Migration as a risk factor for schizophrenia: A Danish population-based cohort study
Open accessAbstract
Background: A growing body of evidence suggests that migration is a risk factor for the development of schizophrenia, although the putative mechanism remains obscure. Aims: To examine immigrant background and history of foreign residence as risk factors for schizophrenia. Method: Using data from the Danish Civil Registration System, we established a population-based cohort of 2.14 million persons resident in Denmark by their fifteenth birthday. Schizophrenia in cohort members and parental psychiatric disorder were identified by cross-linkage with the Danish Psychiatric Case Register. Results: The relative risk of developing schizophrenia was 2.45 (95% CI 2.25–2.67) and 1.92 (95% CI 1.74–2.12) among first- and second-generation immigrants respectively, and 1.60 (95% CI 1.25–2.05) among Danes with a history of foreign residence. Conclusions: Migration confers an increased risk for schizophrenia that is not solely attributable to selection factors and may also be independent of foreign birth.
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Immigrants have a higher incidence of schizophrenia.
“as do immigrants (Cantor-Graae et al. 2003).”
From Excess early mortality in schizophrenia. (2014) · cites this paper as Cantor-Graae et al. 2003
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The Danish Civil Registration System
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“Our findings are consistent with previous studies from industrialized countries, where higher rates of psychotic disorders among some groups of first-generation immigrants have been found (Cantor-Graae et al., 2003; Harrison et al., 1997; Selten et al., 2001; Zolkowska et al., 2001).”
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“Various potential explanations for this association have been put forward, including stressors experienced prior to, during, and post-migration (Cantor-Graae et al. 2003; Veling et al. 2007; Morgan & Hutchinson, 2009; Kirkbride et al. 2012).”
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“…et al., 1997; Sharpley, Hutchinson, McKenzie, & Murray, 2001); this is also the case among immigrants from Surinam, the Dutch Antilles and Morocco living in the Netherlands (Veling et al., 2006) and among immigrants from Australia, Africa and Greenland living in Denmark (Cantor-Graae et al., 2003).”
ResultInfluentialEthnic differences in risk of acute compulsory admission in Amsterdam, 1996–2005
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“The incidence of schizophrenia and other non-affective psychotic disorders is higher among certain groups of migrants in European countries than among the native population of these countries, and the risk is even higher among second-generation migrants [1–7].”
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BackgroundSingh, S., Islam, Z., Brown, L., Gajwani, R., Jasani, R., Rabiee, F., & Parsons, H. (2013) · Programme Grants for Applied Research · doi:10.3310/pgfar01030 · Cited by 27 · see citing works
Examining which factors influence age of onset in males and females with schizophrenia.
Neill, E., Tan, E., Toh, W., Selvendra, A., Morgan, V., Rossell, S., & Castle, D. (2020) · Schizophrenia Research · doi:10.1016/j.schres.2020.08.011 · Cited by 26 · see citing works
Dykxhoorn, J., & Kirkbride, J. (2018) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796018000501 · Cited by 26 · see citing works
“Use of a ‘culturally-sensitive’ diagnostic tool over standard diagnostic assessments reduced the relative risk of schizophrenia observed in Moroccan migrants in the Netherlands compared with the majority white Dutch population (Zandi et al., 2010).”
BackgroundSelten, J., & Cantor‐Graae, E. (2004) · Steinkopff eBooks · doi:10.1007/978-3-7985-1953-4_1 · Cited by 18 · see citing works
Self-citationMitchelson, M. R., Erskine, H., Ramírez, E., Suleman, F., Prasad-Ildes, R., Siskind, D., & Harris, M. (2010) · Advances in Mental Health · doi:10.5172/jamh.9.3.243 · Cited by 23 · see citing works
“In contrast, studies from Denmark, Sweden and England have reported higher prevalence of mental illness in migrant children compared to native children (Cantor-Graae et al., 2003, Hjern et al., 2004, Harrison et al., 1997).”
ResultMigration, family dysfunction and psychotic symptoms in children and adolescents
Patino, L., Selten, J.-P. C. J., van Engeland, H., Duyx, J., Kahn, R., & Burger, H. (2005) · British Journal of Psychiatry · doi:10.1192/bjp.186.5.442 · Cited by 23
Review of Major Social Determinants of Health in Schizophrenia-Spectrum Disorders: II. Assessments
Sturm, E. T., Thomas, M. L., Sares, A. G., Dave, S., Baron, D. A., Compton, M. T., Palmer, B. W., Jester, D. J., & Jeste, D. V. (2023) · Schizophrenia Bulletin · doi:10.1093/schbul/sbad024 · Cited by 24 · see citing works
Jarvis, G. E., Toniolo, I., Ryder, A. G., Sessa, F., & Cremonese, C. (2010) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-010-0187-1 · Cited by 25 · see citing works
“Similar findings were reported in migrants to other Western European countries such as the Netherlands [9, 10], Sweden [11], Norway [12] and Denmark [13].”
ResultAl-saffar, S., Borgå, P., Wicks, S., & Hällström, T. (2004) · Nordic Journal of Psychiatry · doi:10.1080/08039480410006043 · Cited by 22 · see citing works
“Not only had different migrant groups to Denmark an increased prevalence of schizophrenia, but this also applied to Danish-born individuals who had lived abroad (21).”
BackgroundResultGeros, H., Sizer, H., Mifsud, N., Reynolds, S., Kim, D. J., Eaton, S., McGorry, P., Nelson, B., & O'Donoghue, B. (2020) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13099 · Cited by 21 · see citing works
Werbeloff, N., Levine, S., & Rabinowitz, J. (2012) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-011-0342-3 · Cited by 21 · see citing works
“This has been found in comprehensive population-based research from Denmark [ 5 ] and Sweden [14] and in a case‐control population-based study from Denmark [22].”
BackgroundResultInfluentialForensic psychiatric patients among immigrants in Denmark – Diagnoses and criminality
Gabrielsen, G., & Kramp, P. (2009) · Nordic Journal of Psychiatry · doi:10.1080/08039480802423014 · Cited by 21
Migrant status, age, gender and social isolation in very late‐onset schizophrenia‐like psychosis
Mitter, P., Reeves, S., Romero-Rubiales, F., Bell, P., Stewart, R., & Howard, R. (2005) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.1396 · Cited by 21 · see citing works
“However, data on mixed migrant populations has been shown to be potentially informative, for instance in the investigation of schizophrenia in young adults (Cantor-Graae et al., 2003).”
BackgroundHogerzeil, S. J., van Hemert, A. M., Veling, W., & Hoek, H. W. (2016) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-016-1310-8 · Cited by 21 · see citing works
Johnsson, E., Zolkowska, K., & Mcneil, T. (2015) · International Journal of Social Psychiatry · doi:10.1177/0020764014537639 · Cited by 19 · see citing works
Self-citationMigration und psychische Krankheit
Assion, H. (2005) · Springer eBooks · doi:10.1007/3-540-27042-6_14 · Cited by 19 · see citing works
Premigration Traumatic Events and Psychological Distress Among Five Immigrant Groups
Lien, L., Thapa, S., Rove, J. A. B., Kumar, B., & Hauff, E. (2010) · International Journal of Mental Health · doi:10.2753/imh0020-7411390301 · Cited by 18 · see citing works
Invited commentary: Gaining traction on the epidemiologic landscape of schizophrenia.
McGrath, J. (2003) · American Journal of Epidemiology · doi:10.1093/aje/kwg119 · Cited by 18 · see citing works
“risk of schizophrenia (9, 10), suggesting that factors operating between the time of migration and illness onset are important.”
Banaszkiewicz, I., Biała, G., & Kruk-Słomka, M. (2020) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2020.04.020 · Cited by 17 · see citing works
The Concept of Schizophrenia: From Unity to Diversity
Häfner, H. (2014) · Advances in Psychiatry · doi:10.1155/2014/929434 · Cited by 15 · see citing works
“The highly elevated incidence rates for schizophrenia among Afro-Caribbean immigrants to Great Britain [168– 176], among Surinamese immigrants to theNetherlands [177– 179] and among mostly Asian and African immigrants to Denmark [180] and Sweden [181], are outliers.”
BackgroundInfluentialDo risk factors for schizophrenia predispose to emigration?
Pedersen, C., Mortensen, P., & Cantor-Graae, E. (2011) · Schizophrenia Research · doi:10.1016/j.schres.2011.01.013 · Cited by 16 · see citing works
Self-citationCountry of birth and hospital treatment for psychosis in New South Wales
Nielssen, O., Sara, G., Lim, Y., & Large, M. (2013) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-012-0577-7 · Cited by 14 · see citing works
Manhica, H., Hollander, A., Almquist, Y., Rostila, M., & Hjern, A. (2016) · BJPsych Open · doi:10.1192/bjpo.bp.115.002048 · Cited by 13 · see citing works
Durbin, A., Lin, E., Taylor, L., & Callaghan, R. C. (2011) · Canadian journal of psychiatry. Revue canadienne de psychiatrie · doi:10.1177/070674371105600705 · Cited by 13 · see citing works
Norredam, M., García-López, A., Keiding, N., & Krasnik, A. (2010) · International Journal of Public Health · doi:10.1007/s00038-010-0162-3 · Cited by 12 · see citing works
- Authors
- Cantor-Graae, E., Pedersen, C. B., Mcneil, T. F., & Mortensen, P. B.
- Affiliations
- Aarhus University (DK)
- Lund University (SE)
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2003-02
- Volume
- 182
- Issue
- 2
- Pages
- 117-122
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2170443130
- Cited by
- 195
- References
- 0
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 4 · 2023: 5 · 2022: 5 · 2021: 5 · 2020: 8 · 2019: 9 · 2018: 5 · 2017: 7 · 2016: 14 · 2015: 4 · 2014: 8 · 2013: 6 · 2012: 9
- FWCI
- 17.11
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- Funders
- Stanley Medical Research Institute
- National Research Foundation
- Danmarks Grundforskningsfond
- Topics
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- schizophrenia, migration, immigrant health, first-generation immigrants, immigrant children, parental mental illness, risk factors, selection bias
- MeSH terms
- Adolescent, Adult, Age Factors, Denmark, Emigration and Immigration, Female, Humans, Male, Registries, Risk Factors, Schizophrenia, Cohort Studies, Age Distribution, Sex Distribution
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