Migrant integration policies, regional social disadvantage, ethnicity and psychosis risk: Findings from the EU-GEI study

Background: Compared with individual-level factors, macro-level exposures have received less attention in research on the increased risk of psychosis among ethnic minorities. We aimed to investigate the impact of migrant integration policies and area-level social deprivation on higher incidence rates among ethnic minorities. Methods: This study, conducted between 2010 and 2015, analysed incidence data from five countries from the EUropean network of national schizophrenia networks studying Gene-Environment Interactions [EU-GEI]. The total population was multiplied by the duration of case-ascertainment to estimate person-years. Cases with a non-organic psychotic disorder were included. Exposures included population group (based on self/parental region of origin/self-ascribed ethnicity) and area-level exposures including country-level migrant integration policies and regional-level proxies of social deprivation (percentages of unemployment, low education, owner-occupied houses, single person-households). Negative binomial mixed-effects regression models were fitted to calculate the association between individual and area-level exposures and incidence of psychotic disorders. Results: The study included 1933 individuals. Supportive migrant policies (IRR: 0.71; 95 % CI 0.68–0.73) and higher percentages of owner-occupied houses (IRR: 0.97; 95 % CI 0.96–0.97) were associated with lower incidence of psychosis. Higher percentages of unemployment (IRR: 1.08; 95 % CI 1.07–1.09) and single person-households (IRR: 1.10; 95 % CI 1.05–1.14) were associated with higher incidence of psychosis. Accounting for policies and area-level social deprivation markers reduced risk estimates among all migrant/ethnic minority groups, compared to the majority population. Conclusions: This is the first study on the impact of migrant integration policies on psychosis incidence. Migrant integration policies and area-level social deprivation influenced psychosis risk in the overall and minority populations. These findings can inform policies and social epidemiological approaches to studying multi-level exposures in psychosis.