Not all migrants are the same: geographic origin and long-term outcomes after first-episode psychosis—a retrospective cohort study

Background Migration is a well-established risk factor for psychosis, yet limited research has examined long-term clinical trajectories following first-episode psychosis (FEP) in migrant populations within Southern European settings. This study investigates how country of origin and time since migration influence psychiatric outcomes in a naturalistic FEP cohort. Methods A 5-year longitudinal study was conducted on 184 patients with FEP attending the Early Intervention Service from Hospital Universitari de Mataró. Patients were grouped by geographic origin (Spanish, Latin American, Maghrebi, Sub-Saharan) and migration recency (≤5 years vs . >5 years). Primary outcomes included treatment adherence, use of long-acting injectable (LAI) antipsychotics, relapse, and service disengagement. Logistic regression and survival analyses were used to identify associations. Results Maghrebi origin was associated with lower treatment adherence (OR = 0.32, 95% CI [0.12–0.89], p = 0.030). In time-to-event analyses, Maghrebi patients showed a higher hazard of service disengagement compared with Spanish-born patients (HR = 2.42, 95% CI [1.10–5.34], p = 0. 028). Recent migrants (≤5 years in Spain) also had a significantly increased hazard of disengagement (HR = 2.89, 95% CI [1.30–6.40], p = 0.009). Sub-Saharan origin was strongly associated with earlier initiation of long-acting injectable antipsychotics (HR = 3.40, 95% CI [1.58–7.32], p = 0.002), alongside higher overall odds of LAI use. No significant differences were observed in relapse rates across groups. Conclusions Both migrant origin and recent arrival were associated with differences in psychiatric care trajectories following FEP. These findings highlight the need to consider adaptation of treatment approaches for migrant populations according to their origin and migration context in order to improve long-term outcomes.