Schizophrenia in migrants and natives: clinical presentation, treatment patterns, and outcomes in a Spanish acute...

To examine differences in sociodemographic, clinical, and treatment-related variables between migrant and native patients with schizophrenia admitted to an acute psychiatric unit in Spain.

We conducted a retrospective cohort study including 689 patients with schizophrenia admitted to the Acute Psychiatric Unit of Santa María University Hospital (Lleida, Spain) between 2010 and 2020. Patients were classified as natives (n = 475) or migrants (n = 214). Group differences were examined using unadjusted comparisons. Multivariable logistic regression analyses were performed for a priori selected outcomes, adjusting for age, sex, and key social factors. Adherence was defined as pharmacological adherence prior to admission and attendance at a scheduled outpatient psychiatric visit one year after discharge.

Migrant patients were younger and experienced greater social disadvantage. In adjusted analyses, migrant status remained independently associated with higher odds of hallucinations at admission (OR 1.33, 95% CI 1.12-1.59), lower odds of suicidal ideation (OR 0.78, 95% CI 0.65-0.94), and a higher likelihood of initiation of long-acting injectable antipsychotics during hospitalization (OR 1.30, 95% CI 1.09-1.53). Differences in first-episode presentation, other symptom profiles, and one-year follow-up adherence were attenuated after adjustment. Treatment differences at admission largely converged by discharge, and overall functioning at discharge was comparable between groups.

Migrant patients with schizophrenia experience social disadvantage and distinct care trajectories. Most differences were largely explained by social and structural factors rather than migrant status itself, although some clinically relevant differences persisted after adjustment, underscoring the importance of addressing social determinants of care.