Yifan Zhu1, Xinran Hu2, Bo Yang1, Guowei Wu1, Zheng Wang1, Zhimin Xue1, Jincheng Shi3, Xuan Ouyang4, Zhening Liu5, Robert Rosenheck6. 1. The Institute of Mental Health, Second Xiangya Hospital of Central South University, Changsha, PR China. 2. The Institute of Mental Health, Second Xiangya Hospital of Central South University, Changsha, PR China. Electronic address: xinranhu@wustl.edu. 3. Xiangya School of Public Health, Central South University, Changsha, PR China. 4. The Institute of Mental Health, Second Xiangya Hospital of Central South University, Changsha, PR China. Electronic address: ouyangxuan@csu.edu.cn. 5. The Institute of Mental Health, Second Xiangya Hospital of Central South University, Changsha, PR China; The State Key Laboratory of Medical Genetics, Central South University, PR China. Electronic address: zhening.liu@csu.edu.cn. 6. Department of Psychiatry, Yale University, New Haven, USA.
Abstract
BACKGROUND: While transnational migration has been shown to be a risk factor for schizophrenia, studies have not examined whether massive internal rural-to-urban migration in China in recent years has increased the risk of hospitalization for schizophrenia, or schizophrenia symptom severity among migrants. METHOD: In a sample of patients acutely hospitalized with schizophrenia in Changsha, Hunan Province, China (N=334), the proportion of past migrant workers among patients was compared to the proportion of past migrant workers in the general adult population of Hunan. Past migrants were also compared to non-migrants on age of onset, and on symptom severity using the Positive and Negative Syndrome Scale (PANSS). The risk ratio for being a migrant among those hospitalized for schizophrenia was stratified by age and gender subgroups. Multiple regression analysis was used to evaluate group differences in age of onset and symptoms. RESULTS: Of 334 patients diagnosed with schizophrenia hospitalized for <180days, 150 (44.9%) were identified as having been migrant workers compared to 31.0% in the general adult population of Hunan for a risk ratio of 1.45, a risk that was higher for women (2.19) than for men (1.09). Migrant workers also had higher scores than others on total PANSS symptoms. CONCLUSION: Migrant workers appear to be at greater risk of hospitalization for schizophrenia than other residents of Hunan and showed more severe psychopathology. These findings may reflect specific lack of health insurance coverage for workers migrating to non-native provinces in China, thereby delaying access to treatment.
BACKGROUND: While transnational migration has been shown to be a risk factor for schizophrenia, studies have not examined whether massive internal rural-to-urban migration in China in recent years has increased the risk of hospitalization for schizophrenia, or schizophrenia symptom severity among migrants. METHOD: In a sample of patients acutely hospitalized with schizophrenia in Changsha, Hunan Province, China (N=334), the proportion of past migrant workers among patients was compared to the proportion of past migrant workers in the general adult population of Hunan. Past migrants were also compared to non-migrants on age of onset, and on symptom severity using the Positive and Negative Syndrome Scale (PANSS). The risk ratio for being a migrant among those hospitalized for schizophrenia was stratified by age and gender subgroups. Multiple regression analysis was used to evaluate group differences in age of onset and symptoms. RESULTS: Of 334 patients diagnosed with schizophrenia hospitalized for <180days, 150 (44.9%) were identified as having been migrant workers compared to 31.0% in the general adult population of Hunan for a risk ratio of 1.45, a risk that was higher for women (2.19) than for men (1.09). Migrant workers also had higher scores than others on total PANSS symptoms. CONCLUSION: Migrant workers appear to be at greater risk of hospitalization for schizophrenia than other residents of Hunan and showed more severe psychopathology. These findings may reflect specific lack of health insurance coverage for workers migrating to non-native provinces in China, thereby delaying access to treatment.