How Youth and Families with Migration Histories Explain Psychosis: A Scoping Review

Immigrant and refugee youth are at higher risk of developing a psychotic disorder compared to non-newcomers and often have less access to medical care. A potential barrier may be the differing explanatory models of psychosis and attitudes towards mental health care between newcomers and healthcare providers, which can lead to missed early intervention. Furthermore, the explanatory models of psychosis may also differ between youth and their families as a result of acculturation differences, which may lead to intergenerational conflicts and disagreements about care decisions. The aim of the study is to characterize the explanatory models regarding early psychosis and attitudes toward treatment among migrant youth and their caregivers. The Arksey and O'Malley framework for scoping reviews was followed. A search strategy was developed with concepts of "migrants", "youth", "explanatory model", and "psychosis". Medline, Embase, PsycINFO, EBSCO Child Development & Adolescent Studies, Cochrane, and Google Scholar were searched for relevant articles. Of the 1115 studies identified, 10 studies met criteria. The results suggest that people with migration history often held differing explanatory models of psychosis as compared to non-migrants, and that these models were influenced by specific cultural factors. Most studies focused on caregiver perspectives while youth perspectives were underexplored. Rather than a simple relationship in which greater divergence from the biomedical model led to increased disengagement, studies found that explanatory models could evolve over time and that youth and families could hold multiple, sometimes conflicting, illness explanations simultaneously. The integration of multiple explanatory models was crucial in treatment engagement and functional outcomes for many patients. Treating migrant youth with early psychosis remains a significant clinical challenge, yet significant gaps remain in understanding how youth and families understand psychosis. This paper shares findings that add new nuance to the existing literature as the impact of multiple explanatory models and the interaction of familial attitudes have not been reviewed in the treatment of psychosis. Further research should aim to incorporate youth perspectives and how these differ from and/or interact with the perspectives of caregivers. Such work can support more culturally-sensitive care and inform targeted interventions for this marginalized population.