Outcomes for migrants with a first episode of psychosis: A systematic review

Migrants are at a greater risk of developing a psychotic disorder, but knowledge about their outcomes has not yet been collated. We reviewed the literature concerning outcomes (symptomatic, functional, morbidity and mortality and service utilisation) for migrants with first-episode psychosis. Medline, EMBASE and PsycINFO were systematically searched for studies whose population included first- or second-generation migrants with first-episode psychosis, where outcome measures were examined after a minimum follow-up period of 6 months. Fourteen of the 1554 articles identified in the search fulfilled the inclusion criteria. Remission and disengagement rates in migrants were equal or greater than those in non-migrants. Migrants experienced more negative and fewer positive symptoms at follow-up. Functioning scores varied, with studies reporting lower, equivalent or higher functioning at follow-up for migrants. Migrants were less likely to die by suicide compared to native-born individuals affected by first-episode psychosis. Most included studies showed greater rates of involuntary hospitalisation among migrant populations but there were mixed findings regarding number of hospitalisations. Level of insight at follow-up and occupational outcomes for migrants was not found to be different than for non-migrants. No studies were identified which examined relapse rates or physical health outcomes. Migrants affected by psychotic disorders have been shown to be more likely to achieve remission, and often experience higher rates of involuntary admission and disengagement. For all other outcomes, migrants have largely similar outcomes to native-born populations.