Social disadvantage, linguistic distance, ethnic minority status and first-episode psychosis: Results from the EU-GEI case-control study

Hannah E. Jongsma, Charlotte Gayer-Anderson, Ilaria Tarricone, Eva Velthorst, Els Van Der Ven, Diego Quattrone, Marta Di Forti, Paulo Rossi Menezes, Christina Marta Del-Ben, Celso Arango, Antonio Lasalvia, Domenico Berardi, Caterina La Cascia, Julio Bobes, Miguel Bernardo, Julio Sanjuán, Jose Luis Santos, Manuel Arrojo, Lieuwe De Haan, Andrea TortelliAndrei Szöke, Robin M. Murray, Bart P. Rutten, Jim Van Os, Craig Morgan, Peter B. Jones, James B. Kirkbride

Research output: Contribution to journalArticlepeer-review

54 Scopus citations


Background Ethnic minority groups in Western countries face an increased risk of psychotic disorders. Causes of this long-standing public health inequality remain poorly understood. We investigated whether social disadvantage, linguistic distance and discrimination contributed to these patterns. Methods We used case-control data from the EUropean network of national schizophrenia networks studying Gene-Environment Interactions (EU-GEI) study, carried out in 16 centres in six countries. We recruited 1130 cases and 1497 population-based controls. Our main outcome measure was first-episode ICD-10 psychotic disorder (F20-F33), and exposures were ethnicity (white majority, black, mixed, Asian, North-African, white minority and other), generational status, social disadvantage, linguistic distance and discrimination. Age, sex, paternal age, cannabis use, childhood trauma and parental history of psychosis were included as a priori confounders. Exposures and confounders were added sequentially to multivariable logistic models, following multiple imputation for missing data. Results Participants from any ethnic minority background had crude excess odds of psychosis [odds ratio (OR) 2.03, 95% confidence interval (CI) 1.69-2.43], which remained after adjustment for confounders (OR 1.61, 95% CI 1.31-1.98). This was progressively attenuated following further adjustment for social disadvantage (OR 1.52, 95% CI 1.22-1.89) and linguistic distance (OR 1.22, 95% CI 0.95-1.57), a pattern mirrored in several specific ethnic groups. Linguistic distance and social disadvantage had stronger effects for first- and later-generation groups, respectively. Conclusion Social disadvantage and linguistic distance, two potential markers of sociocultural exclusion, were associated with increased odds of psychotic disorder, and adjusting for these led to equivocal risk between several ethnic minority groups and the white majority.

Original languageEnglish
Pages (from-to)1536-1548
Number of pages13
JournalPsychological Medicine
Issue number9
StatePublished - Jul 2021


  • Discrimination
  • epidemiology
  • ethnicity
  • psychotic disorders
  • social disadvantage


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