LAUSR

According to a recent meta-analysis, immigrants had significantly greater odds of having psychotic disorder than their native-born counterparts (pooled incidence rate ratio: 3.09; 95% CI: 2.74–3.49) (Castillejos, Martín-Pérez, & Moreno-Küstner, 2018). Selten and colleagues’ (Selten, van der Ven, & Termorshuizen, 2020) own meta-analysis bolstered this association, by showing that migrants were at increased risk of developing affective and non-affective psychotic disorders, albeit with heterogeneous results by country. At the same time, a large multi-country study found that incidence rates of psychotic disorders vary significantly depending on where immigrants come from and where they settle (Termorshuizen et al., 2020). Most of the studies included in Selten and colleagues’ meta-analysis were conducted in Europe, and the authors rightly pointed out that there has been an absence of studies showing increased risk among migrants to the United States. In fact, immigrants in the United States often exhibit a health advantage (immigrant paradox, also referred to as the Hispanic/Latino paradox; Ruiz, Hamann, Mehl, & O’Connor, 2016). This is possibly due to the selection of healthy or resilient people who have the means and resources to complete what can be an arduous and complicated journey. It is also possible that unhealthy individuals return back to their countries of origin, what is known as ’salmon bias’ (Abraido-Lanza Dohrenwend, Ng-Mak, & Turner, 1999). And yet another possibility is that cultural aspects of one’s heritage (e.g. diet) may protect against health problems (Abraido-Lanza, Chao, & Flórez, 2005). Indeed, having a strong ethnic identity and sense of ethnic community can buffer the deleterious effects of social stressors that lead to health problems (Mossakowski, 2003; Mossakowski, Wongkaren, Hill, & Johnson, 2019; Wei, Wang, Heppner, & Du, 2012). All in all, much depends on the ‘push and pull factors’ of migration, namely where immigrants come from, the circumstances surrounding their departure and their journey, and where they ultimately settle in the host country (Schwartz, Unger, Zamboanga, & Szapocznik, 2010, Schwartz et al., 2014). Still, there is some question as to whether or not the immigrant health advantage observed in the United States extends to psychosis. At most we have evidence that the association between migration and psychosis observed in Europe may not hold true in the United States. For instance, one prior study found no statistically significant associations between immigration and psychotic experiences among White, Black, Latinx, and Asian Americans (Oh, Abe, Negi, & DeVylder, 2015). Granted, prior meta-analyses have tended to focus on psychotic disorders; however, examining subthreshold psychotic experiences has also been informative given their prevalence and their associations to negative health outcomes. We sought to re-test the association between immigration status and psychotic experiences using data from the RAND American Life Panel (N = 2554), which is nationally representative of adults (aged 18 and older) residing in the general population of the United States. Given our focus on psychotic experiences, we dropped 10 respondents who self-reported lifetime schizophrenia from our analyses. The majority of the weighted sample was born in the United States (91.16%, N = 2321). Approximately 17.29% (N = 440) of the sample reported a lifetime psychotic experience, with a slightly higher prevalence among US-born respondents (17.54%; N = 407) when compared with foreign-born respondents (14.67%; N = 33), though this difference was not statistically significant (F-statistic: 1.22; p = 0.27). Approximately 26.17% (N = 635) of the sample had a mental or substance use disorder. Using multivariable logistic regression, we found that immigrant status was significantly associated with lower odds of having lifetime psychotic experience, adjusting for sociodemographic characteristics (model 1). In other words, US-born respondents were 1.54 times as likely to have a lifetime psychotic experience than their foreign-born counterparts (aOR: 1.54; 95% CI: 1.02–2.33). However, this association attenuated and lost significance when additionally controlling for mental health and substance use disorders (model 2). [Table 1] While this analysis comports with previous null findings (Oh et al., 2015), the results again prompt us to consider why immigration is widely shown to be a risk factor for psychosis in