People who migrate in adolescence have an increased risk of psychosis, researchers have found, noting the link is particularly strong among black and north African people. While research has previously suggested migration could play a role in the increased risk of psychosis among people from ethnic minorities, the study suggests age could be an important factor. James Kirkbride, a professor of psychiatric and social epidemiology at University College London (UCL) and co-author of the study, said adolescence was a time when individuals were forming a sense of identity and experiencing social, cognitive and neurological development. He said: “So migrating during adolescence, which interrupts social network formation, and may require teenage migrants to learn a new language, navigate new social and cultural norms and customs, and manage new social environments – including potential exposure to racism and discrimination known to be associated with psychosis risk – could all play a part in making adolescent migration a particularly vulnerable period for increasing future psychosis risk.” Writing in the journal PLOS Mental Health, Kirkbride and colleagues report how they analysed data from 2,132 people aged 18-64 in England, France, Italy, Spain and the Netherlands who were part of a larger research study. Of this group, 937 people had experienced a first episode of a psychotic disorder, with this occurring after migration in those that had migrated. Most of those who migrated, Kirkbride said, had done so for economic reasons, rather than seeking asylum, for example. After taking into account factors including ethnicity, markers of social disadvantage, and parental history of psychosis, the team found those who migrated between the ages of 11 and 17 had almost twice the risk of developing psychosis compared with white people who had not migrated. However, there was no increased risk for people who migrated in infancy, earlier childhood or adulthood. In a further analysis, the team found the increased risk of psychosis in adolescents was significant only among black and north African migrants. While Kirkbride noted the exact association was hard to pin down because of the small size of the latter group in the study, the risk of psychosis was at least two to three times higher for these groups than for white people who had not migrated. The analysis also revealed that north African adults, black people of all ages and non-migrants who were black or from mixed ethnic backgrounds were at greater risk of psychosis compared with white non-migrants. There was no such increase for white or Asian migrants. Humma Andleeb, the first author of the study, also from UCL, said white people were not visible minorities in Europe, meaning they did not face the same disadvantages or may be able to adapt more easily. “They may also be more likely to migrate within Europe and not experience the same disadvantages pre-migration or post-migration,” she said. The study has limitations, including that it cannot show cause and effect, does not track people over time, and the sample sizes for some groups are small. Further work is also needed to unpick why adolescents who migrate have an increased risk of psychosis. Kirkbride said: “What we should be focusing on for that group is ways to help them manage their mental health and help them integrate into society so that they’re armed with the social skills they need to navigate new environments and avoid developing serious mental health problems.” Dr Adam Coutts, of the University of Cambridge, who was not involved in the work, said the health impacts on asylum seekers would be worse given the insecurity and lack of access to services and jobs they faced. “The key issue is that the plight of economic migrants, refugees and asylum seekers has exposed the fragile nature which government frontline services are in such as mental health services. These need to be improved for all including locals and migrants.” Dr Gracia Fellmeth, of the University of Oxford, agreed. She said: “[These] findings highlight the urgent need to ensure that young migrants are offered the care and support they need in order to thrive in their new environments.”