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Fernández de la Cruz L, Llorens M, Jassi A, Krebs G, Vidal-Ribas P, Radua J, Hatch SL, Bhugra D, Heyman I, Clark B, Mataix-Cols D. Ethnic inequalities in the use of secondary and tertiary mental health services among patients with obsessive-compulsive disorder. Br J Psychiatry 2015. [PMID: 26206866 DOI: 10.1192/bjp.bp.114.154062] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) has similar prevalence rates across ethnic groups. However, ethnic minorities are underrepresented in clinical trials of OCD. It is unclear whether this is also the case in clinical services. AIMS To explore whether ethnic minorities with OCD are underrepresented in secondary and tertiary mental health services in the South London and Maudsley (SLaM) NHS Foundation Trust. METHOD The ethnic distribution of patients with OCD seen between 1999 and 2013 in SLaM (n = 1528) was compared with that of the general population in the catchment area using census data. A cohort of patients with depression (n = 22 716) was used for comparative purposes. RESULTS Ethnic minorities with OCD were severely underrepresented across services (-57%, 95% CI -62% to -52%). The magnitude of the observed inequalities was significantly more pronounced than in depression (-29%, 95% CI -31% to -27%). CONCLUSIONS There is a clear need to understand the reasons behind such ethnic inequalities and implement measures to reduce them.
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Affiliation(s)
- Lorena Fernández de la Cruz
- Lorena Fernández de la Cruz, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Marta Llorens, MD, King's College London, Institute of Psychiatry, London, UK; Amita Jassi, DClinPsy, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Georgina Krebs, DClinPsy, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London and National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Pablo Vidal-Ribas, MSc, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Joaquim Radua, MD, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, Fundació per a la Investigació i la Docència Maria Angustias Giménez Research Unit, Germanes Hospitalàries, Barcelona and Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain; Stephani L. Hatch, PhD, Dinesh Bhugra, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Isobel Heyman, MBBS, PhD, FRCPsych, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London and Great Ormond Street Hospital for Children, London, UK; Bruce Clark, MD, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; David Mataix-Cols, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neu
| | - Marta Llorens
- Lorena Fernández de la Cruz, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Marta Llorens, MD, King's College London, Institute of Psychiatry, London, UK; Amita Jassi, DClinPsy, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Georgina Krebs, DClinPsy, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London and National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Pablo Vidal-Ribas, MSc, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Joaquim Radua, MD, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, Fundació per a la Investigació i la Docència Maria Angustias Giménez Research Unit, Germanes Hospitalàries, Barcelona and Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain; Stephani L. Hatch, PhD, Dinesh Bhugra, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Isobel Heyman, MBBS, PhD, FRCPsych, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London and Great Ormond Street Hospital for Children, London, UK; Bruce Clark, MD, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; David Mataix-Cols, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neu
| | - Amita Jassi
- Lorena Fernández de la Cruz, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Marta Llorens, MD, King's College London, Institute of Psychiatry, London, UK; Amita Jassi, DClinPsy, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Georgina Krebs, DClinPsy, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London and National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Pablo Vidal-Ribas, MSc, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Joaquim Radua, MD, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, Fundació per a la Investigació i la Docència Maria Angustias Giménez Research Unit, Germanes Hospitalàries, Barcelona and Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain; Stephani L. Hatch, PhD, Dinesh Bhugra, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Isobel Heyman, MBBS, PhD, FRCPsych, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London and Great Ormond Street Hospital for Children, London, UK; Bruce Clark, MD, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; David Mataix-Cols, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neu
| | - Georgina Krebs
- Lorena Fernández de la Cruz, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Marta Llorens, MD, King's College London, Institute of Psychiatry, London, UK; Amita Jassi, DClinPsy, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Georgina Krebs, DClinPsy, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London and National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Pablo Vidal-Ribas, MSc, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Joaquim Radua, MD, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, Fundació per a la Investigació i la Docència Maria Angustias Giménez Research Unit, Germanes Hospitalàries, Barcelona and Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain; Stephani L. Hatch, PhD, Dinesh Bhugra, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Isobel Heyman, MBBS, PhD, FRCPsych, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London and Great Ormond Street Hospital for Children, London, UK; Bruce Clark, MD, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; David Mataix-Cols, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neu
| | - Pablo Vidal-Ribas
- Lorena Fernández de la Cruz, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Marta Llorens, MD, King's College London, Institute of Psychiatry, London, UK; Amita Jassi, DClinPsy, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Georgina Krebs, DClinPsy, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London and National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Pablo Vidal-Ribas, MSc, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Joaquim Radua, MD, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, Fundació per a la Investigació i la Docència Maria Angustias Giménez Research Unit, Germanes Hospitalàries, Barcelona and Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain; Stephani L. Hatch, PhD, Dinesh Bhugra, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Isobel Heyman, MBBS, PhD, FRCPsych, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London and Great Ormond Street Hospital for Children, London, UK; Bruce Clark, MD, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; David Mataix-Cols, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neu
| | - Joaquim Radua
- Lorena Fernández de la Cruz, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Marta Llorens, MD, King's College London, Institute of Psychiatry, London, UK; Amita Jassi, DClinPsy, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Georgina Krebs, DClinPsy, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London and National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Pablo Vidal-Ribas, MSc, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Joaquim Radua, MD, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, Fundació per a la Investigació i la Docència Maria Angustias Giménez Research Unit, Germanes Hospitalàries, Barcelona and Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain; Stephani L. Hatch, PhD, Dinesh Bhugra, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Isobel Heyman, MBBS, PhD, FRCPsych, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London and Great Ormond Street Hospital for Children, London, UK; Bruce Clark, MD, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; David Mataix-Cols, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neu
| | - Stephani L Hatch
- Lorena Fernández de la Cruz, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Marta Llorens, MD, King's College London, Institute of Psychiatry, London, UK; Amita Jassi, DClinPsy, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Georgina Krebs, DClinPsy, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London and National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Pablo Vidal-Ribas, MSc, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Joaquim Radua, MD, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, Fundació per a la Investigació i la Docència Maria Angustias Giménez Research Unit, Germanes Hospitalàries, Barcelona and Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain; Stephani L. Hatch, PhD, Dinesh Bhugra, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Isobel Heyman, MBBS, PhD, FRCPsych, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London and Great Ormond Street Hospital for Children, London, UK; Bruce Clark, MD, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; David Mataix-Cols, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neu
| | - Dinesh Bhugra
- Lorena Fernández de la Cruz, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Marta Llorens, MD, King's College London, Institute of Psychiatry, London, UK; Amita Jassi, DClinPsy, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Georgina Krebs, DClinPsy, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London and National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Pablo Vidal-Ribas, MSc, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Joaquim Radua, MD, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, Fundació per a la Investigació i la Docència Maria Angustias Giménez Research Unit, Germanes Hospitalàries, Barcelona and Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain; Stephani L. Hatch, PhD, Dinesh Bhugra, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Isobel Heyman, MBBS, PhD, FRCPsych, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London and Great Ormond Street Hospital for Children, London, UK; Bruce Clark, MD, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; David Mataix-Cols, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neu
| | - Isobel Heyman
- Lorena Fernández de la Cruz, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Marta Llorens, MD, King's College London, Institute of Psychiatry, London, UK; Amita Jassi, DClinPsy, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Georgina Krebs, DClinPsy, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London and National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Pablo Vidal-Ribas, MSc, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Joaquim Radua, MD, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, Fundació per a la Investigació i la Docència Maria Angustias Giménez Research Unit, Germanes Hospitalàries, Barcelona and Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain; Stephani L. Hatch, PhD, Dinesh Bhugra, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Isobel Heyman, MBBS, PhD, FRCPsych, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London and Great Ormond Street Hospital for Children, London, UK; Bruce Clark, MD, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; David Mataix-Cols, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neu
| | - Bruce Clark
- Lorena Fernández de la Cruz, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Marta Llorens, MD, King's College London, Institute of Psychiatry, London, UK; Amita Jassi, DClinPsy, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Georgina Krebs, DClinPsy, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London and National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Pablo Vidal-Ribas, MSc, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Joaquim Radua, MD, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, Fundació per a la Investigació i la Docència Maria Angustias Giménez Research Unit, Germanes Hospitalàries, Barcelona and Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain; Stephani L. Hatch, PhD, Dinesh Bhugra, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Isobel Heyman, MBBS, PhD, FRCPsych, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London and Great Ormond Street Hospital for Children, London, UK; Bruce Clark, MD, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; David Mataix-Cols, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neu
| | - David Mataix-Cols
- Lorena Fernández de la Cruz, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Marta Llorens, MD, King's College London, Institute of Psychiatry, London, UK; Amita Jassi, DClinPsy, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Georgina Krebs, DClinPsy, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London and National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Pablo Vidal-Ribas, MSc, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Joaquim Radua, MD, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, Fundació per a la Investigació i la Docència Maria Angustias Giménez Research Unit, Germanes Hospitalàries, Barcelona and Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain; Stephani L. Hatch, PhD, Dinesh Bhugra, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Isobel Heyman, MBBS, PhD, FRCPsych, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London and Great Ormond Street Hospital for Children, London, UK; Bruce Clark, MD, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; David Mataix-Cols, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neu
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