Elsevier

Journal of Affective Disorders

Volume 210, 1 March 2017, Pages 174-180
Journal of Affective Disorders

Research paper
Prevalence and clinical severity of mood disorders among first-, second- and third-generation migrants

https://doi.org/10.1016/j.jad.2016.12.039Get rights and content

Highlights

  • Unipolar depressive disorder is more common among migrants of first, second and third generation.

  • Bipolar disorder is more frequent in the third generation.

  • Migrants with mood disorders presented increased rates of comorbid psychotic disorders

  • Migrants with mood disorders presented increased rates of substance-use disorders.

Abstract

Background

The role of migration as a risk factor remains unknown for mood disorders because of poor data. We sought to examine the prevalence and severity of mood disorders (bipolar disorder (BD), unipolar depressive disorder (UDD) and dysthymia) in first, second, and third generation migrants in France.

Methods

The Mental Health in the General Population survey interviewed 38,694 individuals. The prevalence of lifetime mood disorders, comorbidities, and clinical features was compared between migrants and non-migrants and by generation. All analyses were adjusted for age, sex and level of education.

Results

The prevalence of any lifetime mood disorder was higher in migrants compared with non-migrants (OR = 1.36, 95% CI [1.27 – 1.45]). This increased prevalence was significant for UDD (OR = 1.44, 95% CI [1.34 – 1.54]), but not for BD (OR = 1.15, 95% CI [0.96 – 1.36]) or dysthymia (OR = 1.09, 95% CI [0.94 – 1.27]), although the prevalence of BD was increased in the third generation (OR = 1.27, 95% CI [1.01 – 1.60]). Migrants with BD or UDD were more likely to display a comorbid psychotic disorder compared to non-migrants with BD or UDD. Cannabis-use disorders were more common in migrant groups for the 3 mood disorders, whereas alcohol-use disorders were higher in migrants with UDD. Posttraumatic stress disorder was more frequent among migrants with UDD.

Limitations

The study used cross-sectional prevalence data and could be biased by differences in the course of disease according to migrant status. Moreover, this design does not allow causality conclusion or generalization of the main findings.

Conclusion

Mood disorders are more common among migrants, especially UDD. Moreover, migrants with mood disorders presented with a more severe profile, with increased rates of psychotic and substance-use disorders.

Introduction

Mood disorders, including bipolar disorder (BD), unipolar depressive disorder (UDD) and dysthymia, are leading causes of morbidity around the world due to their high prevalence (approximately 1 to 2% for BD (Fagiolini et al., 2013), 16% for UDD (Kessler et al., 2003) and 1% for dysthymia (Blanco et al., 2010)), their impact on functioning and quality of life, and their long disease course (Bruffaerts et al., 2012, Miret et al., 2013, Phillips and Kupfer, 2013). Subjects with mood disorders have, moreover, elevated mortality rates (Angst et al., 2002), particularly because of suicidal behaviour (Pompili et al., 2012; Schaffer et al., 2014) and cardiovascular diseases (Fagiolini et al., 2005; Mathur et al., 2016). Even if their pathophysiology remains mostly unknown, it is widely demonstrated that gene-environment interactions play an important role in the genesis of mood disorders (Craddock and Forty, 2006, Etain et al., 2008, Geoffroy et al., 2013).

Foreign migration is associated with increased prevalence (i.e., cases in a given population at a specific time) of psychotic disorders and schizophrenia among some minority ethnic and/or migrant populations (Selten et al., 2012, Termorshuizen et al., 2014). Previous studies demonstrated increased incidences (i.e., new cases per given population per year) of psychotic disorders and schizophrenia in migrants in first and second generation, and thus confirmed migration as a risk factor (Bourque et al., 2011, Cantor-Graae and Selten, 2005), which has also been shown to occur in France (Amad et al., 2013, Tortelli et al., 2013). Nevertheless, migration remains a topic of debate concerning a potential influence on incidence and prevalence of mood disorders. For instance, a study using data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) of 43,093 individuals representative of the general population found that foreign-born Mexican Americans and foreign-born non-Hispanic whites had a lower prevalence of mood, anxiety and substance use disorders (SUD) compared with their US-born counterparts, which suggests a “healthy migrant effect” (Grant et al., 2004). More specifically, results from different studies of migration on either mania or BD (Lloyd et al., 2005, Selten et al., 2003), UDD (Bhugra, 2003, Kerkenaar et al., 2013, Selten et al., 2003) or dysthymia (Breslau et al., 2011) were contradictory, driving Swinnen and Selten to conduct a meta-analysis of the 14 incidence-based studies of migration and mood-disorders (BD, UDD, and mood disorders of unspecified polarity). They found that, adjusting for age and gender, the RR of developing any mood disorder was 1.38 (95% CI [1.17 – 1.62], p<0.001) (Swinnen and Selten, 2007), which is less than the risk of developing schizophrenia. More recently, Cantor-Graae et al. studied the influence of migration on the incidence of a full spectrum of psychiatric disorders in a large Danish registry-based cohort study (n =1,859,419). After adjustment for sex, age, calendar year, and the interaction between age and sex, risk for at least one psychiatric disorder was increased in all migrant populations (except Danish expatriates who were born abroad). The incidence of the different psychiatric disorders varied according to generational status of migrants, in particular between the first and second generation. Interestingly, incidence rate ratios (IRR) of BD and affective disorders were only increased among second-generation migrants with one foreign-born parent (Cantor-Graae and Pedersen, 2013).

Most of these migration studies are incidence-based and require long follow-up periods to be accurate. Prevalence studies, on the other hand, are appropriate to assess the severity of a disease and/or the comorbidities according to clinical or biological factors and can provide important insights on factors associated with different courses of the disease, i.e., modifiers of a disease (Stolk et al., 2007).

Therefore, the present study aimed to examine the prevalence of mood disorders (including BD, UDD and dysthymia) in migrant groups, both overall and according to first (1GM), second (2GM) and third (3GM) generation, in a large cross-sectional survey. Finally, we compared psychiatric comorbidities and clinical features, including psychotic disorders, previous suicide attempts, anxiety disorders and SUD, according to migrant status.

Section snippets

Mental Health in General Population (MHGP) survey

The French cross-sectional MHGP survey, conducted by the World Health Organization Collaborating Centre (WHO-CC), interviewed 38,694 subjects between 1999 and 2003. These subjects were selected in 47 study sites (900 subjects per site) by a quota sampling method (Lunsford and Lunsford, 1995). This method develops a sample of subjects with the same characteristics as the general population on predefined characteristics, such as age, sex, educational level, occupational category, and professional

Population and sociodemographic characteristics

Sociodemographic characteristics of individuals with mood disorders are summarized in Table 1 (for the whole sample, see Supplementary Table 1). Of the 38,694 individuals interviewed, 9959 were migrants (25.7%), from 1GM (n = 2052, 5.3%), 2GM (n = 4151, 10.7%), or 3GM (n = 3756, 9.7%). BD was diagnosed in 614 subjects (1.6% of the total population), of whom 194 were migrants (1.9% of the migrant sample) and 420 non-migrants (1.5% of the non-migrant sample). UDD was diagnosed in 4131 subjects

Discussion

Using a large sample of the general population, this is the first study to investigate the prevalence of mood disorders (BD, UDD and dysthymia) in migrant groups in France. Several important findings resulted from this investigation: i) a higher lifetime prevalence of any mood disorder in migrants among all three generations; ii) a higher lifetime prevalence of BD in the third generation; iii) a higher lifetime prevalence of UDD in migrants among all three generations; and iv) no significant

References (55)

  • R. Mathur et al.

    Risk of incident cardiovascular events amongst individuals with anxiety and depression: a prospective cohort study in the east London primary care database

    J. Affect. Disord.

    (2016)
  • M.L. Phillips et al.

    Bipolar disorder diagnosis: challenges and future directions

    Lancet

    (2013)
  • M. Pompili et al.

    Car accidents as a method of suicide: a comprehensive overview

    Forensic Sci. Int.

    (2012)
  • D. Sheehan et al.

    The validity of the Mini International Neuropsychiatric Interview (MINI) according to the SCID-P and its reliability

    Eur. Psychiatry

    (1997)
  • M. Aas et al.

    Additive effects of childhood abuse and cannabis abuse on clinical expressions of bipolar disorders

    Psychol. Med.

    (2014)
  • B. Agic et al.

    Alcohol use Among Immigrants in Ontario

    (2015)
  • D. Bhugra

    Migration and depression

    Acta Psychiatr. Scand. Suppl.

    (2003)
  • C. Blanco et al.

    The epidemiology of chronic major depressive disorder and dysthymic disorder: results from the National Epidemiologic Survey on alcohol and related conditions

    J. Clin. Psychiatry

    (2010)
  • F. Bourque et al.

    A meta-analysis of the risk for psychotic disorders among first- and second-generation immigrants

    Psychol. Med.

    (2011)
  • A. Bradford-Hill

    The environment and disease; association or causation?

    J. R. Soc. Med.

    (1965)
  • J. Breslau et al.

    Migration from Mexico to the united states and subsequent risk for depressive and anxiety disorders: a cross-national study

    Arch. Gen. Psychiatry

    (2011)
  • R. Bruffaerts et al.

    Role of common mental and physical disorders in partial disability around the world

    Br. J. Psychiatry

    (2012)
  • E. Cantor-Graae et al.

    Schizophrenia and migration: a meta-analysis and review

    Am. J. Psychiatry

    (2005)
  • E. Cantor-Graae et al.

    Full spectrum of psychiatric disorders related to foreign migration: a Danish population-based cohort study

    JAMA Psychiatry

    (2013)
  • Carta, M.G., Bernal, M., Hardoy, M.C., Haro-Abad, J.M., “Report on the Mental Health in Europe” working group, 2005....
  • R. Core Team

    R: A Language and Environment for Statistical Computing

    (2013)
  • N. Craddock et al.

    Genetics of affective (mood) disorders

    Eur. J. Hum. Genet.

    (2006)
  • Cited by (32)

    • Trauma exposure and PTSD among men entering jail: A comparative study with the general population

      2022, Journal of Psychiatric Research
      Citation Excerpt :

      Subjects were included in the study if they met the following criteria: (1) provided informed consent to participate in the survey, (2) spoke French, (3) were aged 18 years or older, (4) were residing in Nord or Pas-de-Calais, and (5) were neither institutionalized nor homeless. A full description of the MH-General Population survey procedure is available elsewhere (Amad et al., 2013; Bellamy et al., 2005; Caria et al., 2010; Pignon et al., 2017, 2018). The MH-Prison Population and MH-General Population surveys used the same methodology to collect clinical and sociodemographic data.

    • Increased prevalence of anxiety disorders in third-generation migrants in comparison to natives and to first-generation migrants

      2018, Journal of Psychiatric Research
      Citation Excerpt :

      For the first time, we have recently studied the third-generation migrants in the Mental Health in General Population (MHGP) survey. The studies showed that the prevalence rates of psychotic, mood and addictive disorders were higher among third-generation migrants than among natives (Amad et al., 2013; Pignon et al., 2017a; Rolland et al., 2017); and it could also be the case for anxiety disorders. Finally, migrants studies are important to replicate in varied cultural countries (Bhugra, 2004), and anxiety disorders have never been studied in France.

    • Influence of comorbid alcohol use disorders on the clinical patterns of major depressive disorder: A general population-based study

      2018, Drug and Alcohol Dependence
      Citation Excerpt :

      Subjects were included in the study if they met the following criteria: 1) provides informed consent to participate in the survey, 2) is a French speaker, 3) is at least 18 years of age and 4) is neither institutionalized nor homeless. Additional methodological details can be found elsewhere (Amad et al., 2013; Caria et al., 2010; Grolleau et al., 2008; Leray et al., 2011; Pignon et al., 2017a,b; Rolland et al., 2017; Tebeka et al., 2018). The following socio-demographic characteristics were collected: age, gender, education level, income level, marital status and native variable.

    View all citing articles on Scopus
    View full text