Clinical symptoms and social functioning among immigrant and greek patients with schizophrenia: A comparative study

Migration is considered an important risk factor for schizophrenia. However, studies on the differences in psychotic symptomatology between immigrants and native patients revealed mixed results. This study compared clinical symptoms and social functioning between immigrant and native patients with schizophrenia in Greece in order to examine the influence of social factors on the disorder's manifestation and severity. A structured questionnaire including demographic and clinical information was administered to two groups of patients with schizophrenia; the first one was comprised of 65 immigrant patients (38 men and 27 women) and the second included 58 greek patients (35 men and 23 women). Patients' psychopathology was evaluated by the Positive and Negative Syndrome Scale (PANSS), the Calgary Depression Scale for Schizophrenia (CDSS) and the Global Assessment of Functioning Scale (GAF). The x2 test and the ANOVA were used for the comparisons of categorical and continuous variables respectively between the two groups of patients. Analysis of eigenvalues and multivariate analysis (MANOVA) were also used. Age and duration of illness were significant greater in the greek group of patients. Lack of insight was the only reason of hospitalization of immigrant patients. The immigrant group of patients had significantly lower scores in the negative syndrome subscale, the general psychopathology subscale and the total PANSS scale while they had significantly higher scores in the GAF scale. No between patients' groups difference was found on CDSS scores. Analysis of eigenvalues and MANOVA revealed that the national group (immigrants vs native) and the reason of admission were the only general variables with significant influence on patients' psychopathological features and functioning. Consistently with previous studies that have shown better prognosis in immigrant compared to the native patients with schizophrenia, immigrant patients in our study had milder negative and total psychotic symptomatology and were less impaired in terms of global functioning than the greek group. Being an immigrant appears to be an important factor related to these differences between our study groups. A possible explanation of our findings could be that immigrant patients with schizophrenia attending to greek mental health services have been 'filtered'because of a 'salmon bias' type phenomenon; the severe ill usually return to their country of birth due to the lack of financial and social support for immigrant patients in Greece. An alternative hypothesis is that the families and the local communities of immigrant patients with schizophrenia, being tied enough, provide support to their ill members that results in better outcome, especially with respect to negative syndrome and social functioning.