Addressing Migration Stigma in Latin America Using Mental Health Registry-Based Data

Abstract

Latin America is currently experiencing one of the largest migration flows in its history, involving individuals migrating from, within and into the region. For example, over 7.7 million people have fled Venezuela since 2014, with more than 6.5 million now hosted in Latin American and Caribbean countries [1]. Economic collapse, political instability, increased crime and violence all contribute to increases in migration [2]. This mass movement of people has become a critical social determinant of health in the region. Migration can be both a cause and consequence of severe stressors -including poverty, overcrowding, disrupted social networks and loss of fundamental resources like housing and employment -that adversely affect mental health. Critically, migration status itself often (but not always) becomes a stigmatizing label that elicits a host of stigmatizing consequences. Stigma is known to severely undermine mental health outcomes by creating barriers to care, social support, and recovery [3]. In the context of early psychosis -a time-limited window where prompt intervention can improve long-term outcomes -such barriers can be especially detrimental. In Latin America, where mental healthcare systems are still expanding, addressing both migration-related stigma and psychosis is urgent.Researchers have coined the term "migration stigma," which highlights how migrants are broadly labeled with undesirable characteristics, such as being dangerous or engaged in criminal activities. Yang et al. [4] describe a process whereby being labeled "migrant" triggers stereotyping, social "othering," and discrimination, resulting in loss of social status in the receiving society. Structural stigma can arise when laws or policies treat migrants as second-class (e.g. restricting their access to health services) . Immigrants may also internalize negative societal messages and avoid seeking health or social services due to shame or fear [4] . Although this concept is grounded with examples from the U.S. and Europe, similar processes occur in Latin America, where powerful nationalist or xenophobic rhetoric increasingly frames migrants as burdens or outsiders.Intersectionality theory reminds us that stigma is often multi-layered and multi-level.Migrants in Latin America may also face racism or sexism depending on their phenotype (e.g., skin color), ethnicity, language, or gender. A recent study found that migrants' experiences are shaped by intersecting axes of power. Socio-economic status, legal status, gender, and race/phenotype all combine to affect access to health and mental health care [5] . In practice, this means that a female, undocumented Haitian migrant with limited education may experience stigma differently than a male migrant with legal status and with local language fluency. Overall, these frameworks show that migration-related stigma in mental health is a process of structural discrimination, public attitudes, and internalized fear, and often intersects with other social inequalities.There is a robust global literature showing that migrants (and their children) have higher incidence of psychotic disorders than host populations, although most research has been conducted in Europe or North America. Large meta-analyses indicate that migrants are on average about twice as likely to develop schizophrenia or related psychoses [6]. This elevated risk is thought to be driven largely by social determinants, including social adversity, discrimination, and the stress of migration [7]. These issues have relevance worldwide. For instance, a Swedish national cohort found that migrants living in neighborhoods with fewer co-ethnics had higher risk of non-affective psychosis [8]. Specifically, each 5% decrease in "own-region" migrant density was associated with a 5% higher hazard of psychosis in first-and second-generation migrants [8].How does this relate to Latin America? Latin America has its own migration dynamicsincluding rural-to-urban migration, internal displacement, and flows from within the region (e.g.Haitians, Cubans, Venezuelans to higher income Latin American settings). Research on migration and psychosis in Latin America is sparse, but what does exist suggests similar patterns of vulnerability. For example, in Chile -which has become a significant destination country -migrants show worse mental health outcomes than the native-born population [9].Qualitative research in the region also notes high rates of trauma, stress, and discrimination among migrants, all of which can precipitate or worsen psychotic symptoms [10]. Moreover, the UN Refugee Agency has found that increasing competition for jobs and limited access to public services have led to cases of discrimination and xenophobia towards Venezuelan migrants in South America [1]. Such hostile environments are likely to heighten stress and marginalization for migrants at risk for emerging psychosis.One promising avenue is to harness registry-based data for mental health research [11].High-income countries in Scandinavia and the UK have long used administrative registeries (e.g. birth, health, migration registers) to study psychiatric disorders in entire populations, including migrants. These data allow researchers to link an individual's migration background to their mental health diagnoses and service use over time. Latin America is now beginning to build similar capacities. For example, the Chilean Registries, which contain records for approximately 95% of the entire Chilean population including migrants, offer reliable, population-level documentation on a range of social determinants of health related to migrant status and clinical indicators. These registries include the only national registry of individuals with FEP worldwide, providing the opportunity to examine the association of migrant status and other social determinants with illness onset, progression, and continuity of care for individuals with psychosis. It also documents mental health service access, recording details such as predominant use of crisis intervention (e.g., emergency room visits or psychiatric hospitalization) during the FEP versus earlier modes of detection (e.g., in primary care) --thus providing researchers valuable data to plan better intervention services for migrant health.Chile's National FEP Registry, which includes information on migrants and their countries of origin, captures at which level of care individuals with FEP are first identified (e.g. primary, secondary [specialized services], or tertiary [hospitals and emergency services])--and enables investigations concerning the confluence of migration status and other social determinants on individuals with FEP on the regional level in Chile. This information can provide valuable insight into the populations and sites where future assessments of stigma at individual and structural-levels and other barriers are most needed to decrease treatment delays. In unpublished work from our group, we found migrants with FEP were more likely than Chilean nationals to be identified in hospital and emergency settings. That migrants with FEP are more likely to access care during acute crises suggest substantial barriers and prolonged duration of untreated psychosis, highlighting the need for culturally targeted interventions, grounded in the migration stigma framework, to facilitate earlier engagement with care.Brazil also offers opportunities for research into migration stigma, such as the 100 Million Brazilian Cohort, created by the government, which links the national social-protection registry (Cadastro Único) with mortality, hospital, infectious-disease and birth databases for >130 million low-income residents, allowing researchers to flag both international migrants (country-of-birth field) and internal migrants and to follow mental-health outcomes and service use across the life-course [12]. Elsewhere, Colombia's integrated health-information platform SISPRO unifies hospital, outpatient and insurance claims and records patient nationality in the Individual Service Registry, enabling analyses of service use and psychiatric admissions among migrants versus locals [13]. Finally, PAHO's regional R4V Health & Psychosocial Support dashboard collates standardized clinic-level data on refugee and migrant consultations (diagnosis, service type, nationality) from 17 Latin-American countries, illustrating that even where full-population registries are just emerging, pragmatic surveillance systems already capture migrant mental-health encounters at scale [14].Thus, a registry-based approach could quantify what is currently anecdotal: the mental health disparities faced by migrants. The high-dimensional nature of the data would allow assessment of potential effect modifiers over time (e.g., social deprivation, access to services), and testing of hypotheses derived from stigma theory. Importantly, registries can assess impacts of reducing structural stigma: for instance, by evaluating the impact of a policy change (such as granting legal residency) on mental health service usage among migrants. In Europe, longitudinal registers revealed that when migrant-dense communities provided social support, psychosis risk dropped. Latin American registries could be used similarly, to evaluate whether anti-discrimination laws or regional-level programs have measurable effects [8].Understanding migration stigma in early psychosis has clear policy relevance. PAHO emphasizes the integration of migrant health needs into national policies, and PAHO offers toolboxes for Mental Health and Psychosocial Support (MHPSS) in migration crises [14].However, mental health is often overlooked in migration policy. For instance, while some countries (like Chile) have implemented standard programs to document migrants' health and grant access to services [1], there may be few specific provisions for mental health care.Mexico's General Health Law (2012) and Mental Health Law (2017) enshrine the right to mental health care for everyone, but implementation for migrants remains inconsistent. Brazil's successful "Psychosocial Law" and network of community mental health centers have expanded access, but they too must be adapted to culturally diverse migrants and overcome xenophobic attitudes.At the health system level, it is essential to raise providers' competence in addressing social determinants of health and stigma related to migration. Interventions could include training clinicians in migrant trauma caused by dislocation, anti-bias workshops, and community outreach in migrant neighborhoods. Registry findings could inform such efforts: if data show, for example, that migrants enter care later in the course of illness or more often involuntarily (as seen in some European studies of migrants with psychosis) [15], targeted policies could be devised (e.g. outreach by early psychosis teams in immigrant communities). Additionally, public anti-stigma campaigns in Latin America have largely focused on psychiatric illness among nationals; campaigns should explicitly include migrants' experiences and emphasize shared humanity.Finally, legal and social policies matter. Restrictive migration laws and hostile public discourse create structural stigma. Latin American governments can mitigate this by protecting migrants' rights, promoting inclusive narratives, and ensuring equal access to housing, work, and health. For example, Colombia's 2018 special statute for Venezuelan migrants granted temporary legal status and health coverage; evaluating its impact on mental health via registries would be informative. On a broader scale, aligning national mental health strategies with international commitments (e.g. the UN Global Compact for Migration) can ensure that migrants' mental health is a planning priority.In sum, addressing migration stigma in early psychosis in Latin America requires both deepening our theoretical understanding of stigma and building better evidence leveraging resources such as population-based registries whenever available. Empirical examples make clear that migrants experience multi-faceted and multi-level discrimination that can derail mental health. Integrating registry-based data with inclusive health policies and multi-level anti-stigma interventions will be essential to ensure that migrants with early psychosis receive timely, equitable care. Only with high-quality data and targeted policies can the region overcome multi-faceted forms of migration stigma and provide needed multi-level policies and community resources for its most vulnerable patients. By investing on these promising initiatives, strengthening cross-country collaboration, and embedding migrant perspectives in policy design, the region can take pragmatic steps toward more timely, culturally responsive care for migrants with emerging psychosis-signaling a feasible, hopeful path forward.