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