Schizophrenia and other psychotic disorders in Caribbean-born migrants and their descendants in England:systematic review and meta-analysis of incidence rates, 1950–2013

Purpose: Increased risk of schizophrenia and other psychotic disorders among black Caribbean migrants and their descendants have been described since the 1960s. It remains unclear whether this risk varies over time, between rural and urban areas, or according to methodological artefact.Methods: We conducted a systematic review of the incidence of adult-onset psychotic disorders in black Caribbean groups relative to the baseline population in England, published 1950–2013. Subject to sufficient data (N ≥ 5) we used random effects meta-analyses to estimate pooled incidence rates (IR) and rate ratios (IRR) of seven psychotic disorder outcomes, and meta-regression to inspect whether any variation was attributable to study-level methodological features, including case ascertainment, denominator reliability, choice of baseline population and study quality. Results: Eighteen studies met inclusion for review. Sixteen demonstrated statistically significant elevated incidence rates in the black Caribbean group, present across all major psychotic disorders, including schizophrenia and bipolar disorder. Methodological quality increased over time (p = 0.01), but was not associated with estimated IR or IRR. For schizophrenia (N = 11 studies) the pooled IRR in the black Caribbean group was 4.7 (95 % CI 3.9–5.7) relative to the baseline; no evidence of publication bias was observed. We found weak evidence to suggest schizophrenia IRRs were smaller from studies in more urban settings (odds ratio 0.98; 95 % CI 0.96–1.00; p = 0.06). Conclusions: Higher incidence rates of psychotic disorders have been present for more than 60 years amongst black Caribbean ethnic groups in England, despite improved study methodologies over time. Aetiological explanations appear to more parsimoniously account for this excess than methodological biases.