Immigration and psychotic experiences in the United States: Another example of the epidemiological paradox? $ Hans Oh a,n , Jennifer Abe b , Nalini Negi c , Jordan DeVylder c a Columbia School of Social Work, 1255 Amsterdam Avenue, New York, NY 10027, USA b Loyola Marymount University, School University Hall Suite 4600, 1 LMU Drive, Los Angeles, CA 90045, USA c University of Maryland, School of Social Work, 525 West Redwood Street, Baltimore, MD 21201, USA article info Article history: Received 18 December 2014 Received in revised form 14 July 2015 Accepted 1 August 2015 Keywords: Psychosis Migration NCS-R NLAAS NSAL abstract In Europe, it is widely established that immigration increases risk for psychotic disorder. However, re- search has yet to confirm this association in the United States, where immigrants paradoxically report better health status than their native-born counterparts. Further, few studies have examined this topic with respect to sub-threshold psychotic experiences, which are more common than psychotic disorders in the general population. This study analyzes the (1) National Comorbidity Survey-Replication, (2) the National Latino and Asian American Survey, and (3) the National Survey of American Life, in order to determine whether generation status had any impact on risk for lifetime and 12-month PE, and whether these associations vary across racial/ethnic groups, adjusting for demographic variables and socio- economic status. We found an absence of an immigration effect on PE across various ethnic groups and across various geographic areas, and found that immigration is actually protective among Latinos, sup- porting the idea that the epidemiological paradox extends to the psychosis phenotype. & 2015 Elsevier Ireland Ltd. All rights reserved. 1. Introduction 1.1. Does the pattern of immigration risk for psychosis in Europe extend to the US? In Europe, immigrants have higher rates of psychotic disorder when compared with native-born populations (Bhugra, 2000; Hutchinson and Haasen, 2004). This relationship is pronounced and widely established. Cantor-Graae and Selten (2005) meta- analysis found that immigrants are 2.9 times more likely to de- velop schizophrenia than their native-born counterparts, which corroborates prior effect sizes reported in systematic reviews (McGrath et al., 2004; Saha et al., 2005). Interestingly, second generation immigrants, who by definition are excluded from many of the stressors associated with immigration, are approximately 4.5 times more likely to develop schizophrenia than non-im- migrants (Cantor-Graae and Selten, 2005), which implicates social risk factors that may shape the habitus of psychosis for immigrants and their progeny over time (Bhugra, 2000). Immigrants are at greatest risk for schizophrenia when re- locating to European countries where they will be racial minorities (Selten et al., 2007). Black (especially darker-skinned) immigrants to Europe have much higher rates of psychosis when compared with white immigrants or nonwhite/nonblack immigrants to varying degrees (Cantor-Graae and Selten, 2005), even though psychosis rates are not relatively higher in the African or the Caribbean countries of origin (Hickling and Rodgers-Johnson, 1995; Bhugra et al., 1996; Mahy et al., 1999; Saha et al., 2005). It appears that the receiving context – be it favorable or adverse to a particular immigrant group – can interact with immigrant attri- butes and influence the morbidity of psychosis (see Schwartz et al., 2010) and may help explain the unevenness of risk within coun- tries. For example, there is elevated incidence of schizophrenia in the state of Israel among first- and second-generation immigrants (especially from Ethiopia) (Weiser et al., 2008), but not in Jer- usalem (Corcoran et al., 2009). European studies have also found that immigrants who reside in areas consisting of high densities of their own ethnic groups often experience buffering effects from the social risk factors for psychosis (Boydell et al., 2001; Das- Munshi et al., 2012; Kirkbride et al., 2007; Schofield et al., 2011; Veling et al., 2008a, 2008b), though it is possible that neighbor- hood segregation can be associated with increased risk for psy- chosis, as found among Black minorities in the US (March et al., 2013). Does the pattern of risk for psychosis among immigrants in Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/psychres Psychiatry Research http://dx.doi.org/10.1016/j.psychres.2015.08.002 0165-1781/& 2015 Elsevier Ireland Ltd. All rights reserved. ☆ Hans Oh served as the main writer, and conducted all statistical analyses. Jen- nifer Abe, Nalini Negi, and Jordan DeVylder served as statistical and theoretical consults and helped guide the preparation of manuscript by revising drafts. All authors contributed to and have approved the final manuscript. n Corresponding author. E-mail address: hansoh@gmail.com (H. Oh). Please cite this article as: Oh, H., et al., Immigration and psychotic experiences in the United States: Another example of the epidemiological paradox? Psychiatry Research (2015), http://dx.doi.org/10.1016/j.psychres.2015.08.002i Psychiatry Research ∎ (∎∎∎∎) ∎∎∎–∎∎∎