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MIGRATION AND SCHIZOPHRENIA Professor Dinesh Bhugra Professor of Mental Health and Cultural Diversity Section of C

What is a migrant?. Someone who changes their place of residence for any purpose or for any period of time Legal classification Characteristics of migration Motivation of migration . Dinesh Bhugra 2002. Dinesh Bhugra 2007. Occupational Migration. Anthropology Diplomacy Higher Education Journalism Military Service Missionaries Sales People Seasonal Migratory Work .

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MIGRATION AND SCHIZOPHRENIA Professor Dinesh Bhugra Professor of Mental Health and Cultural Diversity Section of C

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    1. MIGRATION AND SCHIZOPHRENIA Professor Dinesh Bhugra Professor of Mental Health and Cultural Diversity Section of Cultural Psychiatry Institute of Psychiatry King’s College London

    2. What is a migrant? Someone who changes their place of residence for any purpose or for any period of time Legal classification Characteristics of migration Motivation of migration

    3. Occupational Migration Anthropology Diplomacy Higher Education Journalism Military Service Missionaries Sales People Seasonal Migratory Work

    4. Patterns of Migration Across countries In country Rural Urban Urban Rural

    5. Reasons for Migration Political - Exiles - Refugees Economic - Single - Business Transient - Permanent - Group Social - Students - Stars

    6. Demographics of Migrants Age Gender Primary Education Voluntary or Forced? Duration of Location

    7. What Predisposes People to Migrate Schizotypal personality Low rate of CMD Schizophrenia Selective migration Asians versus African Caribbeans Disrupted family life

    8. Reactions to Migration Over accepting, enthusiastic Deny difficulties Actively critical Inhibited Hypo reactive: feel lost, perplexed, dissatisfied

    9. Reactions to Migration Hyper reactive: labile; act out Berry (1976) Adjustment Reaction Withdrawal

    10. Reactions to Migration Khoa and Van Deusen Old line Assimilation Bi-cultural

    11. Stages and Reactions Pre-migration Migration Post-Migration Reasons Preparation as life event Adjustment Generational as event Adjustment

    12. Stages and Reactions Achievement vs. Expectations Cultural Identity

    13. Changes Associated with Migration Communication Verbal Non-verbal Social Support Vocational Change Social Roles Legal Implications

    14. Factors Responsible for Distress Experiences before, during and after arrival Migrated alone or in a group Initial intentions and expectations Attitudes towards new country and culture Helpfulness of the new society in adjustment Previous similar experiences

    15. A General Typology of Migration

    16. Ödegaard (1932) Norwegians in USA n = 1067 in Norway n = 1995 Norwegians in USA showed 30-50% higher incidence of psychiatric morbidity Admissions due to schizophrenia considerably higher 11% presented within two years of migration 50% presented after 10 years or more

    17. UK African Caribbean Immigrants and UK Natives Incidence Rates per 1000 for Schizophrenia

    18. UK African Caribbean Immigrants and UK Natives Incidence Rates per 1000 for Schizophrenia

    19. UK African Caribbean Immigrants and UK Natives Incidence Rates per 1000 for Schizophrenia

    20. Cochrane and Bal (1987) Rates of admission for schizophrenia in the UK are higher for the Irish, Indian, Pakistani and Caribbean born compared to the native. In general the foreign born (except for Pakistani women) have rates of admission which are higher Pakistani women are said to drop out of the formal mental health system

    21. Cochrane and Bal (1987) HMRI (Psych 1/p) form for admissions 1981 N=186,000 COB Diagnosis Age Sex Marital Status First Admission RHA Results reported are not ethnicity but COB based

    24. Denominator vs. Numerator Psychological consequences of racial oppression Genetic and biological vulnerability

    26. Misdiagnosis Social Control: Sections A-C Wrong Diagnosis Schizophrenia difficult diagnosis diagnostic changes cf brief reactive psychosis Precipitated by crisis: delusions of persecution hallucinations/delusions cultural factors

    28. Comparison of Asians in London with WHO data

    30. Additional Hypotheses 1. Ethnic Density 2. Concepts of Self 3. Achievement – Aspiration 4. Cultural Congruity

    32. Individualism: Refers to societies where the ties between individuals are loose and everyone is expected to look after himself or herself and their immediate family Collectivism: People from birth onwards are integrated into strong cohesive in-groups which throughout their lifetime continue to protect them in exchange for unquestioning loyalty

    33. Individualism: I-ness. I consciousness, autonomy, emotional independence, individual initiative right to privacy, pleasure seeking, financial security, need for specific friendship Collectivism: We-ness. We consciousness, collective identity, emotional interdependence, group solidarity, sharing duties and obligations, need for stable and predetermined friendships, group decisions Hofstede 1980, 1984

    34. Conclusions Socio Economic Disadvantages Racial Discrimination Biological Factors: predisposition Premorbid Personality Cultural and Self Identity Achievement-Expectation Contact-Social Networks

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