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Valdez C, Rodrigues R, Reid J, Anderson KK. Disparities in Access to a Regular Primary Care Physician Among First-Generation Migrants with Early Psychosis in Ontario, Canada. Community Ment Health J 2024; 60:1237-1241. [PMID: 38592350 DOI: 10.1007/s10597-024-01266-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/10/2024] [Indexed: 04/10/2024]
Abstract
Disparities in primary care utilization among migrants with early psychosis may be related to lack of access to a regular primary care physician. This study aimed to investigate access to a regular primary care physician among first-generation migrants with early psychosis. People aged 14-35 years with first onset non-affective psychotic disorder in Ontario, Canada were identified in health administrative data (N = 39,440). Access to a regular primary care physician through enrollment in the year prior to diagnosis was compared between first-generation migrants (categorized by country of birth) and the general population using modified Poisson regression. Most migrant groups had a lower prevalence of regular primary care physician access relative to the general population, particularly migrants from Africa (African migrants: 81% vs. non-migrants: 89%). Adjustment for sociodemographic and clinical factors attenuated these differences, although the disparities for migrants from Africa remained (PR = 0.96, 95%CI = 0.94-0.99). Interventions aimed at improving primary care physician access in migrant groups may facilitate help-seeking and improve pathways to care in early psychosis.
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Affiliation(s)
- Crystal Valdez
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, London, ON, Canada
| | - Rebecca Rodrigues
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, London, ON, Canada
| | | | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, London, ON, Canada.
- ICES Western, London, ON, Canada.
- Department of Psychiatry, Schulich School of Medicine & Dentistry, London, ON, Canada.
- Department of Epidemiology and Biostatistics, The Western Centre for Public Health and Family Medicine, Western University, 1465 Richmond Street, N6G 2M1, London, ON, Canada.
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Hagström A, Hasson H, Hollander AC, Vahtra C, Delilovic S, Augustsson H. "Sometimes it can be like an icebreaker": A mixed method evaluation of the implementation of the Refugee Health Screener-13 (RHS-13). J Migr Health 2024; 10:100243. [PMID: 39220097 PMCID: PMC11365362 DOI: 10.1016/j.jmh.2024.100243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 06/29/2024] [Accepted: 07/09/2024] [Indexed: 09/04/2024] Open
Abstract
Background Forced migrants are at risk of developing mental illness, yet challenges remain with underutilization of mental healthcare among this population. This study examined the implementation of the Refugee Health Screener-13 (RHS-13) in the health assessment for forced migrants in eight primary health care centres in Stockholm Region, Sweden. Methods A mixed-methods convergent parallel design was used, combining nurses self-reported quantitative data on the levels and reasons for RHS-13 use in the health assessment with qualitative interview data on the barriers and facilitators for RHS-13 use. The Consolidated Framework for Implementation Research (CFIR) was used as a coding framework for the qualitative analysis. Results Levels of RHS-13 use varied between primary health care centres, resulting in two groups: three centres with high-level (65-92%) and five centres with low-level (0-36%) implementation. Factors related to the tool itself, as well as the inner and outer context, influenced the use of RHS-13. Language barriers, insufficient time, and lack of trust in the validity and utility of RHS-13 were the main barriers, while its availability in many languages and that it was perceived as an important complement to the health assessment were the main facilitators. Conclusion RHS-13 contributes to the standardization of assessing mental health in the health assessment. Identifying context-based implementation strategies and addressing language and time issues as well as nurses trust in the tool's utility are recommended to enhance the use of RHS-13.
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Affiliation(s)
- Ana Hagström
- Region Stockholm, Centre for Epidemiology and Community Medicine (CES, with Swedish acronym), Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden
| | - Henna Hasson
- Region Stockholm, Centre for Epidemiology and Community Medicine (CES, with Swedish acronym), Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden
| | | | - Carl Vahtra
- Department of Global Public Health, Karolinska Institutet, Sweden
| | - Sara Delilovic
- Region Stockholm, Centre for Epidemiology and Community Medicine (CES, with Swedish acronym), Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden
| | - Hanna Augustsson
- Region Stockholm, Centre for Epidemiology and Community Medicine (CES, with Swedish acronym), Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden
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Schlief M, Rich N, Rains LS, Baldwin H, Rojas-Garcia A, Nyikavaranda P, Persaud K, Dare C, French P, Lloyd-Evans B, Crawford M, Smith J, Kirkbride JB, Johnson S. Ethnic differences in receipt of psychological interventions in Early Intervention in Psychosis services in England - a cross-sectional study. Psychiatry Res 2023; 330:115529. [PMID: 37926056 DOI: 10.1016/j.psychres.2023.115529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 09/13/2023] [Accepted: 10/04/2023] [Indexed: 11/07/2023]
Abstract
There is some evidence of differences in psychosis care provision by ethnicity. We investigated variations in the receipt of Cognitive Behavioural Therapy for psychosis (CBTp) and family intervention across ethnic groups in Early Intervention in Psychosis (EIP) teams throughout England, where national policy mandates offering these interventions to all. We included data on 29,610 service users from the National Clinical Audit of Psychosis (NCAP), collected between 2018 and 2021. We conducted mixed effects logistic regression analyses to examine odds ratios of receiving an intervention (CBTp, family intervention, either intervention) across 17 ethnic groups while accounting for the effect of years and variance between teams and adjusting for individual- (age, gender, occupational status) and team-level covariates (care-coordinator caseload, inequalities strategies). Compared with White British people, every minoritized ethnic group, except those of mixed Asian-White and mixed Black African-White ethnicities, had significantly lower adjusted odds of receiving CBTp. People of Black African, Black Caribbean, non-African/Caribbean Black, non-British/Irish White, and of "any other" ethnicity also experienced significantly lower adjusted odds of receiving family intervention. Pervasive inequalities in receiving CBTp for first episode psychosis exist for almost all minoritized ethnic groups, and family intervention for many groups. Investigating how these inequalities arise should be a research priority.
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Affiliation(s)
- Merle Schlief
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK.
| | - Nathalie Rich
- PsyLife Research Group, Division of Psychiatry, University College London, London, UK
| | - Luke Sheridan Rains
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Helen Baldwin
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Antonio Rojas-Garcia
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK; Department of Psychiatry, University of Granada, Granada, Spain
| | - Patrick Nyikavaranda
- NIHR Mental Health Policy Research Unit Co-Production Group, Division of Psychiatry, University College London, London, UK; Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Karen Persaud
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Ceri Dare
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Paul French
- National Clinical Audit of Psychosis (NCAP), Royal College of Psychiatrists, London, UK; Manchester Metropolitan University, Manchester, UK; Pennine Care NHS Foundation Trust, UK
| | - Brynmor Lloyd-Evans
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Mike Crawford
- Division of Psychiatry, Imperial College London, London, UK
| | - Jo Smith
- National Clinical Audit of Psychosis (NCAP), Royal College of Psychiatrists, London, UK; School of Allied Health and Social Care, University of Worcester, Worcester, UK
| | - James B Kirkbride
- PsyLife Research Group, Division of Psychiatry, University College London, London, UK
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, UK
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Buck B, Wingerson M, Whiting E, Snyder J, Monroe-DeVita M, Ben-Zeev D. User-Centered Development of Bolster, an mHealth Intervention for Early Psychosis Caregivers: Needs Assessment, Prototyping, and Field Trial. JMIR Ment Health 2023; 10:e50522. [PMID: 38032692 PMCID: PMC10722359 DOI: 10.2196/50522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/09/2023] [Accepted: 10/21/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Caregivers play a critical role in the treatment and recovery of youth and young adults at risk for psychosis. Caregivers often report feeling isolated, overwhelmed, and lacking in resources. Mobile health (mHealth) has the potential to provide scalable, accessible, and in-the-moment support to caregivers. To date, few if any mHealth resources have been developed specifically for this population. OBJECTIVE The aim of this study was to conduct user-centered design and testing of an mHealth intervention to support early psychosis caregivers. METHODS We conducted a multiphase user-centered development process to develop the Bolster mobile app. In phase 1, a total of 21 caregivers were recruited to participate in a qualitative needs assessment and respond to an initial prototype of the Bolster platform. Content analysis was used to identify key needs and design objectives, which guided the development of the Bolster mobile app. In phase 2, a total of 11 caregivers were recruited to participate in a 1-week field trial wherein they provided qualitative and quantitative feedback regarding the usability and acceptability of Bolster; in addition, they provided baseline and posttest assessments of the measures of distress, illness appraisals, and family communication. RESULTS In phase 1, participants identified psychoeducation, communication coaching, a guide to seeking services, and support for coping as areas to address. Live prototype interaction sessions led to multiple design objectives, including ensuring that messages from the platform were actionable and tailored to the caregiver experience, delivering messages in multiple modalities (eg, video and text), and eliminating a messaging-style interface. These conclusions were used to develop the final version of Bolster tested in the field trial. In phase 2, of the 11 caregivers, 10 (91%) reported that they would use Bolster if they had access to it and would recommend it to another caregiver. They also reported marked changes in their appraisals of illness (Cohen d=0.55-0.68), distress (Cohen d=1.77), and expressed emotion (Cohen d=0.52). CONCLUSIONS To our knowledge, this study is the first to design an mHealth intervention specifically for early psychosis caregivers. Preliminary data suggest that Bolster is usable, acceptable, and promising to improve key targets and outcomes. A future fully powered clinical trial will help determine whether mHealth can reduce caregiver burdens and increase engagement in services among individuals affected by psychosis.
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Affiliation(s)
- Benjamin Buck
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Mary Wingerson
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Erica Whiting
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Jaime Snyder
- Information School, University of Washington, Seattle, WA, United States
| | - Maria Monroe-DeVita
- Supporting Psychosis Innovation through Research Implementation and Training (SPIRIT) Lab, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Dror Ben-Zeev
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
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Patel K, Cardno A, Isherwood T. ' Like I said about culture. You don't talk about mental health ' : An interpretative phenomenological analysis of the experience of first-episode psychosis in South Asian individuals. Early Interv Psychiatry 2023; 17:771-783. [PMID: 36639135 DOI: 10.1111/eip.13368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/27/2022] [Accepted: 01/02/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND There is strong evidence of inequalities in mental healthcare access, experiences and outcomes for service users belonging to Black and Asian Minority Ethnic groups experiencing psychosis. Clinicians and academics have speculated that cultural variation in conceptualisations of psychosis, alongside inequitable service provision may explain disparities. There is, however, a dearth of literature exploring this in a South Asian population, despite this ethnic group being the second largest in the United Kingdom. The present study aimed to explore how people from this minority group have experienced and made sense of first-episode psychosis (FEP). METHODS A qualitative approach was used to explore the lived experience and sense-making of South Asian individuals experiencing FEP and accessing early intervention services. Eight people were interviewed using a semi-structured format. The data were analysed using Interpretative Phenomenological Analysis. RESULTS Three superordinate themes were identified in the group analysis: (1) Disconnection from self and others (2) Doubt and dispute (3) Power and shame. CONCLUSIONS Distinctive ethnic, cultural and systemic influences were strongly evident in how people conceptualized their experiences, how they managed their sense-making and where they sought support. Experiences were discussed in the context of power and shame, and this research proposes that socio-cultural context and racialised discourses have an impact on self-concept, the experiences of help-seeking (formal and informal), and fundamentally how services help individuals from marginalized communities.
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Affiliation(s)
- Krisna Patel
- School of Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Alastair Cardno
- Psychological & Social Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Tom Isherwood
- School of Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Degnan A, Berry K, Crossley N, Edge D. Social network characteristics of Black African and Caribbean people with psychosis in the UK. J Psychiatr Res 2023; 161:62-70. [PMID: 36898328 DOI: 10.1016/j.jpsychires.2023.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/16/2023] [Accepted: 03/02/2023] [Indexed: 03/12/2023]
Abstract
Poorer social networks predict more coercive pathways to care and other adverse outcomes in people with psychosis. People from Black African and Caribbean backgrounds have more negative experiences within UK mental health care systems and family relationships often breakdown. This study aimed to examine the social network characteristics of Black African and Caribbean people experiencing psychosis and associations between network characteristics and severity of psychosis, negative symptoms, and general psychopathology. Fifty-one participants completed social network mapping interviews (a gold standard approach to assessing social network composition) and the Positive and Negative Syndrome Scale. This is the first study to explicitly measure social network size amongst Black people with psychosis living within the UK and results showed that participants' social network size (mean = 12) was comparable to that of other psychosis samples. Networks were of moderate density and comprised disproportionately more relatives than other relationship types. Poor network quality was related to more severe psychosis symptoms suggesting that social network quality may be an important factor in influencing the severity of psychosis. Findings highlight the need for community-based interventions and family therapies to mobilise sources of social support for Black people with psychosis within the UK.
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Affiliation(s)
- Amy Degnan
- Division of Psychology and Mental Health, The University of Manchester, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, The University of Manchester, UK.
| | - Nick Crossley
- The Mitchell Centre for Social Network Analysis, School of Social Sciences, The University of Manchester, UK
| | - Dawn Edge
- Division of Psychology and Mental Health, The University of Manchester, UK
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van der Ven E, Jones N, Bareis N, Scodes JM, Dambreville R, Ngo H, Mathai CM, Bello I, Martínez-Alés G, Mascayano F, Lee RJ, Veling W, Anglin DM, Lewis-Fernandez R, Susser ES, Compton MT, Dixon LB, Wall MM. An Intersectional Approach to Ethnoracial Disparities in Pathways to Care Among Individuals With Psychosis in Coordinated Specialty Care. JAMA Psychiatry 2022; 79:790-798. [PMID: 35767311 PMCID: PMC9244772 DOI: 10.1001/jamapsychiatry.2022.1640] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/30/2022] [Indexed: 01/12/2023]
Abstract
Importance Intersecting factors of social position including ethnoracial background may provide meaningful ways to understand disparities in pathways to care for people with a first episode of psychosis. Objective To examine differences in pathways to care by ethnoracial groups and by empirically derived clusters combining multiple factors of social and clinical context in an ethnoracially diverse multisite early-intervention service program for first-episode psychosis. Design, Setting, and Participants This cohort study used data collected on individuals with recent-onset psychosis (<2 years) by clinicians with standardized forms from October 2013 to January 2020 from a network of 21 coordinated specialty care (CSC) programs in New York State providing recovery-oriented, evidence-based psychosocial interventions and medications to young people experiencing early psychosis. Exposures Ethnoracial group and other factors of social position (eg, insurance status, living situation, English fluency, geographic region) intersecting with first-contact experiences (ie, type of first service, referral source, and symptoms at referral). Main Outcomes and Measures Outcome measures were time from onset to first contact, first contact to CSC, and onset to CSC. Results The total study sample consists of 1726 individuals aged 16 to 30 years and included 452 women (26%), 1263 men (73%), and 11 (<1%) with another gender enrolled in the network of CSC programs. The total sample consisted of 153 Asian (9%), 599 Black (35%), 454 Latinx (26%), and 417 White individuals (24%). White individuals had a significantly shorter time from onset to first contact (median [IQR], 17 [0-80] days) than Asian (median [IQR], 34 [7-94] days) and Black (median [IQR], 30 [1-108] days) individuals but had the longest period from first contact to CSC (median [IQR], 102.5 [45-258] days). Five distinct clusters of individuals emerged that cut across ethnoracial groups. The more disadvantaged clusters in terms of both social position and first-contact experiences had the longest time from onset to first contact, which were longer than for any single ethnoracial group. Conclusions and Relevance In this cohort study of individuals with recent-onset psychosis, time-to-treatment outcomes differed by ethnoracial group and by empirically derived clusters combining multiple factors of social and clinical context. The examination of disparities in durations to treatment through an intersectional, ethnoracial lens may improve understanding of the inequities resulting from the various intersecting factors that may compound delays in treatment initiation.
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Affiliation(s)
- Els van der Ven
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Nev Jones
- School of Social Work, University of Pittsburgh, Pennsylvania
| | - Natalie Bareis
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York
| | - Jennifer M. Scodes
- Area Mental Health Data Science, New York State Psychiatric Institute, New York
| | - Renald Dambreville
- Area Mental Health Data Science, New York State Psychiatric Institute, New York
| | - Hong Ngo
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York
- Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York
| | - Chackupurackal M. Mathai
- Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York
| | - Iruma Bello
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York
- Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York
| | - Gonzalo Martínez-Alés
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
- Instituto de Investigación Hospital Universitario La Paz (IdiPaz), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Franco Mascayano
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Rufina J. Lee
- Silberman School of Social Work, Hunter College, City University of New York, New York
- Department of Psychology, The City College of New York, City University of New York, New York
| | - Wim Veling
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Deidre M. Anglin
- Department of Psychology, The City College of New York, City University of New York, New York
- The Graduate Center, City University of New York, New York
| | - Roberto Lewis-Fernandez
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York
| | - Ezra S. Susser
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Michael T. Compton
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York
- Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York
| | - Lisa B. Dixon
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York
- Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York
| | - Melanie M. Wall
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York
- Area Mental Health Data Science, New York State Psychiatric Institute, New York
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
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Knorr M, Hofmann AB, Miteva D, Noboa V, Rauen K, Frauenfelder F, Seifritz E, Quednow BB, Vetter S, Egger ST. Relationship Between Time of Admission, Help-Seeking Behavior, and Psychiatric Outcomes: "From Dusk Till Dawn". Front Psychiatry 2022; 13:842936. [PMID: 35573363 PMCID: PMC9091816 DOI: 10.3389/fpsyt.2022.842936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/09/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Day and time of admission influence treatment outcomes and prognosis in several medical specialties; this seems related to resources' ability. It is largely unknown whether this also applies to mental health services. We investigate the relationship between time of admission, patients' demographic and clinical profile, and treatment outcomes. METHODS Demographic and clinical profiles of admitted and discharged patients to a general psychiatric ward between January 1st, 2013 and December 31st, 2020, were analyzed. In addition, we used the last year (i.e., 2020) to monitor rehospitalization. Time of admission was defined as weekdays (working day, weekend) and dayshifts (daytime, dusk, and dawn). RESULTS During the study period, 12,449 patient admissions occurred. The mean age of the sample was 48.05 ± 20.90 years, with 49.32% (n = 6,140) females. Most admissions (n = 10,542, 84%) occurred on working days. Two-fifths of admissions (39.7%, n = 4,950) were compulsory, with a higher rate outside daytime hours. Patients had slight differences in the clinical profile, resulting from evaluating the different items of the Health of Nation Outcome Scale (HoNOS). Patients admitted on night shifts, weekends, and holidays showed a shorter length of stay; patients compulsorily admitted during daytime (disregarding the day of the week) had a longer length of stay. All patient groups achieved a robust clinical improvement (i.e., an HoNOS score reduction of around 50%), with similar readmission rates. DISCUSSION The main finding of our study is the relationship between "daytime hours" and fewer compulsory admissions, a result of the interplay between demographics, clinical characteristics, and out-of-clinic service availability (such as ambulatory psychiatric- psychological praxis; day-clinic; home-treatment). The differing clinical profile, in turn, determines differences in treatment selection, with patients admitted after office hours experiencing a higher rate of coercive measures. The shorter length of stay for out-of-office admissions might result from the hospitalization as an intervention. These results should encourage the implementation of outpatient crisis-intervention services, available from dusk till dawn.
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Affiliation(s)
- Marius Knorr
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Andreas B Hofmann
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Dimitrina Miteva
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Vanessa Noboa
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland.,Faculty of Medicine, University San Francisco de Quito, Quito, Ecuador
| | - Katrin Rauen
- Department of Geriatric Psychiatry, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland.,Institute for Stroke and Dementia Research, Laboratory of Experimental Stroke Research, Ludwig Maximilian University of Munich, Munich, Germany
| | - Fritz Frauenfelder
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Boris B Quednow
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Stefan Vetter
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Stephan T Egger
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland.,Faculty of Medicine, Department of Psychiatry, University of Oviedo, Oviedo, Spain
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Symptomatic, functional and service utilization outcomes of migrants with a first episode of psychosis. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1389-1397. [PMID: 33399882 DOI: 10.1007/s00127-020-02011-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Certain migrant groups have been identified as being at increased risk of developing a psychotic disorder, but there is limited research on the outcomes for migrants who develop a first episode of psychosis (FEP). We investigated symptomatic outcomes (remission and relapse rates), functional outcomes (occupational status and relationships) and service utilization (hospital admission and engagement). METHODS Young people, aged between 15 and 24, who presented with FEP to the Early Psychosis Prevention and Intervention Centre (EPPIC) at Orygen between 01.01.11 and 31.12.16 were included. Place of birth was recorded at the time of presentation. To determine remission, symptoms were scored at three-month intervals using the short-form Scale for the Assessment of Positive Symptoms. RESULTS A total of 1220 young people presented with FEP over the six-year period (mean age = 19.6 ± 2.8). Of these, 58.1% were male and 24.0% were first-generation migrants. While there was no difference in overall rates of admission after presentation, migrants were more likely to have an involuntary admission after presentation (31.4% vs. 24.6%, aHR = 1.54, 95% CI [1.19, 2.01]) and this risk was greatest for African migrants (HR = 1.98, 95% C.I. [1.37, 2.86]. The rates of remission and relapse were similar in migrants and those born in Australia and there was no difference in functional outcomes, such as employment rates at follow-up. DISCUSSION The outcomes for migrants who experience FEP appear to be largely similar to those for the Australian-born population. Our finding that a greater rate of involuntary admission for migrants at presentation supports existing literature and needs further exploration to improve clinical care.
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Oduola S, Craig TKJ, Morgan C. Ethnic variations in duration of untreated psychosis: report from the CRIS-FEP study. Soc Psychiatry Psychiatr Epidemiol 2021; 56:931-941. [PMID: 32681277 PMCID: PMC8192380 DOI: 10.1007/s00127-020-01922-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/10/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES There is inconsistent evidence on the influence of ethnicity on duration of untreated psychosis (DUP). We investigated ethnic differences in DUP in a large epidemiological dataset of first episode psychosis patients in an inner city area of south London, UK. METHODS We analysed data on 558 first episode psychosis patients at the South London and Maudsley NHS Trust, between 2010 and 2012. We performed multivariable logistic regression to estimate the odds of a short DUP (≤ 6 months) by ethnic group, controlling for confounders. RESULTS There was no evidence that ethnicity is associated with duration of untreated psychosis. However, we found evidence that a short DUP was strongly associated with age, living circumstances, and pathways to care variables (involuntary admission, out of office hour contact, accident and emergency referral, criminal justice agency referral and family involvement in help-seeking). Conversely, a long DUP was associated with report of social isolation, living alone, being single and General Practitioner referral. CONCLUSION Our findings suggest that indicators of social isolation were associated with long DUP. Our data also show that pathways into care characteristics play significant role in DUP. Thus, the challenge of tackling the issue of timely access to EI under the new Access and Waiting Time standard for psychosis requires a multilevel approach, including joint working with communities, public awareness of psychosis, less restrictive referral pathways and adequate resourcing of early intervention for psychosis services. These will go a long way in addressing patients' needs rather than be determined by service structures.
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Affiliation(s)
- Sherifat Oduola
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
- South London and Maudsley NHS Foundation Trust, Biomedical Research Centre, Mapother House, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
| | - Tom K J Craig
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, Biomedical Research Centre, Mapother House, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Craig Morgan
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, Biomedical Research Centre, Mapother House, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
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How can general practice improve the mental health care experience of Black men in the UK? Br J Gen Pract 2021; 71:124-125. [PMID: 33632687 DOI: 10.3399/bjgp21x715097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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12
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Rodriguez V, Ajnakina O, Stilo SA, Mondelli V, Marques TR, Trotta A, Quattrone D, Gardner-Sood P, Colizzi M, Wiffen BD, Dazzan P, Di Forti M, Falcone MA, David AS, Murray RM. Jumping to conclusions at first onset of psychosis predicts longer admissions, more compulsory admissions and police involvement over the next 4 years: the GAP study. Psychol Med 2019; 49:2256-2266. [PMID: 30392491 DOI: 10.1017/s0033291718003197] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Jumping to conclusions (JTC), which is the proneness to require less information before forming beliefs or making a decision, has been related to formation and maintenance of delusions. Using data from the National Institute of Health Research Biomedical Research Centre Genetics and Psychosis (GAP) case-control study of first-episode psychosis (FEP), we set out to test whether the presence of JTC would predict poor clinical outcome at 4 years. METHODS One-hundred and twenty-three FEP patients were assessed with the Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF) and the probabilistic reasoning 'Beads' Task at the time of recruitment. The sample was split into two groups based on the presence of JTC bias. Follow-up data over an average of 4 years were obtained concerning clinical course and outcomes (remission, intervention of police, use of involuntary treatment - the Mental Health Act (MHA) - and inpatient days). RESULTS FEP who presented JTC at baseline were more likely during the follow-up period to be detained under the MHA [adjusted OR 15.62, 95% confidence interval (CI) 2.92-83.54, p = 0.001], require intervention by the police (adjusted OR 14.95, 95% CI 2.68-83.34, p = 0.002) and have longer admissions (adjusted IRR = 5.03, 95% CI 1.91-13.24, p = 0.001). These associations were not accounted for by socio-demographic variables, IQ and symptom dimensions. CONCLUSIONS JTC in FEP is associated with poorer outcome as indicated and defined by more compulsion police intervention and longer periods of admission. Our findings raise the question of whether the implementation of specific interventions to reduce JTC, such as Metacognition Training, may be a useful addition in early psychosis intervention programmes.
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Affiliation(s)
- Victoria Rodriguez
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Olesya Ajnakina
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Simona A Stilo
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Valeria Mondelli
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tiago Reis Marques
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Antonella Trotta
- Social, Genetics and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Diego Quattrone
- Social, Genetics and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Poonam Gardner-Sood
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Marco Colizzi
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Benjamin D Wiffen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paola Dazzan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Marta Di Forti
- Social, Genetics and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - M Aurora Falcone
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anthony S David
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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13
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Edge D, Lemetyinen H. Psychology across cultures: Challenges and opportunities. Psychol Psychother 2019; 92:261-276. [PMID: 31001925 DOI: 10.1111/papt.12229] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Indexed: 12/27/2022]
Abstract
Large variations of inequalities in rates of mental health disorders and access to mental health care exist within and between countries. Globally, disparities range from countries where there is little provision to those where, despite the availability of evidence-based mental health care, service access and outcomes are mediated by social factors such as socio-economic status, race/ethnicity, and culture. This is salient because increasingly diverse populations are inevitably created with globalization. We posit that in multicultural contexts, effective therapeutic engagement requires therapists who are competent and confident to work with diversity and difference, utilizing insights into their own as well as their clients' internal and external worlds. Although there are many reasons why psychotherapies can be insensitive and harmful, for example, the inherent power imbalance in therapeutic relationships, a lack of awareness of cultural and ethnic variation and needs are among them. Acquisition of 'cultural competence' and increasing availability of culturally-adapted interventions should, in theory, enable practitioners to work with a range of individuals with whom they might have little in common. However, whilst cultural adaptation appears promising, there are concerns regarding its viability as a strategy for tackling disparities in access to psychological care. Evidence for cultural competency is patchy at best. We show how and why delivering effective psychotherapy in the twenty-first century requires a paradigm shift from current approaches to truly integrated models, developed in collaboration with recipients of care. Coproducing interventions, training, and means of evaluating them with clients necessitates taking into consideration social contexts, alternative conceptualizations of mental health and disorders and difficulties, and what constitutes appropriate helpful interventions for psychological distress. PRACTITIONER POINTS: Upskilling therapists to work with diversity and difference is essential for effective delivery of psychological treatments. Increasing the availability of culturally-adapted interventions together with therapists who are sufficiently competent and confident to deliver them should enable practitioners to work with a range of individuals with whom they might have little in common. Coproducing culturally appropriate means of responding to mental health difficulties, staff training and development, and service evaluation methods with clients necessitates taking into consideration social contexts, alternative explanatory models of mental health and 'illness', and what constitutes helpful interventions for psychological distress.
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Affiliation(s)
- Dawn Edge
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, UK.,Research & Innovation, Greater Manchester Mental Health NHS Trust, UK
| | - Henna Lemetyinen
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, UK
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Schofield P, Kordowicz M, Pennycooke E, Armstrong D. Ethnic differences in psychosis-Lay epidemiology explanations. Health Expect 2019; 22:965-973. [PMID: 31037803 PMCID: PMC6803396 DOI: 10.1111/hex.12901] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 03/27/2019] [Accepted: 04/06/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Much research attention has been given to the high rates of psychosis diagnosed in the Black community. However, little has been heard about possible reasons for this from Black African and Caribbean mental health service users themselves. AIMS To determine how Black African and Caribbean service users perceive and explain these apparent differences. METHODS We conducted four focus groups between 2014 and 2015 with 35 participants from the Black African and Black Caribbean community in Lambeth and Southwark, South East London, diagnosed with a psychotic illness. Recruitment was through a local voluntary sector organization and other community contacts. RESULTS Each group described an elevated risk of psychosis in their community and explanations followed the following themes, with increased rates due to: (a) an accumulation of stressors due to disadvantaged ethnic minority status, (b) further disadvantage due to inequitable experiences of mental health services, (c) an absence of community support and (d) a double stigma: as a result of external discrimination, due to ethnicity, and internal stigma about mental illness from within the Black community itself. CONCLUSIONS Black mental health service users attributed an elevated risk of psychosis in their community to an accumulation of stressors directly related to ethnic minority status.
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Affiliation(s)
- Peter Schofield
- School of Population Health & Environmental Sciences, King's College London, London, UK
| | - Maria Kordowicz
- School of Population Health & Environmental Sciences, King's College London, London, UK
| | | | - David Armstrong
- School of Population Health & Environmental Sciences, King's College London, London, UK
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15
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Szanto KB, Li J, Cordero P, Oben JA. Ethnic differences and heterogeneity in genetic and metabolic makeup contributing to nonalcoholic fatty liver disease. Diabetes Metab Syndr Obes 2019; 12:357-367. [PMID: 30936733 PMCID: PMC6430068 DOI: 10.2147/dmso.s182331] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Obesity is the most prevalent noncommunicable disease in the 21st century, associated with triglyceride deposition in hepatocytes leading to nonalcoholic fatty liver disease (NAFLD). NAFLD is now present in around a third of the world's population. Epidemiological studies have concluded that ethnicity plays a role in complications and treatment response. However, definitive correlations of ethnicity with NAFLD are thoroughly under-reported. A comprehensive review was conducted on ethnic variation in NAFLD patients and its potential role as a crucial effector in complications and treatment response. The highest NAFLD prevalence is observed in Hispanic populations, exhibiting a worse disease progression. In contrast, African-Caribbeans exhibit the lowest risk, with less severe steatosis and inflammation, lower levels of triglycerides, and less metabolic derangement, but conversely higher prevalence of insulin resistance. The prevalence of NAFLD in Asian cohorts is under-reported, although reaching epidemic proportions in these populations. The most well-documented NAFLD patient population is that of Caucasian ethnicity, especially from the US. The relative paucity of available literature suggests there is a vital need for more large-scale multi-ethnic clinical cohort studies to determine the incidence of NAFLD within ethnic groups. This would improve therapy and drug development, as well as help identify candidate gene mutations which may differ within the population based on ethnic background.
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Affiliation(s)
- Krisztina B Szanto
- Faculty of Life Sciences and Medicine, School of Medicine, King's College London, London, UK,
- Institute for Liver and Digestive Health, University College London, London, UK,
| | - Jiawei Li
- Institute for Liver and Digestive Health, University College London, London, UK,
- Institute of Child Health, University College London, London, UK
| | - Paul Cordero
- Institute for Liver and Digestive Health, University College London, London, UK,
| | - Jude A Oben
- Institute for Liver and Digestive Health, University College London, London, UK,
- Department of Gastroenterology and Hepatology, Guy's and St Thomas' Hospital, NHS Foundation Trust, London, UK
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16
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Access to and Use of Psychiatric Services by Migrants Resettled in Northern Italy. J Immigr Minor Health 2019; 20:1309-1316. [PMID: 29354861 DOI: 10.1007/s10903-018-0703-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The present study was conducted to describe access to and use of psychiatric services by migrants resettled in a large and well-defined catchment area. The study was conducted in a catchment area of 459,536 inhabitants in Verona, a city located in the Northeast of Italy. Using a psychiatric case register, all native and migrant individuals with a first ever psychiatric contact from 2000 to 2015 were identified. Service use data during the 12 months following first contact were collected. During the study period a total of 2610 migrants and 28,860 natives had at least one psychiatric contact. A progressive rise in the proportion of migrants seeking psychiatric care was observed, from 2.5% in 2000 to more than 14% in 2015. During the 12 months following first contact, the proportion of patients with a single consultation did not differ between resettled migrants and natives. However, migrants were more often marked users or heavy users of psychiatric services. Multivariate linear regression analyses showed that younger male individuals with psychotic disorders experienced higher psychiatric services use regardless their native or migrant condition. In a large catchment area with a well-developed community-based system of mental health care a progressive rise in the number of migrants seeking psychiatric care was observed. The pattern of service use during the 12 months after first contact was not related to nationality, suggesting the capacity of community psychiatric services to retain people in care. These findings call for the development of culturally and linguistically appropriate community psychiatric services.
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Byrne M, Codjoe L, Morgan C, Stahl D, Day F, Fearon P, Fusar-Poli P, Power P, McGuire P, Valmaggia L. The relationship between ethnicity and service access, treatment uptake and the incidence of psychosis among people at ultra high risk for psychosis. Psychiatry Res 2019; 272:618-627. [PMID: 30616132 DOI: 10.1016/j.psychres.2018.12.111] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 12/20/2018] [Accepted: 12/20/2018] [Indexed: 11/29/2022]
Abstract
Black ethnicity is associated with increased risk for psychosis in South London. This study explored the distribution of ethnicity among services users at ultra high risk for psychosis (UHR) and examined the influence of ethnicity on service access, treatment uptake and incidence of psychosis. The ethnic distribution of 228 people at UHR for psychosis, seen in an early detection clinical service over 10 years, was compared with 146 people with first episode psychosis from the same geographic region and census figures for the local population. Black service users were significantly over-represented in the UHR group compared to the background population (34% vs 21%; p < 0.05); but less so than in the first episode sample (58% vs 19%; p < 0.05). Within the UHR sample, there was no strong evidence of differences between ethnic groups in the types of treatment provided, nor in the rate of transition to psychosis over 2 years. The absence of differences between ethnic groups in rates of transition to psychosis raises the possibility that access to mental health care at the high risk stage might have reduced the influence of ethnicity on the incidence of psychosis in this sample. This would need to be replicated in a larger sample.
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Affiliation(s)
- Majella Byrne
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, United Kingdom; South London and Maudsley NHS Foundation Trust, United Kingdom.
| | - Louisa Codjoe
- South London and Maudsley NHS Foundation Trust, United Kingdom; Health Service and Population Research, King's College London, Institute of Psychiatry, Psychology and Neuroscience, United Kingdom
| | - Craig Morgan
- Health Service and Population Research, King's College London, Institute of Psychiatry, Psychology and Neuroscience, United Kingdom
| | - Daniel Stahl
- Biostatistics & Health Informatics, King's College London, Institute of Psychiatry, Psychology and Neuroscience, United Kingdom
| | - Fern Day
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, United Kingdom
| | - Paul Fearon
- St Patrick University Hospital and Trinity College Dublin, Ireland
| | - Paolo Fusar-Poli
- South London and Maudsley NHS Foundation Trust, United Kingdom; Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, United Kingdom
| | - Paddy Power
- St Patrick University Hospital and Trinity College Dublin, Ireland
| | - Philip McGuire
- South London and Maudsley NHS Foundation Trust, United Kingdom; Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, United Kingdom
| | - Lucia Valmaggia
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, United Kingdom; South London and Maudsley NHS Foundation Trust, United Kingdom
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The development and validation of the Brief Experience of Caregiving Inventory (BECI). Compr Psychiatry 2018; 86:54-59. [PMID: 30077807 DOI: 10.1016/j.comppsych.2018.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/02/2018] [Accepted: 07/06/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The social network supporting an individual with psychosis may be adversely affected by the experience of caregiving. The Experience of Caregiving Inventory (ECI) is 66 item self-report measure of the impact of caregiving for carers of people diagnosed with psychotic disorders. This study aimed to create a brief version of the ECI, and evaluate its reliability and validity (n = 626). METHODS The validation process was conducted through a Multidimensional Item Response Theory (MIRT) approach, using a graded response model and a complementary network approach. RESULTS This resulted in a 19 item, four factor inventory with a good model fit, displaying good reliability and validity. CONCLUSION The BECI is a valid measure. The simplicity, ease of application and robust psychometric properties further enhances its acceptability and usefulness as a brief measure in clinical research and trials, as well as in routine practice providing reliable and valid data on experience of caregiving in families of an individual with psychosis.
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Edge D, Grey P. An Assets-Based Approach to Co-Producing a Culturally Adapted Family Intervention (CaFI) with African Caribbeans Diagnosed with Schizophrenia and Their Families. Ethn Dis 2018; 28:485-492. [PMID: 30202202 DOI: 10.18865/ed.28.s2.485] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To determine how to improve the cultural appropriateness and acceptability of an extant evidence-based model of family intervention (FI), a form of 'talking treatment,' for use with African Caribbean service users diagnosed with schizophrenia and their families. Design Community partnered participatory research (CPPR) using four focus groups comprising 31 key stakeholders. Setting Community locations and National Health Service (NHS) mental health care settings in northwest England, UK. Participants African Caribbean service users (n=10), family members, caregivers and advocates (n=14) and health care professionals (n=7). Results According to participants, components of the extant model of FI were valid but required additional items (such as racism and discrimination and different models of mental health and illness) to improve cultural appropriateness. Additionally, emphasis was placed on developing a new ethos of delivery, which participants called 'shared learning.' This approach explicitly acknowledges that power imbalances are likely to be magnified where delivery of interventions involves White therapists and Black clients. In this context, therapists' cultural competence was regarded as fundamental for successful therapeutic engagement and outcomes. Conclusions Despite being labelled 'hard-to-reach' by mainstream mental health services and under-represented in research, our experience suggests that, given the opportunity, members of the African Caribbean community were highly motivated to engage in all aspects of research. Participating in research related to schizophrenia, a highly stigmatized condition, suggests CPPR approaches might prove fruitful in developing interventions to address other health conditions that disproportionately affect members of this community.
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Affiliation(s)
- Dawn Edge
- School of Health Sciences, Faculty of Biology, Medicine & Health; University of Manchester, UK
| | - Paul Grey
- New Testament Church of God, Grey Services, Manchester, UK
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Edge D, Degnan A, Cotterill S, Berry K, Baker J, Drake R, Abel K. Culturally adapted Family Intervention (CaFI) for African-Caribbean people diagnosed with schizophrenia and their families: a mixed-methods feasibility study of development, implementation and acceptability. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06320] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BackgroundAfrican-Caribbean people in the UK experience the highest incidence of schizophrenia and the greatest inequity in mental health care. There is an urgent need to improve their access to evidence-based care and outcomes. Family intervention (FI) is a National Institute for Health and Care Excellence-approved psychosocial intervention. Although clinically effective and cost-effective for schizophrenia, it is rarely offered. Evidence for any research into FI is lacking for ethnic minority people generally and for African-Caribbean people specifically.Aims(1) To assess the feasibility of delivering a novel, culturally appropriate psychosocial intervention within a ‘high-risk’ population to improve engagement and access to evidence-based care. (2) To test the feasibility and acceptability of delivering FI via ‘proxy families’.DesignA mixed-methods, feasibility cohort study, incorporating focus groups and an expert consensus conference.SettingTwo mental health trusts in north-west England.ParticipantsWe recruited a convenience sample of 31 African-Caribbean service users. Twenty-six family units [service users, relatives/family support members (FSMs) or both] commenced therapy. Half of the service users (n = 13, 50%), who did not have access to their biological families, participated by working with FSMs.InterventionsAn extant FI model was culturally adapted with key stakeholders using a literature-derived framework [Culturally adapted Family Intervention (CaFI)]. Ten CaFI sessions were offered to each service user and associated family.Main outcome measuresRecruitment (number approached vs. number consented), attendance (number of sessions attended), attrition (number of dropouts at each time point), retention (proportion of participants who completed therapy sessions), and completeness of outcome measurement.ResultsOf 74 eligible service users, 31 (42%) consented to take part in the feasibility trial. The majority (n = 21, 67.7%) were recruited from community settings, seven (22.6%) were recruited from rehabilitation settings and three (9.7%) were recruited from acute wards. Twenty-four family units (92%) completed all 10 therapy sessions. The proportion who completed treatment was 77.42% (24/31). The mean number of sessions attended was 7.90 (standard deviation 3.96 sessions) out of 10. It proved feasible to collect a range of outcome data at baseline, post intervention and at the 3-month follow-up. The rating of sessions and the qualitative findings indicated that CaFI was acceptable to service users, families, FSMs and health-care professionals.LimitationsThe lack of a control group and the limited sample size mean that there is insufficient power to assess efficacy. The findings are not generalisable beyond this population.ConclusionsIt proved feasible to culturally adapt and test FI with a sample of African-Caribbean service users and their families. Our study yielded high rates of recruitment, attendance, retention and data completion. We delivered CaFI via FSMs in the absence of biological families. This novel aspect of the study has implications for other groups who do not have access to their biological families. We also demonstrated the feasibility of collecting a range of outcomes to inform future trials and confirmed CaFI’s acceptability to key stakeholders. These are important findings. If CaFI can be delivered to the group of service users with the most serious and persistent disparities in schizophrenia care, it has the potential to be modified for and delivered to other underserved groups.Future workA fully powered, multicentre trial, comparing CaFI with usual care, is planned.Trial registrationCurrent Controlled Trials ISRCTN94393315.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 6, No. 32. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Dawn Edge
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Amy Degnan
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sarah Cotterill
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Katherine Berry
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - John Baker
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Richard Drake
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Kathryn Abel
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Ferrari M, Flora N, Anderson KK, Haughton A, Tuck A, Archie S, Kidd S, McKenzie K. Gender differences in pathways to care for early psychosis. Early Interv Psychiatry 2018; 12:355-361. [PMID: 27017924 DOI: 10.1111/eip.12324] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 01/02/2016] [Accepted: 01/15/2016] [Indexed: 12/22/2022]
Abstract
AIMS Gender is a critical demographic determinant in first-episode psychosis research. We used data from the ACE Pathways to Care Project, which examined pathways to care in African-origin, Caribbean-origin and European-origin participants, to investigate the role of gender in pathways to early intervention programmes. METHOD A qualitative approach was used to examine gender differences in the routes to care. We conducted four focus groups and four individual in-depth interviews with 25 service users of early intervention services from African-origin, Caribbean-origin and European-origin populations. RESULTS Gender stereotypes negatively influence the first service contact for women, and the early phase of the help seeking process for men. Women reported trying to seek care. However, family members and service providers often questioned their calls for help. Men described having difficulties in talking about their symptoms, as the act of seeking help was perceived as a sign of weakness by peers. CONCLUSIONS The findings of this study suggest that gender stereotypes shape the journey to specialized care in different ways for men and women. Awareness of the impact that gender stereotypes have when a young person is seeking care for psychosis could help to promote a shift in attitudes among health-care providers and the provision of more compassionate and patient-centred care during this critical time.
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Affiliation(s)
- Manuela Ferrari
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Nina Flora
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Kelly K Anderson
- Department of Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Asante Haughton
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Andrew Tuck
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Suzanne Archie
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Sean Kidd
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Kwame McKenzie
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Development, validation and cultural-adaptation of the knowledge about psychosis questionnaire for African-Caribbean people in the UK. Psychiatry Res 2018; 263:199-206. [PMID: 29573660 DOI: 10.1016/j.psychres.2018.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 03/05/2018] [Accepted: 03/05/2018] [Indexed: 11/21/2022]
Abstract
The absence of assessment tools incorporating different cultural models of mental illness is a major barrier to recruiting ethnic minorities into clinical trials, reducing generalisability of findings and potentially increasing disparities in access to evidence-based care. This study aimed to develop and validate a new Knowledge about Psychosis (KAP) self-report measure and a culturally-adapted version for African-Caribbean people (CaKAP). Content and face validity were achieved through consultations with experts in psychosis and a focus group with service users, carers, and community members. Eighty-seven predominantly White British participants and 79 African-Caribbean participants completed the knowledge questionnaires (KAP and CaKAP) and measures of help-seeking and stigma. Overall, the measures showed good internal consistency and test re-test reliability. Construct validity was evidenced via significant positive associations between knowledge about psychosis and help-seeking and significant negative associations between knowledge and stigma. These measures could improve the delivery of psychosocial interventions and outcome measurement in research trials.
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Abstract
The present study was conducted to describe access to and use of psychiatric services by migrants resettled in a large and well-defined catchment area. The study was conducted in a catchment area of 459,536 inhabitants in Verona, a city located in the Northeast of Italy. Using a psychiatric case register, all native and migrant individuals with a first ever psychiatric contact from 2000 to 2015 were identified. Service use data during the 12 months following first contact were collected. During the study period a total of 2610 migrants and 28,860 natives had at least one psychiatric contact. A progressive rise in the proportion of migrants seeking psychiatric care was observed, from 2.5% in 2000 to more than 14% in 2015. During the 12 months following first contact, the proportion of patients with a single consultation did not differ between resettled migrants and natives. However, migrants were more often marked users or heavy users of psychiatric services. Multivariate linear regression analyses showed that younger male individuals with psychotic disorders experienced higher psychiatric services use regardless their native or migrant condition. In a large catchment area with a well-developed community-based system of mental health care a progressive rise in the number of migrants seeking psychiatric care was observed. The pattern of service use during the 12 months after first contact was not related to nationality, suggesting the capacity of community psychiatric services to retain people in care. These findings call for the development of culturally and linguistically appropriate community psychiatric services.
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24
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Dein K, Williams PS, Dein S. Ethnic bias in the application of the Mental Health Act 1983. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.107.003582] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
There is evidence pointing to a bias in the application of the Mental Health Act 1983 (which is in force in England and Wales). One study found that Black people on in-patient units were four times more likely to have been compulsorily admitted than White people. Furthermore, it has been shown that compulsory admissions to secure units are 2.9–5.6 times higher for Black than for White patients. Any understanding of this bias necessitates an examination of the attitudes of mental health professionals towards Africans and African–Caribbeans. Here we discuss possible contributory factors and examine a number of initiatives that have been instituted in order to tackle this problem.
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Yeung EYW, Irvine F, Ng SM, Tsang KMS. How people from Chinese backgrounds make sense of and respond to the experiences of mental distress: Thematic analysis. J Psychiatr Ment Health Nurs 2017; 24:589-599. [PMID: 28564494 DOI: 10.1111/jpm.12406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/29/2017] [Indexed: 11/30/2022]
Abstract
RATIONALE FOR THE STUDY Many Chinese people do not contact mental health services when they first develop mental health problems. It is therefore important to find out reasons for low uptake of services so that strategies can be identified to promote early intervention. WHAT IS ALREADY KNOWN ABOUT THE TOPIC?: Most Chinese people only come into contact with mental health services during crisis situations. Language difference, lack of knowledge of mainstream services and stigma attached to mental health problems are barriers to access and utilize mental health services. WHAT THE STUDY ADDS TO THE INTERNATIONAL EVIDENCE?: Chinese people apply both Western medication and traditional healing to manage distress caused by mental health problems. Because of the extreme stigma associated with mental health problems, Chinese people are reluctant to accept support from their own cultural groups outside their family. Family plays a major role in caring for relatives with mental health problems. Families are prepared to travel across the world in search of folk healing if not available in Western societies. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: It is important to recognize the different approaches to understanding and managing mental health problems among Chinese people, otherwise they will be dissuaded from engaging with mental health services if their beliefs are disregarded and invalidated. Services that involve Chinese speaking mental health workers can address the issue of language differences and sensitive mental health issues within the Chinese community. ABSTRACT Introduction Late presentation and low utilization of mental health services are common among Chinese populations. An understanding of their journey towards mental health care helps to identify timely and appropriate intervention. Aim We aimed to examine how Chinese populations make sense of the experiences of mental distress, and how this understanding influences their pathways to mental health care. Method We undertook in-depth interviews with fourteen people with mental health problems (MHPs) and sixteen family members. Thematic analysis was used to analyse data. Results/Discussions Different conceptualization of mental distress and the stigma attached to MHPs explained why most participants accessed services at crisis points. Because of mental illness stigma, they were reluctant to seek help outside of the family. Participants used a pragmatic pluralistic approach to incorporate ritual healing and Western interventions to manage mental distress as they travelled further on the pathway journey. Families play a key role in the journey and are prepared to visit different parts of the world to seek traditional healers. Implications for practice Mental health nurses need to adopt a transcultural working approach to address mental health issues so that family will get the support needed to continue their caring role.
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Affiliation(s)
- E Y W Yeung
- Social Work, School of Nursing and Allied Health, Liverpool John Moores University, Liverpool, UK
| | - F Irvine
- Department of Nursing, School of Health and Population Science, University of Birmingham, Birmingham, UK
| | - S M Ng
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong
| | - K M S Tsang
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong
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Ajnakina O, Morgan C, Gayer-Anderson C, Oduola S, Bourque F, Bramley S, Williamson J, MacCabe JH, Dazzan P, Murray RM, David AS. Only a small proportion of patients with first episode psychosis come via prodromal services: a retrospective survey of a large UK mental health programme. BMC Psychiatry 2017; 17:308. [PMID: 28841826 PMCID: PMC5574213 DOI: 10.1186/s12888-017-1468-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 08/15/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Little is known about patients with a first episode of psychosis (FEP) who had first presented to prodromal services with an "at risk mental state" (ARMS) before making the transition to psychosis. We set out to identify the proportion of patients with a FEP who had first presented to prodromal services in the ARMS state, and to compare these FEP patients with FEP patients who did not have prior contact with prodromal services. METHODS In this study information on 338 patients aged ≤37 years who presented to mental health services between 2010 and 2012 with a FEP was examined. The data on pathways to care, clinical and socio-demographic characteristics were extracted from the Biomedical Research Council Case Register for the South London and Maudsley NHS Trust. RESULTS Over 2 years, 14 (4.1% of n = 338) young adults presented with FEP and had been seen previously by the prodromal services. These ARMS patients were more likely to enter their pathway to psychiatric care via referral from General Practice, be born in the UK and to have had an insidious mode of illness onset than FEP patients without prior contact with the prodromal services. CONCLUSIONS In the current pathways to care configuration, prodromal services are likely to prevent only a few at-risk individuals from transitioning to psychosis even if effective preventative treatments become available.
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Affiliation(s)
- Olesya Ajnakina
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.
| | - Craig Morgan
- 0000 0001 2322 6764grid.13097.3cSociety and Mental Health Research Group, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF UK
| | - Charlotte Gayer-Anderson
- 0000 0001 2322 6764grid.13097.3cSociety and Mental Health Research Group, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF UK
| | - Sherifat Oduola
- 0000 0001 2322 6764grid.13097.3cNIHR Biomedical Research Centre, David Goldberg Building, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AF UK
| | - François Bourque
- 0000 0001 2322 6764grid.13097.3cSociety and Mental Health Research Group, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF UK
| | - Sally Bramley
- 0000 0001 2322 6764grid.13097.3cGuy’s, King’s and St Thomas’ School of Medical Education, King’s College London, London, UK
| | - Jessica Williamson
- 0000 0004 0426 7183grid.450709.fViolence Prevention Research Unit Queen Mary University of London & East London NHS Foundation Trust, Garrod Building, Turner Street, London, E1 2AD UK
| | - James H. MacCabe
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF UK ,0000 0001 2116 3923grid.451056.3National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK
| | - Paola Dazzan
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF UK ,0000 0001 2116 3923grid.451056.3National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK
| | - Robin M. Murray
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF UK
| | - Anthony S. David
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF UK
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Morgan C, Fearon P, Lappin J, Heslin M, Donoghue K, Lomas B, Reininghaus U, Onyejiaka A, Croudace T, Jones PB, Murray RM, Doody GA, Dazzan P. Ethnicity and long-term course and outcome of psychotic disorders in a UK sample: the ÆSOP-10 study. Br J Psychiatry 2017; 211. [PMID: 28642258 PMCID: PMC5537567 DOI: 10.1192/bjp.bp.116.193342] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BackgroundThe incidence of psychotic disorders is elevated in some minority ethnic populations. However, we know little about the outcome of psychoses in these populations.AimsTo investigate patterns and determinants of long-term course and outcome of psychoses by ethnic group following a first episode.MethodÆSOP-10 is a 10-year follow-up of an ethnically diverse cohort of 532 individuals with first-episode psychosis identified in the UK. Information was collected, at baseline, on clinical presentation and neurodevelopmental and social factors and, at follow-up, on course and outcome.ResultsThere was evidence that, compared with White British, Black Caribbean patients experienced worse clinical, social and service use outcomes and Black African patients experienced worse social and service use outcomes. There was evidence that baseline social disadvantage contributed to these disparities.ConclusionsThese findings suggest ethnic disparities in the incidence of psychoses extend, for some groups, to worse outcomes in multiple domains.
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Affiliation(s)
- Craig Morgan
- Craig Morgan, PhD, Institute of Psychiatry, Psychology & Neuroscience, King's College London and National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK; Paul Fearon, MRCPsych, Department of Psychiatry, Trinity College Dublin, Dublin, Ireland; Julia Lappin, MRCPsych, School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia; Margaret Heslin, MSc, Kim Donoghue, PhD, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Ben Lomas, MRCPsych, Division of Psychiatry, University of Nottingham, Nottingham, UK; Ulrich Reininghaus, PhD, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK and School of Mental Health and Neuroscience, Maastricht University, The Netherlands; Adanna Onyejiaka, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Tim Croudace, PhD, School of Nursing and Midwifery, University of Dundee, UK; Peter B. Jones, FRCPsych, Department of Psychiatry, University of Cambridge, Cambridge, UK; Robin M. Murray, FRS, Institute of Psychiatry, Psychology & Neuroscience, King's College London and National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK; Gillian A. Doody, MRCPsych, Division of Psychiatry, University of Nottingham, Nottingham, UK; Paola Dazzan, MRCPsych, Institute of Psychiatry, Psychology & Neuroscience, King's College London and National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
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Fassaert T, Heijnen H, de Wit MAS, Peen J, Beekman ATF, Dekker J. The association between ethnic background and characteristics of first mental health treatment for psychotic disorders in the Netherlands between 2001 and 2005. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1591-1601. [PMID: 27333981 DOI: 10.1007/s00127-016-1248-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 05/30/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To test the hypothesis that ethnic minority status of patients is associated with specific psychotic disorder treatment characteristics. METHODS Longitudinal data (2001-2005) were extracted from a nationwide psychiatric case register in the Netherlands. The sample consisted of 30,655 episodes of mental health treatment for 23,122 patients with psychotic disorders. Information was available about waiting time and treatment duration, source of referral, occurrence of crisis contacts, admittance to clinical care and compulsory admissions. In addition, information was available about ethnicity (based on country of birth), gender, age and marital status. Results were calculated for ethnic and gender groups separately. In addition, a number of multivariate regression analyses were conducted to correct for differences in age and marital status. RESULTS There was substantial variation between ethnic minority and gender groups in relation to the treatment characteristics. Compared with a Dutch ethnic background, ethnic minority background was generally associated with less waiting time, and more police referrals, crisis contacts, admittance to clinical care and compulsory admission, but shorter treatment duration. Characteristics appeared to be least favorable in episodes that involved male patients with Antillean and Surinamese backgrounds, whereas episodes were quite similar for ethnic Dutch and Turkish patients. CONCLUSIONS Characteristics of mental health treatment for psychosis in the Netherlands are different for ethnic minority patient groups than for patients with an ethnic Dutch background. However, there were substantial differences between ethnic minority groups.
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Affiliation(s)
- T Fassaert
- Department of Community Mental Health Care (MGGZ), Public Health Service Amsterdam, Nieuwe Achtergracht 100, P.O. Box 2200, 1000 CE, Amsterdam, The Netherlands.
| | - H Heijnen
- Heijnen Organisatieadviseurs, Amsterdam, The Netherlands
| | - M A S de Wit
- Department of Epidemiology and Health Promotion, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - J Peen
- Arkin, Amsterdam, The Netherlands
| | - A T F Beekman
- Department of Psychiatry, VU University, Amsterdam, The Netherlands.,GGZ inGeest, Amsterdam, The Netherlands
| | - J Dekker
- Arkin, Amsterdam, The Netherlands.,Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
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Co-production as an approach to developing stakeholder partnerships to reduce mental health inequalities: an evaluation of a pilot service. Prim Health Care Res Dev 2016; 18:14-23. [PMID: 27132634 DOI: 10.1017/s1463423616000141] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Aim This study aimed to evaluate a pilot cross-sector initiative - bringing together public health, a community group, primary mental health teams and patients - in using co-production approaches to deliver a mental health service to meet the needs of the black and minority ethnic communities. BACKGROUND Black and minority ethnic communities continue to face inequalities in mental health service access and provision. They are under-represented in low-level interventions as they are less likely to be referred, and more likely to disengage from mainstream mental health services. Effective models that lead to improved access and better outcomes are yet to be established. It has long been recognised that to be effective, services need to be more culturally competent, which may be achieved through a co-production approach. METHODS This study aimed to evaluate the role of co-production in the development of a novel community mental health service for black and minority ethnic service users. Qualitative research methods, including semi-structured interviews and focus groups, were used to collect data to examine the use of co-production methods in designing and delivering an improved mental health service. Findings Twenty-five patients enrolled into the study; of these, 10 were signposted for more intensive psychological support. A 75% retention rate was recorded (higher than is generally the case for black and minority ethnic service users). Early indications are that the project has helped overcome barriers to accessing mental health services. Although small scale, this study highlights an alternative model that, if explored and developed further, could lead to delivery of patient-centred services to improve access and patient experience within mental health services, particularly for black and minority ethnic communities.
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Edbrooke-Childs J, Newman R, Fleming I, Deighton J, Wolpert M. The association between ethnicity and care pathway for children with emotional problems in routinely collected child and adolescent mental health services data. Eur Child Adolesc Psychiatry 2016; 25:539-46. [PMID: 26345326 DOI: 10.1007/s00787-015-0767-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 08/27/2015] [Indexed: 11/29/2022]
Abstract
Adults from black and minority ethnic (BAME) backgrounds are less likely to access mental health services through voluntary care pathways and are more likely to access through compulsory ones. The aim of the present research was to explore the association between ethnicity and care pathway through child and adolescent mental health services (CAMHS), in terms of reason for referral and case closure, in children presenting with emotional problems. A sample of N = 11,592 children from 26 CAMHS was taken from a national routinely collected dataset (56 % female; 7 % aged 0-5 years, 40 % 6-12 years, 53 % 13-18 years, and <1 % 19-25 years). Multinomial logistic regressions showed that BAME children were consistently more likely to be referred to CAMHS through education, social, and other services than primary care, compared to White British children (odds ratio (OR) = 1.52-9.96, p < .001) and they were less likely to end treatment due to child and family non-attendance (OR = 0.59-0.79, p < .05). Similar to adults, children from BAME groups may be more likely to access CAMHS through compulsory than voluntary care pathways.
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Affiliation(s)
- Julian Edbrooke-Childs
- Evidence Based Practice Unit, UCL and Anna Freud Centre, 21 Maresfield Gardens, London, NW3 5SU, UK
| | - Robbie Newman
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK
| | - Isobel Fleming
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK
| | - Jessica Deighton
- Evidence Based Practice Unit, UCL and Anna Freud Centre, 21 Maresfield Gardens, London, NW3 5SU, UK
| | - Miranda Wolpert
- Evidence Based Practice Unit, UCL and Anna Freud Centre, 21 Maresfield Gardens, London, NW3 5SU, UK. .,Child Outcomes Research Consortium, Anna Freud Centre, London, UK.
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Asthana S, Gibson A, Bailey T, Moon G, Hewson P, Dibben C. Equity of utilisation of cardiovascular care and mental health services in England: a cohort-based cross-sectional study using small-area estimation. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BackgroundA strong policy emphasis on the need to reduce both health inequalities and unmet need in deprived areas has resulted in the substantial redistribution of English NHS funding towards deprived areas. This raises the question of whether or not socioeconomically disadvantaged people continue to be disadvantaged in their access to and utilisation of health care.ObjectivesTo generate estimates of the prevalence of cardiovascular disease (CVD) and common mental health disorders (CMHDs) at a variety of scales, and to make these available for public use via Public Health England (PHE). To compare these estimates with utilisation of NHS services in England to establish whether inequalities of use relative to need at various stages on the health-care pathway are associated with particular sociodemographic or other factors.DesignCross-sectional analysis of practice-, primary care trust- and Clinical Commissioning Group-level variations in diagnosis, prescribing and specialist management of CVD and CMHDs relative to the estimated prevalence of those conditions (calculated using small-area estimation).ResultsThe utilisation of CVD care appears more equitable than the utilisation of care for CMHDs. In contrast to the reviewed literature, we found little evidence of underutilisation of services by older populations. Indeed, younger populations appear to be less likely to access care for some CVD conditions. Nor did deprivation emerge as a consistent predictor of lower use relative to need for either CVD or CMHDs. Ethnicity is a consistent predictor of variations in use relative to need. Rates of primary management are lower than expected in areas with higher percentages of black populations for diabetes, stroke and CMHDs. Areas with higher Asian populations have higher-than-expected rates of diabetes presentation and prescribing and lower-than-expected rates of secondary care for diabetes. For both sets of conditions, there are pronounced geographical variations in use relative to need. For instance, the North East has relatively high levels of use of cardiac care services and rural (shire) areas have low levels of use relative to need. For CMHDs, there appears to be a pronounced ‘London effect’, with the number of people registered by general practitioners as having depression, or being prescribed antidepressants, being much lower in London than expected. A total of 24 CVD and 41 CMHD prevalence estimates have been provided to PHE and will be publicly available at a range of scales, from lower- and middle-layer super output areas through to Clinical Commissioning Groups and local authorities.ConclusionsWe found little evidence of socioeconomic inequality in use for CVD and CMHDs relative to underlying need, which suggests that the strong targeting of NHS resources to deprived areas may well have addressed longstanding concerns about unmet need. However, ethnicity has emerged as a significant predictor of inequality, and there are large and unexplained geographical variations in use relative to need for both conditions which undermine the principle of equal access to health care for equal needs. The persistence of ethnic variations and the role of systematic factors (such as rurality) in shaping patterns of utilisation deserve further investigation, as does the fact that the models were far better at explaining variation in use of CVD than mental health services.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Sheena Asthana
- School of Government, University of Plymouth, Plymouth, UK
| | - Alex Gibson
- School of Government, University of Plymouth, Plymouth, UK
| | - Trevor Bailey
- College of Mathematics and Physical Sciences, University of Exeter, Exeter, UK
| | - Graham Moon
- School of Geography and the Environment, University of Southampton, Southampton, UK
| | - Paul Hewson
- School of Computing and Mathematics, University of Plymouth, Plymouth, UK
| | - Chris Dibben
- School of Geosciences, University of Edinburgh, Edinburgh, UK
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Abstract
BACKGROUND The definition of ultra-high risk (UHR) for psychosis was derived from community-based help-seeking populations. Prisoners have high rates of psychosis and other severe mental health (MH) problems. They also have high rates of risk factors for psychiatric morbidity and yet they are among the populations who are less likely to seek help in the community. Despite a policy of equivalence of care for individuals in prison there are no early intervention services for psychosis in prisons in the UK. This was a study exploring feasibility of introducing such a service into a local London prison. This paper discusses the differences in MH profile of prisoners who met criteria for at-risk mental state compared with those who did not. METHOD A two-stage procedure was used. Participants in a local London prison were routinely screened in the first week of arrival in prison with the Prodrome Questionnaire - Brief Version (PQ-B; Loewy et al. 2011). Those that screened positive as well as a small sample of those who screened negative underwent a further semi-structured assessment to see whether they met criteria for UHR state. Data on self-harm and suicide attempt, family psychiatric history, and anxiety and depression was also collected. RESULTS A total of 891 prisoners were screened, 44% of whom screened positive. A total of 354 underwent second stage assessment, 60 of whom had screened negative. Four groups were identified: those that had no MH problems, a group experiencing First Episode Psychosis, those at UHR of psychosis and a group with other MH problems. The UHR state and Psychotic groups had very similar MH profiles of symptoms and distress. Prisoners with no MH problems were at the other end of the spectrum with few symptoms and little distress. The Other group fell in between this group and the psychotic spectrum group in terms of symptomology and distress. CONCLUSIONS This study is the first to examine risk for psychosis in an adult male prison population. We identified a broad spectrum of MH disorder for which there is little current service provision in prisons. Screening early in the custodial process has the potential to identify unmet MH need and has implications for keeping individuals safe in custody. A long-term strategic approach is required to address MH need in prisons.
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Gramaglia C, Gambaro E, Rossi A, Toso A, Feggi A, Cattaneo CI, Castignoli G, Mainini P, Tarricone I, Torre E, Zeppegno P. Immigrants’ Pathways to Outpatient Mental Health: Are there Differences with the Native Population? J Immigr Minor Health 2015; 18:878-885. [PMID: 26705107 DOI: 10.1007/s10903-015-0336-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Carla Gramaglia
- Institute of Psychiatry, Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Via Solaroli n. 17, 28100, Novara, Italy
| | - Eleonora Gambaro
- Institute of Psychiatry, Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Via Solaroli n. 17, 28100, Novara, Italy
| | - Annalisa Rossi
- Institute of Psychiatry, Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Via Solaroli n. 17, 28100, Novara, Italy
| | - Alessandra Toso
- Institute of Psychiatry, Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Via Solaroli n. 17, 28100, Novara, Italy
| | - Alessandro Feggi
- Institute of Psychiatry, Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Via Solaroli n. 17, 28100, Novara, Italy
| | | | - Giorgio Castignoli
- Community Mental Health Centre (CMHCs), Viale Zoppis 8, 28021, Borgomanero, NO, Italy
| | - Piera Mainini
- Community Mental Health Centre (CMHCs), Viale Zoppis 8, 28021, Borgomanero, NO, Italy
| | - Ilaria Tarricone
- Dipartimento di Scienze Mediche e Chirurgiche, viale C.Pepoli 5, Bologna, Italy
| | - Eugenio Torre
- Institute of Psychiatry, Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Via Solaroli n. 17, 28100, Novara, Italy
| | - Patrizia Zeppegno
- Institute of Psychiatry, Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Via Solaroli n. 17, 28100, Novara, Italy.
- SC Psichiatria, AOU Maggiore della Carità, Corso Mazzini n. 18, 28100, Novara, Italy.
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Bhui K, Ullrich S, Kallis C, Coid JW. Criminal justice pathways to psychiatric care for psychosis. Br J Psychiatry 2015; 207:523-9. [PMID: 26294370 PMCID: PMC4664857 DOI: 10.1192/bjp.bp.114.153882] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 11/02/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Some patients are at higher risk of contact with criminal justice agencies when experiencing a first episode of psychosis. AIMS To investigate whether violence explains criminal justice pathways (CJPs) for psychosis in general, and ethnic vulnerability to CJPs. METHOD Two-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. RESULTS CJPs 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. CONCLUSIONS CJPs 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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Affiliation(s)
- Kamaldeep Bhui
- Kamaldeep Bhui, MD, Simone Ullrich, PhD, Constantinos Kallis, PhD, Jeremy W. Coid, MD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
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Basu S, Subramaniam M, Abdin E, Poon LY, Verma S. Does ethnicity have an impact on duration of untreated psychoses: A retrospective study in Singapore. Int J Soc Psychiatry 2015; 61:623-30. [PMID: 25608690 DOI: 10.1177/0020764014568128] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Some studies have suggested ethnicity as being one of the causes leading to a longer duration of untreated psychosis (DUP) in first episode psychosis. AIM We sought to investigate this issue, in a large cohort of patients with a first episode of psychosis, in Singapore. METHOD In this naturalistic retrospective study, 794 patients accepted into Early Psychosis Intervention Programme (EPIP) services in Singapore were recruited. Diagnosis was made based on SCID 1 (Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), Axis I Disorders). Information about DUP and sociodemographic characteristics was collected from patients and relatives. Positive and Negative Symptom Scale (PANSS) and Global Assessment of Functioning (GAF) Scale were used as tools to assess the severity of symptoms and functioning of the patient, respectively, at baseline, 3, 6, 12 and 24 months. RESULTS The mean and 50th quantile (median) of DUP for this sample were 14.2 and 6, respectively. The mean and median DUP were higher among Indians than in the other ethnic groups. After adjusting for demographic variables, Indian ethnicity was significantly associated with higher median and 75th Percentile DUP than Chinese. Secondary and tertiary education and diagnosis of affective psychosis and brief psychotic disorder (vs. schizophrenia spectrum and delusional disorder) were also significantly associated with lower mean, median and 75th percentile DUP symptoms. Increase in age was significantly associated with higher mean, median and 75th percentile DUP while married and separated/divorced (vs. single) was significantly associated with lower mean and 75th percentile DUP. CONCLUSION This study found a positive correlation between certain ethnic groups and DUP. Indian ethnicity, older age, single, lower education and patients diagnosed with schizophrenia spectrum and delusional disorders were more likely to be associated with longer DUP.
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Affiliation(s)
- Sutapa Basu
- Department of Early Psychosis Intervention Programme, Institute of Mental Health, Singapore
| | | | | | - Lye Yin Poon
- Department of Early Psychosis Intervention Programme, Institute of Mental Health, Singapore
| | - Swapna Verma
- Department of Early Psychosis Intervention Programme, Institute of Mental Health, Singapore
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Skubby D, Bonfine N, Tracy H, Knepp K, Munetz MR. The Help-Seeking Experiences of Parents of Children with a First-Episode of Psychosis. Community Ment Health J 2015; 51:888-96. [PMID: 25876766 DOI: 10.1007/s10597-015-9877-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 04/09/2015] [Indexed: 10/23/2022]
Abstract
The objective was to understand the experiences of parents as they sought psychological and specialized medical services for a loved one having a first episode of psychosis. The research method was qualitative and the data gathering was done through semi-structured interviews. Eleven parents of eight adolescent or young adult children consented to be interviewed. Data from these interviews were coded and sorted. Parents reported that many of their encounters resulted in delays in accessing treatment. These encounters were characterized by misattributions of the child's behavior, poor advice, misdiagnosis, disbelief in the seriousness of the child's condition, and an unwillingness to share information. But parents also reported that encounters with other individuals were characterized by helpful advice, emotional support, and suggestions as to how to access early intervention services. Encounters with many professionals were generally not helpful to parents. These encounters served as roadblocks to accessing proper treatment for their child. More publicity, outreach, and education are recommended in the professional community.
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Affiliation(s)
- David Skubby
- Department of Sociology and Anthropology, Hendrix College, 1600 Washington Ave., Conway, AR, 72032, USA.
| | - Natalie Bonfine
- Department of Psychiatry, Northeast Ohio Medical University, State Route 44, Rootstown, OH, 44272, USA
| | - Hattie Tracy
- Child Guidance and Family Solutions, 18 North Forge St., Akron, OH, 44304, USA
| | - Kristen Knepp
- Department of Psychiatry, Northeast Ohio Medical University, State Route 44, Rootstown, OH, 44272, USA
| | - Mark R Munetz
- Department of Psychiatry, Northeast Ohio Medical University, State Route 44, Rootstown, OH, 44272, USA
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Stigma- and non-stigma-related treatment barriers to mental healthcare reported by service users and caregivers. Psychiatry Res 2015; 228:612-9. [PMID: 26115840 DOI: 10.1016/j.psychres.2015.05.044] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 04/20/2015] [Accepted: 05/03/2015] [Indexed: 11/23/2022]
Abstract
Delayed treatment seeking for people experiencing symptoms of mental illness is common despite available mental healthcare. Poor outcomes are associated with untreated mental illness and caregivers may eventually need to seek help on the service user's behalf. More attention has recently focused on the role of stigma in delayed treatment seeking. This study aimed to establish the frequency of stigma- and non-stigma-related treatment barriers reported by 202 service users and 80 caregivers; to compare treatment barriers reported by service users and caregivers; and to investigate demographic predictors of reporting stigma-related treatment barriers. The profile of treatment barriers differed between service users and caregivers. Service users were more likely to report stigma-related treatment barriers than caregivers across all stigma-related items. Service users who were female, had a diagnosis of schizophrenia or with GCSEs (UK qualifications usually obtained at age 16) were significantly more likely to report stigma-related treatment barriers. Caregivers who were female or of Black ethnicities were significantly more likely to report stigma-related treatment barriers. Multifaceted approaches are needed to reduce barriers to treatment seeking for both service users and caregivers, with anti-stigma interventions being of particular importance for the former group.
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Stergiopoulos V, Gozdzik A, Misir V, Skosireva A, Connelly J, Sarang A, Whisler A, Hwang SW, O'Campo P, McKenzie K. Effectiveness of Housing First with Intensive Case Management in an Ethnically Diverse Sample of Homeless Adults with Mental Illness: A Randomized Controlled Trial. PLoS One 2015; 10:e0130281. [PMID: 26176621 PMCID: PMC4503775 DOI: 10.1371/journal.pone.0130281] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 05/18/2015] [Indexed: 11/30/2022] Open
Abstract
Housing First (HF) is being widely disseminated in efforts to end homelessness among homeless adults with psychiatric disabilities. This study evaluates the effectiveness of HF with Intensive Case Management (ICM) among ethnically diverse homeless adults in an urban setting. 378 participants were randomized to HF with ICM or treatment-as-usual (TAU) in Toronto (Canada), and followed for 24 months. Measures of effectiveness included housing stability, physical (EQ5D-VAS) and mental (CSI, GAIN-SS) health, social functioning (MCAS), quality of life (QoLI20), and health service use. Two-thirds of the sample (63%) was from racialized groups and half (50%) were born outside Canada. Over the 24 months of follow-up, HF participants spent a significantly greater percentage of time in stable residences compared to TAU participants (75.1% 95% CI 70.5 to 79.7 vs. 39.3% 95% CI 34.3 to 44.2, respectively). Similarly, community functioning (MCAS) improved significantly from baseline in HF compared to TAU participants (change in mean difference = +1.67 95% CI 0.04 to 3.30). There was a significant reduction in the number of days spent experiencing alcohol problems among the HF compared to TAU participants at 24 months (ratio of rate ratios = 0.47 95% CI 0.22 to 0.99) relative to baseline, a reduction of 53%. Although the number of emergency department visits and days in hospital over 24 months did not differ significantly between HF and TAU participants, fewer HF participants compared to TAU participants had 1 or more hospitalizations during this period (70.4% vs. 81.1%, respectively; P=0.044). Compared to non-racialized HF participants, racialized HF participants saw an increase in the amount of money spent on alcohol (change in mean difference = $112.90 95% CI 5.84 to 219.96) and a reduction in physical community integration (ratio of rate ratios = 0.67 95% CI 0.47 to 0.96) from baseline to 24 months. Secondary analyses found a significant reduction in the number of days experiencing problems due to alcohol use among foreign-born (vs. Canadian-born) HF participants at 24 months (ratio of rate ratios = 0.19 95% 0.04 to 0.88), relative to baseline. Compared to usual care, HF with ICM can improve housing stability and community functioning and reduce the days of alcohol related problems in an ethnically diverse sample of homeless adults with mental illness within 2-years.
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Affiliation(s)
- Vicky Stergiopoulos
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Agnes Gozdzik
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Vachan Misir
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Anna Skosireva
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Jo Connelly
- Toronto North Support Services, Toronto, Ontario, Canada
| | | | - Adam Whisler
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Stephen W Hwang
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Patricia O'Campo
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kwame McKenzie
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Health Services and Health Equity Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Anderson KK, Flora N, Ferrari M, Tuck A, Archie S, Kidd S, Tang T, Kirmayer LJ, McKenzie K. Pathways to First-Episode Care for Psychosis in African-, Caribbean-, and European-Origin Groups in Ontario. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:223-31. [PMID: 26174526 PMCID: PMC4484691 DOI: 10.1177/070674371506000504] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 08/01/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare the pathways to care and duration of untreated psychosis (DUP) for people of Black-African, Black-Caribbean, or White-European origin with first-episode psychosis (FEP). METHODS We recruited a sample of 171 patients with FEP of Black-African, Black-Caribbean, and White-European origin from hospital- and community-based early intervention services (EIS) in the cities of Toronto and Hamilton. We compared the 3 groups on DUP and key indicators of the pathway to care. RESULTS We observed differences in pathways to care across the 3 groups. Black-Caribbean participants had an increased odds of referral from an inpatient unit to EIS (OR 3.33; 95% CI 1.46 to 7.60) and a decreased odds of general practitioner involvement on the pathway to care (OR 0.17; 95% CI 0.07 to 0.46), as well as fewer total contacts (exp[β] 0.77; 95% CI 0.60 to 0.99) when compared with White-European participants. Black-African participants had an increased odds of contact with the emergency department at first contact (OR 3.78; 95% CI 1.31 to 10.92). The differences in the DUP between groups were not statistically significant. CONCLUSIONS Our findings suggest that there are significant differences in the pathways to EIS for psychosis for people of African and Caribbean origin in our Canadian context. It is essential to gain a comprehensive understanding of the pathways that different population groups take to mental health services, and the reasons behind observed differences, to inform the development of equitable services, targeting patients in the critical early stages of psychotic disorder.
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Affiliation(s)
- Kelly K Anderson
- Post-doctoral Fellow, Centre for Addiction and Mental Health, Toronto, Ontario
| | - Nina Flora
- Research Analyst, Centre for Addiction and Mental Health, Toronto, Ontario
| | - Manuela Ferrari
- Post-doctoral Fellow, Centre for Addiction and Mental Health, Toronto, Ontario
| | - Andrew Tuck
- Project Coordinator, Centre for Addiction and Mental Health, Toronto, Ontario
| | - Suzanne Archie
- Associate Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
| | - Sean Kidd
- Independent Scientist, Centre for Addiction and Mental Health; Assistant Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Taryn Tang
- Manager of Research, Schizophrenia Society of Ontario; Assistant Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Laurence J Kirmayer
- Professor, Division of Social and Transcultural Psychiatry, Department of Psychiatry, McGill University; Director, Culture and Mental Health Research Unit, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec
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Graham T, Rose D, Murray J, Ashworth M, Tylee A. User-generated quality standards for youth mental health in primary care: a participatory research design using mixed methods. BMJ Qual Saf 2014; 23:857-66. [PMID: 24920648 PMCID: PMC4173988 DOI: 10.1136/bmjqs-2014-002842] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 05/01/2014] [Accepted: 05/10/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To develop user-generated quality standards for young people with mental health problems in primary care using a participatory research model. METHODS 50 young people aged 16-25 from community settings and primary care participated in focus groups and interviews about their views and experiences of seeking help for mental health problems in primary care, cofacilitated by young service users and repeated to ensure respondent validation. A second group of young people also aged 16-25 who had sought help for any mental health problem from primary care or secondary care within the last 5 years were trained as focus groups cofacilitators (n=12) developed the quality standards from the qualitative data and participated in four nominal groups (n=28). RESULTS 46 quality standards were developed and ranked by young service users. Agreement was defined as 100% of scores within a two-point region. Group consensus existed for 16 quality standards representing the following aspects of primary care: better advertising and information (three); improved competence through mental health training and skill mix within the practice (two); alternatives to medication (three); improved referral protocol (three); and specific questions and reassurances (five). Alternatives to medication and specific questions and reassurances are aspects of quality which have not been previously reported. CONCLUSIONS We have demonstrated the feasibility of using participatory research methods in order to develop user-generated quality standards. The development of patient-generated quality standards may offer a more formal method of incorporating the views of service users into quality improvement initiatives. This method can be adapted for generating quality standards applicable to other patient groups.
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Affiliation(s)
- Tanya Graham
- Florence Nightingale School of Nursing and Midwifery, King's College London, London, UK
| | - Diana Rose
- Health Services and Population Research Department, Institute of Psychiatry, King's College London, London, UK
| | - Joanna Murray
- Health Services and Population Research Department, Institute of Psychiatry, King's College London, London, UK
| | - Mark Ashworth
- Department of Primary Care and Public Health Sciences, King's College London, School of Medicine, London, UK
| | - André Tylee
- Health Services and Population Research Department, Institute of Psychiatry, King's College London, London, UK
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Anderson KK, Flora N, Archie S, Morgan C, McKenzie K. A meta-analysis of ethnic differences in pathways to care at the first episode of psychosis. Acta Psychiatr Scand 2014; 130:257-68. [PMID: 24580102 PMCID: PMC4336563 DOI: 10.1111/acps.12254] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We sought to systematically review the literature on ethnic differences in the likelihood of general practitioner (GP) involvement, police involvement, and involuntary admission on the pathway to care of patients with first-episode psychosis (FEP). METHOD We searched electronic databases and conducted forward and backward tracking to identify relevant studies. We calculated pooled odds ratios (OR) to examine the variation between aggregated ethnic groups in the indicators of the pathway to care. RESULTS We identified seven studies from Canada and England that looked at ethnic differences in GP involvement (n=7), police involvement (n=7), or involuntary admission (n=5). Aggregated ethnic groups were most often compared. The pooled ORs suggest that Black patients have a decreased likelihood of GP involvement (OR=0.70, 0.57-0.86) and an increased likelihood of police involvement (OR=2.11, 1.67-2.66), relative to White patients. The pooled ORs were not statistically significant for patients with Asian backgrounds (GP involvement OR=1.23, 0.87-1.75; police involvement OR=0.86, 0.57-1.30). There is also evidence to suggest that there may be ethnic differences in the likelihood of involuntary admission; however, effect modification by several sociodemographic factors precluded a pooling of these data. CONCLUSION Ethnic differences in pathways to care are present at the first episode of psychosis.
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Affiliation(s)
- K K Anderson
- Social and Epidemiological Research, Centre for Addiction and Mental Health (CAMH)Toronto, ON, Canada,
Kelly K. Anderson, PhD, Social and Epidemiological Research, Centre for Addiction and Mental Health (CAMH), 455 Spadina Avenue, Suite 300, Toronto, ON M5S 2G8, Canada., E-mail:
| | - N Flora
- Social and Epidemiological Research, Centre for Addiction and Mental Health (CAMH)Toronto, ON, Canada
| | - S Archie
- Department of Psychiatry and Behavioural Neurosciences, McMaster UniversityHamilton, ON, Canada
| | - C Morgan
- Section of Social Psychiatry, Institute of Psychiatry, King's College LondonLondon, UK
| | - K McKenzie
- Social and Epidemiological Research, Centre for Addiction and Mental Health (CAMH)Toronto, ON, Canada,Department of Psychiatry, University of TorontoToronto, ON, Canada
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Recruiting South Asians into a UK Mental Health Randomised Controlled Trial: Experiences of Field Researchers. J Racial Ethn Health Disparities 2014. [DOI: 10.1007/s40615-014-0024-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Boydell J, Onwumere J, Dutta R, Bhavsar V, Hill N, Morgan C, Dazzan P, Morgan K, Pararajan M, Kuipers E, Jones P, Murray R, Fearon P. Caregiving in first-episode psychosis: social characteristics associated with perceived 'burden' and associations with compulsory treatment. Early Interv Psychiatry 2014; 8:122-9. [PMID: 23458284 DOI: 10.1111/eip.12041] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 01/06/2013] [Indexed: 01/03/2023]
Abstract
AIMS High incidence of psychosis and compulsory treatment within black and minority ethnic (BME) groups in the UK remain a concern. Psychosis has an impact on families and family involvement is important in predicting compulsory treatment. We therefore aimed to report the levels and predictors of caregiver burden in first-episode psychosis, in white British, and BME groups of carers, and investigate their relevance to compulsory treatment. METHODS A total of 124 caregivers were interviewed soon after the onset of psychosis using the General Health Questionnaire, GHQ-28, the Experience of Caregiving Inventory, the Personal and Psychiatric History Schedule, and the MRC Sociodemographic Schedule. RESULTS The overall level of distress as measured by GHQ-28 was high (mean 50, SD 11.4). Feelings of carer burden were also high (mean total negative score 72.5, SD 34.8), increased in men, and with carer age. Neither ethnicity nor social class nor social support was associated with distress or burden. Compulsory treatment was predicted by carer burden (as indicated by carer reports of 'problems with services' (OR 1.08; 95% CI 1.01, 1.15; P = 0.023)); this was particularly evident in the black Caribbean group of carers (OR 1.28; 95% CI 1.04, 1.57; P = 0.02) CONCLUSION: Carers of adults with first-episode psychosis experience considerable psychological distress and feelings of burden. There was a specific association between carer burden, specifically in terms of experience of services, and compulsory admission of service users, particularly in the black Caribbean group. Better ways of liaising with carers and targeted efforts to reduce carer burden at illness onset are needed.
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Affiliation(s)
- Jane Boydell
- King's College London, Institute of Psychiatry, London, UK
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Adeosun II, Adegbohun AA, Adewumi TA, Jeje OO. The Pathways to the First Contact with Mental Health Services among Patients with Schizophrenia in Lagos, Nigeria. SCHIZOPHRENIA RESEARCH AND TREATMENT 2013; 2013:769161. [PMID: 24490072 PMCID: PMC3893872 DOI: 10.1155/2013/769161] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 11/06/2013] [Accepted: 11/14/2013] [Indexed: 11/13/2022]
Abstract
There is increasing evidence that delay in the commencement of treatment, following the onset of schizophrenia, may be related to the pathways patients navigate before accessing mental health care. Therefore, insight into the pattern and correlates of pathways to mental care of patients with schizophrenia may inform interventions that could fast track their contact with mental health professionals and reduce the duration of untreated psychosis. This study assessed the pathways to mental health care among patients with schizophrenia (n = 138), at their first contact with mental health services at the Federal Neuro-Psychiatric Hospital Yaba Lagos, Nigeria. Traditional and religious healers were the first contact for the majority (69%) of the patients. Service users who first contacted nonorthodox healers made a greater number of contacts in the course of seeking help, eventuating in a longer duration of untreated psychosis (P < 0.001). However, the delay between the onset of psychosis and contact with the first point of care was shorter in patients who patronized nonorthodox practitioners. The findings suggest that collaboration between orthodox and nonorthodox health services could facilitate the contact of patients with schizophrenia with appropriate treatment, thereby reducing the duration of untreated psychosis. The need for public mental health education is also indicated.
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Affiliation(s)
| | | | | | - Oyetayo O. Jeje
- Federal Neuro-Psychiatric Hospital Yaba, 8 Harvey Road, PMB, Lagos 2008, Nigeria
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Social support in depression: structural and functional factors, perceived control and help-seeking. Epidemiol Psychiatr Sci 2013; 22:345-53. [PMID: 24063718 PMCID: PMC8367349 DOI: 10.1017/s2045796013000504] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Aims. This study examined the associations of social support, loneliness and locus of control with depression and help-seeking in persons with major depression. Methods. Twelve-month help-seeking for emotional problems was assessed in a cross-sectional 2006 Estonian Health Survey. Non-institutionalized individuals aged 18-84 years (n = 6105) were interviewed. A major depressive episode was assessed using the Mini-International Neuropsychiatric Interview. Factors describing social support, social and emotional loneliness and locus of control were assessed, and their associations with depression were analysed. The associations with reported help-seeking behaviour among people identified as having a major depressive episode (n = 343) were explored. Results. Low frequency of contacts with one's friends and parents, emotional loneliness, external locus of control and emotional dissatisfaction with couple relations were significant factors predicting depression in the multivariate model. External locus of control was associated with help-seeking in the depressed sample. Interactions of emotional loneliness, locus of control and frequency of contacts with parents significantly predicted help-seeking in the depressed sample. Conclusions. Depression is associated with structural and functional factors of social support and locus of control. Help-seeking of depressed persons depends on locus of control, interactions of emotional loneliness, locus of control and contacts with the parental family.
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Singh SP, Islam Z, Brown LJ, Gajwani R, Jasani R, Rabiee F, Parsons H. Ethnicity, detention and early intervention: reducing inequalities and improving outcomes for black and minority ethnic patients: the ENRICH programme, a mixed-methods study. PROGRAMME GRANTS FOR APPLIED RESEARCH 2013. [DOI: 10.3310/pgfar01030] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundBlack and minority ethnic (BME) service users experience adverse pathways into care. Ethnic differences are evident even at first-episode psychosis (FEP); therefore, contributory factors must operate before first presentation to psychiatric services. The ENRICH programme comprised three interlinked studies that aimed to understand ethnic and cultural determinants of help-seeking and pathways to care.Aims and objectivesStudy 1: to understand ethnic differences in pathways to care in FEP by exploring cultural determinants of illness recognition, attribution and help-seeking among different ethnic groups. Study 2: to evaluate the process of detention under the Mental Health Act (MHA) and determine predictors of detention. Study 3: to determine the appropriateness, accessibility and acceptability of generic early intervention services for different ethnic groups.MethodsStudy 1: We recruited a prospective cohort of FEP patients and their carers over a 2-year period and assessed the chronology of symptom emergence, attribution and help-seeking using semistructured tools: the Nottingham Onset Schedule (NOS), the Emerging Psychosis Attribution Schedule and the ENRICH Amended Encounter Form. A stratified subsample of user–carer NOS interviews was subjected to qualitative analyses. Study 2: Clinical and sociodemographic data including reasons for detention were collected for all MHA assessments conducted over 1 year (April 2009–March 2010). Five cases from each major ethnic group were randomly selected for a qualitative exploration of carer perceptions of the MHA assessment process, its outcomes and alternatives to detention. Study 3: Focus groups were conducted with service users, carers, health professionals, key stakeholders from voluntary sector and community groups, commissioners and representatives of spiritual care with regard to the question: ‘How appropriate and accessible are generic early intervention services for the specific ethnic and cultural needs of BME communities in Birmingham?’ResultsThere were no ethnic differences in duration of untreated psychosis (DUP) and duration of untreated illness in FEP. DUP was not related to illness attribution; long DUP was associated with patients being young (< 18 years) and living alone. Black patients had a greater risk of MHA detention, more criminal justice involvement and more crisis presentations than white and Asian groups. Asian carers and users were most likely to attribute symptoms to faith-based or supernatural explanations and to seek help from faith organisations. Faith-based help-seeking, although offering comfort and meaning, also risked delaying access to medical care and in some cases also resulted in financial exploitation of this vulnerable group. The BME excess in MHA detentions was not because of ethnicity per se; the main predictors of detention were a diagnosis of mental illness, presence of risk and low level of social support. Early intervention services were perceived to be accessible, supportive, acceptable and culturally appropriate. There was no demand or perceived need for separate services for BME groups or for ethnic matching between users and clinicians.ConclusionsStatutory health-care organisations need to work closely with community groups to improve pathways to care for BME service users. Rather than universal public education campaigns, researchers need to develop and evaluate public awareness programmes that are specifically focused on BME groups.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- SP Singh
- Division of Mental Health and Wellbeing, Warwick Medical School, Warwick University, Coventry, UK
- Research and Innovation Department, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Z Islam
- Division of Mental Health and Wellbeing, Warwick Medical School, Warwick University, Coventry, UK
- Research and Innovation Department, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - LJ Brown
- Division of Mental Health and Wellbeing, Warwick Medical School, Warwick University, Coventry, UK
- Research and Innovation Department, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - R Gajwani
- School of Psychology, University of Birmingham, Birmingham, UK
| | - R Jasani
- Humanitarian and Conflict Response Institute (HCRI), University of Manchester, Manchester, UK
| | - F Rabiee
- Centre for Health and Social Care Research, Faculty of Health, Birmingham City University, Birmingham, UK
| | - H Parsons
- Division of Health Sciences, Warwick Medical School, Warwick University, Coventry, UK
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Hui CLM, Tang JYM, Wong GHY, Chang WC, Chan SKW, Lee EHM, Chen EYH. Predictors of help-seeking duration in adult-onset psychosis in Hong Kong. Soc Psychiatry Psychiatr Epidemiol 2013; 48:1819-28. [PMID: 23620097 DOI: 10.1007/s00127-013-0688-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 04/05/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Delay in receiving treatment in psychosis may lead to adverse consequences. We examined the predictors for help-seeking duration in adult-onset psychosis Chinese patients in Hong Kong. We hypothesized that factors which are more related to the illness manifestation would be predictive of waiting time before any help-seeking initiation, and factors which are more related to one's knowledge about mental health services would be predictive of help-seeking duration. METHODS First-episode patients with psychosis were recruited from the Jockey Club Early Psychosis project. They were asked to report retrospectively all help-seeking behaviors involved since their first occurrence of psychotic symptoms until receipt of effective psychiatric treatment. Baseline characteristics, pre-morbid functioning and traits, and mode of illness onset were assessed. RESULTS Help-seeking pattern was analyzed in 360 patients who had subsequently reached the psychiatric services. They had an average of 2.5 help-seeking contacts. Nearly half of the first help-seeking process was initiated by family members. Only 1 % approached priests or traditional healers as the first step in help-seeking. Whereas a gradual mode of onset was significantly associated with longer waiting time to first help-seeking initiation, more premorbid schizoid and schizotypal traits and a migrant status were related to longer help-seeking duration. CONCLUSIONS Current findings suggested that family members were the key decision makers in initiating help-seeking. Longer help-seeking duration in migrants has significant implications to both local and global mental health policy.
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Affiliation(s)
- Christy L M Hui
- Department of Psychiatry, Queen Mary Hospital, University of Hong Kong, 102, Pokfulam Road, Hong Kong SAR, China,
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48
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Abstract
Pathways into care have not changed significantly since the introduction of early intervention services for psychosis in London. Some groups have different pathways into care and those whose pathway originates in primary care have a longer route to services. This editorial explores the nature of these challenges, for both early intervention services and referring agencies.
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Ghali S, Fisher HL, Joyce J, Major B, Hobbs L, Soni S, Chisholm B, Rahaman N, Papada P, Lawrence J, Bloy S, Marlowe K, Aitchison KJ, Power P, Johnson S. Ethnic variations in pathways into early intervention services for psychosis. Br J Psychiatry 2013; 202:277-83. [PMID: 22955006 DOI: 10.1192/bjp.bp.111.097865] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Ethnic variations have previously been identified in the duration of untreated psychosis (DUP) and pathways into psychiatric services. These have not been examined in the context of early intervention services, which may alter these trajectories. AIMS To explore ethnic differences in the nature and duration of pathways into early intervention services. METHOD In a naturalistic cohort study, data were collected for 1024 individuals with psychotic disorders accepted for case management by eight London early intervention services. RESULTS Duration of untreated psychosis was prolonged in the White British group compared with most other ethnic groups. White British individuals were more likely to make contact with their general practitioner and less likely to be seen within emergency medical services. All Black patient groups were more likely than their White British counterparts to experience involvement of criminal justice agencies. CONCLUSIONS Variations continue to exist in how and when individuals from different ethnic groups access early intervention services. These may account for disparities in DUP.
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Bécares L, Das-Munshi J. Ethnic density, health care seeking behaviour and expected discrimination from health services among ethnic minority people in England. Health Place 2013; 22:48-55. [PMID: 23603426 DOI: 10.1016/j.healthplace.2013.03.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 02/19/2013] [Accepted: 03/17/2013] [Indexed: 10/27/2022]
Abstract
The health of ethnic minority people is reported to be poorer in areas of lower ethnic density. Based on this literature, higher rates of health seeking behaviours would be expected among ethnic minorities resident in neighbourhoods of lower ethnic density. Should health seeking not increase in areas of lower ethnic density, a possible explanation might be that ethnic minority people resident in these neighbourhoods are not accessing services for fear of racial discrimination. The present study examined this hypothesis using two nationally-representative surveys from England. Health seeking behaviour did not vary by ethnic density. Lower ethnic density was associated with increased reports of expected discrimination from services, but also with increased satisfaction with services.
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Affiliation(s)
- Laia Bécares
- Centre on Dynamics of Ethnicity, University of Manchester, Oxford Road, Manchester M13 9PL, UK.
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