Ethnic minority status, age-at-immigration and psychosis risk in rural environments: Evidence from the SEPEA study

James B. Kirkbride, Yasir Hameed, Konstantinos Ioannidis, Gayatri Ankireddypalli, Carolyn M. Crane, Mukhtar Nasir, Nikolett Kabacs, Antonio Metastasio, Oliver Jenkins, Ashkan Espandian, Styliani Spyridi, Danica Ralevic, Suneetha Siddabattuni, Ben Walden, Adewale Adeoye, Jesus Perez, Peter B. Jones

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Objective: Several ethnic minority groups experience elevated rates of first-episode psychosis (FEP), but most studies have been conducted in urban settings. We investigated whether incidence varied by ethnicity, generation status, and age-at-immigration in a diverse, mixed rural, and urban setting.

Method: We identified 687 people, 16–35 years, with an ICD-10 diagnosis of FEP, presenting to Early Intervention Psychosis services in the East of England over 2 million person-years. We used multilevel Poisson regression to examine incidence variation by ethnicity, rural–urban setting, generation status, and age-at-immigration, adjusting for several confounders including age, sex, socioeconomic status, population density, and deprivation.

Results: People of black African (incidence rate ratio: 4.06; 95% confidence interval [CI]: 2.63–6.25), black Caribbean (4.63; 95% CI: 2.38–8.98) and Pakistani (2.31; 95% CI: 1.35–3.94) origins were at greatest FEP risk relative to the white British population, after multivariable adjustment. Non-British white migrants were not at increased FEP risk (1.00; 95% CI: 0.77–1.32). These patterns were independently present in rural and urban settings. For first-generation migrants, migration during childhood conferred greatest risk of psychotic disorders (2.20; 95% CI: 1.33–3.62).

Conclusions: Elevated psychosis risk in several visible minority groups could not be explained by differences in postmigratory socioeconomic disadvantage. These patterns were observed across rural and urban areas of our catchment, suggesting that elevated psychosis risk for some ethnic minority groups is not a result of selection processes influencing rural–urban living. Timing of exposure to migration during childhood, an important social and neurodevelopmental window, may also elevate risk.
Original languageEnglish
Pages (from-to)1251–1261
Number of pages11
JournalSchizophrenia Bulletin
Issue number6
Early online date17 May 2017
Publication statusPublished - Nov 2017


  • epidemiology
  • ethnicity
  • migration
  • urbanicity
  • incidence
  • early intervention
  • social determinants

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