Anales de la RANM

127 A N A L E S R A N M R E V I S T A F U N D A D A E N 1 8 7 9 THE IMPACT OF MIGRATION IN FIRST-EPISODE PSYCHOSIS López Ortega A et al. An RANM. 2024;141(02): 126 - 133 con los nativos (p < 0.01). Un análisis adicional mostró que esta diferencia se debía a puntajes promedio más altos en migrantes de primera generación en comparación con no migrantes (p < 0.027). Los migrantes de primera generación reportaron niveles más altos de adversidad infantil en comparación con los no migrantes. El análisis multivariado reveló que el sexo sería un predictor significativo de los puntajes negativos del PANSS en migrantes de primera generación, teniendo los hombres puntajes más altos que las mujeres. Conclusiones: Los migrantes de primera generación, particularmente los hombres, presentaron mayor severidad de síntomas negativos en comparación con los nativos. Estos hallazgos respaldan la importancia de considerar el estatus migratorio al evaluar a los sujetos con primeros episodios psicóticos, ya que esto ayudará a una caracterización más precisa de la patología y la implementación de tratamientos clínicos personalizados. INTRODUCTION Migration has become a global phenomenon involving 281 million migrants, 3.60% of the world's population in 2020 (1). In the community of Madrid, INE statistics revealed that 14% of the population in 2022 were immigrants. With the increasing number of migrant indivi- duals, the need to understand its implications, particularly on the development of mayor mental health conditions such as psychosis, has become apparent. Psychosis refers to a wide range of psycholo- gical symptoms that lead to a loss of contact with reality. It is estimated that between 1.5 and 3.5 per cent of the world population will meet the diagnostic criteria for a psychotic disorder in their lifetime (2). There is consistent evidence that stress related to major life events such as migration is a risk factor for psychosis (3,4). A recent meta-analysis revealed that first- and second- generation migrants from outside Europe have a higher risk (3-6%) of developing psychosis compared to Europeans (1-2%)(5). The underlying causes of the increased risk for psychosis between migrants have been explored in previous studies. Proposed explanatory hypotheses include the intertwin of a number of epidemiological, psychological, biological and social factors (3,6,7). A multinational European study has shown that social disadvantages and adversities during the migration experience are associated with an increased risk of psychosis in first-generation migrants (8). In addition, traumatic experiences are also a risk factor for psychosis, and migrants have been found to report a greater exposure to cumulative trauma (7) than general population. In terms of clinical presentation, studies have also explored the influence of ethnicity and migration. Concerning ethnic differences, a Cambridge study found evidence that indivi- duals of Black and North African ethnicity experienced more positive symptoms than those of White ethnicity (9).Consistent with this, a study conducted in the Netherlands revealed that first- and second-generation immigrants from Morocco exhibited higher symptom scores, on both positive and negative symptoms, compared to native Dutch individuals (10). However, findings are heterogeneous. A recent Canadian study found no difference in the prevalence of positive and negative symptoms between migrants and non-migrants (11). This is similar to some previous studies, that found no differences in clinical scales between groups (12,13). Moreover, in addition to identifying migrants' risk of developing psychosis, it is important to assess their outcomes and how they differ from non-migrants. Symptomatic outcomes for people who develop first-episode psychosis (FEP) are highly variable, about half of individuals achieve complete remission of symptoms and no further episodes, while others have a more persistent, refractory course (14). Several factors have been associated with the course of FEP, some of these include cannabis use, biological, social and ethnic factors (15). It is thus reasonable to assume that some of these and other related factors, may be expressed differently in migrants. For instance, according to a recent systematic review, immigrants with first-episode psychosis are more likely to achieve remission and often have higher rates of involuntary admission (16). It is acknowledged that clinical management and prognosis of psychosis is influenced by clinical presentation. Therefore, exploring whether migration experience influences clinical presen- tation may contribute to a greater understan- ding and improvement of the experience lived by these minority groups. We hypothesised that migration experience would have an impact on the clinical expression at the time of presentation in first episode psychosis (FEP), resulting in greater severity of symptoms in migrants. Consequently, the primary aim of the current study was to examine the clinical presentation and to explore the differences between migrant and non-migrant individuals with FEP at baseline. A secondary objective was to explore specific factors that might be contri- buting to the observed clinical manifestations in the subgroup of migrant individuals with FEP, that has been previously associated to clinical presentation or migration status such as the presence of childhood adversities, sex, age, and the age at migration.