Does depression diagnosis and antidepressant prescribing vary by location? Analysis of ethnic density associations using a large primary-care dataset

BackgroundStudies have linked ethnic differences in depression rates with neighbourhood ethnic density although results have not been conclusive. We looked at this using a novel approach analysing whole population data covering just over one million GP patients in four London boroughs.MethodUsing a dataset of GP records for all patients registered in Lambeth, Hackney, Tower Hamlets and Newham in 2013 we investigated new diagnoses of depression and antidepressant use for: Indian, Pakistani, Bangladeshi, black Caribbean and black African patients. Neighbourhood effects were assessed independently of GP practice using a cross-classified multilevel model.ResultsBlack and minority ethnic groups are up to four times less likely to be newly diagnosed with depression or prescribed antidepressants compared to white British patients. We found an inverse relationship between neighbourhood ethnic density and new depression diagnosis for some groups, where an increase of 10% own-ethnic density was associated with a statistically significant (p < 0.05) reduced odds of depression for Pakistani [odds ratio (OR) 0.81, 95% confidence interval (CI) 0.70–0.93], Indian (OR 0.88, CI 0.81–0.95), African (OR 0.88, CI 0.78–0.99) and Bangladeshi (OR 0.94, CI 0.90–0.99) patients. Black Caribbean patients, however, showed the opposite effect (OR 1.26, CI 1.09–1.46). The results for antidepressant use were very similar although the corresponding effect for black Caribbeans was no longer statistically significant (p = 0.07).ConclusionNew depression diagnosis and antidepressant use was shown to be less likely in areas of higher own-ethnic density for some, but not all, ethnic groups.

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The ‘Count Me In’ psychiatric in-patient census for 2007 and the elderly: evidence of improvement or cause for concern?

Psychiatric Bulletin ◽

10.1192/pb.bp.108.023457 ◽

2009 ◽

Vol 33 (6) ◽

pp. 201-203 ◽

Cited By ~ 3

Author(s):

Ajit Shah

Keyword(s):

Length Of Stay ◽

Ethnic Groups ◽

The Elderly ◽

Institutional Racism ◽

Bed Occupancy ◽

Black African ◽

Admission Rates ◽

Minority Ethnic Groups ◽

Black Caribbean ◽

Minority Ethnic

SummaryThe recently published Count Me In 2007 census specifically reported age-standardised admission rates for individuals aged over 65 years from different Black and minority ethnic groups. the standardised admission ratio was higher in the White Irish, other White, White and Black Caribbean, other Asian, Black Caribbean, Black African and other Black ethnic groups; and lower in the White British and Chinese ethnic groups. As this census was undertaken on a single day for all psychiatric in-patients, it measured bed occupancy rather than admission rates and so it was actually referring to standardised bed occupancy ratios. Bed occupancy is a function of admission rates and length of stay. This editorial critically explores factors (including those related to institutional racism) that may affect both admission rates and length of stay, and ultimately bed occupancy, of Black and minority ethnic elders.

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Black, Asian and Minority Ethnic groups in England are at increased risk of death from COVID-19: indirect standardisation of NHS mortality data

Wellcome Open Research ◽

10.12688/wellcomeopenres.15922.1 ◽

2020 ◽

Vol 5 ◽

pp. 88 ◽

Cited By ~ 12

Author(s):

Robert W. Aldridge ◽

Dan Lewer ◽

Srinivasa Vittal Katikireddi ◽

Rohini Mathur ◽

Neha Pathak ◽

...

Keyword(s):

Ethnic Groups ◽

Geographical Region ◽

Mortality Data ◽

Black African ◽

Risk Of Death ◽

Occupational Risks ◽

Minority Ethnic Groups ◽

Black Caribbean ◽

Increased Risk ◽

Minority Ethnic

Background: International and UK data suggest that Black, Asian and Minority Ethnic (BAME) groups are at increased risk of infection and death from COVID-19. We aimed to explore the risk of death in minority ethnic groups in England using data reported by NHS England. Methods: We used NHS data on patients with a positive COVID-19 test who died in hospitals in England published on 28th April, with deaths by ethnicity available from 1st March 2020 up to 5pm on 21 April 2020. We undertook indirect standardisation of these data (using the whole population of England as the reference) to produce ethnic specific standardised mortality ratios (SMRs) adjusted for age and geographical region. Results: The largest total number of deaths in minority ethnic groups were Indian (492 deaths) and Black Caribbean (460 deaths) groups. Adjusting for region we found a lower risk of death for White Irish (SMR 0.52; 95%CIs 0.45-0.60) and White British ethnic groups (0.88; 95%CIs 0.86-0.0.89), but increased risk of death for Black African (3.24; 95%CIs 2.90-3.62), Black Caribbean (2.21; 95%CIs 2.02-2.41), Pakistani (3.29; 95%CIs 2.96-3.64), Bangladeshi (2.41; 95%CIs 1.98-2.91) and Indian (1.70; 95%CIs 1.56-1.85) minority ethnic groups. Conclusion: Our analysis adds to the evidence that BAME people are at increased risk of death from COVID-19 even after adjusting for geographical region. We believe there is an urgent need to take action to reduce the risk of death for BAME groups and better understand why some ethnic groups experience greater risk. Actions that are likely to reduce these inequities include ensuring adequate income protection (so that low paid and zero-hours contract workers can afford to follow social distancing recommendations), reducing occupational risks (such as ensuring adequate personal protective equipment), reducing barriers in accessing healthcare and providing culturally and linguistically appropriate public health communications.

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Black, Asian and Minority Ethnic groups in England are at increased risk of death from COVID-19: indirect standardisation of NHS mortality data

Wellcome Open Research ◽

10.12688/wellcomeopenres.15922.2 ◽

2020 ◽

Vol 5 ◽

pp. 88 ◽

Cited By ~ 62

Author(s):

Robert W. Aldridge ◽

Dan Lewer ◽

Srinivasa Vittal Katikireddi ◽

Rohini Mathur ◽

Neha Pathak ◽

...

Keyword(s):

Ethnic Groups ◽

Geographical Region ◽

Mortality Data ◽

Black African ◽

Risk Of Death ◽

Occupational Risks ◽

Minority Ethnic Groups ◽

Black Caribbean ◽

Increased Risk ◽

Minority Ethnic

Background: International and UK data suggest that Black, Asian and Minority Ethnic (BAME) groups are at increased risk of infection and death from COVID-19. We aimed to explore the risk of death in minority ethnic groups in England using data reported by NHS England. Methods: We used NHS data on patients with a positive COVID-19 test who died in hospitals in England published on 28th April, with deaths by ethnicity available from 1st March 2020 up to 5pm on 21 April 2020. We undertook indirect standardisation of these data (using the whole population of England as the reference) to produce ethnic specific standardised mortality ratios (SMRs) adjusted for age and geographical region. Results: The largest total number of deaths in minority ethnic groups were Indian (492 deaths) and Black Caribbean (460 deaths) groups. Adjusting for region we found a lower risk of death for White Irish (SMR 0.52; 95%CIs 0.45-0.60) and White British ethnic groups (0.88; 95%CIs 0.86-0.0.89), but increased risk of death for Black African (3.24; 95%CIs 2.90-3.62), Black Caribbean (2.21; 95%CIs 2.02-2.41), Pakistani (3.29; 95%CIs 2.96-3.64), Bangladeshi (2.41; 95%CIs 1.98-2.91) and Indian (1.70; 95%CIs 1.56-1.85) minority ethnic groups. Conclusion: Our analysis adds to the evidence that BAME people are at increased risk of death from COVID-19 even after adjusting for geographical region, but was limited by the lack of data on deaths outside of NHS settings and ethnicity denominator data being based on the 2011 census. Despite these limitations, we believe there is an urgent need to take action to reduce the risk of death for BAME groups and better understand why some ethnic groups experience greater risk. Actions that are likely to reduce these inequities include ensuring adequate income protection, reducing occupational risks, reducing barriers in accessing healthcare and providing culturally and linguistically appropriate public health communications.

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Breast cancer screening uptake among women from different ethnic groups in London: a population-based cohort study

BMJ Open ◽

10.1136/bmjopen-2014-005586 ◽

2014 ◽

Vol 4 (10) ◽

pp. e005586 ◽

Cited By ~ 18

Author(s):

Ruth H Jack ◽

Henrik Møller ◽

Tony Robson ◽

Elizabeth A Davies

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Ethnic Groups ◽

Breast Cancer Screening ◽

Population Based ◽

African Women ◽

Black African ◽

Screening Uptake ◽

Black And White ◽

Black Caribbean

ObjectiveTo use newly available self-assigned ethnicity information to investigate variation in breast cancer screening uptake for women from the 16 specific ethnic groups within the broad Asian, Black and White groups that previous studies report.SettingNational cancer screening programme services within London.Participants655 516 female residents aged 50–69, invited for screening between March 2006 and December 2009. Ethnicity information was available for 475 478 (72.5%). White British women were the largest group (306 689, 46.8%), followed by Indian (34 687, 5.3%), White Other (30 053, 4.6%), Black Caribbean (25 607, 3.9%), White Irish (17 271, 2.6%), Black African (17 071, 2.6%) and Asian Other (10 579, 1.6%).Outcome measuresUptake for women in different ethnic groups aged 50–52 for a first call invitation to the programme, and for women aged 50–69 for a routine recall invitation after a previous mammography. Uptake is reported (1) for London overall, adjusted using logistic regression, for age at invitation, socioeconomic deprivation and geographical screening area, and (2) for individual areas, adjusted for age and deprivation.ResultsWhite British women attended their first call (67%) and routine recall (78%) invitations most often. Indian women were more likely to attend their first (61%) or routine recall (74%) than Bangladeshi women (43% and 61%, respectively), and Black Caribbean women were more likely than Black African women to attend first call (63% vs 49%, respectively) and routine recall (74% vs 64%, respectively). There was less variation between ethnic groups in some screening areas.ConclusionsBreast cancer screening uptake in London varies by specific ethnic group for first and subsequent invitations, with White British women being more likely to attend. The variation in the uptake for women from the same ethnic groups in different geographical areas suggests that collaboration about the successful engagement of services with different communities could improve uptake for all women.

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Criminal justice pathways to psychiatric care for psychosis

The British Journal of Psychiatry ◽

10.1192/bjp.bp.114.153882 ◽

2015 ◽

Vol 207 (6) ◽

pp. 523-529 ◽

Cited By ~ 12

Author(s):

Kamaldeep Bhui ◽

Simone Ullrich ◽

Constantinos Kallis ◽

Jeremy W. Coid

Keyword(s):

Criminal Justice ◽

Drug Use ◽

Psychiatric Care ◽

Care Pathway ◽

Population Based ◽

First Episode ◽

Black African ◽

Black Caribbean ◽

African Patients ◽

First Contact

BackgroundSome patients are at higher risk of contact with criminal justice agencies when experiencing a first episode of psychosis.AimsTo investigate whether violence explains criminal justice pathways (CJPs) for psychosis in general, and ethnic vulnerability to CJPs.MethodTwo-year population-based survey of people presenting with a first-episode of psychosis. A total of 481 patients provided information on pathways to psychiatric care. The main outcome was a CJP at first contact compared with other services on the care pathway.ResultsCJPs were more common if there was violence at first presentation (odds ratio (OR) = 4.23, 95% CI 2.74–6.54, P<0.001), drug use in the previous year (OR = 2.28, 95% CI 1.50–3.48, P<0.001) and for high psychopathy scores (OR = 2.54, 95% CI 1.43–4.53, P = 0.002). Compared with White British, CJPs were more common among Black Caribbean (OR = 2.97, 95% CI 1.54–5.72, P<0.001) and Black African patients (OR = 1.95, 95% CI 1.02–3.72, P = 0.01). Violence mediated 30.2% of the association for Black Caribbeans, but was not a mediator for Black African patients. These findings were sustained after adjustment for age, marital status, gender and employment.ConclusionsCJPs were more common in violent presentations, for greater psychopathy levels and drug use. Violence presentations did not fully explain ethnic vulnerability to CJPs.

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Associations of dietary intake with cardiometabolic risk in a multi-ethnic cohort: a longitudinal analysis of the Determinants of Adolescence, now young Adults, Social well-being and Health (DASH) study

British Journal Of Nutrition ◽

10.1017/s0007114519000291 ◽

2019 ◽

Vol 121 (09) ◽

pp. 1069-1079

Author(s):

Louise M. Goff ◽

Peiyuan Huang ◽

Maria J. Silva ◽

Claire Bordoli ◽

Elli Z. Enayat ◽

...

Keyword(s):

Dietary Intake ◽

Ethnic Groups ◽

Young Adulthood ◽

Cardiometabolic Risk ◽

Well Being ◽

Dietary Behaviour ◽

Black African ◽

Dietary Behaviours ◽

Black Caribbean ◽

Skipping Breakfast

AbstractUnfavourable dietary habits, such as skipping breakfast, are common among ethnic minority children and may contribute to inequalities in cardiometabolic disease. We conducted a longitudinal follow-up of a subsample of the UK multi-ethnic Determinants of Adolescent Social well-being and Health cohort, which represents the main UK ethnic groups and is now aged 21–23 years. We aimed to describe longitudinal patterns of dietary intake and investigate their impact on cardiometabolic risk in young adulthood. Participants completed a dietary behaviour questionnaire and a 24 h dietary intake recall; anthropometry, blood pressure, total cholesterol and HDL-cholesterol and HbA1c were measured. The cohort consisted of 107 White British, 102 Black Caribbean, 132 Black African, 98 Indian, 111 Bangladeshi/Pakistani and 115 other/mixed ethnicity. Unhealthful dietary behaviours such as skipping breakfast and low intake of fruits and vegetables were common (56, 57 and 63 %, respectively). Rates of skipping breakfast and low fruit and vegetable consumption were highest among Black African and Black Caribbean participants. BMI and cholesterol levels at 21–23 years were higher among those who regularly skipped breakfast at 11–13 years (BMI 1·41 (95 % CI 0·57, 2·26), P=0·001; cholesterol 0·15 (95 % CI –0·01, 0·31), P=0·063) and at 21–23 years (BMI 1·05 (95 % CI 0·22, 1·89), P=0·014; cholesterol 0·22 (95 % CI 0·06, 0·37), P=0·007). Childhood breakfast skipping is more common in certain ethnic groups and is associated with cardiometabolic risk factors in young adulthood. Our findings highlight the importance of targeting interventions to improve dietary behaviours such as breakfast consumption at specific population groups.

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Influence of weaning timing advice and associated weaning behaviours in a survey of black and minority ethnic groups in the UK

Public Health Nutrition ◽

10.1017/s1368980013002383 ◽

2013 ◽

Vol 17 (9) ◽

pp. 2094-2103 ◽

Cited By ~ 2

Author(s):

Amanda P Moore ◽

Kristina Nanthagopan ◽

Grace Hammond ◽

Peter Milligan ◽

Louise M Goff

Keyword(s):

Infant Feeding ◽

South Asian ◽

South Asians ◽

Black African ◽

Department Of Health ◽

Minority Ethnic Groups ◽

Black Caribbean ◽

African Black ◽

The Uk ◽

Minority Ethnic

AbstractObjectiveTo assess understanding of the Department of Health weaning guidelines and weaning influences in a self-selected sample of black and minority ethnic (BME) parents, residing in London.DesignA face-to-face, questionnaire-facilitated survey among Black African, Black Caribbean and South Asian parents.SettingAn opportunistic sample of parents was recruited from Sure Start centres, churches and play groups across key London boroughs.SubjectsThree hundred and forty-nine interviews were included; 107 Black African, fifty-four Black Caribbean, 120 South Asian and sixty-four of Black mixed-race ethnicity.ResultsFifty-two per cent of Black and 66 % of South Asian parents had accurate understanding of the guidelines. Inaccurate knowledge of the guidelines was associated with weaning before 17 weeks (P < 0·001); 36 % of Black Africans and 31 % of Black Caribbeans were weaned before 4 months compared with 16 % of South Asians. All BME groups were most influenced by weaning information from the previous generations of mothers in their families, which was associated with earlier weaning (21·5 (sd 6·5) v. 24·1 (sd 4·2) weeks; F(2,328) = 5·79, P = 0·003), and less so by professional infant feeding advice, which was associated with a later weaning age (23·7 (sd 5·1) v. 20·7 (sd 5·7) weeks; F(1,344) = 34·7, P < 0·001).ConclusionsLack of awareness of the Department of Health weaning guidelines is common among these BME populations, whose weaning behaviour is strongly influenced by informal advice. Further research is necessary to elucidate the influences on weaning in these populations and to facilitate the development of infant feeding support which is salient for BME groups in the UK.

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Ethnic density as a buffer for psychotic experiences: findings from a national survey (EMPIRIC)

The British Journal of Psychiatry ◽

10.1192/bjp.bp.111.102376 ◽

2012 ◽

Vol 201 (4) ◽

pp. 282-290 ◽

Cited By ~ 65

Author(s):

Jayati Das-Munshi ◽

Laia Bécares ◽

Jane E. Boydell ◽

Michael E. Dewey ◽

Craig Morgan ◽

...

Keyword(s):

Ethnic Groups ◽

Social Risk ◽

Psychotic Experiences ◽

Social Risk Factors ◽

Ethnic Density ◽

Point Reduction ◽

Minority Ethnic Groups ◽

Increased Risk ◽

Group Density ◽

Minority Ethnic

BackgroundAetiological mechanisms underlying ethnic density associations with psychosis remain unclear.AimsTo assess potential mechanisms underlying the observation that minority ethnic groups experience an increased risk of psychosis when living in neighbourhoods of lower own-group density.MethodMultilevel analysis of nationally representative community-level data (from the Ethnic Minorities Psychiatric Illness Rates in the Community survey), which included the main minority ethnic groups living in England, and a White British group. Structured instruments assessed discrimination, chronic strains and social support. The Psychosis Screening Questionnaire ascertained psychotic experiences.ResultsFor every ten percentage point reduction in own-group density, the relative odds of reporting psychotic experiences increased 1.07 times (95% CI 1.01–1.14, P = 0.03 (trend)) for the total minority ethnic sample. In general, people living in areas of lower own-group density experienced greater social adversity that was in turn associated with reporting psychotic experiences.ConclusionsPeople resident in neighbourhoods of higher own-group density experience ‘buffering’ effects from the social risk factors for psychosis.

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Does the ethnic density effect extend to obesity? A cross-sectional study of 415 166 adults in east London

BMJ Open ◽

10.1136/bmjopen-2018-024779 ◽

2019 ◽

Vol 9 (5) ◽

pp. e024779 ◽

Cited By ~ 2

Author(s):

Shailen Sutaria ◽

Rohini Mathur ◽

Sally A Hull

Keyword(s):

Primary Care ◽

Ethnic Group ◽

Ethnic Groups ◽

Cross Sectional Study ◽

Obesity Prevalence ◽

Sectional Study ◽

Ethnic Density ◽

Cross Sectional ◽

Black African ◽

Prevalence Of Obesity

ObjectivesTo examine the prevalence of obesity by ethnic group and to examine the association between ethnic density and obesity prevalence.Design and settingCross-sectional study utilising electronic primary care records of 128 practices in a multiethnic population of east London.ParticipantsElectronic primary care records of 415 166 adults with a body mass index recorded in the previous 3 years.Outcome measures(1) Odds of obesity for different ethnic groups compared with white British. (2) Prevalence of obesity associated with each 10% increase in own-group ethnic density, by ethnic group.ResultsUsing multilevel logistic regression models, we find that compared with white British/Irish males, the odds of obesity were significantly higher among black ethnic groups and significantly lower among Asian and white other groups. Among females, all ethnic groups except Chinese and white other were at increased odds of obesity compared with white British/Irish. There was no association between increasing ethnic density and obesity prevalence, except among black Africans and Indian females. A 10% increase in black ethnic density was associated with a 15% increase in odds of obesity among black African males (95% CI 1.07 to 1.24) and 18% among black African females (95% CI 1.08 to 1.30). Among Indian females, a 10% increase in Indian ethnic density was associated with a 7% decrease in odds of obesity (95% CI 0.88 to 0.99).ConclusionWider environmental factors play a greater role in determining obesity than the ethnic composition of the area for most ethnic groups. Further research is needed to understand the mechanism through which increasing ethnic density is associated with increased odds of obesity among black Africans and decreased odds of obesity among Indian females.

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Integration between primary and secondary services in the care of the severely mentally ill: patients' and general practitioners' views

The British Journal of Psychiatry ◽

10.1192/bjp.171.2.169 ◽

1997 ◽

Vol 171 (2) ◽

pp. 169-174 ◽

Cited By ~ 59

Author(s):

Jonathan Bindman ◽

Sonia Johnson ◽

Steve Wright ◽

George Szmukler ◽

Paul Bebbington ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Health Care ◽

General Practitioners ◽

Mentally Ill ◽

Black African ◽

Severely Mentally Ill ◽

Black Caribbean ◽

African Patients ◽

Physical Care

BackgroundCommunication between secondary and primary care is an important aspect of continuity of care. We investigated communication between general practitioners (GPs) and psychiatric teams about a representative group of patients with severe mental illness (SMI). We also sought views on GP involvement in care from the patients and their GPs.MethodsOne hundred patients with SMI were randomly selected from those under the care of two psychiatric sector teams in inner London. The patients and their GPs were interviewed.ResultsGPs' knowledge about the care their patients received was limited. Most GPs perceived their role as providing physical care and prescribing. Few patients consulted GPs for mental health care. GPs perceived themselves as less involved in the care of Black Caribbean or Black African patients.ConclusionsConsiderable discontinuities of care between secondary and primary care were identified. GP involvement in the care of patients with SMI appears limited. Better communication is necessary if care is to be shared.

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