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Monk NJ, Cunningham R, Stanley J, Crengle S, Fitzjohn J, Kerdemelidis M, Lockett H, McLachlan AD, Waitoki W, Lacey C. The physical health and premature mortality of Indigenous Māori following first-episode psychosis diagnosis: A 15-year follow-up study. Aust N Z J Psychiatry 2024:48674241270981. [PMID: 39169471 DOI: 10.1177/00048674241270981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
BACKGROUND People experiencing psychosis are at greater risk of physical health conditions and premature mortality. It is likely that Indigenous Māori youth, who experience additional systemic inequities caused by settler-colonisation, face even greater physical health and mortality risks following a diagnosis of first-episode psychosis. OBJECTIVE Compare Māori and non-Māori for risk of hospitalisation and mortality for up to 15 years following first-episode psychosis diagnosis. METHODS A cohort (N = 14,122) of young people (16-24 years) with first-episode psychosis diagnosis between 2001 and 2019 were identified. Using crude Kaplan-Meier and adjusted Cox proportional hazards models, Māori (n = 5211) and non-Māori (n = 8911) were compared on hospitalisation and mortality outcomes for up to 15 years. RESULTS In the 15 years following first-episode psychosis diagnosis, Māori had higher adjusted risk of all-cause mortality (hazard ratio = 1.21, 95% confidence interval = [1.01, 1.45]), hospitalisation with diabetes (hazard ratio = 1.44, 95% confidence interval = [1.15, 1.79]), injury/poisoning (hazard ratio = 1.11, 95% confidence interval = [1.05, 1.16]), general physical health conditions (hazard ratio = 1.07, 95% confidence interval = [1.02, 1.13]) and also appeared to be at greater risk of cardiovascular hospitalisations (hazard ratio = 1.34, 95% confidence interval = [0.97, 1.86]). Kaplan-Meier plots show hospitalisation and mortality inequities emerging approximately 4-7 years following first-episode psychosis diagnosis. CONCLUSIONS Māori are at greater risk for hospitalisation and premature mortality outcomes following first-episode psychosis. Early screening and intervention, facilitated by culturally safe health service delivery, is needed to target these inequities early.
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Affiliation(s)
- Nathan J Monk
- Department of Māori/Indigenous Health Innovation, University of Otago, Christchurch, New Zealand
| | - Ruth Cunningham
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - James Stanley
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Sue Crengle
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Christchurch, New Zealand
| | - Julie Fitzjohn
- Specialist Mental Health Service, Te Whatu Ora - Waitaha Canterbury, Christchurch, New Zealand
| | - Melissa Kerdemelidis
- Population Health Gain, Service Improvement and Innovation, Te Whatu Ora - Waitaha Canterbury, Christchurch, New Zealand
| | - Helen Lockett
- Department of Public Health, University of Otago, Wellington, New Zealand
- Te Pou, Wellington, New Zealand
| | - Andre D McLachlan
- Centre for Health and Social Practice, Waikato Institute of Technology, Hamilton, New Zealand
| | - Waikaremoana Waitoki
- Faculty of Māori and Indigenous Studies, The University of Waikato, Hamilton, New Zealand
| | - Cameron Lacey
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Grattan RE, Mehta A, Clifford A. Disparities in Psychosis Risk Symptoms for New Zealand Māori May Be Explained by Systemic Stressors and Inappropriate Conceptualization of Culturally Normative Experiences. Schizophr Bull 2024; 50:89-95. [PMID: 37318180 PMCID: PMC10754151 DOI: 10.1093/schbul/sbad085] [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] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND HYPOTHESIS Māori, the indigenous peoples of New Zealand, experience increased rates of psychotic disorders and first-episode psychosis. However, it is unclear whether they also present with increased psychosis risk symptoms, such as subclinical psychotic-like experiences (PLEs). Measurement of risk symptoms is key for early intervention. Further, it is unclear if systemic factors such as the increased rates of social adversity and discrimination or cultural biases contribute to this disparity in psychosis rates. STUDY DESIGN This study surveyed 466 18- to 30-year olds in New Zealand, and compared Māori to non-Māori participant responses on the Prodromal Questionnaire Brief, alongside the history of childhood trauma, discrimination, and financial adversity. STUDY RESULTS Māori reported a higher number of PLEs compared to non-Māori-however, this was not associated with increased distress related to these experiences. The increased number of psychosis-like experiences reported by Māori was likely explained by systemic factors such as childhood trauma, discrimination, and financial stress. Māori were more likely to report that the PLEs were positive. CONCLUSIONS Measurement of psychosis risk for Māori is nuanced, and increased scores on these tools may reflect pathologizing potentially normative experiences for Māori, such as spiritual encounters or discrimination, alongside the impact of increased rates of systemic discrimination, trauma, and financial stress.
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Affiliation(s)
- Rebecca E Grattan
- School of Psychology, Te Herenga Waka, Victoria University of Wellington, Wellington, New Zealand
| | - Aleesha Mehta
- School of Psychology, Te Herenga Waka, Victoria University of Wellington, Wellington, New Zealand
| | - Amanda Clifford
- Department of Psychology, University of Otago, Dunedin, New Zealand
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Manuel J, Pitama S, Clark M, Crowe M, Crengle S, Cunningham R, Gibb S, Petrović-van der Deen FS, Porter RJ, Lacey C. Racism, early psychosis, and institutional contact: A qualitative study of Indigenous experiences. Int J Soc Psychiatry 2023; 69:2121-2127. [PMID: 37665228 PMCID: PMC10685688 DOI: 10.1177/00207640231195297] [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] [Indexed: 09/05/2023]
Abstract
BACKGROUND There is evidence of Indigenous and ethnic minority inequities in the incidence and outcomes of early psychosis. Racism has been implicated as having an important role. AIM To use Indigenous experiences to develop a more detailed understanding of how racism operates to impact early psychosis outcomes. METHODS Critical Race Theory informed the methodology used. Twenty-three Indigenous participants participated in four family focus group interviews and thirteen individual interviews, comprising of 9 Māori youth with early psychosis, 10 family members and 4 Māori mental health professionals. An analysis of the data was undertaken using deductive structural coding to identify descriptions of racism, followed by inductive descriptive and pattern coding. RESULTS Participant experiences revealed how racism operates as a socio-cultural phenomenon that interacts with institutional policy and culture across systems pertaining to social responsiveness, risk discourse, and mental health service structures. This is described across three major themes: 1) selective responses based on racial stereotypes, 2) race related risk assessment bias and 3) institutional racism in the mental health workforce. The impacts of racism were reported as inaction in the face of social need, increased use of coercive practices and an under resourced Indigenous mental health workforce. CONCLUSION The study illustrated the inter-related nature of interpersonal, institutional and structural racism with examples of interpersonal racism in the form of negative stereotypes interacting with organizational, socio-cultural and political priorities. These findings indicate that organizational cultures may differentially impact Indigenous and minority people and that social responsiveness, risk discourse and the distribution of workforce expenditure are important targets for anti-racism efforts.
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Affiliation(s)
- Jenni Manuel
- Māori/Indigenous Health Innovation, University of Otago Christchurch, New Zealand
- Department of Psychological Medicine, University of Otago Christchurch, New Zealand
| | - Suzanne Pitama
- Māori/Indigenous Health Innovation, University of Otago Christchurch, New Zealand
| | | | - Marie Crowe
- Department of Psychological Medicine, University of Otago Christchurch, New Zealand
| | - Sue Crengle
- Department of Preventive and Social Medicine, University of Otago, Dunedin School of Medicine, New Zealand
| | - Ruth Cunningham
- Department of Public Health, University of Otago Wellington, Newtown, Wellington, New Zealand
| | - Sheree Gibb
- Department of Public Health, University of Otago Wellington, Newtown, Wellington, New Zealand
| | | | - Richard J Porter
- Department of Psychological Medicine, University of Otago Christchurch, New Zealand
- Te Whatu Ora Waitaha, New Zealand
| | - Cameron Lacey
- Māori/Indigenous Health Innovation, University of Otago Christchurch, New Zealand
- Department of Psychological Medicine, University of Otago Christchurch, New Zealand
- Te Whatu Ora Waitaha, New Zealand
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Termorshuizen F, de Vries AL, Wiepjes CM, Selten JP. The risk of psychosis for transgender individuals: a Dutch national cohort study. Psychol Med 2023; 53:7923-7932. [PMID: 37539460 PMCID: PMC10755224 DOI: 10.1017/s0033291723002088] [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: 11/24/2022] [Revised: 06/15/2023] [Accepted: 07/10/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND The stressful minority position of transgender persons may result in a high risk of psychosis. Conflicting data suggest that the observed risk depends on setting of recruitment. We assessed the relative risk of non-affective psychotic disorder (NAPD) in a large, representative cohort of transgender persons. METHODS This cohort was composed using: data on legal sex change from the Dutch population registry and data on dispensing of cross-sex hormones (route 1), and a registry of insurance claims from mental health care including persons with a diagnosis of gender identity disorder (DSM-IV) or gender dysphoria (DSM-5) (route 2). They were matched by sex at birth, calendar year and country of birth to controls from the general population. Transgender persons (N = 5564) and controls (N = 27 820), aged 16-60 years at 1 January 2011, were followed until the first insurance claim for NAPD in 2011-2019. RESULTS The incidence rate ratio (IRR) of NAPD for transgender persons selected exclusively through route 1 (N = 3859, IRR = 2.00, 95%-CI 1.52-2.63) was increased, but significantly lower than the IRRs for those selected exclusively through route 2 (N = 694, IRR = 22.15, 95%-CI 13.91-35.28) and for those found by both routes (N = 1011, IRR = 5.17, 95%-CI 3.57-7.49; p value for differences in IRR < 0.001). CONCLUSIONS This study supports the social defeat-hypothesis of NAPD. The results also show the presence of a substantial number of transgender persons with severe psychiatric problems who have not (yet) taken steps to gender-affirmative care.
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Affiliation(s)
- Fabian Termorshuizen
- Rivierduinen Institute for Mental Health Care, Sandifortdreef 19, 2333 ZZ Leiden, the Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Annelou L.C. de Vries
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
| | - Chantal M. Wiepjes
- Department of Endocrinology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
| | - Jean-Paul Selten
- Rivierduinen Institute for Mental Health Care, Sandifortdreef 19, 2333 ZZ Leiden, the Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, P.O. Box 616, 6200 MD Maastricht, the Netherlands
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Jenkins M, Gardiner T, Pekepo C, Ramritu P, Drysdale B, Every-Palmer S, Chinn V. Developing a System of Health Support for Young People Experiencing First-Episode Psychosis: Protocol for a Co-design Process. JMIR Res Protoc 2023; 12:e44980. [PMID: 37129953 DOI: 10.2196/44980] [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: 12/12/2022] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND People living with psychosis face a substantially increased risk of poor psychological well-being and physical health and premature mortality. Encouraging positive health behaviors from an early stage is crucial to the health and well-being of this population but is often overshadowed by symptom management within early intervention services. OBJECTIVE Experience-based co-design is a participant-centered approach that aims to combine service user narratives with service design methods to design systems of support for health and well-being. This study aims to use experience-based co-design principles to co-design a system that supports the health and well-being of young people experiencing first-episode psychosis (FEP), which considers the lived experience of these people within the context of early intervention services. We also aim to develop a set of principles to guide future systems to support the health and well-being of young people experiencing FEP. METHODS Up to 15 young people living with FEP aged 16 to 24 years who are service users of early intervention services in psychosis, their immediate support networks (family or friends), and health professionals involved with early intervention services in psychosis will be invited to participate in a series of co-design workshops. Data will be collected in various forms, including expressive forms (eg, art and spoken word) and traditional methods (interview transcription and surveys), with phenomenographic and thematic analyses being used to understand these data. Furthermore, the co-design process will draw upon indigenous (Māori) knowledge and the lived experience of mental health services from the perspectives of the members of the research team. The co-design process will be evaluated in terms of acceptability from the perspective of service users via rating scales and interviews. The study will be conducted within the Lower North Island in Aotearoa New Zealand. RESULTS Data collection will be performed between August 2022 and February 2023. Drawing from extended consultations with service users and service providers, we have developed a robust co-design process with which we intend to collect rich qualitative and quantitative data. The results of this process will be used to create a system of support that can be immediately applied and as preliminary evidence for funding and resource applications to deliver and evaluate a "full" version of the co-designed system of support. CONCLUSIONS The co-designed system of support and accompanying set of principles will offer a potentially impactful health and well-being intervention for young people experiencing FEP in Aotearoa New Zealand. Furthermore, making the co-design process transparent will further the field in terms of providing a blueprint for this form of participant-focused research. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12622001323718; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384775&isReview=true. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/44980.
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Affiliation(s)
- Matthew Jenkins
- Department of Psychological Medicine, University of Otago Wellington, Wellington / Te Whanganui-a-Tara, New Zealand
| | - Tracey Gardiner
- Department of Psychological Medicine, University of Otago Wellington, Wellington / Te Whanganui-a-Tara, New Zealand
| | | | - Pāyal Ramritu
- Department of Psychological Medicine, University of Otago Wellington, Wellington / Te Whanganui-a-Tara, New Zealand
| | - Briony Drysdale
- Department of Psychological Medicine, University of Otago Wellington, Wellington / Te Whanganui-a-Tara, New Zealand
| | - Susanna Every-Palmer
- Department of Psychological Medicine, University of Otago Wellington, Wellington / Te Whanganui-a-Tara, New Zealand
| | - Victoria Chinn
- School of Health, Te Herenga Waka Victoria University of Wellington, Wellington / Te Whanganui-a-Tara, New Zealand
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Manuel J, Pitama S, Clark MTR, Crowe M, Crengle S, Cunningham R, Gibb S, Petrović-van der Deen FS, Porter RJ, Lacey C. Racism, early psychosis and institutional contact: a qualitative study of Indigenous experiences. Int Rev Psychiatry 2023; 35:323-330. [PMID: 37267030 DOI: 10.1080/09540261.2023.2188074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/03/2023] [Indexed: 06/03/2023]
Abstract
There is evidence of Indigenous and ethnic minority inequities in the incidence and outcomes of early psychosis. racism has an important role. This study aimed to use Indigenous experiences to develop a more detailed understanding of how racism operates to impact early psychosis. Critical Race Theory informed the methods used. Twenty-three Indigenous participants participated in 4 family focus group interviews and 13 individual interviews, comprising of 9 youth, 10 family members and 4 mental health professionals. An analysis of the data was undertaken using deductive structural coding to identify descriptions of racism, followed by inductive descriptive and pattern coding. Participant experiences revealed how racism operates as a socio-cultural phenomenon that interacts with institutional policy and culture across systems. This is described across three themes: (1) selective responses based on racial stereotypes, (2) race related risk assessment bias and (3) institutional racism in the mental health workforce. The impacts of racism were reported as inaction in the face of social need, increased coercion and an under resourced Indigenous workforce. These findings indicate that organizational cultures may differentially impact Indigenous and minority people and that social responsiveness, risk discourse and the distribution of workforce expenditure are important targets for anti-racism efforts.
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Affiliation(s)
- Jenni Manuel
- Department of Māori Indigenous Health Innovation (MIHI), University of Otago Christchurch, Christchurch, New Zealand
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Suzanne Pitama
- Department of Māori Indigenous Health Innovation (MIHI), University of Otago Christchurch, Christchurch, New Zealand
| | | | - Marie Crowe
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Sue Crengle
- Department of Preventive and Social Medicine, University of Otago, Dunedin School of Medicine, Dunedin, New Zealand
| | - Ruth Cunningham
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Sheree Gibb
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | | | - Richard J Porter
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand
- Te Whatu Ora Waitaha, Christchurch, New Zealand
| | - Cameron Lacey
- Department of Māori Indigenous Health Innovation (MIHI), University of Otago Christchurch, Christchurch, New Zealand
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand
- Te Whatu Ora Waitaha, Christchurch, New Zealand
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Carr G, Cunningham R, Petrović-van der Deen FS, Manuel J, Gibb S, Porter RJ, Pitama S, Crowe M, Crengle S, Lacey C. Evolution of first episode psychosis diagnoses and health service use among young Māori and non-Māori-A New Zealand national cohort study. Early Interv Psychiatry 2023; 17:290-298. [PMID: 35733282 DOI: 10.1111/eip.13327] [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: 03/09/2022] [Revised: 04/06/2022] [Accepted: 05/29/2022] [Indexed: 11/24/2022]
Abstract
AIMS The validity of diagnostic classification in early psychosis has important implications for early intervention; however, it is unknown if previously found disparities between Māori (Indigenous people of New Zealand) and non-Māori in first episode diagnoses persist over time, or how these differences impact service use. METHODS We used anonymized routine mental health service data and a previously established cohort of over 2400 13-25-year-old youth diagnosed with FEP between 2009 and 2012, to explore differences in diagnostic stability of psychosis diagnoses, comorbid (non-psychosis) diagnoses, and mental health service contacts between Māori and non-Māori in the five-year period following diagnosis. RESULTS Differences in schizophrenia and affective psychosis diagnoses between Māori and non-Māori were maintained in the five-year period, with Māori being more likely to be diagnosed with schizophrenia (51% vs. 35%), and non-Māori with bipolar disorder (28% vs. 18%). Stability of diagnosis was similar (schizophrenia 75% Māori vs. 67% non-Maori; bipolar disorder 55% Māori vs. 48% non-Māori) and those with no stable diagnosis at FEP were most likely to move towards a schizophrenia disorder diagnosis in both groups. Māori had a lower rate of diagnosed co-morbid affective and anxiety symptoms and higher rates of continued face to face contact and inpatient admission across all diagnoses. CONCLUSIONS Indigenous differences in schizophrenia and affective psychosis diagnoses could be related to differential exposure to socio-environmental risk or assessor bias. The lower rate of co-morbid affective and anxiety disorders indicates a potential under-appreciation of affective symptoms in Māori youth with first episode psychosis.
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Affiliation(s)
- Gawen Carr
- Capital and Coast District Health Board, Wellington, New Zealand
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Ruth Cunningham
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Frederieke S Petrović-van der Deen
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
- Department of Māori/Indigenous Health Innovation (MIHI), University of Otago Christchurch, Christchurch, New Zealand
| | - Jenni Manuel
- Department of Māori/Indigenous Health Innovation (MIHI), University of Otago Christchurch, Christchurch, New Zealand
| | - Sheree Gibb
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand
- Canterbury District Health Board, Christchurch, New Zealand
| | - Suzanne Pitama
- Department of Māori/Indigenous Health Innovation (MIHI), University of Otago Christchurch, Christchurch, New Zealand
| | - Marie Crowe
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Sue Crengle
- Department of Preventive and Social Medicine, University of Otago, Dunedin School of Medicine, Dunedin, New Zealand
| | - Cameron Lacey
- Department of Māori/Indigenous Health Innovation (MIHI), University of Otago Christchurch, Christchurch, New Zealand
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand
- Canterbury District Health Board, Christchurch, New Zealand
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Milne BJ, D'Souza S, Andersen SH, Richmond-Rakerd LS. Use of Population-Level Administrative Data in Developmental Science. ANNUAL REVIEW OF DEVELOPMENTAL PSYCHOLOGY 2022; 4:447-468. [PMID: 37284522 PMCID: PMC10241456 DOI: 10.1146/annurev-devpsych-120920-023709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Population-level administrative data-data on individuals' interactions with administrative systems (e.g., health, criminal justice, and education)-have substantially advanced our understanding of life-course development. In this review, we focus on five areas where research using these data has made significant contributions to developmental science: (a) understanding small or difficult-to-study populations, (b) evaluating intergenerational and family influences, (c) enabling estimation of causal effects through natural experiments and regional comparisons, (d) identifying individuals at risk for negative developmental outcomes, and (e) assessing neighborhood and environmental influences. Further advances will be made by linking prospective surveys to administrative data to expand the range of developmental questions that can be tested; supporting efforts to establish new linked administrative data resources, including in developing countries; and conducting cross-national comparisons to test findings' generalizability. New administrative data initiatives should involve consultation with population subgroups including vulnerable groups, efforts to obtain social license, and strong ethical oversight and governance arrangements.
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Affiliation(s)
- Barry J Milne
- School of Social Sciences and Centre of Methods and Policy Application in the Social Sciences (COMPASS), University of Auckland, Auckland, New Zealand
| | - Stephanie D'Souza
- School of Social Sciences and Centre of Methods and Policy Application in the Social Sciences (COMPASS), University of Auckland, Auckland, New Zealand
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Manuel J, Cunningham R, Gibb S, Petrović-van der Deen FS, Porter RJ, Pitama S, Crowe M, Crengle S, Carr G, Lacey C. Non-Indigenous privilege in health, justice and social services preceding first episode psychosis: A population-based cohort study. Aust N Z J Psychiatry 2022; 57:834-843. [PMID: 36002996 DOI: 10.1177/00048674221119964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is evidence of disparities between non-Indigenous and Indigenous incidence of psychotic disorders. Despite these disparities being a clear signpost of the impact of structural racism, there remains a lack of evidence to target institutional factors. We aimed to investigate non-Indigenous and Indigenous differences in government service use prior to first episode diagnosis as a means of identifying points of intervention to improve institutional responses. METHODS We used a previously established national New Zealand cohort of 2385 13 to 25-year-old youth diagnosed with psychosis between 2009 and 2012 and a linked database of individual-level multiple government agency administration data, to investigate the differences in health, education, employment, child protection and criminal-justice service use between non-Indigenous (60%) and Indigenous youth (40%) in the year preceding first episode diagnosis. Further comparisons were made with the general population. RESULTS A high rate of health service contact did not differ between non-Indigenous and Indigenous youth (adjusted rate ratio 1.0, 95% confidence interval [0.9, 1.1]). Non-Indigenous youth had higher rates of educational enrolment (adjusted rate ratio 1.2, 95% confidence interval [1.1, 1.3]) and employment (adjusted rate ratio 1.2, 95% confidence interval [1.1, 1.3]) and were 40% less likely to have contact with child protection services (adjusted rate ratio 0.6, 95% confidence interval [0.5, 0.8]) and the criminal-justice system (adjusted rate ratio 0.6, 95% confidence interval [0.5, 0.7]). Both first episode cohorts had a higher risk of criminal justice contact compared to the general population, but the difference was greater for non-Indigenous youth (risk ratio 3.0, 95% confidence interval [2.7, 3.4] vs risk ratio 2.0, 95% confidence interval [1.8, 2.2]), explained by the lower background risk. INTERPRETATION The results indicate non-Indigenous privilege in multiple sectors prior to first episode diagnosis. Indigenous-based social disparities prior to first episode psychosis are likely to cause further inequities in recovery and will require a response of health, education, employment, justice and political systems.
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Affiliation(s)
- Jenni Manuel
- Department of Māori/Indigenous Health Innovation (MIHI), University of Otago, Christchurch, Christchurch, New Zealand
| | - Ruth Cunningham
- Department of Public Health, University of Otago, Wellington, Wellington, New Zealand
| | - Sheree Gibb
- Department of Public Health, University of Otago, Wellington, Wellington, New Zealand
| | - Frederieke S Petrović-van der Deen
- Department of Māori/Indigenous Health Innovation (MIHI), University of Otago, Christchurch, Christchurch, New Zealand.,Department of Public Health, University of Otago, Wellington, Wellington, New Zealand
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand.,Department of Specialist Mental Health Service, Canterbury District Health Board, Christchurch, New Zealand
| | - Suzanne Pitama
- Department of Māori/Indigenous Health Innovation (MIHI), University of Otago, Christchurch, Christchurch, New Zealand
| | - Marie Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Sue Crengle
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Gawen Carr
- Department of Specialist Mental Health Service, Capital and Coast District Health Board, Wellington, New Zealand
| | - Cameron Lacey
- Department of Māori/Indigenous Health Innovation (MIHI), University of Otago, Christchurch, Christchurch, New Zealand.,Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand.,Department of Specialist Mental Health Service, Canterbury District Health Board, Christchurch, New Zealand
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Muller D, Paine SJ, Signal TL. The role of sleep in health and health inequities in early childhood in Aotearoa New Zealand. J R Soc N Z 2022. [DOI: 10.1080/03036758.2022.2109689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Diane Muller
- Sleep/Wake Research Centre, School of Health Sciences, College of Health, Massey University Wellington, Wellington, New Zealand
| | - Sarah-Jane Paine
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Tracey Leigh Signal
- Sleep/Wake Research Centre, School of Health Sciences, College of Health, Massey University Wellington, Wellington, New Zealand
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Mirza T, Taft W, He VY, Gooding J, Dingwall K, Nagel T. Incidence of treated first-episode psychosis amongst Aboriginal and non-Aboriginal youth in the Top End of the Northern Territory, Australia. Australas Psychiatry 2022; 30:513-517. [PMID: 35196902 DOI: 10.1177/10398562221075193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study aims to estimate the incidence rate of first episode of psychosis (FEP) in the Top End of the Northern Territory (NT), exploring how rates vary by age, sex, Aboriginal status and remoteness. METHOD Youths (ages 15-24) presenting with FEP to the two specialist mental health services in the Top End were identified through audit of the electronic health records between 2014-2018. Population demographic data were collected from the 2016 Australian National Census. Statistical analysis estimated variation in incidence rates by age, sex, Aboriginal status and remoteness. RESULTS A total of 236 youths with FEP were included in the study. The overall incidence rate was 174 per 100,000 person-years. Rates were very high in the Aboriginal (331 per 100,000 person-years) and remote populations (308 per 100,000 person-years), and lower in the non-Aboriginal population (85 per 100,000 person-years). CONCLUSION This study shows high rates of FEP in young people in the Top End, attributable to very high rates in the Aboriginal population, many of whom live in remote areas. Resources should be allocated to support this high-risk group.
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Affiliation(s)
- Tamoor Mirza
- 104539headspace Darwin, Royal Darwin Hospital, Charles Darwin University, NT, Australia
| | - William Taft
- 8458Hutt Valley District Health Board, Wellington, New Zealand
| | | | - Jade Gooding
- 104539headspace Darwin, Casuarina, NT, Australia
| | - Kylie Dingwall
- 2306Menzies School of Health Research, NT, Australia; Charles Darwin University, NT, Australia
| | - Tricia Nagel
- 2306Menzies School of Health Research, NT, Australia; Charles Darwin University, NT, Australia
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