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Mood disorders in first- and second-generation immigrants: Systematic review and meta-analysis

  • Irina Mindlis (a1) and Paolo Boffetta (a2)

Although there are consistent reports of higher psychosis rates among immigrants, the information on mood disorders is limited.


To review and quantify the difference in incidence of mood disorders in first- and second-generation immigrant (FGI and SGI) groups v. non-immigrants.


PubMed, EMBASE and PsycINFO were searched for articles from cohort studies reporting incidence of mood disorders among FGIs and SGIs.


Eighteen studies met our inclusion criteria. The summary relative risk (RR) for FGIs was 1.25 (95% CI 1.11–1.41), based on 17 effect sizes and 6120 cases, and 1.16 (95% CI 0.96–1.40) for SGIs based on three effect sizes. Men seemed at higher risk (RR = 1.29, 95% CI 1.06–1.56).


Clinicians should view FGIs as a group at risk of mood disorders, especially men. Further research is needed to understand immigrants' risk, especially in SGI.

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Corresponding author
Irina Mindlis, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1087, New York, NY 10029, USA. Email:
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1 United Nations, Population Division. Trends in International Migrant Stock: The 2013 Revision. UN, 2013.
2 Bhugra, D. Migration and mental health. Acta Psychiatr Scand 2004; 109: 243–58.
3 Bourque, F, van der Ven, E, Malla, A. A meta-analysis of the risk for psychotic disorders among first- and second-generation immigrants. Psychol Med 2011; 41: 897910.
4 Cantor-Graae, E, Pedersen, CB. Full spectrum of psychiatric disorders related to foreign migration: a Danish population-based cohort study. JAMA Psychiatry 2013; 70: 427–35.
5 Selten, JP, Veen, ND, Hoek, HW, Laan, W, Schols, D, van der Tweel, I, et al. Early course of schizophrenia in a representative Dutch incidence cohort. Schizophr Res 2007; 97: 7987.
6 Swinnen, SGHA, Selten, J-P. Mood disorders and migration: meta-analysis. Br J Psychiatry 2007; 190: 610.
7 Salas-Wright, CP, Kagotho, N, Vaughn, MG. Mood, anxiety, and personality disorders among first and second-generation immigrants to the United States. Psychiatry Res 2014; 220: 1028–36.
8 Moher, D, Liberati, A, Tetzlaff, J, Altman, DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009; 151: 264–9.
9 Wells, G, Shea, B, O'Connell, D, Peterson, J, Welch, V, Losos, M, et al. The Newcastle–Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa Hospital Research Institute, 2013 (
10 Higgins, J, Green, S. Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Collaboration, 2011.
11 Krupinski, J, Stoller, A. Incidence of mental disorders in Victoria, Australia, according to country of birth. Med J Aust 1965; 2: 265–9.
12 Westman, J, Johansson, LM, Sundquist, K. Country of birth and hospital admission rates for mental disorders: a cohort study of 4.5 million men and women in Sweden. Eur Psychiatry 2006; 21: 307–14.
13 Sundquist, K, Frank, G, Sundquist, J. Urbanisation and incidence of psychosis and depression: follow-up study of 4.4 million women and men in Sweden. Br J Psychiatry 2004; 184: 293–8.
14 Hollander, AC, Bruce, D, Ekberg, J, Burstrom, B, Ekblad, S. Hospitalisation for depressive disorder following unemployment-differentials by gender and immigrant status: a population-based cohort study in Sweden. J Epidemiol Community Health 2013; 67: 875–81.
15 Norredam, M, Garcia-Lopez, A, Keiding, N, Krasnik, A. Risk of mental disorders in family reunification migrants and native Danes: a register-based historically prospective cohort study. Int J Public Health 2010; 55: 413–9.
16 Saraiva Leao, T, Sundquist, J, Johansson, LM, Johansson, SE, Sundquist, K. Incidence of mental disorders in second-generation immigrants in Sweden: a four-year cohort study. Ethn Health 2005; 10: 243–56.
17 Norredam, M, Garcia-Lopez, A, Keiding, N, Krasnik, A. Risk of mental disorders in refugees and native Danes: a register-based retrospective cohort study. Soc Psychiatry Psychiatr Epidemiol 2009; 44: 1023–9.
18 Leff, JP, Fischer, M, Bertelsen, A. A cross-national epidemiological study of mania. Br J Psychiatry 1976; 129: 428–42.
19 Selten, JP, van Os, J, Nolen, WA. First admissions for mood disorders in immigrants to the Netherlands. Soc Psychiatry Psychiatr Epidemiol 2003; 38: 547–50.
20 Gershon, E, Liebowitz, JH. Sociocultural and demographic correlates of affective disorders in Jerusalem. J Psychiatr Res 1975; 12: 3750.
21 Thomas, CS, Stone, K, Osborn, M, Thomas, PF, Fisher, M. Psychiatric morbidity and compulsory admission among UK-born Europeans, Afro-Caribbeans and Asians in central Manchester. Br J Psychiatry 1993; 163: 91–9.
22 Mortensen, PB, Cantor-Graae, E, McNeil, TF. Increased rates of schizophrenia among immigrants: some methodological concerns raised by Danish findings. Psychol Med 1997; 27: 813–20.
23 Rwegellera, GGC. Psychiatric morbidity among West Africans and West Indians living in London. Psychol Med 1977; 7: 317–29.
24 Hemsi, LK. Psychiatric morbidity of West Indian immigrants. Soc Psychiatry 1967; 2: 95100.
25 Hitch, PJ, Clegg, P. Modes of referral of overseas immigrant and native-born first admissions to psychiatric hospital. Soc Sci Med Med Psychol Med Sociol 1980; 14a: 369–74.
26 Weyerer, S, Hafner, H. The high incidence of psychiatrically treated disorders in the inner city of Mannheim. Susceptibility of German and foreign residents. Soc Psychiatry Psychiatr Epidemiol 1992; 27: 142–6.
27 Krupinski, J, Cochrane, R. Migration and mental health – a comparative study. J Intercultural Studies 1980; 1: 4957.
28 Malzberg, B. Mental disease among native and foreignborn whites in New York state. Am J Psychiatry 1936; 93: 127–37.
29 McGovern, D, Cope, RV. First psychiatric admission rates of first and second generation Afro Caribbeans. Soc Psychiatry 1987; 22: 139–49.
30 Egger, M, Davey Smith, G, Schneider, M, Minder, C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629–34.
31 Begg, CB, Mazumdar, M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994; 50: 1088–101.
32 Bhugra, D, Gupta, S. Migration and Mental Health. CUP, 2011.
33 United Nations. Internal Migration of Women in Developing Countries: Proceedings of the United Nations Expert Meeting on the Feminization of Internal Migration. UN, 1993.
34 United Nations. Women and Migration. UN, 2004.
35 Harrison, G, Owens, D, Holton, A, Neilson, D, Boot, D. A prospective study of severe mental disorder in Afro-Caribbean patients. Psychol Med 1988; 18: 643–57.
36 Lindert, J, Ehrenstein, OS, Priebe, S, Mielck, A, Brahler, E. Depression and anxiety in labor migrants and refugees – a systematic review and meta-analysis. Soc Sci Med 2009; 69: 246–57.
37 Thapa, SB, Dalgard, OS, Claussen, B, Sandvik, L, Hauff, E. Psychological distress among immigrants from high- and low-income countries: findings from the Oslo Health Study. Nord J Psychiatry 2007; 61: 459–65.
38 Ryan, L, Leavey, G, Golden, A, Blizard, R, King, M. Depression in Irish migrants living in London: case–control study. Br J Psychiatry 2006; 188: 560–6.
39 Haasen, C, Demiralay, C, Reimer, J. Acculturation and mental distress among Russian and Iranian migrants in Germany. Eur Psychiatry 2008; 23: S103.
40 Han, HR, Kim, M, Lee, HB, Pistulka, G, Kim, KB. Correlates of depression in the Korean American elderly: focusing on personal resources of social support. J Cross Cult Gerontol 2007; 22: 115–27.
41 Miller, AM, Sorokin, O, Wang, E, Feetham, S, Choi, M, Wilbur, J. Acculturation, social alienation, and depressed mood in midlife women from the former Soviet Union. Res Nurs Health 2006; 29: 134–46.
42 Hernandez, D, Charney, E. The Health and Well-being of Children in Immigrants Families. National Academy Press, 1998.
43 Schwartz, SJ, Unger, JB, Lorenzo-Blanco, EI, Des Rosiers, SE, Villamar, JA, Soto, DW, et al. Perceived context of reception among recent Hispanic immigrants: conceptualization, instrument development, and preliminary validation. Cultur Divers Ethnic Minor Psychol 2014; 20: 115.
44 Keskimaki, I, Salinto, M, Aro, S. Socioeconomic equity in Finnish hospital care in relation to need. Soc Sci Med 1995; 41: 425–31.
45 Lorant, V, Kampfl, D, Seghers, A, Deliege, D, Closon, MC, Ansseau, M. Socioeconomic differences in psychiatric in-patient care. Acta Psychiatr Scand 2003; 107: 170–7.
46 Kawachi, I, Berkman, LF. Social ties and mental health. J Urban Health 2001; 78: 458–67.
47 Seeman, TE. Social ties and health: the benefits of social integration. Ann Epidemiol. 1996; 6: 442–51.
48 Bassuk, SS, Glass, TA, Berkman, LF. Social disengagement and incident cognitive decline in community-dwelling elderly persons. Ann Intern Med 1999; 131: 165–73.
49 Berkman, LF, Melchior, M, Chastang, JF, Niedhammer, I, Leclerc, A, Goldberg, M. Social integration and mortality: a prospective study of French employees of Electricity of France–Gas of France: the GAZEL Cohort. Am J Epidemiol 2004; 159: 167–74.
50 Cacioppo, JT, Hawkley, LC, Crawford, LE, Ernst, JM, Burleson, MH, Kowalewski, RB, et al. Loneliness and health: potential mechanisms. Psychosom Med 2002; 64: 407–17.
51 Hamrick, N, Cohen, S, Rodriguez, MS. Being popular can be healthy or unhealthy: stress, social network diversity, and incidence of upper respiratory infection. Health Psychol 2002; 21: 294–8.
52 Walen, HR, Lachman, ME. Social support and strain from partner, family, and friends: costs and benefits for men and women in adulthood. J Soc Personal Relationships 2000; 17: 530.
53 Lin, N. Social networks and mental health. In A Handbook for the Study of Mental Health: Social Contexts, Theories and Systems: 241–58. CUP, 1999.
54 Cobb, S. Presidential Address – 1976. Social support as a moderator of life stress. Psychosom Med 1976; 38: 300–14.
55 Mulvaney-Day, NE, Alegria, M, Sribney, W. Social cohesion, social support, and health among Latinos in the United States. Soc Sci Med 2007; 64: 477–95.
56 Cattell, V. Poor people, poor places, and poor health: the mediating role of social networks and social capital. Soc Sci Med 2001; 52: 1501–16.
57 Cantor-Graae, E, Selten, JP. Schizophrenia and migration: a meta-analysis and review. Am J Psychiatry 2005; 162: 1224.
58 Odegaard, O. Emigration and insanity. Acta Psychiatr Scand Suppl 1932; 4(1).
59 Selten, JP, Cantor-Graae, E, Slaets, J, Kahn, RS. Odegaard's selection hypothesis revisited: schizophrenia in Surinamese immigrants to The Netherlands. Am J Psychiatry 2002; 159: 669–71.
60 Van der Ven, E, Dalman, C, Wicks, S, Allebeck, P, Magnusson, C, van Os, J, et al. Testing Odegaard's selective migration hypothesis: a longitudinal cohort study of risk factors for non-affective psychotic disorders among prospective emigrants. Psychol Med 2015; 45: 727–34.
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Mood disorders in first- and second-generation immigrants: Systematic review and meta-analysis

  • Irina Mindlis (a1) and Paolo Boffetta (a2)
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