Morgan Craig, Knowles Gemma, Hutchinson Gerard
Economic and Social Research Council (ESRC) Centre for Society and Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
University of the West Indies, St. Augustine, Trinidad and Tobago.
World Psychiatry. 2019 Oct;18(3):247-258. doi: 10.1002/wps.20655.
There is a large body of research reporting high rates of psychotic disorders among many migrant and minority ethnic groups, particularly in Northern Europe. In the context of increasing migration and consequent cultural diversity in many places worldwide, these findings are a major social and public health concern. In this paper, we take stock of the current state of the art, reviewing evidence on variations in rates of psychoses and putative explanations, including relevant theories and models. We discuss in particular: a) the wide variation in reported rates of psychotic disorders by ethnic group, and b) the evidence implicating social risks to explain this variation, at ecological and individual levels. We go on to set out our proposed socio-developmental model, that posits greater exposure to systemic social risks over the life course, particularly those involving threat, hostility and violence, to explain high rates of psychoses in some migrant and minority ethnic groups. Based on this analysis, the challenge of addressing this social and public health issue needs to be met at multiple levels, including social policy, community initiatives, and mental health service reform.
有大量研究报告称，许多移民和少数族裔群体中精神障碍的发病率很高，尤其是在北欧。在全球许多地方移民不断增加以及随之而来的文化多样性的背景下，这些研究结果成为了一个重大的社会和公共卫生问题。在本文中，我们总结了当前的研究现状，回顾了关于精神病发病率差异及假定解释的证据，包括相关理论和模型。我们特别讨论了：a）不同种族群体报告的精神障碍发病率的广泛差异，以及b）在生态和个体层面上，表明社会风险可解释这种差异的证据。我们接着阐述我们提出的社会发展模型，该模型假定在整个生命过程中更多地暴露于系统性社会风险中，尤其是那些涉及威胁、敌意和暴力的风险，以解释一些移民和少数族裔群体中精神病的高发病率。基于这一分析，需要在多个层面应对这一社会和公共卫生问题的挑战，包括社会政策、社区倡议和心理健康服务改革。
