Outcome of mental illness following repatriation: a predictive study

A study is made of indices which predict the outcome of psychotic mental illness among migrant patients who had become ill in England and who were repatriated home to Jamaica. The findings of a field survey among 55 cases showed that a poor outcome had taken place in 32. This may have been predicted by indices of chronicity and the resulting poor employment history in England. Prediction in Jamaica is associated with socio-economic hardship and psychological attitudes of relatives who had agreed to accommodate patients. Diagnosis of illness and a history of this in the family are not associated with outcome. It is of interest that evidence of adequate intelligence predicts a poor outcome. These findings are discussed. The purpose of the present paper is to make an investigation of those factors which may be of significance in predicting the outcome of psychosis among patients who had been repatriated to Jamaica from England. It is widely believed that in countries like Jamaica the socio-cultural environment of the predominantly rural areas allows higher rates of recovery from psychosis than will be found in industrial cities in the western world (Barahona Fernandes et al., 1967; Murphy and Raman, 1972). These findings would indicate that when patients become ill in these developed countries their repatriation may be in their medical interest. None the less, in an early study of this problem Frey (1961) concluded that returning home had not altered the course of illness among Algerian mine-workers who had become acutely psychotic in France. Asuni (1968) traced 70 per cent of a group of Nigerian students who had become psychotic in London and who were repatriated home because of the unlikelihood that they would have been able to complete their courses of study. He concluded that repatriation had been of therapeutic benefit in the majority of these students. The most recent study of this problem was carried out in Jamaica by the present author. The findings indicated that a poor outcome had occurred among three-fifths of a consecutive series of patients (Burke, 1982). If these findings are found to be associated with diagnosis then particular groups of patients would be considered to be eligible for repatriation.