PsyLife group, Division of Psychiatry,UCL,London,UK.
Epidemiol Psychiatr Sci. 2019 Apr;28(2):146-152. doi: 10.1017/S2045796018000501. Epub 2018 Sep 13.
Understanding the excess risk of psychotic disorders in migrant and ethnic minority groups has long been an important research focus in psychiatric epidemiology and public mental health. Heterogeneity between migrant groups based on the region of origin, minority status and other socioeconomic factors may provide clues as to the underlying aetiological mechanisms explaining this risk, as well as informing our general understanding of psychotic disorders. Nonetheless, disentangling the mechanisms underlying this association has been the focus of more speculation and theory to date than empirical research. Now more than ever, we need to move beyond studies which demonstrate excess rates in migrant and ethnic minority groups to novel population-based studies which identify the determinants and mechanisms through which this risk is shaped. In this paper, we review the main hypotheses proposed to explain these disparities and the current level of support for them. We then highlight recent evidence from epidemiology and neuroscience which provides important new clues in our understanding of the aetiology of psychotic disorders. We concluded with suggestions for future interdisciplinary research to prevent this public mental health inequality within a generation.
理解精神障碍在移民和少数族裔群体中的风险过高,一直是精神医学流行病学和公共精神卫生领域的一个重要研究重点。基于原籍地区、少数民族身份和其他社会经济因素的移民群体之间的异质性,可能为解释这种风险的潜在病因机制提供线索,并有助于我们全面了解精神障碍。尽管如此,到目前为止,阐明这种关联背后的机制一直是更多推测和理论的焦点,而不是实证研究。现在比以往任何时候都更需要我们超越那些仅仅证明移民和少数族裔群体中发病率过高的研究,开展新的基于人群的研究,确定形成这种风险的决定因素和机制。在本文中,我们回顾了为解释这些差异而提出的主要假设以及目前对这些假设的支持程度。然后,我们重点介绍了来自流行病学和神经科学的最新证据,这些证据为我们理解精神障碍的病因学提供了重要的新线索。最后,我们提出了未来跨学科研究的建议,以期在一代人的时间内预防这种公共精神健康不平等。