Andleeb, Humma; (2025) Migration, ethnicity and psychosis: A mixed-methods exploration of psychosis risk and experience in ethnic minority migrant populations. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Epidemiological research has provided key insight into the association between migration and psychosis risk with evidence suggesting that some ethnic minority groups may be at higher risk of psychosis than others. Research has shown Black people are at significantly higher risk of psychosis than other groups however evidence of risk in other groups is less clear. It is also unclear whether specific migrant characteristics might influence the risk of psychosis. Yet, despite a vast effort at attempting to understand this increased risk, quantitative methods have been limited in the exploration of specific risk factors in ethnic minority groups due to limited sample sizes in a rare outcome like psychosis. Using a mixed methods approach and lived experience involvement, this thesis aimed to understand risk of psychosis in ethnic minority groups in different ages of migration and what the experiences of migrants with psychosis from different ethnic groups are. Study One consisted of an epidemiological case-control sample of 937 cases and 1,195 controls from the EUropean network of national schizophrenia networks studying Gene-Environment Interactions [EU-GEI] study to explore how migrating at different ages affected later risk of psychosis and whether this differed across ethnic groups. After adjusting for all confounders including ethnicity, only migration during adolescence remained associated with psychosis (OR 1.94, 95%CI: 1.11–3.36). In stratified analyses, migration during adolescence was associated with increased odds of psychosis in Black (OR: 6.52, 95%CI: 3.00–14.20) and North African (OR: 16.43, 95%CI: 1.88–143.51) groups. Adolescent migrants were at highest risk of psychosis compared to the White non-migrant group. This was significantly higher in Black and North African migrants. Study Two was a qualitative systematic review to synthesise data from qualitative literature on migrants who experience psychosis. A total of eight records were included in the synthesis, highlighting limited literature of migrants’ experiences and their perceptions of psychosis. Four synthesised themes were identified as encompassing the experiences of migrants with psychosis in the current literature: Theme 1) Systemic and structural barriers create significant difficulties to daily life, Theme 2) Psychosis experience, treatment and recovery has an impact on daily life, Theme 3) Social relationships can be facilitators and barriers to recovery, Theme 4) Hope for the future and having faith and religion are important to migrants’ psychosis recovery. A gap in exploring experiences in specific ethnic groups was identified. Study Three was a qualitative exploration of Pakistani migrants’ first experiences of psychosis using Interpretative Phenomenological Analysis (IPA). Six participants were interviewed, and six themes were identified reflecting the journey of how migrants made sense of their psychosis journey in relation to themselves and other people. This included the lead up to first experiences of psychosis which consisted of three themes: Theme 1) Breakdown of significant close relationships and community isolation evokes emotional turmoil, Theme 2) First experiences of psychosis: detachment from self, lack of control and disconnected relationships and Theme 3) Navigating social stigma: struggling with disclosure, ownership of experience and fear of shame. The following three themes represented the management and adaptation to life with psychosis: Theme 4) Living with psychosis: Developing acceptance and reconnection with self and surroundings, Theme 5) Navigating social world: Negotiating fractured family relationships and finding solace in shared experiences and Theme 6) Recentring faith: Reconnection and reclaiming practice enables sense of strength and routine. This thesis highlights the importance in utilising different methods to explore characteristics, specifically ethnicity, to understand psychosis risk and experience in migrant groups. Further qualitative exploration in other ethnic groups will provide further insight into whether and how psychosis is differentially experienced in different groups

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