Anales de la RANM

128 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 Otega A et al. An RANM. 2024;141(02): 126 - 133 METHODS a. Study design This is a naturalistic, observational, prospec- tive, case-control first episode of psychosis study. Data was gathered from a regional consortia for the study of “Environment and Genes interac- tion in Schizophrenia – Community of Madrid research group (AGES-CM)”, a multicentric study that involves seven University Hospitals in Madrid, Spain (i.e. La Paz University General Hospital, Gregorio Marañón University General Hospital, 12 de Octubre University General Hospital, La Princesa University Hospital, Ramón y Cajal University Hospital, San Carlos University General Hospital and Fundación Jimenez Díaz). Recruitment started in 2014 and it is still ongoing. Subjects admitted for a first- episode psychosis, first degree relatives and matched controls were recruited in each of the participating hospitals and associated community centres. Only first-episode participants recruited from 2013 to 2023 were included for this study purpose. The study was approved by the correspondent ethical committees at each clinical centre. Methods were designed and assessments were conducted according to the Declaration of Helsinki principles, international and national guidelines. All participants and/ or their legal guardians gave written informed consent before participation. b. Participants From February 2013 to July 2023, 417 participants with FEP were recruited for the AGES-CM study. A total of 363 subjects out of this sample had completed the variables of interest (e.g. migrant status, sex, ethnicity, PANSS Negative) and were thus selected for the current study. FEP partici- pants were selected according to the following inclusion and exclusion criteria. The inclusion criteria were: 1) age between 7 and 40 years at the time of the baseline initial assessment; 2) persis- tence of positive psychotic symptoms for less than 24 months in the context of a FEP according to DSM-IV criteria. Individuals with the following criteria were excluded: 1) concurrent diagnosis of another Axis I mental disorder, other than substance abuse or dependence; 2) intellectual disability if functioning was impaired before the onset of the disorder; 3) history of neurodevelop- mental disorder or traumatic head injury with loss of consciousness; 4) pregnancy. c. Sociodemographic and migrant status Sociodemographic data including age, sex, ethnicity, and socioeconomic status was collected at the baseline clinical interview (i.e. study entrance). Ethnicity was divided into 3 groups for descriptive purposes only: Caucasic, Hispanic and Others. The parental socioeconomic status (SES) was evaluated using the Hollingshead’s Index of Social Position (17). The scale is comprised of five levels (Class I = highest level, Class V = lowest level), reflecting both occupational status and educational achievement. The original SES was re-coded into one categorical variable with 3 groups: low (classes V and IV), middle (class III) and high (classes II and I). For migration status, personal migration was considered, subdividing the sample into two groups (yes=first genera- tion migrants, no=natives). In addition, based on parental migration experience, they were divided into 3 groups (1 st generation migrants, 2 nd genera- tion migrants and non-migrants). First-genera- tion migrants (1 st G migrants) were defined as individuals born in a foreign country. Second- generation migrants (2nd G migrants) were identi- fied as individuals born in Spain with at least one parent who was a first-generation migrant. Indivi- duals not complying with those definitions were considered as non-migrants. d. Clinical assessment Clinical evaluation was performed by trained psychiatrists in the use of the correspondent clinical instruments with inter-rater reliability of at least 80% using the interclass correlation coeffi- cient. The Positive and Negative Syndrome Scale (PANSS) (18) was used to assess the severity of symptoms in a 7 point Likert-scale; ranking levels of psychopathology in increasing order from 1= “absent” to 7= “extreme”. The Positive, Negative, and General Psychopathology dimensions were computed, then the total score was calculated for each of the subscales. The PANSS scale demons- trated highly satisfactory internal consistency in our sample, with Cronbach’s alpha coefficients for each dimension as follows: 0.81 for the Positive Scale, 0.86 for the Negative Scale, and 0.85 for the General Scale. To assess the severity of depression, The Hamilton Depression Rating Scale (19) was used. It contains 21 items, rated on a 3- or 5-point Likert-scale. Total score was computed. The internal consis- tency, measured by Cronbach’s alpha, was 0.82 for the total scale. The Young Mania Rating Scale (20) was used to assess the severity of manic symptoms. It is based on 11 items rated on a 5-point Likert-scale. A total score was calculated. In our sample the scale’s internal consistency was α = 0.76. e. Childhood adversity and bullying Childhood adversity that occurred before the age of 17 was collected using an adapted version of the Childhood Experience of Care and Abuse Questionnaire (CECA.Q)(21). Participants completed a retrospective self-report question- naire. The current study focused on nine forms of childhood adversity: (i) physical abuse inflicted by one or both parental figures; (ii) sexual abuse perpetrated by a person ≥ 5 years older; (iii) death of one or both biological parents; (iv) emotional abuse by parental figures; (v) neglect; (vi) separa- tion from one or both parent-figures for ≥ 6 months; (vii) household poverty, (viii) parental