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de Montgomery CJ, Faurholdt IM, Cullen AE, Taipale H, Mittendorfer-Rutz E, Krasnik A, Norredam M. Involuntary admissions for non-affective psychotic disorders in young refugees and peers in Denmark: A population cohort study. Schizophr Res 2024; 270:366-371. [PMID: 38971014 DOI: 10.1016/j.schres.2024.06.049] [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: 02/28/2023] [Revised: 04/11/2024] [Accepted: 06/25/2024] [Indexed: 07/08/2024]
Abstract
INTRODUCTION People with psychotic disorders are at increased risk of experiencing involuntary hospital admissions relative to other psychiatric patients. Within this group, refugees and other minority groups may be at even greater risk. However, little is known about the role of migration background in the risk of involuntary admissions around the time of first psychosis-related treatment. METHOD We utilized nationwide administrative data from Denmark covering the period 2006-2018. We included all persons aged 18-35 years in first treatment for psychotic disorders [inpatient and hospital-based outpatient settings (N = 11,871)]. We estimated odds ratios (OR) of any involuntary inpatient admission within three months of first treatment using logistic regression, and rate ratios (RR) of further involuntary admissions, total number of involuntary admissions, and days of involuntary care among patients initially admitted involuntarily using Poisson regression. We compared refugees with majority peers (native-born with native-born parent), other migrants, and descendants of non-refugee migrants. RESULTS Compared with the majority group, refugees, non-refugee migrants and descendants were at increased risk of involuntarily admissions (ORrange = 2.12-2.69). Differences in sex, age, education, household income and family situation did not explain these disparities. In contrast, the risk of subsequent involuntary care did not differ between groups (RRrange = 0.77-1.31). CONCLUSIONS The findings highlight the need to review if and why processes of needs detection and voluntary treatment enrolment are less effective for minorities in Denmark. Further studies should investigate the pathways to care across population groups to inform interventions that address disparities.
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Affiliation(s)
- Christopher Jamil de Montgomery
- Department of Public Health, Danish Research Centre for Migration, Ethnicity and Health (MESU), University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen K, Denmark; Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden.
| | | | - Alexis E Cullen
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Heidi Taipale
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden; Niuvanniemi Hospital, Kuopio, Finland; School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Ellenor Mittendorfer-Rutz
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden; Section for Science of Complex Systems, CeMSIIS, Medical University of Vienna, Vienna, Austria
| | - Allan Krasnik
- Department of Public Health, Danish Research Centre for Migration, Ethnicity and Health (MESU), University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen K, Denmark
| | - Marie Norredam
- Department of Public Health, Danish Research Centre for Migration, Ethnicity and Health (MESU), University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen K, Denmark; Section of Immigrant Medicine, Department of Infectious Diseases, University Hospital Hvidovre, Copenhagen, Denmark
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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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de Montgomery CJ, Cullen AE, Taipale H, Krasnik A, Norredam M, Mittendorfer-Rutz E. Incidence of non-affective psychotic disorders in refugees and peers growing up in Denmark and Sweden: a registry linkage study. Soc Psychiatry Psychiatr Epidemiol 2024; 59:1153-1165. [PMID: 37919440 PMCID: PMC11178564 DOI: 10.1007/s00127-023-02578-x] [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: 03/28/2023] [Accepted: 09/28/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE Higher rates of non-affective psychotic disorders (NAPD) in minority groups have been reported in many countries. However, few studies have explored how rates differ between refugees and other minority groups and none with an international comparative angle. A comparative perspective makes it possible to relate group differences to aspects national context that underpin the social determinants of disease. METHODS We compared the incidence of treated NAPD among youth born in or who immigrated to Denmark/Sweden before turning 18. Youth aged 18-35 during 2006-2018 were included (NDenmark/NSweden = 1,606,423/2,614,721) and were followed until first NAPD treatment (cases [Denmark/Sweden] = 12,193/9,641), 36th birthday, emigration or death. Incidence rates (IR) and ratios (IRR) comparing refugees, non-refugee migrants, descendants of non-refugee migrants and majority youth were obtained through Poisson regression on data aggregated by country, sex and age, contrasted by sex and country. Complementary analyses on individual-level data adjusting for further socio-demographic factors were conducted in each country separately. RESULTS Incidence rates were higher in all groups compared with the majority group (IRRrange = 1.4-2.9, 95% CI[min, max] = 1.2-3.1). Relative differences between the three minority groups were smaller (IRRrange = 0.7-1.0, 95% CI[min, max] = 0.5-1.2). Although incidence rates were higher in Denmark than Sweden, relative group differences were similar. CONCLUSION Exposures shared between young refugees and other minority groups growing up in Denmark and Sweden may be especially important for their excess risk of NAPD. Further studies should investigate the mechanisms behind the elevated rates in minority groups with special paid attention to factors such as discrimination, social exclusion and acculturation stress.
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Affiliation(s)
- Christopher J de Montgomery
- Department of Public Health, Danish Research Centre for Migration, Ethnicity and Health (MESU), University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark.
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Alexis E Cullen
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Heidi Taipale
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
- Niuvanniemi Hospital, Kuopio, Finland
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Allan Krasnik
- Department of Public Health, Danish Research Centre for Migration, Ethnicity and Health (MESU), University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
| | - Marie Norredam
- Department of Public Health, Danish Research Centre for Migration, Ethnicity and Health (MESU), University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
- Section of Immigrant Medicine, Department of Infectious Diseases, University Hospital Hvidovre, Copenhagen, Denmark
| | - Ellenor Mittendorfer-Rutz
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
- Section for Science of Complex Systems, CeMSIIS, Medical University of Vienna, Vienna, Austria
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Rodrigues R, Reid JNS, Wiener JC, Archie S, Booth RG, Cheng C, MacDougall AG, Palaniyappan L, Ryan BL, Voineskos A, Kurdyak P, Jan SH, Anderson KK. Access to a regular primary care physician among young people with early psychosis in Ontario, Canada. Early Interv Psychiatry 2024; 18:513-523. [PMID: 38036458 DOI: 10.1111/eip.13487] [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: 04/17/2023] [Revised: 09/29/2023] [Accepted: 11/19/2023] [Indexed: 12/02/2023]
Abstract
AIM Access to a primary care physician in early psychosis facilitates help-seeking and engagement with psychiatric treatment. We examined access to a regular primary care physician in people with early psychosis, compared to the general population, and explored factors associated with access. METHODS Using linked health administrative data from Ontario (Canada), we identified people aged 14-35 years with a first diagnosis of nonaffective psychotic disorder (n = 39 449; 2005-2015). We matched cases to four randomly selected general population controls based on age, sex, neighbourhood, and index date (n = 157 796). We used modified Poisson regression to estimate prevalence ratios (PR) for access to a regular primary care physician in the year prior to first diagnosis of psychotic disorder, and the sociodemographic and clinical factors associated with access. RESULTS A larger proportion of people with early psychosis had a regular primary care physician, relative to the general population (89% vs. 68%; PR = 1.30, 95%CI = 1.30-1.31). However, this was accounted for by a higher prevalence of comorbidities among people with psychosis, and this association was no longer present after adjustment (PR = 0.97, 95%CI = 0.97, 0.98). People with early psychosis who were older, male, refugees and those residing in lower income or high residential instability neighbourhoods were less likely to have a regular primary care physician. CONCLUSION Approximately one in ten young people with early psychosis in Ontario lack access to a regular primary care physician. Strategies to improve primary care physician access are needed for management of physical comorbidities and to ensure continuity of care.
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Affiliation(s)
- Rebecca Rodrigues
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | | | - Joshua C Wiener
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Suzanne Archie
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Richard G Booth
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Chiachen Cheng
- Department of Psychiatry, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Arlene G MacDougall
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Lena Palaniyappan
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Centre for Youth Mental Health, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Bridget L Ryan
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Centre for Studies in Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Aristotle Voineskos
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Paul Kurdyak
- ICES, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Saadia Hameed Jan
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Gannon L, Mullen E, McGorry P, O'Donoghue B. Prevalence and predictors of admission at the time of presentation in first episode psychosis. Soc Psychiatry Psychiatr Epidemiol 2024; 59:1143-1151. [PMID: 37660304 PMCID: PMC11178553 DOI: 10.1007/s00127-023-02552-7] [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: 01/03/2023] [Accepted: 08/15/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Individuals presenting with first episode psychosis (FEP) constitute a population with high admission rates. Across psychiatric services, community based treatment is aimed for where appropriate. Therefore, further knowledge on predictors of admission is required. PURPOSE The objectives were to: (i) determine the proportion of individuals with FEP admitted at time of presentation (voluntarily and involuntarily) (ii) identify associated demographic and clinical factors. METHODS This study included all young people (aged 15-24) who presented with FEP to the Early Psychosis Prevention and Intervention Centre, Melbourne, Australia from 01.01.11 to 31.12.16. Binary logistic regression was used to determine unadjusted and adjusted odds ratios. RESULTS Of 1208 participants, 58.6% were male and the median age was 20 years (I.Q.R.17-22). At time of presentation, 50.2% were admitted. On multivariate analysis, the following factors predicted admission: being a migrant (OR = 1.75, 95% CI [1.17, 2.62]), aggression (OR = 1.42, 95% CI [1.02, 1.99]), and more severe psychotic symptoms. Longer duration of untreated psychosis was associated with lower admission rates. 70.1% of admissions were involuntary (33.7% of the cohort). Risk factors for involuntary admission were consistent with any admission, other than aggression, and with the addition of older age and male sex. CONCLUSION There remains a high admission rate for FEP, even in an established early intervention service, with severity of psychopathology being the strongest predictive factor. There is an independent association between migrancy and admission. Potential reasons for these findings are discussed, and initiatives to reduce admission rates including (i) interventions to prevent admission and (ii) alternative care pathways.
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Affiliation(s)
- Louisa Gannon
- Department of Psychiatry, University College Dublin, Ireland, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Eddie Mullen
- Orygen, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Patrick McGorry
- Orygen, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Brian O'Donoghue
- Department of Psychiatry, University College Dublin, Ireland, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
- Orygen, Melbourne, VIC, Australia.
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.
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Savill M, Loewy RL, Niendam TA, Porteus AJ, Rosenthal A, Gobrial S, Meyer M, Bolden KA, Lesh TA, Ragland JD, Carter CS. The diagnostic accuracy of screening for psychosis spectrum disorders in behavioral health clinics integrated into primary care. Schizophr Res 2024; 266:190-196. [PMID: 38422889 PMCID: PMC11140870 DOI: 10.1016/j.schres.2024.02.007] [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: 04/25/2023] [Revised: 01/29/2024] [Accepted: 02/10/2024] [Indexed: 03/02/2024]
Abstract
Screening for psychosis spectrum disorders in primary care could improve early identification and reduce the duration of untreated psychosis. However, the accuracy of psychosis screening in this setting is unknown. To address this, we conducted a diagnostic accuracy study of screening for psychosis spectrum disorders in eight behavioral health services integrated into primary care clinics. Patients attending an integrated behavioral health appointment at their primary care clinic completed the Prodromal Questionnaire - Brief (PQ-B) immediately prior to their intake assessment. This was compared to a diagnostic phone interview based on the Structured Interview for Psychosis Risk Syndromes (SIPS). In total, 145 participants completed all study procedures, of which 100 screened positive and 45 negative at a provisional PQ-B threshold of ≥20. The PQ-B was moderately accurate at differentiating psychosis spectrum from no psychosis spectrum disorders; a PQ-B distress score of ≥27 had a sensitivity and specificity of 71.2 % and 57.0 % respectively. In total, 66 individuals (45.5 %) met criteria for a psychosis spectrum disorder and 24 (16.7 %) were diagnosed with full psychosis, indicating a high prevalence of psychosis in the sample. Overall, screening for psychosis spectrum disorders in an IBH primary care setting identified a relatively high number of individuals and may identify people that would otherwise be missed. The PQ-B performed slightly less well than in population-based screening in community mental health settings. However, the findings suggest this may represent an effective way to streamline the pathway between specialty early psychosis programs and primary care clinics for those in need.
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Affiliation(s)
- Mark Savill
- University of California, Davis, United States of America.
| | - Rachel L Loewy
- University of California, San Francisco, United States of America
| | - Tara A Niendam
- University of California, Davis, United States of America
| | | | - Adi Rosenthal
- University of California, Davis, United States of America
| | - Sarah Gobrial
- University of California, Davis, United States of America
| | - Monet Meyer
- University of California, Davis, United States of America
| | | | - Tyler A Lesh
- University of California, Davis, United States of America
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Senger B, Pencer A, Crocker CE, Simon P, Taylor B, Tibbo PG. The role of referral pathway to early intervention services for psychosis on 2-year inpatient and emergency service use. J Psychiatr Res 2024; 172:340-344. [PMID: 38442449 DOI: 10.1016/j.jpsychires.2024.02.035] [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: 07/04/2023] [Revised: 02/05/2024] [Accepted: 02/13/2024] [Indexed: 03/07/2024]
Abstract
This study examined the relationship between terminal referral source and subsequent urgent health service use in a Canadian early intervention service (EIS) for psychosis. Administrative health record data of emergency and inpatient mental health service use over a 2-year follow up from entry to EIS were retrospectively analyzed (n = 515). Negative binomial regression models were used to assess for the relationship between referral source and care outcomes. Compared to those referred from primary care services, the rate of urgent health care use was significantly greater for individuals referred to early intervention services from urgent care services while accounting for social and occupational functioning and psychotic symptom severity. Findings suggest that those referred from urgent services may be at an increased risk for subsequent urgent health care use while attending EIS for psychosis. Further research examining this relationship while incorporating additional relevant predictors is needed.
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Affiliation(s)
- Brannon Senger
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Alissa Pencer
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Candice E Crocker
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Patryk Simon
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Bryanne Taylor
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Philip G Tibbo
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
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Oluwoye O, Weeks DL. Ethnoracial Differences in Family Members' Early Contact with Formal and Informal Resources on the Pathway to Care during the Early Stages of Psychosis. Community Ment Health J 2024; 60:244-250. [PMID: 37418116 PMCID: PMC10993660 DOI: 10.1007/s10597-023-01163-5] [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: 01/15/2023] [Accepted: 06/17/2023] [Indexed: 07/08/2023]
Abstract
The present study examined whether there were ethnoracial differences in the use of formal and informal resources by family members of individuals in the early stages of psychosis. A sample of 154 family member respondents participated in an online cross-sectional survey. Ethnoracially minoritized family members disproportionately made early contact with informal resources (e.g., religious/spiritual leaders, friends, online support groups) on the pathway to care compared to non-Hispanic white family members who tended to contact formal resources (primary care doctors/nurses or school counselors). A description of early contact among Black and Hispanic family members are also described. Study findings highlight that ethnoracially minoritized families seek out support and/or resources from informal resources embedded within their community. Our findings suggest the need for targeted strategies that leverage the reach of informal settings to capture family members as well as general community members.
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Affiliation(s)
- Oladunni Oluwoye
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99202-1495, USA.
| | - Douglas L Weeks
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99202-1495, USA
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Duveau C, Wets C, Delaruelle K, Demoulin S, Dauvrin M, Lepièce B, Ceuterick M, De Maesschalck S, Bracke P, Lorant V. Individual, interpersonal, and organisational factors associated with discrimination in medical decisions affecting people with a migration background with mental health problems: the case of general practice. ETHNICITY & HEALTH 2024; 29:126-145. [PMID: 37936401 DOI: 10.1080/13557858.2023.2279476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 10/31/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVES Although people with a migration background (MB) have more unmet mental health needs than the general population, patients with a MB are still underrepresented in mental health care services. Provider bias towards these patients has been evidenced repeatedly but its driving factors remain elusive. We assessed the moderating effect of the individual (e.g. age and ethnicity), interpersonal (e.g. healthcare provider trust), and organisational (e.g. perceived workload) factors on general practitioners (GPs) differential decision-making regarding diagnosis, treatment, and referral for a depressed patient with or without a MB. DESIGN An experimental study was carried out in which GPs were shown one of two video vignettes featuring adult male depressed patients, one with a MB and the other without. Belgian GPs (n = 797, response rate was 13%) had to decide on their diagnosis, treatment, and referral. Analysis of variance and logistic regression were used to analyse the effect of a MB, adding interaction terms for the explanatory variables. RESULTS Overall, we found that there were ethnic differences in GPs' decisions regarding diagnosis and treatment recommendations. GPs perceived the symptoms of the patient with a MB as less severe (F = 7.68, p < 0.01) and demonstrated a reduced likelihood to prescribe a combination of medical and non-medical treatments (F = 11.55, p < 0.001). Those differences increased in accordance with the GP's age and perceived workload; at an interpersonal level, we found that differences increased when the GP thought the patient was exaggerating his distress. CONCLUSION This paper showed that lower levels of trust among GPs' towards their migrant patients and high GP workloads contribute to an increased ethnic bias in medical decision-making. This may perpetuate ethnic inequalities in mental health care. Future researchers should develop an intervention to decrease the ethnic inequities in mental health care by addressing GPs' trust in their migrant and ethnic minority patients.
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Affiliation(s)
- Camille Duveau
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Camille Wets
- Health and Demographic Research, Ghent University, Ghent, Belgium
| | | | - Stéphanie Demoulin
- Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Marie Dauvrin
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
- Belgian Health Care Knowledge Centre, KCE, Brussels, Belgium
| | - Brice Lepièce
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | | | | | - Piet Bracke
- Health and Demographic Research, Ghent University, Ghent, Belgium
| | - Vincent Lorant
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
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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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11
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Duveau C, Smith P, Lorant V. Mental health among people with a migration background in Belgium over the past 20 years: how has the situation evolved? Arch Public Health 2023; 81:176. [PMID: 37770954 PMCID: PMC10536759 DOI: 10.1186/s13690-023-01187-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/05/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Poor mental health is highly stigmatized and stereotyped, even more when it comes to migrant and ethnic minority groups (MEM). Belgium, which has a long history of immigration, is a good case study for analysing how the prevalence of mental illness (MI) has evolved over time and how such evolution had differed between MEM. This paper seeks to explore the prevalence of MI and potential inequalities among MEM compared to native Belgians between 1997 and 2018, shedding light on this important issue. METHODS The data set is composed of the six cross-sectional waves of the Belgian Health Interview Survey from 1997 to 2018. The 12-item General Health Questionnaire was used to assess the average level of mental health and the prevalence of MI (score ≥ 4) among five major MEM groups in Belgium (Belgian, Moroccan, Turkish, European migrants, and non-European migrants). Multivariate logistic and linear regression models were used to assess the likelihood of having a MI in the different MEM groups and survey years. The minimal clinically important difference (MID) was also calculated for the severity of MI. RESULTS After controlling for socioeconomic status, the average marginal effect indicated a decrease in mental health among Moroccans and Turks in Belgium between 1997 and 2018, compared to Belgians. This result was confirmed by the Chi²-test, which showed that Turkish (χ²=17.75, p < 0.001) and Moroccans respondents (χ²=4.19, p < 0.04) had a higher overall level of mental distress than Belgians. Furthermore, in 2018, even after adjusting for age, sex and education level, having a mother born in a non-EU country increased the risk of mental illness. CONCLUSIONS Mental health inequalities between migrant and ethnic groups are on the rise in Belgium. To address this issue, particular attention should be given to the Moroccan and Turkish background populations. Specific interventions and policies must be implemented to prevent the increase of psychological distress among migrants and ethnic minorities, on the one hand, and ensure that high-quality mental health care is accessible to all, regardless of ethnicity, on the other hand. Additionally, we recommend that future research on ethnic mental healthcare includes better data collection on the country of birth of respondents and their parents.
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Affiliation(s)
- Camille Duveau
- Faculty of Public Health, Institute of Health and Society (IRSS), Université catholique de Louvain, B1.31.15, Brussels, 1200, Belgium.
| | - Pierre Smith
- Faculty of Public Health, Institute of Health and Society (IRSS), Université catholique de Louvain, B1.31.15, Brussels, 1200, Belgium
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Vincent Lorant
- Faculty of Public Health, Institute of Health and Society (IRSS), Université catholique de Louvain, B1.31.15, Brussels, 1200, Belgium
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12
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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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13
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Xavier SM, Barbosa S, Correia AF, Dindo V, Sequeira M, Maia T, Goes AR. Images that speak: A Portuguese Photovoice study on the psychosocial experience of a migrant population from Cape Verde after a first episode of psychosis. Transcult Psychiatry 2023:13634615231187252. [PMID: 37519012 DOI: 10.1177/13634615231187252] [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: 08/01/2023]
Abstract
Several migrant populations have been identified worldwide as high-risk groups for psychosis because of their experience of social adversity. Recent evidence suggests that the local contexts in which these populations live should be addressed in their complexity to take into account individual and larger societal environmental aspects. This study aimed to assess the lived experiences of a group of migrant Cape Verdean patients, who had been recently hospitalized for a first episode of psychosis in a mental health service on the outskirts of Lisbon, Portugal. The study used Photovoice, a qualitative participatory research method in which people's experiences are documented through photography. Six individuals were recruited, and five weekly sessions were conducted to collect data that were analyzed thematically. Emergent themes addressed two main categories of well-being and illness. Participant concepts of well-being were rooted in a definition of freedom encompassing cultural expression, conveyed by familiar environments and supporting communities. Cultural differences may be experienced as important obstacles for well-being and can be associated with feelings of oppression and guilt. Participants' accounts focused on positive aspects of life despite illness and on personal concepts of recovery. The study findings contribute to knowledge of the dynamics of migrants' social experience and underscore the importance of socially and culturally informed mental healthcare institutions.
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Affiliation(s)
| | | | | | - Vera Dindo
- Hospital Professor Doutor Fernando Fonseca
- Sahlgrenska University Hospital
| | - Márcia Sequeira
- Hospital Professor Doutor Fernando Fonseca
- Hunter New England Health District
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14
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Percudani ME, Iardino R, Porcellana M, Lisoni J, Brogonzoli L, Barlati S, Vita A. The Patient Journey of Schizophrenia in Mental Health Services: Results from a Co-Designed Survey by Clinicians, Expert Patients and Caregivers. Brain Sci 2023; 13:brainsci13050822. [PMID: 37239294 DOI: 10.3390/brainsci13050822] [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: 03/27/2023] [Revised: 04/29/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The Patient Journey Project aims to collect real-world experiences on schizophrenia management in clinical practice throughout all the phases of the disorder, highlighting virtuous paths, challenges and unmet needs. METHODS A 60-item survey was co-designed with all the stakeholders (clinicians, expert patients and caregivers) involved in the patient's journey, focusing on three areas: early detection and management, acute phase management and long-term management/continuity of care. For each statement, the respondents expressed their consensus on the importance and the degree of implementation in clinical practice. The respondents included heads of the Mental Health Services (MHSs) in the Lombardy region, Italy. RESULTS For early diagnosis and management, a strong consensus was found; however, the implementation degree was moderate-to-good. For acute phase management, a strong consensus and a good level of implementation were found. For long-term management/continuity of care, a strong consensus was found, but the implementation level was slightly above the cut-off, with 44.4% of the statements being rated as only moderately implemented. Overall, the survey showed a strong consensus and a good level of implementation. CONCLUSIONS The survey offered an updated evaluation of the priority intervention areas for MHSs and highlighted the current limitations. Particularly, early phases and chronicity management should be further implemented to improve the patient journey of schizophrenia patients.
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Affiliation(s)
- Mauro Emilio Percudani
- Department of Mental Health and Addiction Services, Niguarda Hospital, 20162 Milan, Italy
| | | | - Matteo Porcellana
- Department of Mental Health and Addiction Services, Niguarda Hospital, 20162 Milan, Italy
| | - Jacopo Lisoni
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, 25123 Brescia, Italy
| | | | - Stefano Barlati
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, 25123 Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy
| | - Antonio Vita
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, 25123 Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy
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15
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Tarricone I, D'Andrea G, Galatolo M, Carloni AL, Descovich C, Muratori R. Psychiatric Admission Among Migrants Before and During Pandemic: a Retrospective Study in Acute Psychiatric Ward in Bologna, Italy. J Immigr Minor Health 2023; 25:507-521. [PMID: 36952152 PMCID: PMC10034892 DOI: 10.1007/s10903-023-01464-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 03/24/2023]
Abstract
Previous evidence showed significant discrepancies in psychiatric services utilization between migrants and reference populations. Our study aims were to evaluate incidence and characteristics of psychiatric hospitalizations of migrant patients compared with reference populations and to assess how the COVID-19 pandemic affected admissions. All patients admitted to the psychiatric ward "SPDC-Malpighi" of the Bologna Mental Health Department from 01/01/2018 to 31/12/2020 were included. Differences in sociodemographic and clinical characteristics were tested by migrant status. Incidence rate ratios of hospital admissions by migrant status were estimated via Poisson regression considering population-at-risk, gender, and age-group. Migrants had higher hospitalization rates due to any psychiatric disorder (IRR = 1.16). The risk was especially pronounced among women (IRR = 1.25) and within the youngest age-group (IRR = 3.24). Young migrants had also a greater risk of compulsory admission (IRR = 3.77). Regarding admissions due to a specific diagnosis, we found relevant differences in hospitalization rates for psychosis, mood disorders, and personality disorders. Finally, migrants were more likely to be admitted via Emergency Department and less likely to be referred from a specialist. During the year of pandemic (2020) we observed an increase in the proportion of migrants admitted voluntarily or compulsorily. Migrants, especially those from the youngest age-group, had higher hospitalization rates for any disorder. Younger migrants were also at higher risk of compulsory treatment. The distribution of psychiatric admissions during the pandemic period seemed to have further increased discrepancies in mental healthcare needs and provision between migrants and the reference population. Tailored interventions and policies are urgently needed to address this issue.
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Affiliation(s)
- I Tarricone
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
- Department of Mental Health and Pathological Addictions, Bologna Local Health Authority, Bologna, Italy
| | - G D'Andrea
- Department of BioMedical and NeuroMotor Sciences (DIBINEM), Section of Psychiatry, University of Bologna, Bologna, Italy
| | - M Galatolo
- Department of BioMedical and NeuroMotor Sciences (DIBINEM), Section of Psychiatry, University of Bologna, Bologna, Italy.
- Institute of Psychiatry, Bologna University, Viale Pepoli 5, 40123, Bologna, Italy.
| | - A L Carloni
- Department of BioMedical and NeuroMotor Sciences (DIBINEM), Section of Psychiatry, University of Bologna, Bologna, Italy
| | - C Descovich
- Clinical Governance and Quality Unit, Bologna Local Healthcare Authority Staff, Bologna, Italy
| | - R Muratori
- Department of Mental Health and Pathological Addictions, Bologna Local Health Authority, Bologna, Italy
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16
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DeTore NR, Balogun-Mwangi O, Mueser KT, McGurk SR. Comparison of Black and White participants with severe mental illness in response to cognitive remediation as an augmentation of vocational rehabilitation. Schizophr Res 2023; 253:60-67. [PMID: 34772592 PMCID: PMC9088896 DOI: 10.1016/j.schres.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Despite evidence that cognitive remediation improves cognitive and employment outcomes in persons with severe mental illnesses (SMI), its effects have not been systematically compared between Black and White participants. Considering that Black adults have more negative experiences receiving mental health treatment, providers may have greater difficulty engaging and retaining Black Americans in cognitive remediation. Due to the effects of structural racism on reducing employment opportunities for Black Americans, it is unclear whether Black participants will reap the same benefits of cognitive remediation on work outcomes as White Americans. This paper addressed this question. METHODS A secondary analysis was conducted of five randomized controlled trials comparing cognitive remediation (the Thinking Skills for Work program: TSW) and vocational rehabilitation vs. vocational rehabilitation only in 137 Black and 147 White Americans (64.2% schizophrenia-schizoaffective disorder) who were followed up for two years. RESULTS Comparable proportions of Black and White participants were engaged and retained in TSW (>75%). Participants who received TSW improved significantly more in cognition than those receiving vocational services alone, with no racial differences in benefit. Participants in TSW obtained more work, earned more wages, and worked more weeks than those receiving vocational services alone, with no differences between the races. CONCLUSIONS The findings indicate that Black Americans with SMI receiving vocational services could be successfully engaged in and benefit from cognitive remediation, highlighting the vital role of healthcare service systems in giving credence to structural racism to more effectively mitigate racial disparities in treatment outcomes.
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Affiliation(s)
- N R DeTore
- Massachusetts General Hospital, United States of America; Department of Psychiatry, Harvard Medical School, United States of America
| | | | - K T Mueser
- Center for Psychiatric Rehabilitation, Boston University, United States of America; Department of Occupational Therapy, Boston University, United States of America.
| | - S R McGurk
- Center for Psychiatric Rehabilitation, Boston University, United States of America; Department of Occupational Therapy, Boston University, United States of America
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17
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Wiener JC, Rodrigues R, Reid JNS, Archie S, Booth RG, Cheng C, Jan SH, Kurdyak P, MacDougall AG, Palaniyappan L, Ryan BL, Anderson KK. Patient and Physician Factors Associated with First Diagnosis of Non-affective Psychotic Disorder in Primary Care. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:212-224. [PMID: 36403173 DOI: 10.1007/s10488-022-01233-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 11/21/2022]
Abstract
Primary care physicians play a central role in pathways to care for first-episode psychosis, and their increased involvement in early detection could improve service-related outcomes. The aim of this study was to estimate the proportion of psychosis first diagnosed in primary care, and identify associated patient and physician factors. We used linked health administrative data to construct a retrospective cohort of people aged 14-35 years with a first diagnosis of non-affective psychosis in Ontario, Canada between 2005-2015. We restricted the sample to patients with help-seeking contacts for mental health reasons in primary care in the six months prior to first diagnosis of psychotic disorder. We used modified Poisson regression models to examine patient and physician factors associated with a first diagnosis of psychosis in primary care. Among people with early psychosis (n = 39,449), 63% had help-seeking contacts in primary care within six months prior to first diagnosis. Of those patients, 47% were diagnosed in primary care and 53% in secondary/tertiary care. Patients factors associated with lower likelihood of diagnosis in primary care included male sex, younger age, immigrant status, and comorbid psychosocial conditions. Physician factors associated with lower likelihood of diagnosis in primary care included solo practice model, urban practice setting, international medical education, and longer time since graduation. Our findings indicate that primary care is an important contact for help-seeking and diagnosis for a large proportion of people with early psychosis. For physicians less likely to diagnose psychosis in primary care, targeted resources and interventions could be provided to support them in caring for patients with early psychosis.
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Affiliation(s)
- Joshua C Wiener
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada. .,Western Centre for Public Health and Family Medicine, 1465 Richmond Street, London, ON, N6G 2M1, Canada.
| | - Rebecca Rodrigues
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | | | - Suzanne Archie
- Department of Psychiatry & Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Richard G Booth
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Chiachen Cheng
- Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Saadia Hameed Jan
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Paul Kurdyak
- ICES, Toronto, ON, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Arlene G MacDougall
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada
| | - Lena Palaniyappan
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada.,Robarts Research Institute, Western University, London, ON, Canada
| | - Bridget L Ryan
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,ICES, Toronto, ON, Canada.,Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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18
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Bommersbach TJ, Rhee TG, Stefanovics EA, Rosenheck RA. Comparison of Black and white individuals who report diagnoses of schizophrenia in a national sample of US adults: Discrimination and service use. Schizophr Res 2023; 253:22-29. [PMID: 34088549 DOI: 10.1016/j.schres.2021.05.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 05/22/2021] [Accepted: 05/27/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND While there is increasing recognition of disparities in healthcare for Black Americans, there have been no comparisons in a nationally representative U.S. sample of Black and White adults with clinical diagnoses of schizophrenia. METHODS Using nationally representative survey data from the National Epidemiologic Survey on Alcohol and Related Conditions-III, we compared Black (n = 240, 36.2%) and White (n = 423, 63.8%) adults who report having been told by a physician that they have schizophrenia. Due to the large sample size, effect sizes (risk ratios and Cohen's d), rather than p-values, were used to identify the magnitude of differences in sociodemographic and clinical characteristics, including experiences of discrimination and service use. Multivariate analyses were used to identify independent factors. RESULTS Black individuals with diagnoses of schizophrenia reported multiple sociodemographic disadvantages, including lower rates of employment, educational attainment, income, marriage, and social support, with little difference in incarceration, violent behavior, and quality of life. They reported much higher scores on a general lifetime discrimination scale (Cohen's d = 0.75) and subscales representing job discrimination (d = 0.85), health system discrimination (d = 0.70), and public race-based abuse (d = 0.55) along with higher rates of past year alcohol and drug use disorders, but lower rates of co-morbid psychiatric disorders. Multivariable-adjusted regression analyses highlighted the independent association of Black race with measures of discrimination and religious service attendance; less likelihood of receiving psychiatric treatment (p = 0.02) but no difference in substance use treatment. CONCLUSION Black adults with schizophrenia report numerous social disadvantages, especially discrimination, but religious service attendance may be an important social asset.
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Affiliation(s)
- Tanner J Bommersbach
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, USA.
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, USA; U.S. Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, 950 Campbell Avenue, West Haven, CT, USA; Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, USA
| | - Elina A Stefanovics
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, USA; U.S. Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, 950 Campbell Avenue, West Haven, CT, USA
| | - Robert A Rosenheck
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, USA; U.S. Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, 950 Campbell Avenue, West Haven, CT, USA
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19
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Waldron I, Senger B, Cookey J, Crown M, Tibbo P. Addressing Stigma and Promoting Help-Seeking Among African Nova Scotian Youth Experiencing Psychosis and Other Mental Health Problems. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:200-207. [PMID: 36113102 PMCID: PMC9974652 DOI: 10.1177/07067437221125305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The purpose of this study was to gain an in-depth understanding of perceptions of mental illnesses (especially psychosis), help-seeking, barriers to help-seeking, and opportunities to facilitate help-seeking in the African Nova Scotian Community. METHODS A qualitative interpretive narrative approach, using the focus group method, was employed to engage African Nova Scotians in discussions on their perceptions and beliefs about mental illnesses and help-seeking in their communities. Youth in Early Intervention services, their caregivers, youth in the community, their caregivers, community leaders, and health service providers, were recruited from four locations in the Halifax Regional Municipality. A total of 75 individuals (37 female, 38 male) participated in the study. Narrative emplotment was used to analyse data from focus groups. RESULTS Findings from focus groups were categorized based on four areas of discussion: (a) perceptions about psychosis and other mental illnesses among youth, caregivers, service providers and community leaders (b) beliefs about help-seeking among youth, caregivers, services providers and community leaders; (c) barriers and facilitators to seeking help for mental illnesses; and (d) the content and format of educational resources to educate and support youth, families and communities. CONCLUSIONS Stigma surrounding mental illnesses in the community, lack of knowledge of illness and available services, concerns regarding negative involvement with police, or dismissal of difficulties by health care providers represent significant barriers to help-seeking in this community. Additionally, barriers include a lack of trust in health care services and a dearth of African Nova Scotian service providers. Bolstering capacity of community organizations to support and educate individuals around illness as well as fostering collaboration between health services and community organizations could reduce barriers to care. Future research should focus on examining ways to engage African Nova Scotians in collaboration with existing community organizations.
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Affiliation(s)
- Ingrid Waldron
- Department of History, 177373McMaster University, Hamilton, ON, Canada
| | - Brannon Senger
- Department of Psychology and Neuroscience, 3688Dalhousie University, Halifax, NS, Canada
| | - Jacob Cookey
- Department of Psychiatry, 3688Dalhousie University, Halifax, NS, Canada
| | - Margie Crown
- 432234Nova Scotia Health Authority, Halifax, NS, Canada
| | - Phil Tibbo
- Department of Psychology and Neuroscience, 3688Dalhousie University, Halifax, NS, Canada.,Department of Psychiatry, 3688Dalhousie University, Halifax, NS, Canada.,432234Nova Scotia Health Authority, Halifax, NS, Canada
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20
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Lehti V, Taipale H, Gissler M, Tanskanen A, Elonheimo M, Tiihonen J, Suvisaari J. Continuity of antipsychotic medication use among migrant and Finnish-born populations with a psychotic disorder: a register-based study. Psychol Med 2023; 53:833-843. [PMID: 34074352 DOI: 10.1017/s003329172100218x] [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: 11/07/2022]
Abstract
BACKGROUND Higher incidence of psychotic disorders and underuse of mental health services have been reported among many migrant populations. This study examines the initiation and continuity of antipsychotic treatment among migrants and non-migrants with a non-affective psychosis during a new treatment episode. METHODS This study is based on a nationwide sample of migrants and Finnish-born controls. Participants who were diagnosed with a psychotic disorder in 2011-2014 were identified from the Care Register for Health Care (n = 1693). Information on purchases of antipsychotic drugs in 2011-2015 was collected from the National Prescription Register. The duration of antipsychotic treatment since diagnosis was estimated using the PRE2DUP model. Cox regression analysis was used to study factors that are associated with discontinuing the use of medication. RESULTS There were fewer initiators of antipsychotic treatment after being diagnosed with psychosis among migrants (68.1%) than among Finnish-born patients (73.6%). After controlling for sociodemographic background and factors related to the type of disorder and treatment, migrants were more likely to discontinue medication (adjusted hazard ratio 1.28, 95% confidence interval 1.08-1.52). The risk of discontinuation was highest among migrants from North Africa and the Middle East and Sub-Saharan Africa and among recent migrants. Non-use of antipsychotic treatment before being diagnosed with psychosis, involuntary hospitalization and diagnosis other than schizophrenia were associated with earlier discontinuation both among migrants and non-migrants. CONCLUSIONS Migrants with a psychotic disorder are less likely to continue antipsychotic treatment than non-migrants. The needs of migrant patients have to be addressed to improve adherence.
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Affiliation(s)
- Venla Lehti
- Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Heidi Taipale
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Mika Gissler
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- Information Services Department, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Antti Tanskanen
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Impact Assessment Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Martta Elonheimo
- Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Specialized Psychiatric Services, Helsinki, Finland
- Doctoral Programme in Clinical Research, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jari Tiihonen
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
| | - Jaana Suvisaari
- Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
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21
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Pedersen ML, Gildberg F, Baker J, Damsgaard JB, Tingleff EB. Ethnic disparities in the use of restrictive practices in adult mental health inpatient settings: a scoping review. Soc Psychiatry Psychiatr Epidemiol 2022; 58:505-522. [PMID: 36454269 PMCID: PMC9713127 DOI: 10.1007/s00127-022-02387-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE To identify and summarise extant knowledge about patient ethnicity and the use of various types of restrictive practices in adult mental health inpatient settings. METHODS A scoping review methodological framework recommended by the JBI was used. A systematic search was conducted in APA PsycINFO, CINAHL with Full Text, Embase, PubMed and Scopus. Additionally, grey literature searches were conducted in Google, OpenGrey and selected websites, and the reference lists of included studies were explored. RESULTS Altogether, 38 studies were included: 34 were primary studies; 4, reviews. The geographical settings were as follows: Europe (n = 26), Western Pacific (n = 8), Americas (n = 3) and South-East Asia (n = 1). In primary studies, ethnicity was reported according to migrant/national status (n = 16), mixed categories (n = 12), indigenous vs. non-indigenous (n = 5), region of origin (n = 1), sub-categories of indigenous people (n = 1) and religion (n = 1). In reviews, ethnicity was not comparable. The categories of restrictive practices included seclusion, which was widely reported across the studies (n = 20), multiple restrictive practices studied concurrently (n = 17), mechanical restraint (n = 8), rapid tranquillisation (n = 7) and manual restraint (n = 1). CONCLUSIONS Ethnic disparities in restrictive practice use in adult mental health inpatient settings has received some scholarly attention. Evidence suggests that certain ethnic minorities were more likely to experience restrictive practices than other groups. However, extant research was characterised by a lack of consensus and continuity. Furthermore, widely different definitions of ethnicity and restrictive practices were used, which hampers researchers' and clinicians' understanding of the issue. Further research in this field may improve mental health practice.
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Affiliation(s)
- Martin Locht Pedersen
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark. .,Forensic Mental Health Research Unit Middelfart (RFM), Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Østre Hougvej 70, 5500, Middelfart, Denmark. .,Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Østre Hougvej 70, 5500, Middelfart, Denmark.
| | - Frederik Gildberg
- grid.10825.3e0000 0001 0728 0170Forensic Mental Health Research Unit Middelfart (RFM), Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Østre Hougvej 70, 5500 Middelfart, Denmark ,grid.425874.80000 0004 0639 1911Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Østre Hougvej 70, 5500 Middelfart, Denmark
| | - John Baker
- grid.9909.90000 0004 1936 8403School of Healthcare, University of Leeds, Baines Wing, Woodhouse Lane, Leeds, LS2 9JT UK
| | - Janne Brammer Damsgaard
- grid.7048.b0000 0001 1956 2722Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
| | - Ellen Boldrup Tingleff
- grid.10825.3e0000 0001 0728 0170Forensic Mental Health Research Unit Middelfart (RFM), Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Østre Hougvej 70, 5500 Middelfart, Denmark ,grid.425874.80000 0004 0639 1911Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Østre Hougvej 70, 5500 Middelfart, Denmark ,grid.10825.3e0000 0001 0728 0170OPEN, Odense Patient Data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 9 A, 5000 Odense C, Denmark
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22
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Knight S, Jarvis GE, Ryder AG, Lashley M, Rousseau C. ‘It Just Feels Like an Invasion’: Black First-Episode Psychosis Patients’ Experiences With Coercive Intervention and Its Influence on Help-Seeking Behaviours. JOURNAL OF BLACK PSYCHOLOGY 2022. [DOI: 10.1177/00957984221135377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Studies from the United States and United Kingdom show that Black patients are disproportionately diagnosed with psychosis and receive excess coercive medical intervention. There has been little discussion of this topic in Canada, and of how coercive interventions may have influenced Black patient attitudes towards mental health services. To address these issues, semi-structured interviews were administered to five Black men with first-episode psychosis (FEP) to (a) explore their experiences with coercive interventions and (b) describe how these experiences may have influenced help-seeking behaviours. Interpretative phenomenological analysis (IPA) was used to analyze the data. Four core themes and four additional themes emerged from the interviews. Patients described loneliness, not being heard, police contact and forced medication as influencing their attitudes towards mental health care. Further research is needed to develop reparative strategies to encourage reflection about and awareness of coercive intervention among Black FEP patients.
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Affiliation(s)
- Sommer Knight
- Division of Social and Transcultural Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - G. Eric Jarvis
- Division of Social and Transcultural Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada
- First Episode Psychosis Program, Institute of Community and Family Psychiatry, Jewish General Hospital, Montreal, QC, Canada
| | - Andrew G. Ryder
- Division of Social and Transcultural Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada
- Department of Psychology, Faculty of Social Science, Concordia University, Montreal, QC, Canada
| | - Myrna Lashley
- Division of Social and Transcultural Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Cecile Rousseau
- Division of Social and Transcultural Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada
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23
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Abstract
Experiences of psychedelics and psychosis were deeply entangled in scientific practices in the mid-20th century, from uses of psychedelic drugs that could model psychosis, to detailed phenomenological comparisons of endogenous and drug-induced madness. After the moral panic of the 1960s shut down psychedelic research, however, these two phenomena became disentangled. In the decades following, the science of psychosis transformed, shedding the language of psychoanalysis, and adopting the new scientific veneer of psychiatry. Today, as psychedelic science re-emerges, the research programs surrounding psychosis and psychedelics now stand in stark contrast. Here, I look closely at how these research programs respond to questions related to what is worth measuring, what is worth investigating, and how we ought to respond to these experiences. This comparison reveals radically different assumptions and values that guide each research paradigm and shape clinical practice. While psychedelic research often includes scales that seek to capture experiences of mysticism, meaningfulness, and ego dissolution, research related to psychosis focuses on the measurement of pathological symptoms and functioning. Research into psychosis primarily seeks universal and reductionist causal explanations and interventions, while psychedelic research embraces the importance of set and setting in shaping unique experiences. Responses to psychedelic crisis involve warmth, compassion, and support, while responses to psychotic experiences often involve restraint, seclusion, and weapons. I argue that these differences contain important lessons for psychiatry. However, as psychedelic research struggles to meet regulatory requirements and fit within the paradigm of evidence-based medicine, these differences may quickly dissolve.
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Affiliation(s)
- Phoebe Friesen
- Biomedical Ethics Unit, Department of Social Studies of Medicine, 5620McGill University, Montreal, QC, Canada
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24
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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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25
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Trauma and psychosis: a qualitative study exploring the perspectives of people with psychosis on the influence of traumatic experiences on psychotic symptoms and quality of life. BMC Psychiatry 2022; 22:213. [PMID: 35331194 PMCID: PMC8944047 DOI: 10.1186/s12888-022-03808-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 02/23/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Despite experiencing high rates of trauma and trauma-related conditions, people with psychosis are seldomly asked about possible traumatic events. While there are some barriers to discussing trauma in clinical services, research has shown that disclosure is not only possible but also beneficial to both psychotic and traumatic symptoms. The current study is the first to evaluate service users' perception of the influence of trauma on the development and maintenance of their psychotic symptoms, as well as their views on how their life and mental health have been affected by traumatic events and their disclosure (or lack of). METHODS Eleven participants with experiences of psychosis and trauma took part in semi-structured interviews. RESULTS Consistently with previous literature, our participants reported high rates of interpersonal trauma, but had rarely had the opportunity to discuss any of these events. Using thematic analysis, we identified three major themes that have important implications for healthcare: factors that facilitate or hinder talking about trauma; consequences of talking or not; and relationship between trauma and psychosis. Participants generally benefited from talking about trauma and concerningly often associated the prolonged lack of opportunities to discuss traumatic events with negative feelings towards the self and with a deterioration of their mental health. Participants also recognised direct links between past traumas and the content and characteristics of their psychotic experiences. CONCLUSIONS Our findings highlight the importance, as perceived by service users, of discussing trauma and looking at psychosis through a "trauma lens". These results stress the need to systematically assess trauma history and traumatic symptoms in psychosis and might potentially help to overcome clinicians' worries about discussing trauma with service users. Our findings underscore the need to change current practice and implement trauma-informed approaches to understand clients' difficulties and provide support.
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26
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Woodberry KA, Johnson KA, Shrier LA. Screening for Early Emerging Mental Experiences (SEE ME): A Model to Improve Early Detection of Psychosis in Integrated Primary Care. Front Pediatr 2022; 10:899653. [PMID: 35757126 PMCID: PMC9226538 DOI: 10.3389/fped.2022.899653] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
Early intervention in serious mental health conditions relies on the accurate identification of adolescents and young adults at high risk or with very recent onset of psychosis. Current early detection strategies have had limited success, identifying only a fraction of these individuals within the recommended 3- to 6-month window. Broader public health strategies such as population screening are hampered by low base rates and poor self-report screen specificity. Screening for Early Emerging Mental Experiences (SEE ME) is a three-stage "SCREEN-TRIAGE-ENGAGE" model for the early detection of psychosis in integrated primary care adolescent and young adult patients during the period of peak onset. It builds on the KNOW THE SIGNS-FIND THE WORDS-MAKE THE CONNECTION framework outlined on psychosisscreening.org and developed with input from community collaborators. Systematic screening aims to expand the reach of early detection and reduce reliance on provider knowledge. Triage and engagement by trained mental health clinicians aims to improve the specificity of screen responses, enhance engagement in appropriate care, and reduce provider burden. Leveraging the low stigma of primary care, its reach to non-help-seeking adolescents and young adults, and the mental health training of clinicians within integrated care practices, SEE ME has potential to improve the benefit/risk ratio of early detection of psychosis by improving both the sensitivity and specificity of screening and clinical response. We review the rationale and design of this promising model.
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Affiliation(s)
- Kristen A Woodberry
- Center for Psychiatric Research, MaineHealth, Portland, ME, United States.,Department of Psychiatry, Tufts School of Medicine, Boston, MA, United States
| | - Kelsey A Johnson
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Lydia A Shrier
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States
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27
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Terhune J, Dykxhoorn J, Mackay E, Hollander AC, Kirkbride JB, Dalman C. Migrant status and risk of compulsory admission at first diagnosis of psychotic disorder: a population-based cohort study in Sweden. Psychol Med 2022; 52:362-371. [PMID: 32578529 PMCID: PMC8842197 DOI: 10.1017/s0033291720002068] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Minority ethnic and migrant groups face an elevated risk of compulsory admission for mental illness. There are overlapping cultural, socio-demographic, and structural explanations for this risk that require further investigation. METHODS By linking Swedish national register data, we established a cohort of persons first diagnosed with a psychotic disorder between 2001 and 2016. We used multilevel mixed-effects logistic modelling to investigate variation in compulsory admission at first diagnosis of psychosis across migrant and Swedish-born groups with individual and neighbourhood-level covariates. RESULTS Our cohort included 12 000 individuals, with 1298 (10.8%) admitted compulsorily. In an unadjusted model, being a migrant [odds ratio (OR) 1.48; 95% confidence interval (CI) 1.26-1.73] or child of a migrant (OR 1.27; 95% CI 1.10-1.47) increased risk of compulsory admission. However after multivariable modelling, region-of-origin provided a better fit to the data than migrant status; excess risk of compulsory admission was elevated for individuals from sub-Saharan African (OR 1.94; 95% CI 1.51-2.49), Middle Eastern and North African (OR 1.46; 95% CI 1.17-1.81), non-Nordic European (OR 1.27; 95% CI 1.01-1.61), and mixed Swedish-Nordic backgrounds (OR 1.33; 95% CI 1.03-1.72). Risk of compulsory admission was greater in more densely populated neighbourhoods [OR per standard deviation (s.d.) increase in the exposure: 1.12, 95% CI 1.06-1.18], an effect that appeared to be driven by own-region migrant density (OR per s.d. increase in exposure: 1.12; 95% CI 1.02-1.24). CONCLUSIONS Inequalities in the risk of compulsory admission by migrant status, region-of-origin, urban living and own-region migrant density highlight discernible factors which raise barriers to equitable care and provide potential targets for intervention.
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Affiliation(s)
- J. Terhune
- PsyLife Group, Division of Psychiatry, UCL, London, W1T 7NF, UK
| | - J. Dykxhoorn
- PsyLife Group, Division of Psychiatry, UCL, London, W1T 7NF, UK
| | - E. Mackay
- CORE Group, Division of Psychology and Language Science, UCL, London, WC1E 7HB, UK
| | - A.-C. Hollander
- EPICSS, Department of Global Public Health, Karolinska Institutet, Solnavägen 1E, SE-171 77Stockholm, UK
| | - J. B. Kirkbride
- PsyLife Group, Division of Psychiatry, UCL, London, W1T 7NF, UK
| | - C. Dalman
- EPICSS, Department of Global Public Health, Karolinska Institutet, Solnavägen 1E, SE-171 77Stockholm, UK
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28
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Systematic review of pathways to care in the U.S. for Black individuals with early psychosis. NPJ SCHIZOPHRENIA 2021; 7:58. [PMID: 34857754 PMCID: PMC8639758 DOI: 10.1038/s41537-021-00185-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/03/2021] [Indexed: 11/09/2022]
Abstract
The pathway to receiving specialty care for first episode psychosis (FEP) among Black youth in the US has received little attention despite documented challenges that negatively impact engagement in care and clinical outcomes. We conducted a systematic review of US-based research, reporting findings related to the pathway experiences of Black individuals with FEP and their family members. A systematic search of PubMed, PsycInfo, and Embase/Medline was performed with no date restrictions up to April 2021. Included studies had samples with at least 75% Black individuals and/or their family members or explicitly examined racial differences. Of the 80 abstracts screened, 28 peer-reviewed articles met the inclusion criteria. Studies were categorized into three categories: premordid and prodromal phase, help-seeking experiences, and the duration of untreated psychosis (DUP). Compounding factors such as trauma, substance use, and structural barriers that occur during the premorbid and prodromal contribute to delays in treatment initiation and highlight the limited use of services for traumatic childhood experiences (e.g., sexual abuse). Studies focused on help-seeking experiences demonstrated the limited use of mental health services and the potentially traumatic entry to services (e.g., law enforcement), which is associated with a longer DUP. Although the majority of studies focused on help-seeking experiences and predictors of DUP, findings suggests that for Black populations, there is a link between trauma and substance use in the pathway to care that impacts the severity of symptoms, initiation of treatment, and DUP. The present review also identifies the need for more representative studies of Black individuals with FEP.
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29
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A systematic review of longitudinal studies of suicidal thoughts and behaviors in first-episode psychosis: course and associated factors. Soc Psychiatry Psychiatr Epidemiol 2021; 56:2117-2154. [PMID: 34432071 DOI: 10.1007/s00127-021-02153-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 07/30/2021] [Indexed: 02/07/2023]
Abstract
PURPOSES To better assess and reduce suicidal risk in first-episode psychosis (FEP), we aimed to investigate the evolution of suicidal thoughts and behaviors (STBs) and associated factors in FEP. METHOD This systematic review (PROSPERO-CRD42020168050) meets PRISMA guidelines. PubMed, Medline, PsycINFO, Embase, EBM Reviews and references lists of relevant articles were searched (February 2020) to identify longitudinal studies, published in English or in French, that assessed the prevalence of STBs at entry to services and over follow-up, and examined factors associated with STBs among all persons with affective and non-affective FEP from a defined catchment area. Screening, data extraction and quality assessment using the adapted Newcastle Ottawa Scale were done independently by two reviewers. Results on prevalence and associated factors are presented by type of STB. RESULTS Of 3,177 references, 17 studies of 11 non-overlapping samples (n = 14,907) with varying lengths of follow-up (1-41.7 years) were included. The prevalence of STBs decreased over follow-up. Up to 21.6% made at least one suicide attempt, 27% had suicidal ideation, and 1-4.3% died by suicide during follow-up. Of 53 factors assessed across studies, only male sex, depressive symptoms, and STBs occurring early during follow-up were associated with subsequent STBs. Early intervention for psychosis decreased STBs in the first three years. Other factors were assessed in a single study, yielded conflicting results, or were not associated with STBs. CONCLUSIONS The high prevalence of STBs following onset of psychosis highlights the need for early detection and intervention and ongoing assessment of suicidal risk throughout follow-up, with attention to identified risk factors. The heterogeneity of the studies precluded a meta-analysis and several factors were each assessed by a single study. Additional well-designed longitudinal studies of STBs and associated factors are warranted.
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30
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Friedman BR, Durán DK, Nestsiarovich A, Tohen M, Lenroot RK, Bustillo JR, Crisanti AS. Characteristics of Hispanics Referred to Coordinated Specialty Care for First-Episode Psychosis and Factors Associated With Enrollment. Psychiatr Serv 2021; 72:1407-1414. [PMID: 34074143 DOI: 10.1176/appi.ps.202000798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The primary objectives of this study were to examine referral sources and demographic, clinical, and socioenvironmental characteristics of Hispanics referred to and enrolled in a program of coordinated specialty care (Early CSC program) for first-episode psychosis, to compare them with characteristics of other referred and enrolled racial-ethnic groups, and to identify factors associated with enrollment in the program. METHODS A retrospective review was conducted for all individuals referred to and enrolled in the Early CSC program over a 2-year period. Extracted data included referral sources and demographic and clinical characteristics. Zip code-level data from publicly available sources were cross-referenced with individual records. Nonparametric tests and appropriate secondary analysis were used to determine significant differences across racial-ethnic groups referred to (N=180) or enrolled in (N=75) the Early CSC program. A random forest model was used to determine which factors or interacting factors were associated with enrollment among the eligible referrals (N=114). RESULTS Hispanic individuals were more likely to be referred from inpatient or outpatient mental health providers and not from other community sources. Among eligible Hispanic referrals, those who lived in areas with a lower percentage of Spanish speaking in the home were more likely to enroll in services, compared with those who lived in areas with a higher percentage of Spanish speaking. CONCLUSIONS Continued exploration of factors associated with referral and enrollment in CSC programs for the growing Hispanic ethnic group in the United States can help determine best steps for developing these programs.
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Affiliation(s)
- Bess Rose Friedman
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque
| | - Danielle K Durán
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque
| | | | - Mauricio Tohen
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque
| | - Rhoshel K Lenroot
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque
| | - Juan R Bustillo
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque
| | - Annette S Crisanti
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque
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31
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Ajnakina O, Rodriguez V, Quattrone D, di Forti M, Vassos E, Arango C, Berardi D, Bernardo M, Bobes J, de Haan L, Del-Ben CM, Gayer-Anderson C, Jongsma HE, Lasalvia A, Tosato S, Llorca PM, Menezes PR, Rutten BP, Santos JL, Sanjuán J, Selten JP, Szöke A, Tarricone I, D’Andrea G, Richards A, Tortelli A, Velthorst E, Jones PB, Arrojo Romero M, La Cascia C, Kirkbride JB, van Os J, O’Donovan M, Murray RM. Duration of Untreated Psychosis in First-Episode Psychosis is not Associated With Common Genetic Variants for Major Psychiatric Conditions: Results From the Multi-Center EU-GEI Study. Schizophr Bull 2021; 47:1653-1662. [PMID: 33963865 PMCID: PMC8562562 DOI: 10.1093/schbul/sbab055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Duration of untreated psychosis (DUP) is associated with clinical outcomes in people with a diagnosis of first-episode psychosis (FEP), but factors associated with length of DUP are still poorly understood. Aiming to obtain insights into the possible biological impact on DUP, we report genetic analyses of a large multi-center phenotypically well-defined sample encompassing individuals with a diagnosis of FEP recruited from 6 countries spanning 17 research sites, as part of the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) study. Genetic propensity was measured using polygenic scores for schizophrenia (SZ-PGS), bipolar disorder (BD-PGS), major depressive disorder (MDD-PGS), and intelligence (IQ-PGS), which were calculated based on the results from the most recent genome-wide association meta-analyses. Following imputation for missing data and log transformation of DUP to handle skewedness, the association between DUP and polygenic scores (PGS), adjusting for important confounders, was investigated with multivariable linear regression models. The sample comprised 619 individuals with a diagnosis of FEP disorders with a median age at first contact of 29.0 years (interquartile range [IQR] = 22.0-38.0). The median length of DUP in the sample was 10.1 weeks (IQR = 3.8-30.8). One SD increases in SZ-PGS, BD-PGS, MDD-PGS or IQ-PGS were not significantly associated with the length of DUP. Our results suggest that genetic variation does not contribute to the DUP in patients with a diagnosis of FEP disorders.
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Affiliation(s)
- Olesya Ajnakina
- Department of Biostatistics & Health Informatics,
Institute of Psychiatry, Psychology and Neuroscience, King’s College
London, University of London, London,
UK
- Department of Behavioural Science and Health, Institute of
Epidemiology and Health Care, University College London,
London, UK
- Department of Clinical Medicine, Aarhus
University, Aarhus, Denmark
| | - Victoria Rodriguez
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London,
London, UK
| | - Diego Quattrone
- Social, Genetic and Developmental Psychiatry Centre,
Institute of Psychiatry, Psychology and Neuroscience, King’s College
London, London, UK
| | - Marta di Forti
- Social, Genetic and Developmental Psychiatry Centre,
Institute of Psychiatry, Psychology and Neuroscience, King’s College
London, London, UK
| | - Evangelos Vassos
- Social, Genetic and Developmental Psychiatry Centre,
Institute of Psychiatry, Psychology and Neuroscience, King’s College
London, London, UK
| | - Celso Arango
- Child and Adolescent Psychiatry Department, Institute of
Psychiatry and Mental Health, Hospital General Universitario Gregorio
Marañón, School of Medicine, Universidad Complutense,
Madrid, Spain
| | - Domenico Berardi
- Department of Biomedical and Neuromotor Sciences,
Psychiatry Unit, Alma Mater Studiorum Università di Bologna,
Bologna, Italy
| | - Miguel Bernardo
- Department of Psychiatry, Barcelona Clinic Schizophrenia
Unit, Neuroscience Institute, Hospital Clinic of Barcelona, University of
Barcelona, IDIBAPS, CIBERSAM, Barcelona,
Spain
| | - Julio Bobes
- Faculty of Medicine and Health Sciences –
Psychiatry, Universidad de Oviedo, ISPA, INEUROPA, CIBERSAM,
Oviedo, Spain
| | - Lieuwe de Haan
- Department of Psychiatry, Early Psychosis Section,
Amsterdam UMC, University of Amsterdam,
Amsterdam, The
Netherlands
| | - Cristina Marta Del-Ben
- Neuroscience and Behavior Department, Ribeirão Preto
Medical School, University of São Paulo, São
Paulo, Brazil
| | - Charlotte Gayer-Anderson
- Department of Health Service and Population Research,
Institute of Psychiatry, Psychology and Neuroscience, King’s College
London, De Crespigny Park, Denmark Hill, London,
UK
| | - Hannah E Jongsma
- Centre for Longitudinal Studies, University College
London, London, UK
- Centre for Transcultural Psychiatry
Veldzicht, Balkbrug, The Netherlands
- University Centre for Psychiatry, University Medical
Centre Groningen, Groningen, The Netherlands
| | - Antonio Lasalvia
- Section of Psychiatry, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona,
Verona,Italy
| | - Sarah Tosato
- Section of Psychiatry, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona,
Verona,Italy
| | - Pierre-Michel Llorca
- Université Clermont Auvergne, CMP-B CHU, CNRS,
Clermont Auvergne INP, Institut Pascal,
Clermont-Ferrand, France
| | - Paulo Rossi Menezes
- Department of Preventative Medicine, Faculdade de Medicina
FMUSP, University of São Paulo, São
Paulo, Brazil
| | - Bart P Rutten
- Department of Psychiatry and Neuropsychology, School for
Mental Health and Neuroscience, South Limburg Mental Health Research and
Teaching Network, Maastricht University Medical Centre,
Maastricht, The
Netherlands
| | - Jose Luis Santos
- Department of Psychiatry, Servicio de Psiquiatría
Hospital “Virgen de la Luz,”Cuenca, Spain
| | - Julio Sanjuán
- Department of Psychiatry, Hospital Clínico
Universitario de Valencia, INCLIVA, CIBERSAM, School of Medicine, Universidad de
Valencia, Valencia, Spain
| | - Jean-Paul Selten
- Rivierduinen Institute for Mental Health
Care, Sandifortdreef 19, 2333 ZZ Leiden,
The Netherlands
| | - Andrei Szöke
- Univ Paris Est Creteil, INSERM, IMRB, AP-HP, Hôpitaux
Universitaires “ H. Mondor ,” DMU IMPACT, Fondation
FondaMental, Creteil, France
| | - Ilaria Tarricone
- Division of Psychological Medicine and Clinical
Neurosciences, Cardiff, UK
| | - Giuseppe D’Andrea
- Department of Biomedical and Neuromotor Sciences,
Psychiatry Unit, Alma Mater Studiorum Università di Bologna,
Bologna, Italy
| | - Alexander Richards
- Division of Psychological Medicine and Clinical
Neurosciences, Cardiff, UK
| | | | - Eva Velthorst
- Department of Psychiatry, Early Psychosis Section,
Academic Medical Centre, University of Amsterdam,
Amsterdam, The
Netherlands
- Department of Psychiatry, Icahn School of Medicine at
Mount Sinai, New York, NY
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Herchel
Smith Building for Brain & Mind Sciences,
Cambridge, UK
- CAMEO Early Intervention Service, Cambridgeshire &
Peterborough NHS Foundation Trust,
Cambridge, UK
| | - Manuel Arrojo Romero
- Department of Psychiatry, Psychiatric Genetic Group,
Instituto de Investigación Sanitaria de Santiago de Compostela, Complejo
Hospitalario Universitario de Santiago de Compostela,
Santiago de Compostela, Spain
| | - Caterina La Cascia
- Department of Experimental Biomedicine and Clinical
Neuroscience, University of Palermo,
Palermo, Italy
| | - James B Kirkbride
- Psylife Group, Division of Psychiatry, University College
London, London, UK
| | - Jim van Os
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London,
London, UK
- Department of Psychiatry and Neuropsychology, School for
Mental Health and Neuroscience, South Limburg Mental Health Research and
Teaching Network, Maastricht University Medical Centre,
Maastricht, The
Netherland
- UMC Utrecht Brain Centre, Utrecht University Medical
Centre, Utrecht, The
Netherlands
| | - Mick O’Donovan
- Division of Psychological Medicine and Clinical
Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff
University, Cardiff, UK
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London,
London, UK
- Department of Psychiatry, Experimental Biomedicine and
Clinical Neuroscience, University of Palermo,
Palermo, Italy
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Allan SM, Hodgekins J, Beazley P, Oduola S. Pathways to care in at-risk mental states: A systematic review. Early Interv Psychiatry 2021; 15:1092-1103. [PMID: 33047505 DOI: 10.1111/eip.13053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/23/2020] [Accepted: 09/26/2020] [Indexed: 12/13/2022]
Abstract
AIM Pathways to care are well studied in the First Episode Psychosis field, but less attention has been given to At-Risk Mental States or prodromal psychosis. This is important because accessing appropriate help at the earliest opportunity is likely to improve outcomes, particularly for those who make transition to psychosis. The present systematic review aimed to synthesize the available literature on pathways to care in ARMS or prodromal psychosis, and investigate the barriers and facilitators to receiving care for ARMS. METHODS The CINAHL Complete, EMBASE, Medline Complete, PsycINFO and PubMED databases were searched. Studies were included if they were published in English between 1985 and 2019, where reported data came exclusively from an At-Risk Mental State population, and the study described or related to pathways to care. RESULTS Ten studies met the inclusion criteria, of which 8 were quantitative. Screening tools and pathways to care instruments varied. Mental health professionals, and general practitioners played a key role in help seeking. Family involvement was also found to be an important factor. CONCLUSIONS Pathways to care research in At-Risk Mental States are more scarce than in the field of First Episode Psychosis. More research is warranted, especially concerning the role of patient-level characteristics on pathways to care. A validated measure of pathways to care may also be of benefit.
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Affiliation(s)
- Sophie M Allan
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, Elizabeth House, Cambridgeshire, UK
| | - Jo Hodgekins
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Peter Beazley
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Sheri Oduola
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, UK
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33
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Jongsma HE, Gayer-Anderson C, Tarricone I, Velthorst E, van der Ven E, Quattrone D, di Forti M, Menezes PR, Del-Ben CM, Arango C, Lasalvia A, Berardi D, La Cascia C, Bobes J, Bernardo M, Sanjuán J, Santos JL, Arrojo M, de Haan L, Tortelli A, Szöke A, Murray RM, Rutten BP, van Os J, Morgan C, Jones PB, Kirkbride JB. Social disadvantage, linguistic distance, ethnic minority status and first-episode psychosis: results from the EU-GEI case-control study. Psychol Med 2021; 51:1536-1548. [PMID: 32122439 PMCID: PMC8311819 DOI: 10.1017/s003329172000029x] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/15/2020] [Accepted: 01/28/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Ethnic minority groups in Western countries face an increased risk of psychotic disorders. Causes of this long-standing public health inequality remain poorly understood. We investigated whether social disadvantage, linguistic distance and discrimination contributed to these patterns. METHODS We used case-control data from the EUropean network of national schizophrenia networks studying Gene-Environment Interactions (EU-GEI) study, carried out in 16 centres in six countries. We recruited 1130 cases and 1497 population-based controls. Our main outcome measure was first-episode ICD-10 psychotic disorder (F20-F33), and exposures were ethnicity (white majority, black, mixed, Asian, North-African, white minority and other), generational status, social disadvantage, linguistic distance and discrimination. Age, sex, paternal age, cannabis use, childhood trauma and parental history of psychosis were included as a priori confounders. Exposures and confounders were added sequentially to multivariable logistic models, following multiple imputation for missing data. RESULTS Participants from any ethnic minority background had crude excess odds of psychosis [odds ratio (OR) 2.03, 95% confidence interval (CI) 1.69-2.43], which remained after adjustment for confounders (OR 1.61, 95% CI 1.31-1.98). This was progressively attenuated following further adjustment for social disadvantage (OR 1.52, 95% CI 1.22-1.89) and linguistic distance (OR 1.22, 95% CI 0.95-1.57), a pattern mirrored in several specific ethnic groups. Linguistic distance and social disadvantage had stronger effects for first- and later-generation groups, respectively. CONCLUSION Social disadvantage and linguistic distance, two potential markers of sociocultural exclusion, were associated with increased odds of psychotic disorder, and adjusting for these led to equivocal risk between several ethnic minority groups and the white majority.
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Affiliation(s)
- Hannah E. Jongsma
- PsyLife Group, Division of Psychiatry, UCL, London, England
- Department of Psychiatry, University of Cambridge, Cambridge, England
| | - Charlotte Gayer-Anderson
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
| | - Ilaria Tarricone
- Transcultural Psychosomatic Team (BoTPT), Department of Surgical and Medical Sciences, Bologna University, Bologna, Italy
| | - Eva Velthorst
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Preventative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Early Psychosis Section, Department of Psychiatry, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Els van der Ven
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
- Rivierduinen Institute for Mental Health Care, Leiden, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Diego Quattrone
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
| | - Marta di Forti
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
| | | | - Paulo Rossi Menezes
- Department of Preventive Medicine, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | - Christina Marta Del-Ben
- Division of Psychiatry, Department of Neuroscience and Behaviour, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Antonio Lasalvia
- Section of Psychiatry, Azienda Ospedaliera Universitaria Integra di Verona, Verona, Italy
| | - Domenico Berardi
- Department of Biomedical and Neuro-motor Sciences, Psychiatry Unit, Alma Mater Studiorum Università di Bologna, 40126Bologna, Italy
| | | | - Julio Bobes
- Department of Medicine, Psychiatry Area, School of Medicine, Universidad de Oviedo, Centro de Investigación Biomédica en Red de Salud Mental, Instituto Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Department of Medicine, Neuroscience Institute, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain
| | - Julio Sanjuán
- Department of Psychiatry, School of Medicine, Universidad de Valencia, Centro de Investigación Biomédica en Red de Salud Mental, Valencia, Spain
| | - Jose Luis Santos
- Department of Psychiatry, Servicio de Psiquiatría Hospital ‘Virgen de la Luz’, Cuenca, Spain
| | - Manuel Arrojo
- Department of Psychiatry, Psychiatric Genetic Group, Instituto de Investigación Sanitaria de Santiago de Compostela, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Lieuwe de Haan
- Early Psychosis Section, Department of Psychiatry, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | | | - Andrei Szöke
- Institut National de la Santé et de la Recherche Médicale, U955, Créteil, France
| | - Robin M. Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
| | - Bart P. Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
- Department of Psychiatry, Brain Center Rudolf Magnus, Utrecht University Medical Centre, Utrecht, The Netherlands
| | - Craig Morgan
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, England
- CAMEO Early Intervention Service, Cambridgeshire and Peterborough National Health Service Foundation Trust, Cambridge, England
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34
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Schoer N, Rodrigues R, Reid J, Ryan BL, Lizotte DJ, Booth R, MacDougall AG, Kurdyak P, Anderson KK. Patterns of Primary Care Use Prior to a First Diagnosis of Nonaffective Psychotic Disorder in Ontario, Canada: Modèles d'utilisation des soins de première ligne avant un premier diagnostic de trouble psychotique non affectif en Ontario, Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:406-417. [PMID: 33016113 PMCID: PMC8172343 DOI: 10.1177/0706743720961732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Many people experience early signs and symptoms before the onset of psychotic disorder, suggesting that there may be help-seeking prior to first diagnosis. The family physician has been found to play a key role in pathways to care. This study examined patterns of primary care use preceding a first diagnosis of psychotic disorder. METHODS We used health administrative data from Ontario (Canada) to construct a population-based retrospective cohort. We investigated patterns of primary care use, including frequency and timing of contacts, in the 6 years prior to a first diagnosis of psychosis, relative to a general population comparison group matched on age, sex, geographic area, and index date. We used latent class growth modeling to identify distinct trajectories of primary care service use, and associated factors, preceding the first diagnosis. RESULTS People with early psychosis contacted primary care over twice as frequently in the 6 years preceding first diagnosis (RR = 2.22; 95% CI, = 2.19 to 2.25), relative to the general population, with a sharp increase in contacts 10 months prior to diagnosis. They had higher contact frequency across nearly all diagnostic codes, including mental health, physical health, and preventative health. We identified 3 distinct service use trajectories: low-, medium-, and high-increasing usage. DISCUSSION We found elevated patterns of primary care service use prior to first diagnosis of psychotic disorder, suggesting that initiatives to support family physicians in their role on the pathway to care are warranted. Earlier intervention has implications for improved social, educational, and professional development in young people with first-episode psychosis.
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Affiliation(s)
- Nicole Schoer
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Rebecca Rodrigues
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | | | - Bridget L Ryan
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada.,Department of Family Medicine, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Daniel J Lizotte
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada.,Department of Computer Science, The University of Western Ontario, London, Ontario, Canada
| | - Richard Booth
- Arthur Labatt Family School of Nursing, The University of Western Ontario, London, Ontario, Canada
| | - Arlene G MacDougall
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada.,Department of Family Medicine, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Paul Kurdyak
- 50010ICES, Toronto, Ontario, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada.,50010ICES, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
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MacDonald K, Ferrari M, Fainman-Adelman N, Iyer SN. Experiences of pathways to mental health services for young people and their carers: a qualitative meta-synthesis review. Soc Psychiatry Psychiatr Epidemiol 2021; 56:339-361. [PMID: 33206200 DOI: 10.1007/s00127-020-01976-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 10/24/2020] [Indexed: 01/28/2023]
Abstract
Worldwide, growing concern with young people's mental health is spurring service reform efforts. Such reform requires a full understanding of the experiences of young people and their carers when seeking mental health help. To generate such an understanding, we conducted a meta-synthesis of qualitative literature on the perspectives of youths and their carers on navigating mental health systems. Five electronic databases were searched (Medline, PsycINFO, EMBASE, CINAHL, HealthSTAR). Studies were included if they explored the experiences of pathways to mental health services of persons aged 11-30 years and/or their carers; were published in English or French; and used qualitative methodology. Quality appraisal was conducted using the CASP tool. The synthesis of 31 included studies yielded three themes-initiating contact with mental health services; characteristics of services' response; and youths' and carers' appraisal of services. Themes about initiating contact included mental health literacy, structural barriers, and social support. Service response-related themes included complex pathways, waitlists, eligibility, and fragmented care. In terms of service appraisal, positive encounters featured providers who were accessible and perceived as caring. Negative appraisals resulted from feeling misunderstood and excluded and being ill-informed about treatment. Across diagnoses and settings, youths and carers had difficult experiences accessing mental healthcare. While individual, social, and healthcare factors shaping pathways to care varied, systemic complexities were a common inhibitor. This synthesis informs recommendations for improving mental health services and youths' pathways to them. It underlines the need for grounding reform in youths' and carers' perspectives and needs.
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Affiliation(s)
- Kathleen MacDonald
- Department of Psychiatry, McGill University, Montreal, Canada. .,Douglas Research Centre, Montreal, Canada. .,ACCESS Open Minds, Pan-Canadian Youth Mental Health Services Research Network, Montreal, Canada. .,Prevention and Early Intervention Program for Psychosis (PEPP), Montreal, Canada.
| | - Manuela Ferrari
- Department of Psychiatry, McGill University, Montreal, Canada.,Douglas Research Centre, Montreal, Canada.,ACCESS Open Minds, Pan-Canadian Youth Mental Health Services Research Network, Montreal, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Montreal, Canada
| | - Nina Fainman-Adelman
- Department of Psychiatry, McGill University, Montreal, Canada.,Douglas Research Centre, Montreal, Canada
| | - Srividya N Iyer
- Department of Psychiatry, McGill University, Montreal, Canada.,Douglas Research Centre, Montreal, Canada.,ACCESS Open Minds, Pan-Canadian Youth Mental Health Services Research Network, Montreal, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Montreal, Canada
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Waldron IR. The wounds that do not heal: Black expendability and the traumatizing aftereffects of anti-Black police violence. EQUALITY, DIVERSITY AND INCLUSION: AN INTERNATIONAL JOURNAL 2020. [DOI: 10.1108/edi-06-2020-0175] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe murders of Black people at the hands of police in 2020 have led to global protests that have called on public officials to defund or abolish the police. What has been drowned out in these conversations, however, is the traumatizing aftereffects of anti-Black police violence as a public health crisis. In this paper, I argue that the racial terrorism of anti-Black police violence is a deeply felt wound in Black communities that extends beyond the individuals who directly experience it and that this type of collective trauma must be understood as an urgent public health crisis.Design/methodology/approachUsing published studies and online commentaries on anti-Black police violence and its mental health impacts in Canada and the United States, this paper examines the mental health impacts of anti-Black police violence at both the individual and community levels.FindingsA public health response to the traumatizing aftereffects of anti-Black police violence and other forms of state violence must highlight important policy imperatives, such as policies of action focused on improving the public health system. It must also encompass a recognition that the public health crisis of anti-Black police violence is not solvable solely by public health agencies alone. Rather, strategic opportunities to address this crisis arise at every level of governmental interaction, including law enforcement, health care, employment, business, education and the media.Originality/valueWhile the impact of anti-Black police violence on the mental health of Black individuals has been emerging in the literature over the last several years, what has been less focused on and what I address in this paper is how the threat of that violence lingers in Black communities long after the protestors have packed up their megaphones, resulting in collective trauma in Black communities.
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Smith LM, Onwumere J, Craig TK, Kuipers E. An ethnic-group comparison of caregiver beliefs about early psychotic illness in a UK sample: Implications for evidence-based caregiver interventions. Transcult Psychiatry 2020; 57:432-444. [PMID: 32106782 DOI: 10.1177/1363461519900596] [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
This study aimed to investigate potential ethnic differences in cognitive responses to caregiving in psychosis that might be relevant to the delivery of caregiver interventions for difficulties related to psychosis. We compared cross-sectional outcomes across early-stage caregivers who self-identified as white British (n = 37) and those who self-identified as black African or Caribbean (n = 41) using United Kingdom (UK) census ethnicity criteria. Self-report questionnaires were used to examine caregiver beliefs about psychosis, including the perceived causes, consequences, timeline, the degree of control that patients have over their difficulties, as well as their appraisals of caregiving. Caregivers from black African or Caribbean backgrounds reported a significantly shorter expected duration of illness than white British caregivers. They were also more likely to cite psychosocial causes (e.g., relationship issues), and less likely to cite biological and genetic causes, as their principal explanations for problems. However, overall differences in perceived causes of illness between ethnicities were not significant, despite the power in this sample to detect medium-sized effects. Factors associated with ethnicity may contribute to individual differences in explanatory models of illness and in experiences of caregiving. A degree of sensitivity to the range of views that people might hold about psychosis may help to engage caregivers from diverse ethnic backgrounds.
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Affiliation(s)
- Lindsay M Smith
- Department of Psychology, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Juliana Onwumere
- Department of Psychology, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Tom Kj Craig
- Department of Health Service & Population Research, King's College London, London, UK
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38
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van der Ven E, Susser E, Dixon LB, Olfson M, Gilmer TP. Racial-Ethnic Differences in Service Use Patterns Among Young, Commercially Insured Individuals With Recent-Onset Psychosis. Psychiatr Serv 2020; 71:433-439. [PMID: 31931683 DOI: 10.1176/appi.ps.201900301] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to investigate racial-ethnic differences in use of mental health services and antipsychotic medication in the year following the recent onset of a psychotic disorder and to examine the role of household income as a proxy for socioeconomic status. METHODS Deidentified administrative claims data from the OptumLabs Data Warehouse were used to identify 8,021 commercially insured individuals ages 14 through 30 with a recent-onset psychotic disorder (January 1, 2011, through December 31, 2015). The authors compared mental health service use among African-American (11.5%), Hispanic (11.0%), and non-Hispanic white (77.4%) individuals during the year following an index diagnosis and adjusted these analyses for household income. RESULTS The probability of any use of outpatient mental health services was lower among African-American (67.4%±1.4%) and Hispanic individuals (66.5%±1.5%) compared with non-Hispanic white patients (72.3%±0.6%; p<0.05 for each comparison). Among those who used services, African-American and Hispanic individuals had fewer mean outpatient mental health visits per year compared with non-Hispanic whites (9.7±0.7 and 10.2±0.7 versus 14.3±0.5, respectively, p<0.001 for each comparison). These racial-ethnic differences in service use remained after adjustment for household income. CONCLUSIONS Among young, commercially insured individuals using outpatient services following an index diagnosis of psychotic disorder, African Americans and Hispanics received less intensive outpatient mental health care than their non-Hispanic white counterparts. Amid the upsurge of early intervention programs, special attention should be paid to increasing access to mental health services for racial-ethnic minority groups.
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Affiliation(s)
- Els van der Ven
- Mailman School of Public Health, Columbia University, New York (van der Ven, Susser); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); New York State Psychiatric Institute, New York (Susser, Dixon, Olfson); Vagelos College of Physicians and Surgeons, Columbia University, New York (Dixon, Olfson); Department of Family Medicine and Public Health, University of California, San Diego, and OptumLabs, Cambridge, Massachusetts (Gilmer)
| | - Ezra Susser
- Mailman School of Public Health, Columbia University, New York (van der Ven, Susser); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); New York State Psychiatric Institute, New York (Susser, Dixon, Olfson); Vagelos College of Physicians and Surgeons, Columbia University, New York (Dixon, Olfson); Department of Family Medicine and Public Health, University of California, San Diego, and OptumLabs, Cambridge, Massachusetts (Gilmer)
| | - Lisa B Dixon
- Mailman School of Public Health, Columbia University, New York (van der Ven, Susser); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); New York State Psychiatric Institute, New York (Susser, Dixon, Olfson); Vagelos College of Physicians and Surgeons, Columbia University, New York (Dixon, Olfson); Department of Family Medicine and Public Health, University of California, San Diego, and OptumLabs, Cambridge, Massachusetts (Gilmer)
| | - Mark Olfson
- Mailman School of Public Health, Columbia University, New York (van der Ven, Susser); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); New York State Psychiatric Institute, New York (Susser, Dixon, Olfson); Vagelos College of Physicians and Surgeons, Columbia University, New York (Dixon, Olfson); Department of Family Medicine and Public Health, University of California, San Diego, and OptumLabs, Cambridge, Massachusetts (Gilmer)
| | - Todd P Gilmer
- Mailman School of Public Health, Columbia University, New York (van der Ven, Susser); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); New York State Psychiatric Institute, New York (Susser, Dixon, Olfson); Vagelos College of Physicians and Surgeons, Columbia University, New York (Dixon, Olfson); Department of Family Medicine and Public Health, University of California, San Diego, and OptumLabs, Cambridge, Massachusetts (Gilmer)
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Risk of involuntary admission among first-generation ethnic minority groups with early psychosis: a retrospective cohort study using health administrative data. Epidemiol Psychiatr Sci 2019; 29:e59. [PMID: 31610825 PMCID: PMC8061249 DOI: 10.1017/s2045796019000556] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
AIMS Ethnic minority groups often have more complex and aversive pathways to mental health care. However, large population-based studies are lacking, particularly regarding involuntary hospitalisation. We sought to examine the risk of involuntary admission among first-generation ethnic minority groups with early psychosis in Ontario, Canada. METHODS Using health administrative data, we constructed a retrospective cohort (2009-2013) of people with first-onset non-affective psychotic disorder aged 16-35 years. This cohort was linked to immigration data to ascertain migrant status and country of birth. We identified the first involuntary admission within 2 years and compared the risk of involuntary admission for first-generation migrant groups to the general population. To control for the role of migrant status, we restricted the sample to first-generation migrants and examined differences by country of birth, comparing risk of involuntary admission among ethnic minority groups to a European reference. We further explored the role of migrant class by adjusting for immigrant vs refugee status within the migrant cohort. We also explored effect modification of migrant class by ethnic minority group. RESULTS We identified 15 844 incident cases of psychotic disorder, of whom 19% (n = 3049) were first-generation migrants. Risk of involuntary admission was higher than the general population in five of seven ethnic minority groups. African and Caribbean migrants had the highest risk of involuntary admission (African: risk ratio (RR) = 1.52, 95% CI = 1.34-1.73; Caribbean: RR = 1.58, 95% CI = 1.37-1.82), and were the only groups where the elevated risk persisted when compared to the European reference group within the migrant cohort (African: RR = 1.24, 95% CI = 1.04-1.48; Caribbean: RR = 1.29, 95% CI = 1.07-1.56). Refugee status was independently associated with involuntary admission (RR = 1.16, 95% CI = 1.02-1.32); however, this risk varied by ethnic minority group, with Caribbean refugees having an elevated risk of involuntary admission compared with Caribbean immigrants (RR = 1.72, 95% CI = 1.15-2.58). CONCLUSIONS Our findings are consistent with the international literature showing increased rates of involuntary admission among some ethnic minority groups with early psychosis. Interventions aimed at improving pathways to care could be targeted at these groups to reduce disparities.
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Schoer N, Huang CW, Anderson KK. Differences in duration of untreated psychosis for racial and ethnic minority groups with first-episode psychosis: an updated systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1295-1298. [PMID: 31183503 DOI: 10.1007/s00127-019-01737-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 06/03/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Ethnic minority groups with early psychosis may have longer treatment delays, potentially leading to poorer outcomes. We updated a previous systematic review of the literature on racial and ethnic differences in duration of untreated psychosis (DUP) among people with first-episode psychosis. RESULTS Six of 17 studies described significant differences across aggregated racial groups; however, the pooled estimates did not show differences across groups. Additional data from this update allowed for disaggregated analyses, finding that Black-African groups have a shorter DUP, whereas Black-Caribbean groups have longer DUP, relative to White groups. CONCLUSIONS These findings highlight the importance of in-depth research on disaggregated ethnic groups to inform targeted early intervention strategies for minority populations.
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Affiliation(s)
- Nicole Schoer
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, 1151 Richmond Street, Kresge Building, Room K213, London, ON, N6A 5C1, Canada
| | - Chen Wei Huang
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, 1151 Richmond Street, Kresge Building, Room K213, London, ON, N6A 5C1, Canada
| | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, 1151 Richmond Street, Kresge Building, Room K213, London, ON, N6A 5C1, Canada. .,Department of Psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada.
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Morgan C, Knowles G, Hutchinson G. Migration, ethnicity and psychoses: evidence, models and future directions. World Psychiatry 2019; 18:247-258. [PMID: 31496097 PMCID: PMC6732691 DOI: 10.1002/wps.20655] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
There is a large body of research reporting high rates of psychotic disorders among many migrant and minority ethnic groups, particularly in Northern Europe. In the context of increasing migration and consequent cultural diversity in many places worldwide, these findings are a major social and public health concern. In this paper, we take stock of the current state of the art, reviewing evidence on variations in rates of psychoses and putative explanations, including relevant theories and models. We discuss in particular: a) the wide variation in reported rates of psychotic disorders by ethnic group, and b) the evidence implicating social risks to explain this variation, at ecological and individual levels. We go on to set out our proposed socio-developmental model, that posits greater exposure to systemic social risks over the life course, particularly those involving threat, hostility and violence, to explain high rates of psychoses in some migrant and minority ethnic groups. Based on this analysis, the challenge of addressing this social and public health issue needs to be met at multiple levels, including social policy, community initiatives, and mental health service reform.
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Affiliation(s)
- Craig Morgan
- Economic and Social Research Council (ESRC) Centre for Society and Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Gemma Knowles
- Economic and Social Research Council (ESRC) Centre for Society and Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
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Oduola S, Craig TKJ, Das-Munshi J, Bourque F, Gayer-Anderson C, Morgan C. Compulsory admission at first presentation to services for psychosis: does ethnicity still matter? Findings from two population-based studies of first episode psychosis. Soc Psychiatry Psychiatr Epidemiol 2019; 54:871-881. [PMID: 30895353 PMCID: PMC6656788 DOI: 10.1007/s00127-019-01685-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 03/04/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Compared with the majority population, those from minority ethnic groups in the UK are more likely to be admitted compulsorily during a first episode of psychosis (FEP). We investigated whether these disparities in pathways in to care continue. METHODS We analysed data from two first episode psychosis studies, conducted in the same geographical area in south London 15 years apart: the Aetiology and Ethnicity in Schizophrenia and Other Psychosis (AESOP) and the Clinical Record Interactive Search-First Episode Psychosis (CRIS-FEP) studies. The inclusion/exclusion criteria for case ascertainment for first episode psychosis were identical across the two studies. We performed multivariable logistic regression to estimate odds of compulsory admission by ethnic group, controlling for confounders. PARTICIPANTS Two hundred sixty-six patients with first episode psychosis, aged 18-64 years, who presented to mental health services in south London in 1997-1999 and 446 with FEP who presented in 2010-2012. RESULTS When the two samples were compared, ethnic differences in compulsory admission appear to have remained the same for black African patients, i.e. three times higher than white British in both samples: AESOP (adj. OR = 3.96; 95% CI = 1.80-8.71) vs. CRIS-FEP (adj. OR = 3.12; 95% CI = 1.52-6.35). Black Caribbean patients were three times more likely to be compulsorily admitted in AESOP (adj. OR = 3.20; 95% CI = 1.56-6.54). This was lower in the CRIS-FEP sample (adj. OR = 1.68; 95% CI = 0.71-3.98) and did not meet conventional levels for statistical significance. CONCLUSION Ethnicity is strongly associated with compulsory admissions at first presentation for psychosis with evidence of heterogeneity across groups, which deserves further research.
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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 & Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
- South London & Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK.
| | - Tom K J Craig
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Jayati Das-Munshi
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- South London & Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
| | - Francois Bourque
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- Division of Social and Cultural Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, QC, H4H 1R3, Canada
| | - Charlotte Gayer-Anderson
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Craig Morgan
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
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Arranz S, Camacho J, Andrés C, Niubó I, Sanchez Gistau V. Comparison between a morocco and a native-born population, in a sample of first episode psychosis. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2019; 13:73-79. [PMID: 31109904 DOI: 10.1016/j.rpsm.2019.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 02/20/2019] [Accepted: 03/11/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Ethnic differences have been studied previously in schizophrenia and first episodes of psychosis (FEP). Previous studies in Netherlands have reported a higher incidence of psychosis in male Moroccan immigrants and more clinical severity. However there is lack of studies in Spain with morocco population and FEP. OBJECTIVES This study aims to determine the clinical differences in a sample of FEP between Morocco and Spanish population, recruited in a hospitalisation unit. MATERIAL AND METHODS Descriptive and cross-sectional study of 83 inpatients (FEP). Functionality and symptomatology were evaluated at entry and discharge, the pattern of use of cannabis was evaluated at entry, the dose of antipsychotic and the pattern of side-effects at discharge. Comparisons between native-born population and Morocco population was made with univariate analysis and logistic regression was made for evaluating the independence of the associations. RESULTS The 28.9% of the sample was Morocco group. No significance differences were found in clinical characteristics between groups at entry or at discharge. Compared with native-born, the Morocco group were more male, with less years of education, worse functionality, reported less use of cannabis, a better pattern of side effects and a tendency of more prescription of LAis. After the multivariate analysis, just remains a lower functionality (OR 0.93; IC 95%: 0.88-0.99, P=0.02) and lower years of education (OR 0.75; IC 95%: 0.56-1.01, P=0.05), remain significative with being related with Morocco origin. CONCLUSIONS Our study provides evidence for ethnic differences in Morocco population with FEP. Patients with Morocco ethnicity have more probability of being males, less years of educations. Have lower functionality and a better profile of side effects.
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Affiliation(s)
- Sara Arranz
- Parc Sanitari Sant Joan de Déu, Barcelona, España; Hospital Universitario Instituto Pere Mata, Universitat Rovira Virgili, Reus, España.
| | - Julia Camacho
- Parc Sanitari Sant Joan de Déu, Barcelona, España; Hospital Universitario Instituto Pere Mata, Universitat Rovira Virgili, Reus, España
| | - Claudia Andrés
- Parc Sanitari Sant Joan de Déu, Barcelona, España; Hospital Universitario Instituto Pere Mata, Universitat Rovira Virgili, Reus, España
| | - Inés Niubó
- Parc Sanitari Sant Joan de Déu, Barcelona, España; Hospital Universitario Instituto Pere Mata, Universitat Rovira Virgili, Reus, España
| | - Vanessa Sanchez Gistau
- Parc Sanitari Sant Joan de Déu, Barcelona, España; Hospital Universitario Instituto Pere Mata, Universitat Rovira Virgili, Reus, España
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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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Edbrooke-Childs J, Patalay P. Ethnic Differences in Referral Routes to Youth Mental Health Services. J Am Acad Child Adolesc Psychiatry 2019; 58:368-375.e1. [PMID: 30768415 DOI: 10.1016/j.jaac.2018.07.906] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 07/10/2018] [Accepted: 08/15/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine whether there are ethnic differences in referral route to youth mental health services. METHOD This was an analysis of national, routinely collected data from 14,588 young people (mean [SD] age = 12.28 [3.75] years, 54% female; 64% white British) accessing mental health services in the United Kingdom. Ethnicity was self-reported by young people and carers, and referral route was recorded by services. RESULTS After accounting for service-level variation and controlling for age, sex, problem type, and contextual factors, ethnicity was significantly associated with referral route. Compared to white British young people, black young people (odds ratio [OR] = 2.90, 95% CI = 2.07-4.06) and mixed-race young people (OR = 2.66, 95% CI = 1.91-3.72) were more than twice as likely to be referred through social care/youth justice than through primary care. Compared to white British young people, Asian young people (OR = 1.85, 95% CI = 1.34-2.54) were almost twice as likely to be referred through social care/youth justice than through primary care. We conducted a sensitivity analysis to examine whether ethnic differences in referral route were attenuated when also accounting for service area deprivation, and the above effects were only partially attenuated. CONCLUSION There are ethnic differences in referral route to youth mental health services in the United Kingdom, and young people from minority ethnic backgrounds are more likely to be referred through routes that are less likely to be voluntary. Understanding the reasons for these differences is critical for reducing inequalities and improving pathways to mental health care access.
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Affiliation(s)
| | - Praveetha Patalay
- Institute of Psychology, Health and Society, University of Liverpool, UK
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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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Abstract
Delays in accessing appropriate care affect patients with most major health conditions, including psychosis. These delays may also be affected by pathways to care. In a recent article in BMC Medicine, Bhui and colleagues review the current evidence for ethnic differences in pathways to care for psychosis in England. They reveal that black and Asian people are 3 and 1.5 times more likely, respectively, to come to the attention of psychosis services via compulsory admission than white British people. In this Commentary, I discuss the implications of this on achieving equitable care for psychosis patients and outcomes following their care. The current review of the Mental Health Act provides a timely opportunity to remove such inequalities in England.Please see related article: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-018-1201-9 .
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Affiliation(s)
- James B Kirkbride
- PsyLife Group, Division of Psychiatry, University College London, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
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Halvorsrud K, Nazroo J, Otis M, Brown Hajdukova E, Bhui K. Ethnic inequalities and pathways to care in psychosis in England: a systematic review and meta-analysis. BMC Med 2018; 16:223. [PMID: 30537961 PMCID: PMC6290527 DOI: 10.1186/s12916-018-1201-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/29/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND As part of a national programme to tackle ethnic inequalities, we conducted a systematic review and meta-analysis of research on ethnic inequalities in pathways to care for adults with psychosis living in England and/or Wales. METHODS Nine databases were searched from inception to 03.07.17 for previous systematic reviews, including forward and backward citation tracking and a PROSPERO search to identify ongoing reviews. We then carried forward relevant primary studies from included reviews (with the latest meta-analyses reporting on research up to 2012), supplemented by a search on 18.10.17 in MEDLINE, Embase, PsycINFO and CINAHL for primary studies between 2012 and 2017 that had not been covered by previous meta-analyses. RESULTS Forty studies, all conducted in England, were included for our updated meta-analyses on pathways to care. Relative to the White reference group, elevated rates of civil detentions were found for Black Caribbean (OR = 3.43, 95% CI = 2.68 to 4.40, n = 18), Black African (OR = 3.11, 95% CI = 2.40 to 4.02, n = 6), and South Asian patients (OR = 1.50, 95% CI 1.07 to 2.12, n = 10). Analyses of each Mental Health Act section revealed significantly higher rates for Black people under (civil) Section 2 (OR = 1.53, 95% CI = 1.11 to 2.11, n = 3). Rates in repeat admissions were significantly higher than in first admission for South Asian patients (between-group difference p < 0.01). Some ethnic groups had more police contact (Black African OR = 3.60, 95% CI = 2.15 to 6.05, n = 2; Black Caribbean OR = 2.64, 95% CI = 1.88 to 3.72, n = 8) and criminal justice system involvement (Black Caribbean OR = 2.76, 95% CI = 2.02 to 3.78, n = 5; Black African OR = 1.92, 95% CI = 1.32 to 2.78, n = 3). The White Other patients also showed greater police and criminal justice system involvement than White British patients (OR = 1.49, 95% CI = 1.03 to 2.15, n = 4). General practitioner involvement was less likely for Black than the White reference group. No significant variations over time were found across all the main outcomes. CONCLUSIONS Our updated meta-analyses reveal persisting but not significantly worsening patterns of ethnic inequalities in pathways to psychiatric care, particularly affecting Black groups. This provides a comprehensive evidence base from which to inform policy and practice amidst a prospective Mental Health Act reform. TRIAL REGISTRATION CRD42017071663.
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Affiliation(s)
- Kristoffer Halvorsrud
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - James Nazroo
- Sociology, School of Social Sciences, University of Manchester, Humanities, Bridgeford Street, Oxford Road, Manchester, M13 9PL, UK
| | - Michaela Otis
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Eva Brown Hajdukova
- Centre for Research in Public Health and Community Care (CRIPACC), University of Hertfordshire, Health Research Building, College Lane, Hatfield, AL10 9AB, UK
| | - Kamaldeep Bhui
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
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Lemetyinen H, Onwumere J, Drake RJ, Abel K, Haigh C, Moulton G, Edge D. Co-production and evaluation of an e-learning resource to improve African-Caribbean families' knowledge about schizophrenia and engagement with services: a pilot randomised controlled trial protocol. Pilot Feasibility Stud 2018; 4:174. [PMID: 30479829 PMCID: PMC6245541 DOI: 10.1186/s40814-018-0368-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 11/07/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND A higher proportion of African-Caribbean people in the UK are diagnosed with schizophrenia spectrum disorders than other ethnic groups. High levels of shame and stigma at individual and community levels contribute to delayed access to care, potentially increasing the duration of untreated psychosis and so worsening outcomes. Inferior access, more coercive care, and worse outcomes have created a 'circle of fear' of mental health services within African-Caribbean communities. This further discourages early engagement with statutory services and increases the burden of care for families living with schizophrenia.Providing tailored and relevant information about psychosis (psychoeducation) has the potential for improving outcomes for patients and families. However, there are no culturally appropriate psychoeducation programmes for African-Caribbeans in the UK. We aim to determine whether an e-learning resource, co-produced with African-Caribbean stakeholders to improve knowledge about psychoses, would be culturally acceptable and accessible to members of this population. METHODS A pilot randomised controlled trial of the feasibility of co-producing and testing a novel e-learning resource to improve knowledge about and attitudes towards schizophrenia in African-Caribbean families. We will seek to recruit 40 participants, aged ≥ 16 years, either to receive the intervention or as controls. They will self-refer or be referred via inpatient and wellbeing services, family and carers' forums, statutory community mental health teams, and voluntary sector/non-governmental agencies (NGOs). Participants will complete the Ca-KAP, ASMI, and SF-12. Acceptability will be explored qualitatively via focus groups and individual semi-structured interviews. DISCUSSION The proposed trial will demonstrate the feasibility of conducting a fully powered RCT to evaluate the efficacy of an e-learning resource about schizophrenia with African-Caribbean families. Qualitative work will explore the intervention's accessibility and barriers/facilitators to participation, including attitudes to randomisation. These data will facilitate further refinement of the intervention. TRIAL REGISTRATION ISRCTN11394005, retrospectively registered 20/03/2018.
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Affiliation(s)
- Henna Lemetyinen
- Division of Psychology & Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Juliana Onwumere
- King’s College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX UK
| | - Richard James Drake
- Division of Psychology & Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Bury New Road, Prestwich, Manchester, UK
| | - Kathryn Abel
- Division of Psychology & Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Bury New Road, Prestwich, Manchester, UK
| | - Carol Haigh
- Manchester Metropolitan University, Brook Building, Bonsall Street, Manchester, UK
| | - Georgina Moulton
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Dawn Edge
- Division of Psychology & Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, Manchester, UK
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MacDonald K, Fainman-Adelman N, Anderson KK, Iyer SN. Pathways to mental health services for young people: a systematic review. Soc Psychiatry Psychiatr Epidemiol 2018; 53:1005-1038. [PMID: 30136192 PMCID: PMC6182505 DOI: 10.1007/s00127-018-1578-y] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 07/30/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE While early access to appropriate care can minimise the sequelae of mental illnesses, little is known about how youths come to access mental healthcare. We therefore conducted a systematic review to synthesise literature on the pathways to care of youths across a range of mental health problems. METHODS Studies were identified through searches of electronic databases (MEDLINE, PsycINFO, Embase, HealthSTAR and CINAHL), supplemented by backward and forward mapping and hand searching. We included studies on the pathways to mental healthcare of individuals aged 11-30 years. Two reviewers independently screened articles and extracted data. RESULTS Forty-five studies from 26 countries met eligibility criteria. The majority of these studies were from settings that offered services for the early stages of psychosis, and others included inpatient and outpatient settings targeting wide-ranging mental health problems. Generally, youths' pathways to mental healthcare were complex, involved diverse contacts, and, sometimes, undue treatment delays. Across contexts, family/carers, general practitioners and emergency rooms featured prominently in care pathways. There was little standardization in the measurement of pathways. CONCLUSIONS Except in psychosis, youths' pathways to mental healthcare remain understudied. Pathways to care research may need to be reconceptualised to account for the often transient and overlapping nature of youth mental health presentations, and the possibility that what constitutes optimal care may vary. Despite these complexities, additional research, using standardized methodology, can yield a greater understanding of the help-seeking behaviours of youths and those acting on their behalf; service responses to help-seeking; and the determinants of pathways. This understanding is critical to inform ongoing initatives to transform youth mental healthcare.
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Affiliation(s)
- Kathleen MacDonald
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Prevention and Early Intervention Program for Psychosis (PEPP) and ACCESS Open Minds (pan-Canadian youth mental health services research network), Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Nina Fainman-Adelman
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Prevention and Early Intervention Program for Psychosis (PEPP) and ACCESS Open Minds (pan-Canadian youth mental health services research network), Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London, ON, Canada
- Department of Psychiatry, The University of Western Ontario, London, ON, Canada
| | - Srividya N Iyer
- Department of Psychiatry, McGill University, Montreal, QC, Canada.
- Prevention and Early Intervention Program for Psychosis (PEPP) and ACCESS Open Minds (pan-Canadian youth mental health services research network), Douglas Mental Health University Institute, Montreal, QC, Canada.
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