Schizophrenia among ethnic minorities: Social and cultural explanations for the increased incidence of schizophrenia among first- and second-generation immigrants in the Netherlands

The incidence of schizophrenia is high among several immigrant groups in Western Europe, but the explanation for this finding is unknown. The research presented in this thesis shows that the incidence of schizophrenia in the Netherlands is increased among first- and second-generation immigrants from Morocco, Surinam and other non-Western countries, and that this increase is strongly influenced by the social and cultural context in which immigrants live. The incidence varied among ethnic minority groups according to the degree these groups perceived discrimination, and was most strongly increased among immigrants who lived in neighborhoods where their own ethnic group comprised a small proportion of the population. Individuals who had developed schizophrenia reported somewhat higher rates of perceived discrimination than their siblings and than general hospital controls, but these differences were not statistically significant. Weak and negative identification with oneâ €™s own ethnic group was a strong determinant of schizophrenia, whereas a separated identity, defined as a positive identification with the own ethnic group but not with the Dutch majority group, was associated with a lower risk of schizophrenia. Belonging to a group that experiences a high degree of discrimination, and having a weak and negative ethnic identity, may represent a situation of chronic social stress, which may precipitate schizophrenia in individuals who have a (genetic) predisposition for the illness. This social stress may be buffered or prevented by living in a neighborhood with many others of one’s own ethnic group, and by seeking positive distinctiveness from the majority population.

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