in high income settings should be aware of the early signs of psychosis in refugees,” the authors wrote. “Just as for the general population, refugees and their families will benefit from timely and early intervention and care, particularly in those exposed to severe psychosocial adversity.”

Although the authors point out that refugees fleeing violence generally have worse mental health, Cornelius Katona, medical director of the Helen Bamber Foundation in London, noted in an editorial the researchers’ lack of information on racism, discrimination and other post-migration risk factors.

“Consideration also needs to be given to the challenges that asylum seekers face during what is often a prolonged and distressing process,” Katona wrote. “These factors may include institutional detention, inability to work (and resultant deskilling and loss of self esteem), destitution and difficulty in accessing health and social care.”


Hollander A, et al. Refugee migration and risk of schizophrenia and other non-affective psychoses: cohort study of 1.3 million people in Sweden. BMJ. 2016; 352:i1030.