Perceptions of disadvantage, ethnicity and psychosis

BackgroundPeople from Black ethnic groups (African-Caribbean and Black African) are more prone to develop psychosis in Western countries. This excess might be explained by perceptions of disadvantage.AimsTo investigate whether the higher incidence of psychosis in Black people is mediated by perceptions of disadvantage.MethodA population-based incidence and case-control study of first-episode psychosis (Aetiology and Ethnicity in Schizophrenia and Other Psychoses (ÆSOP)). A total of 482 participants answered questions about perceived disadvantage.ResultsBlack ethnic groups had a higher incidence of psychosis (OR=4.7, 95% CI 3.1–7.2). After controlling for religious affiliation, social class and unemployment, the association of ethnicity with psychosis was attenuated (OR=3.0, 95% CI 1.6–5.4) by perceptions of disadvantage. Participants in the Black non-psychosis group often attributed their disadvantage to racism, whereas Black people in the psychosis group attributed it to their own situation.ConclusionsPerceived disadvantage is partly associated with the excess of psychosis among Black people living in the UK. This may have implications for primary prevention.

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Satisfaction with inpatient treatment for first-episode psychosis among different ethnic groups: A report from the UK ÆSOP study

International Journal of Social Psychiatry ◽

10.1177/0020764010382691 ◽

2010 ◽

Vol 58 (1) ◽

pp. 98-105 ◽

Cited By ~ 16

Author(s):

Jane Boydell ◽

Craig Morgan ◽

Rina Dutta ◽

Barry Jones ◽

Fana Alemseged ◽

...

Keyword(s):

Ethnic Groups ◽

Inpatient Treatment ◽

First Episode Psychosis ◽

First Episode ◽

Episode Psychosis ◽

The Uk

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Outcome of psychosis in people of African–Caribbean family origin

The British Journal of Psychiatry ◽

10.1192/bjp.175.1.43 ◽

1999 ◽

Vol 175 (1) ◽

pp. 43-49 ◽

Cited By ~ 38

Author(s):

Glynn Harrison ◽

Shazad Amin ◽

Swaran P. Singh ◽

Tim Croudace ◽

Peter Jones

Keyword(s):

Odds Ratio ◽

Psychotic Disorders ◽

Family Background ◽

Population Based ◽

Good Prognosis ◽

First Episode ◽

Population Based Study ◽

African Caribbean ◽

The Uk ◽

First And Second Generation

BackgroundAn increased incidence of psychotic disorders has repeatedly been reported among African–Caribbeans in the UK.AimsTo test whether the increased incidence of psychotic disorders in first-and second-generation African–Caribbeans in the UK could be caused by a relative excess of affective-related psychoses with good prognosis.MethodThirty-three patients of African–Caribbean family origin identified in a population-based study of first-episode psychoses were compared with the remaining cases. Three-year outcomes and patterns of course were compared.ResultsThere was a trend for better outcomes in African–Caribbean patients for symptoms and social disability, but patterns of course were similar (odds ratio=0.9 (–0.50 to –2.00)). Pattern of course improved after adjustment for confounding by gender, social class, age, diagnosis and duration of untreated illness (odds ratio=0.59 (–0.21 to –1.66)). Diagnostic profiles were similar, with no evidence of greater diagnostic instability in the African–Caribbean group.ConclusionPattern of course of psychosis did not differ significantly by ethnic family background. An excess of good-prognosis affective psychoses is an unlikely explanation for increased rates of psychosis in African–Caribbeans.

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Pathways to care and ethnicity. 1: Sample characteristics and compulsory admission

The British Journal of Psychiatry ◽

10.1192/bjp.186.4.281 ◽

2005 ◽

Vol 186 (4) ◽

pp. 281-289 ◽

Cited By ~ 109

Author(s):

Craig Morgan ◽

Rosemarie Mallett ◽

Gerard Hutchinson ◽

Hemant Bagalkote ◽

Kevin Morgan ◽

...

Keyword(s):

Pathways To Care ◽

First Episode ◽

Compulsory Admission ◽

Sampling Frame ◽

Black African ◽

Epidemiological Sample ◽

African Caribbean ◽

Sample Characteristics ◽

African Patients ◽

The Uk

BackgroundMany studies have found high levels of compulsory admission to psychiatric hospital in the UK among African–Caribbean and Black African patients with a psychotic illness.AimsTo establish whether African–Caribbean and Black African ethnicity is associated with compulsory admission in an epidemiological sample of patients with a first episode of psychosis drawn from two UK centres.MethodAll patients with a first episode of psychosis who made contact with psychiatric services over a 2-year period and were living in defined areas were included in the (ÆSOP) study. For this analysis we included all White British, other White, African–Caribbean and Black African patients from the ÆSOP sampling frame. Clinical, socio-demographic and pathways to care data were collected from patients, relatives and case notes.ResultsAfrican–Caribbean patients were significantly more likely to be compulsorily admitted than White British patients, as were Black African patients. African–Caribbean men were the most likely to be compulsorily admitted.ConclusionsThese findings suggest that factors are operating at or prior to first presentation to increase the risk of compulsory admission among African–Caribbean and Black African patients.

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Differing patterns of brain structural abnormalities between black and white patients with their first episode of psychosis

Psychological Medicine ◽

10.1017/s0033291709991565 ◽

2009 ◽

Vol 40 (7) ◽

pp. 1137-1147 ◽

Cited By ~ 8

Author(s):

K. D. Morgan ◽

P. Dazzan ◽

C. Morgan ◽

J. Lappin ◽

G. Hutchinson ◽

...

Keyword(s):

Grey Matter ◽

First Episode Psychosis ◽

First Episode ◽

Grey Matter Volume ◽

Black African ◽

Caribbean Black ◽

Matter Volume ◽

Episode Psychosis ◽

African Caribbean ◽

African Patients

BackgroundAfrican-Caribbean and black African people living in the UK are reported to have a higher incidence of diagnosed psychosis compared with white British people. It has been argued that this may be a consequence of misdiagnosis. If this is true they might be less likely to show the patterns of structural brain abnormalities reported in white British patients. The aim of this study therefore was to investigate whether there are differences in the prevalence of structural brain abnormalities in white and black first-episode psychosis patients.MethodWe obtained dual-echo (proton density/T2-weighted) images from a sample of 75 first-episode psychosis patients and 68 healthy controls. We used high resolution magnetic resonance imaging and voxel-based methods of image analysis. Two separate analyses were conducted: (1) 34 white British patients were compared with 33 white British controls; (2) 41 African-Caribbean and black African patients were compared with 35 African-Caribbean and black African controls.ResultsWhite British patients and African-Caribbean/black African patients had ventricular enlargement and increased lenticular nucleus volume compared with their respective ethnic controls. The African-Caribbean/black African patients also showed reduced global grey matter and increased lingual gyrus grey-matter volume. The white British patients had no regional or global grey-matter loss compared with their normal ethnic counterparts but showed increased grey matter in the left superior temporal lobe and right parahippocampal gyrus.ConclusionsWe found no evidence in support of our hypothesis. Indeed, the finding of reduced global grey-matter volume in the African-Caribbean/black African patients but not in the white British patients was contrary to our prediction.

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Are ethnic differences in pathways to care for psychosis in England reducing?

Early Intervention in Psychiatric Disorders Across Cultures ◽

10.1093/med/9780198820833.003.0007 ◽

2019 ◽

pp. 73-86

Author(s):

Sherifat Oduola ◽

Craig Morgan ◽

Tom K.J. Craig

Keyword(s):

Family Involvement ◽

Ethnic Differences ◽

Psychiatric Care ◽

Population Based ◽

First Episode Psychosis ◽

Pathways To Care ◽

First Episode ◽

Black African ◽

Minority Ethnic Groups ◽

Episode Psychosis

Studies in the 1990s showed that, compared with the majority populations, people from minority ethnic groups in England were more likely to access psychiatric care via crisis routes. This chapter, and the studies it is based on, explore whether this adverse pattern continues. The authors analysed data from two population-based studies of first-episode psychosis (FEP) carried out 15 years apart. Participants for the studies were 193 FEP patients, aged 18–35 years, presenting to psychiatric care in South London between 1997 and 1999, and 265 FEP patients presenting in 2010–2012. The outcome measure was source of referral during first-episode psychosis. Results of the studies showed that, compared with 15 years ago, ethnic differences were not evident for police or GP involvement. However, ethnic minorities were more likely to access care via accident and emergency departments (Black Caribbean: adj. OR = 48.89; 95% CI = 3.49–684.71; Black African: adj. OR = 7.34; 95% CI = 1.15–46.74). It seems, from these results, that the disparities in pathways to care appear to be narrowing. This may be explained by changing socioeconomic factors and family involvement.

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Risk of psychosis in Yorkshire African, Caribbean and Mixed Ethnic communities

Journal of Psychiatric Intensive Care ◽

10.20299/jpi.2021.005 ◽

2021 ◽

Author(s):

Prakash Hosalli ◽

Alastair Cardno ◽

Anita Brewin ◽

Jamshid Nazari ◽

Steven J Clapcote ◽

...

Keyword(s):

Ethnic Groups ◽

Minority Groups ◽

Census Data ◽

Elevated Risk ◽

First Episode ◽

Ethnic Communities ◽

Episode Psychosis ◽

African Caribbean ◽

Icd 10 ◽

Risk Ratios

Background: An elevated risk of psychosis in migrant and ethnic minority groups has been frequently reported. Previous UK studies have found an elevated risk in African-Caribbean, African and Mixed Ethnic groups, but risks for these groups in West Yorkshire are not known.Aim: To carry out a naturalistic study of the relative risk of psychosis in Yorkshire African, African-Caribbean and Mixed Ethnic groups as compared with the British White population.Method: We used data from Early Intervention for Psychosis services on 15–35 year-olds diagnosed with first episode psychosis (ICD-10, F20-29) in 2013–2015 and local census data to calculate risks.Results: Risk ratios (RR) are significantly increased in African (RR 3.23: 95% CI, 2.46, 4.25), African Caribbean (RR 3.15: 95% CI, 2.04, 4.85) and Mixed Ethnic group (RR 2.27: 95% CI, 1.77, 2.91).Conclusion: Risks are elevated but not as much as elsewhere in England. The reasons for this difference require further investigation.

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Change in incidence rates for psychosis in different ethnic groups in south London: findings from the Clinical Record Interactive Search-First Episode Psychosis (CRIS-FEP) study

Psychological Medicine ◽

10.1017/s0033291719003234 ◽

2019 ◽

pp. 1-10 ◽

Cited By ~ 2

Author(s):

Sherifat Oduola ◽

Jayati Das-Munshi ◽

Francois Bourque ◽

Charlotte Gayer-Anderson ◽

Jason Tsang ◽

...

Keyword(s):

Ethnic Group ◽

Ethnic Groups ◽

Psychotic Disorders ◽

First Episode Psychosis ◽

Incidence Rates ◽

First Episode ◽

Black African ◽

Episode Psychosis ◽

Clinical Records ◽

Over Time

Abstract Background A higher incidence of psychotic disorders has been consistently reported among black and other minority ethnic groups, particularly in northern Europe. It is unclear whether these rates have changed over time. Methods We identified all individuals with a first episode psychosis who presented to adult mental health services between 1 May 2010 and 30 April 2012 and who were resident in London boroughs of Lambeth and Southwark. We estimated age-and-gender standardised incidence rates overall and by ethnic group, then compared our findings to those reported in the Aetiology and Ethnicity of Schizophrenia and Other Psychoses (ÆSOP) study that we carried out in the same catchment area around 10 years earlier. Results From 9109 clinical records we identified 558 patients with first episode psychosis. Compared with ÆSOP, the overall incidence rates of psychotic disorder in southeast London have increased from 49.4 (95% confidence interval (CI) 43.6–55.3) to 63.1 (95% CI 57.3–69.0) per 100 000 person-years at risk. However, the overall incidence rate ratios (IRR) were reduced in some ethnic groups: for example, IRR (95% CI) for the black Caribbean group reduced from 6.7 (5.4–8.3) to 2.8 (2.1–3.6) and the ‘mixed’ group from 2.7 (1.8–4.2) to 1.4 (0.9–2.1). In the black African group, there was a negligible difference from 4.1 (3.2–5.3) to 3.5 (2.8–4.5). Conclusions We found that incidence rates of psychosis have increased over time, and the IRR varied by the ethnic group. Future studies are needed to investigate more changes over time and determinants of change.

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