Subclinical psychosis in adult migrants and ethnic minorities: systematic review and meta-analysis

BackgroundIt is well established that migration and ethnic minority status are risk factors for psychotic disorders. Recent studies have aimed to determine if they are also associated with subclinical psychosis (psychotic-like experiences and schizotypal traits).AimsWe aimed to determine to what extent migrant and ethnic minority groups are associated with higher risk of subclinical psychosis.MethodWe conducted a systematic review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, and examined findings by ethnicity, migrant status, outcomes of subclinical psychosis and host country. A meta-analysis was carried out with robust variance estimation where possible, to handle statistically dependent effect size estimates.ResultsWe included 28 studies (19 studies on psychotic-like experiences and 9 studies on schizotypal traits) and found that ethnicity, but not migrant status, was associated with current and lifetime psychotic-like experiences. In the narrative analysis, we observed the effect of psychosocial risk factors on this association: Black ethnicity groups showed consistent increased prevalence of current and lifetime psychotic-like experiences compared with the reference population across countries.ConclusionsMore generalisable and standardised cohort studies of psychotic-like experiences and schizotypal traits in relation to migration/ethnicity are necessary to examine the effects of exposures and outcomes in different contexts, and to understand the underlying mechanisms of the association between subclinical psychosis and migrant and ethnic minority status.Declaration of interestNone.

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Ethnic minority position and migrant status as risk factors for psychotic symptoms in the general population: a meta-analysis

Psychological Medicine ◽

10.1017/s0033291718002271 ◽

2018 ◽

Vol 49 (4) ◽

pp. 545-558 ◽

Cited By ~ 12

Author(s):

Edouard Leaune ◽

Marie-Jose Dealberto ◽

David Luck ◽

Stéphanie Grot ◽

Halima Zeroug-Vial ◽

...

Keyword(s):

General Population ◽

Ethnic Minority ◽

Ethnic Groups ◽

Psychotic Disorders ◽

Meta Analysis ◽

Psychotic Symptoms ◽

Migrant Status ◽

Increased Risk ◽

Black Populations

AbstractPsychotic symptoms (PS) are experienced by a substantial proportion of the general population. When not reaching a threshold of clinical relevance, these symptoms are defined as psychotic experiences (PEs) and may exist on a continuum with psychotic disorders. Unfavorable socio-environmental conditions, such as ethnic minority position (EMP) and migrant status (MS), may increase the risk of developing PS and PEs. We conducted an electronic systematic review and a meta-analysis assessing the role of EMP and MS for the development and persistence of PS in the general population. Sub-group analyses were performed investigating the influence of ethnic groups, host countries, age, types of PS, and scales. Twenty-four studies met our inclusion criteria. EMP was a relevant risk factor for reporting PS [odds ratio (OR) 1.44, 95% confidence interval (CI) 1.22–1.70) and PEs (OR 1.36, 95% CI 1.16–1.60). The greatest risk was observed in people from the Maghreb and the Middle East ethnic groups in Europe (OR 3.30, 95% CI 2.09–5.21), in Hispanic in the USA (OR 1.98, 95% CI 1.43–2.73), and in the Black populations (OR 1.85, 95% CI 1.39–2.47). We found a significant association between MS and delusional symptoms (OR 1.47, 95% CI 1.33–1.62). We found no association between EMP and persistence of PEs.EMP was associated with increased risk of reporting PS and PEs, and the risk was higher in ethnic groups facing deprivation and discrimination. We found an association between MS and delusional symptoms. These results raise questions about the precise role of socio-environmental factors along the psychosis continuum.

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Risk factors for pain and functional impairment in people with knee and hip osteoarthritis: a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-038720 ◽

2020 ◽

Vol 10 (8) ◽

pp. e038720

Author(s):

Sandeep Sandhar ◽

Toby O Smith ◽

Kavanbir Toor ◽

Franklyn Howe ◽

Nidhi Sofat

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Narrative Analysis ◽

Data Extraction ◽

Meta Analysis ◽

Hip Osteoarthritis ◽

Chronic Widespread Pain ◽

Scoring Method ◽

Knee Oa ◽

Functional Deterioration

ObjectiveTo identify risk factors for pain and functional deterioration in people with knee and hip osteoarthritis (OA) to form the basis of a future ‘stratification tool’ for OA development or progression.DesignSystematic review and meta-analysis.MethodsAn electronic search of the literature databases, Medline, Embase, CINAHL, and Web of Science (1990–February 2020), was conducted. Studies that identified risk factors for pain and functional deterioration to knee and hip OA were included. Where data and study heterogeneity permitted, meta-analyses presenting mean difference (MD) and ORs with corresponding 95% CIs were undertaken. Where this was not possible, a narrative analysis was undertaken. The Downs & Black tool assessed methodological quality of selected studies before data extraction. Pooled analysis outcomes were assessed and reported using the Grading of Reccomendation, Assessment, Development and Evaluation (GRADE) approach.Results82 studies (41 810 participants) were included. On meta-analysis: there was moderate quality evidence that knee OA pain was associated with factors including: Kellgren and Lawrence≥2 (MD: 2.04, 95% CI 1.48 to 2.81; p<0.01), increasing age (MD: 1.46, 95% CI 0.26 to 2.66; p=0.02) and whole-organ MRI scoring method (WORMS) knee effusion score ≥1 (OR: 1.35, 95% CI 0.99 to 1.83; p=0.05). On narrative analysis: knee OA pain was associated with factors including WORMS meniscal damage ≥1 (OR: 1.83). Predictors of joint pain in hip OA were large acetabular bone marrow lesions (BML; OR: 5.23), chronic widespread pain (OR: 5.02) and large hip BMLs (OR: 4.43).ConclusionsOur study identified risk factors for clinical pain in OA by imaging measures that can assist in predicting and stratifying people with knee/hip OA. A ‘stratification tool’ combining verified risk factors that we have identified would allow selective stratification based on pain and structural outcomes in OA.PROSPERO registration numberCRD42018117643.

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