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Park Y, Cho S, Lee YS, Roh S. Depression Literacy and Depressive Symptoms: The Mediating Role of Self-Rated Mental Health Among Korean Americans. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2024; 21:561-575. [PMID: 38721748 DOI: 10.1080/26408066.2024.2349529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
OBJECTIVE Depression literacy (DL) is increasingly recognized as an important predictor of mental health outcomes, but there remains a noticeable lack of scientific inquiry focusing on Korean Americans in this area. In addition, women are known to be more susceptible to depression, potentially affecting their DL and depressive symptoms differently than men. This study aimed to explore two primary objectives: (1) the potential role of self-rated mental health (SRMH) in mediating the association between DL and depressive symptoms in this population, and (2) whether gender differences exist in the presence and magnitudes of these mediation effects. METHOD Data were drawn from a survey with 693 Korean Americans aged 18 and older residing in New York and New Jersey. The PROCESS macro was used to test the mediation effect of self-rated mental health on the relationship between depression literacy and depressive symptoms in men and women. RESULTS Self-rated mental health was found to mediate the relation between depression literacy and depressive symptoms in women but not in men. CONCLUSIONS Providing evidence-informed, culturally tailored and gender specific depression literacy education and programs for the KA communities may be an important strategy to reduce depressive symptoms in this group.
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Affiliation(s)
- Yeddi Park
- School of Education and Human Development, Fairfield University, Fairfield, Connecticut, USA
| | - Soyeon Cho
- Department of Human Services, New York City College of Technology/CUNY, Brooklyn, New York, USA
| | - Yeon-Shim Lee
- College of Health & Social Sciences, School of Social Work, San Francisco State University, San Francisco, California, USA
| | - Soonhee Roh
- Department of Social Work, University of South Dakota-Sioux Falls, Sioux Falls, South Dakota, USA
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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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Smyth N, Buckman JEJ, Naqvi SA, Aguirre E, Cardoso A, Pilling S, Saunders R. Understanding differences in mental health service use by men: an intersectional analysis of routine data. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2065-2077. [PMID: 35318495 PMCID: PMC9477949 DOI: 10.1007/s00127-022-02256-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/18/2022] [Indexed: 02/05/2023]
Abstract
PURPOSE Rates of help-seeking for common mental health problems are lower for men, but less is known about patterns of engagement once they are in contact with services. Previous research has been limited in its ability to understand the intersection between service user characteristics and engagement. This study compared analytic approaches to investigate intersectional associations between sociodemographic and socioeconomic indicators and use of psychological treatment services by men. METHOD Data from 9,904 male service users attending two psychological treatment services in London were analysed. The association between ethnicity, sexual orientation, religious affiliation and employment status of service users and service use outcomes was explored using multinomial logistic regression and latent class analysis (LCA). RESULTS Being from a minoritised ethnic background, of Muslim faith, being unemployed, and living in the most deprived neighbourhoods were associated with greater risk of not commencing or completing treatment. Seven classes were identified in LCA, with men predominately differentiated by self-reported ethnicity and religion. Compared with the 'White British, non-religious' class, the 'Asian Muslim' class and the 'minoritised ethnic, non-religious' class were at higher risk of disengagement, whilst the 'Asian, other religion' class were at higher risk of being referred elsewhere rather than completing initiated treatment. CONCLUSIONS There were significant inequalities in engagement by men associated with ethnicity, religion and socioeconomic status. Compared with the regression models, further nuance was apparent in LCA regarding the intersection of gender, religion and ethnicity. Identifying groups at greater risk of discontinuation of treatment could inform more personalised pathways through care.
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Affiliation(s)
- Natasha Smyth
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, WC1E 7HB, UK.
| | - Joshua E J Buckman
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, WC1E 7HB, UK
- iCope, Camden and Islington Psychological Therapies Services, Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Syed A Naqvi
- North East London NHS Foundation Trust, London, UK
| | | | - Ana Cardoso
- North East London NHS Foundation Trust, London, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, WC1E 7HB, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Rob Saunders
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, WC1E 7HB, UK
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Stamboglis N, Jacobs R. Factors Associated with Patient Satisfaction of Community Mental Health Services: A Multilevel Approach. Community Ment Health J 2020; 56:50-64. [PMID: 31522349 PMCID: PMC6942033 DOI: 10.1007/s10597-019-00449-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 09/05/2019] [Indexed: 11/30/2022]
Abstract
Community care is increasingly the mainstay of mental healthcare provision in many countries and patient satisfaction is an important barometer of quality of patient care. This paper explores the key factors associated with patient satisfaction with community mental health services in England and then compares providers' performance on patient satisfaction. Our analysis is based on patient-level responses from the community mental health survey, which is run annually by the Care Quality Commission (CQC) for the years 2010 to 2013. We perform a repeated cross-section analysis, identifying factors associated with patient satisfaction via a multi-level ordered probit model, including both patient- and provider-level variables. We identify hospital-specific effects via empirical Bayes estimation. Our analysis identifies a number of novel results. First, patient characteristics such as older age, being employed, and being able to work, are associated with higher satisfaction, while being female is associated with lower satisfaction. Service contact length, time since last visit, condition severity and admission to a mental health institution, are all associated with lower satisfaction. Second, treatment type affects satisfaction, with patients receiving talking therapies or being prescribed medications being more satisfied. Third, care continuity and involvement, as proxied by having a care plan, is associated with higher satisfaction. Fourth, seeing a health professional closer to the community improves satisfaction, with patients seeing a community-psychiatric nurse, a social worker or a mental-health support worker being more satisfied. Finally, our study identifies the need for service integration, with patients experiencing financial, accommodation, or physical health needs being less satisfied. At a provider level, we find a negative association between the percentage of occupied beds and satisfaction. We further identify significant provider-specific effects after accounting for observable differences in patient and provider characteristics which suggests significant differences in provider quality of care.
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Affiliation(s)
- Niccolò Stamboglis
- The Pool, City, University of London, St John Street, London, EC1V 4PB, UK. .,Calle del Magazen 5589, 30120, Venice, Italy.
| | - Rowena Jacobs
- Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK
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Mercer L, Evans LJ, Turton R, Beck A. Psychological Therapy in Secondary Mental Health Care: Access and Outcomes by Ethnic Group. J Racial Ethn Health Disparities 2018; 6:419-426. [PMID: 30430460 DOI: 10.1007/s40615-018-00539-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/05/2018] [Accepted: 10/29/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To explore the differences in access to, and outcomes of, psychological therapy for different ethnic groups across a South London Mental Health Trust. METHOD This study used Trust data to explore the proportions of ethnic groups accessing psychological therapy as a proportion of all patients supported by the Trust, as well as their outcomes within broad diagnostic clusters. RESULTS Compared to proportions in the local population, there were significantly more White/White British patients and significantly fewer patients from 'other ethnic groups' in the Trust (p < .05). There was also significantly greater proportion of Black/Black British patients with schizophrenia diagnoses compared to the proportion of Black/Black British people in the local population (p < .001). Of those accessing psychological therapy, there were significantly more White/White British and 'other ethnic group' patients and significantly fewer Black/Black British patients (p < .05). For schizophrenia diagnoses, significantly fewer Black/Black British and 'other ethnic group' patients were accessing psychological therapy (p < .05); however for behavioural and emotional disorders, there were significantly higher proportions of 'other ethnic group' and White/White British patients. Outcomes varied by diagnosis; Black/Black British patients experienced significantly higher distress scores at the beginning of therapy for depression and neurotic diagnoses (p < .05), with the latter persisting at the end of treatment. CONCLUSIONS Across the Trust, there were significant differences in the proportion of ethnic groups in accessing psychological therapy, as well as in outcomes. More research is needed to understand the factors that may underlie these disparities.
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Affiliation(s)
- Louise Mercer
- South London and Maudsley NHS Foundation Trust, London, England, UK
- Department of Psychology and Psychotherapy, Maudsley Hospital, Denmark Hill, London, UK
| | - Lauren Jayne Evans
- South London and Maudsley NHS Foundation Trust, London, England, UK
- Department of Psychology and Psychotherapy, Maudsley Hospital, Denmark Hill, London, UK
| | - Robert Turton
- South London and Maudsley NHS Foundation Trust, London, England, UK.
- Department of Psychology and Psychotherapy, Maudsley Hospital, Denmark Hill, London, UK.
| | - Alison Beck
- South London and Maudsley NHS Foundation Trust, London, England, UK
- Department of Psychology and Psychotherapy, Maudsley Hospital, Denmark Hill, London, UK
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Das-Munshi J, Bhugra D, Crawford MJ. Ethnic minority inequalities in access to treatments for schizophrenia and schizoaffective disorders: findings from a nationally representative cross-sectional study. BMC Med 2018; 16:55. [PMID: 29669549 PMCID: PMC5904997 DOI: 10.1186/s12916-018-1035-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/13/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Ethnic minority service users with schizophrenia and schizoaffective disorders may experience inequalities in care. There have been no recent studies assessing access to evidence-based treatments for psychosis amongst the main ethnic minority groups in the UK. METHODS Data from nationally representative surveys from England and Wales, for 10,512 people with a clinical diagnosis of schizophrenia or schizoaffective disorders, were used for analyses. Multi-level multivariable logistic regression analyses were used to assess ethnic minority inequalities in access to pharmacological treatments, psychological interventions, shared decision making and care planning, taking into account a range of potential confounders. RESULTS Compared with white service users, black service users were more likely prescribed depot/injectable antipsychotics (odds ratio 1.56 (95% confidence interval 1.33-1.84)). Black service users with treatment resistance were less likely to be prescribed clozapine (odds ratio 0.56 (95% confidence interval 0.39-0.79)). All ethnic minority service users, except those of mixed ethnicity, were less likely to be offered cognitive behavioural therapy, compared to white service users. Black service users were less likely to have been offered family therapy, and Asian service users were less likely to have received copies of care plans (odds ratio 0.50 (95% confidence interval 0.33-0.76)), compared to white service users. There were no clinician-reported differences in shared decision making across each of the ethnic minority groups. CONCLUSION Relative to white service users, ethnic minority service users with psychosis were generally less likely to be offered a range of evidence-based treatments for psychosis, which included pharmacological and psychological interventions as well as involvement in care planning.
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Affiliation(s)
- Jayati Das-Munshi
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. .,South London & Maudsley NHS Foundation Trust, London, UK.
| | - Dinesh Bhugra
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Greenwood N, Holley J, Ellmers T, Bowling A, Cloud G. Assessing satisfaction with social care services among black and minority ethnic and white British carers of stroke survivors in England. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:1571-1580. [PMID: 26503620 PMCID: PMC5573938 DOI: 10.1111/hsc.12298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 09/13/2015] [Indexed: 06/05/2023]
Abstract
Overall satisfaction levels with social care are usually high but lower levels have been reported among black and minority ethnic (BME) service users in England. Reasons for this are poorly understood. This qualitative study therefore explored satisfaction with services among informal carer participants from five different ethnic groups. Fifty-seven carers (black Caribbean, black African, Asian Indian, Asian Pakistani and white British) were recruited from voluntary sector organisations and a local hospital in England, and took part in semi-structured interviews using cognitive interviewing and the critical incident technique. Interviews took place from summer 2013 to spring 2014. Thematic analysis of the interviews showed that participants often struggled to identify specific 'incidents', especially satisfactory ones. When describing satisfactory services, participants talked mostly about specific individuals and relationships. Unsatisfactory experiences centred on services overall. When rating services using cognitive interviewing, explicit comparisons with expectations or experiences with other services were common. Highest satisfaction ratings tended to be justified by positive personal characteristics among practitioners, trust and relationships. Lower level ratings were mostly explained by inconsistency in services, insufficient or poor care. Lowest level ratings were rare. Overall, few differences between ethnic groups were identified, although white British participants rated services higher overall giving more top ratings. White British participants also frequently took a more overall view of services, highlighting some concerns but still giving top ratings, while South Asian carers in particular focused on negative aspects of services. Together these methods provide insight into what participants mean by satisfactory and unsatisfactory services. Cognitive interviewing was more challenging for some BME participants, possibly a reflection of the meaningfulness of the concept of service satisfaction to them. Future research should include comparisons between BME and white participants' understanding of the most positive parts of satisfaction scales and should focus on dissatisfied participants.
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Affiliation(s)
- Nan Greenwood
- Faculty of Health, Social Care and EducationSt George's University of London and Kingston UniversitySt George's University of LondonLondonUK
| | - Jess Holley
- Faculty of Health, Social Care and EducationSt George's University of London and Kingston UniversitySt George's University of LondonLondonUK
| | - Theresa Ellmers
- Faculty of Health, Social Care and EducationSt George's University of London and Kingston UniversitySt George's University of LondonLondonUK
| | - Ann Bowling
- Faculty of Health ScienceUniversity of SouthamptonSouthamptonUK
| | - Geoffrey Cloud
- Department of NeurologySt George's Healthcare NHS TrustLondonUK
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Memon A, Taylor K, Mohebati LM, Sundin J, Cooper M, Scanlon T, de Visser R. Perceived barriers to accessing mental health services among black and minority ethnic (BME) communities: a qualitative study in Southeast England. BMJ Open 2016; 6:e012337. [PMID: 27852712 PMCID: PMC5128839 DOI: 10.1136/bmjopen-2016-012337] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE In most developed countries, substantial disparities exist in access to mental health services for black and minority ethnic (BME) populations. We sought to determine perceived barriers to accessing mental health services among people from these backgrounds to inform the development of effective and culturally acceptable services to improve equity in healthcare. DESIGN AND SETTING Qualitative study in Southeast England. PARTICIPANTS 26 adults from BME backgrounds (13 men, 13 women; aged >18 years) were recruited to 2 focus groups. Participants were identified through the registers of the Black and Minority Ethnic Community Partnership centre and by visits to local community gatherings and were invited to take part by community development workers. Thematic analysis was conducted to identify key themes about perceived barriers to accessing mental health services. RESULTS Participants identified 2 broad themes that influenced access to mental health services. First, personal and environmental factors included inability to recognise and accept mental health problems, positive impact of social networks, reluctance to discuss psychological distress and seek help among men, cultural identity, negative perception of and social stigma against mental health and financial factors. Second, factors affecting the relationship between service user and healthcare provider included the impact of long waiting times for initial assessment, language barriers, poor communication between service users and providers, inadequate recognition or response to mental health needs, imbalance of power and authority between service users and providers, cultural naivety, insensitivity and discrimination towards the needs of BME service users and lack of awareness of different services among service users and providers. CONCLUSIONS People from BME backgrounds require considerable mental health literacy and practical support to raise awareness of mental health conditions and combat stigma. There is a need for improving information about services and access pathways. Healthcare providers need relevant training and support in developing effective communication strategies to deliver individually tailored and culturally sensitive care. Improved engagement with people from BME backgrounds in the development and delivery of culturally appropriate mental health services could facilitate better understanding of mental health conditions and improve access.
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Affiliation(s)
- Anjum Memon
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Katie Taylor
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Lisa M Mohebati
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Josefin Sundin
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Max Cooper
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Thomas Scanlon
- Public Health Directorate, Brighton and Hove City Council, Brighton and Hove, UK
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Trenchard L, Mc Grath-Lone L, Ward H. Ethnic variation in cancer patients' ratings of information provision, communication and overall care. ETHNICITY & HEALTH 2016; 21:515-533. [PMID: 26853061 PMCID: PMC4940888 DOI: 10.1080/13557858.2015.1126561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 09/30/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Ethnic inequalities in cancer patient experience exist but variation within broad ethnic categories is under-explored. This study aimed to describe variation by ethnic sub-category in experiences of information provision and communication (key domains of patient experience) using National Cancer Patient Experience Survey (NCPES) data. DESIGN The NCPES 2012-2013 contained responses from 68,737 cancer patients treated at 155 NHS Trusts in England. Multivariate logistic regression was used to investigate associations between ethnicity and patients' ratings of overall care, information provision and communication. RESULTS Variation by and within broad ethnic categories was evident. Non-White patients (particularly Asian patients (ORadj:0.78; 95%CI:0.67-0.90, p=0.001)) were less likely than White patients to receive an understandable explanation of treatment side effects. Among Asian patients, those of Bangladeshi ethnicity were least likely to receive an understandable explanation. CONCLUSIONS Effective communication and information provision are important to ensure patients are well informed, receive the best possible care and have a positive patient experience. However, ethnic inequalities exist in cancer patients' experiences of information provision and communication with variation evident both between and within broad ethnic categories. Further work to understand the causes of this variation is required to address ethnic inequalities at practice and policy level.
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Affiliation(s)
- Lorna Trenchard
- School of Public Health, Imperial College London, London, UK
| | - Louise Mc Grath-Lone
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK
| | - Helen Ward
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK
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Casey D, Brown L, Gajwani R, Islam Z, Jasani R, Parsons H, Tah P, Birchwood M, Singh SP. Predictors of engagement in first-episode psychosis. Schizophr Res 2016; 175:204-208. [PMID: 27132495 DOI: 10.1016/j.schres.2016.04.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 04/14/2016] [Accepted: 04/18/2016] [Indexed: 11/19/2022]
Abstract
Engagement with psychiatric services is critical for ensuring successful outcomes in patients experiencing a first episode of psychosis (FEP). However, it is not known how sociodemographic factors and patient beliefs about the causes of mental illness affect engagement. This study explored predictors of engagement in a cohort of 103 FEP patients presenting to an early-intervention service. Beliefs that mental illness is caused by social stress or thinking odd thoughts predicted higher engagement scores. Patients with no qualifications were found to have higher engagement scores than those educated to a higher level. Ethnicity, gender, age and socioeconomic factors were not significantly correlated with engagement scores. Duration of untreated illness (DUI) significantly predicted higher engagement scores, but only for values >1220days. Duration of untreated psychosis (DUP) was not a significant predictor of patient engagement scores. Patient beliefs about the causes of mental illness are an important factor to be taken into consideration and may represent a target of interventions to increase engagement in FEP.
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Affiliation(s)
- Daniel Casey
- James Paget University Hospital, Lowestoft Rd., Gorleston NR31 6LA, UK.
| | - Luke Brown
- Gibbet Hill Campus, University of Warwick, Coventry CV4 7AL, UK
| | - Ruchika Gajwani
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, G3 8SJ
| | - Zoebia Islam
- Gibbet Hill Campus, University of Warwick, Coventry CV4 7AL, UK
| | - Rubina Jasani
- Gibbet Hill Campus, University of Warwick, Coventry CV4 7AL, UK
| | - Helen Parsons
- Gibbet Hill Campus, University of Warwick, Coventry CV4 7AL, UK
| | - Priya Tah
- Gibbet Hill Campus, University of Warwick, Coventry CV4 7AL, UK
| | - Max Birchwood
- Gibbet Hill Campus, University of Warwick, Coventry CV4 7AL, UK
| | - Swaran P Singh
- Gibbet Hill Campus, University of Warwick, Coventry CV4 7AL, UK
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Asthana S, Gibson A, Bailey T, Moon G, Hewson P, Dibben C. Equity of utilisation of cardiovascular care and mental health services in England: a cohort-based cross-sectional study using small-area estimation. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BackgroundA strong policy emphasis on the need to reduce both health inequalities and unmet need in deprived areas has resulted in the substantial redistribution of English NHS funding towards deprived areas. This raises the question of whether or not socioeconomically disadvantaged people continue to be disadvantaged in their access to and utilisation of health care.ObjectivesTo generate estimates of the prevalence of cardiovascular disease (CVD) and common mental health disorders (CMHDs) at a variety of scales, and to make these available for public use via Public Health England (PHE). To compare these estimates with utilisation of NHS services in England to establish whether inequalities of use relative to need at various stages on the health-care pathway are associated with particular sociodemographic or other factors.DesignCross-sectional analysis of practice-, primary care trust- and Clinical Commissioning Group-level variations in diagnosis, prescribing and specialist management of CVD and CMHDs relative to the estimated prevalence of those conditions (calculated using small-area estimation).ResultsThe utilisation of CVD care appears more equitable than the utilisation of care for CMHDs. In contrast to the reviewed literature, we found little evidence of underutilisation of services by older populations. Indeed, younger populations appear to be less likely to access care for some CVD conditions. Nor did deprivation emerge as a consistent predictor of lower use relative to need for either CVD or CMHDs. Ethnicity is a consistent predictor of variations in use relative to need. Rates of primary management are lower than expected in areas with higher percentages of black populations for diabetes, stroke and CMHDs. Areas with higher Asian populations have higher-than-expected rates of diabetes presentation and prescribing and lower-than-expected rates of secondary care for diabetes. For both sets of conditions, there are pronounced geographical variations in use relative to need. For instance, the North East has relatively high levels of use of cardiac care services and rural (shire) areas have low levels of use relative to need. For CMHDs, there appears to be a pronounced ‘London effect’, with the number of people registered by general practitioners as having depression, or being prescribed antidepressants, being much lower in London than expected. A total of 24 CVD and 41 CMHD prevalence estimates have been provided to PHE and will be publicly available at a range of scales, from lower- and middle-layer super output areas through to Clinical Commissioning Groups and local authorities.ConclusionsWe found little evidence of socioeconomic inequality in use for CVD and CMHDs relative to underlying need, which suggests that the strong targeting of NHS resources to deprived areas may well have addressed longstanding concerns about unmet need. However, ethnicity has emerged as a significant predictor of inequality, and there are large and unexplained geographical variations in use relative to need for both conditions which undermine the principle of equal access to health care for equal needs. The persistence of ethnic variations and the role of systematic factors (such as rurality) in shaping patterns of utilisation deserve further investigation, as does the fact that the models were far better at explaining variation in use of CVD than mental health services.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Sheena Asthana
- School of Government, University of Plymouth, Plymouth, UK
| | - Alex Gibson
- School of Government, University of Plymouth, Plymouth, UK
| | - Trevor Bailey
- College of Mathematics and Physical Sciences, University of Exeter, Exeter, UK
| | - Graham Moon
- School of Geography and the Environment, University of Southampton, Southampton, UK
| | - Paul Hewson
- School of Computing and Mathematics, University of Plymouth, Plymouth, UK
| | - Chris Dibben
- School of Geosciences, University of Edinburgh, Edinburgh, UK
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Gajwani R, Parsons H, Birchwood M, Singh SP. Ethnicity and detention: are Black and minority ethnic (BME) groups disproportionately detained under the Mental Health Act 2007? Soc Psychiatry Psychiatr Epidemiol 2016; 51:703-11. [PMID: 26886264 PMCID: PMC4846695 DOI: 10.1007/s00127-016-1181-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 01/17/2016] [Indexed: 12/05/2022]
Abstract
PURPOSE There is substantial evidence to suggest that Black and minority ethnic (BME) patients are disproportionately detained under the Mental Health Act (MHA). We examined ethnic differences in patients assessed for detention and explored the effect of ethnicity after controlling for confounders. METHODS A prospective study of all MHA assessments conducted in 1 year (April 2009-March 2010) within Birmingham and Solihull Mental Health Foundation Trust, UK. Proportion of assessments and detentions within denominator population of service users and regional populations were calculated. Multiple regression analysis was conducted to determine which variables were associated with the outcome of MHA assessment and the role of ethnicity. RESULTS Of the 1115 assessments, 709 led to detentions (63.58 %). BME ethnic groups were statistically more likely to be assessed and detained under the MHA as compared to Whites, both in the service user and the ethnic population estimates in Birmingham, UK. MHA detention was predicted by having a serious mental illness, the presence of risk, older age and living alone. Ethnicity was not associated with detention under the MHA with age, diagnosis, risk and level of social support accounted for. CONCLUSION The BME 'disproportionality' in detention rates seems to be due to higher rates of mental illness, greater risk and poorer levels of social support rather than ethnicity per se.
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Affiliation(s)
- Ruchika Gajwani
- Institute of Health and Wellbeing, Yorkhill Hospital, University of Glasgow, Caledonia House, Glasgow, G3 8SJ, UK.
| | - Helen Parsons
- Cancer Research, Warwick Medical School, Coventry, CV4 7AL, UK
| | - Max Birchwood
- Mental Health and Wellbeing, Warwick Medical School, Coventry, CV4 7AL, UK
| | - Swaran P Singh
- Mental Health and Wellbeing, Warwick Medical School, Coventry, CV4 7AL, UK.
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Gramaglia C, Gambaro E, Rossi A, Toso A, Feggi A, Cattaneo CI, Castignoli G, Mainini P, Tarricone I, Torre E, Zeppegno P. Immigrants’ Pathways to Outpatient Mental Health: Are there Differences with the Native Population? J Immigr Minor Health 2015; 18:878-885. [PMID: 26705107 DOI: 10.1007/s10903-015-0336-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Carla Gramaglia
- Institute of Psychiatry, Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Via Solaroli n. 17, 28100, Novara, Italy
| | - Eleonora Gambaro
- Institute of Psychiatry, Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Via Solaroli n. 17, 28100, Novara, Italy
| | - Annalisa Rossi
- Institute of Psychiatry, Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Via Solaroli n. 17, 28100, Novara, Italy
| | - Alessandra Toso
- Institute of Psychiatry, Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Via Solaroli n. 17, 28100, Novara, Italy
| | - Alessandro Feggi
- Institute of Psychiatry, Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Via Solaroli n. 17, 28100, Novara, Italy
| | | | - Giorgio Castignoli
- Community Mental Health Centre (CMHCs), Viale Zoppis 8, 28021, Borgomanero, NO, Italy
| | - Piera Mainini
- Community Mental Health Centre (CMHCs), Viale Zoppis 8, 28021, Borgomanero, NO, Italy
| | - Ilaria Tarricone
- Dipartimento di Scienze Mediche e Chirurgiche, viale C.Pepoli 5, Bologna, Italy
| | - Eugenio Torre
- Institute of Psychiatry, Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Via Solaroli n. 17, 28100, Novara, Italy
| | - Patrizia Zeppegno
- Institute of Psychiatry, Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Via Solaroli n. 17, 28100, Novara, Italy.
- SC Psichiatria, AOU Maggiore della Carità, Corso Mazzini n. 18, 28100, Novara, Italy.
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Ethnic differences in the utilization of mental health services in Lombardy (Italy): an epidemiological analysis. Soc Psychiatry Psychiatr Epidemiol 2015; 50:59-65. [PMID: 24990276 DOI: 10.1007/s00127-014-0922-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 06/22/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To analyze the differences in mental health service utilization by immigrant and native populations of Lombardy, an Italian region that hosts one-fourth of the immigrants living in Italy. METHOD The data are drawn from the regional mental health information system (based on the case register model), which supplies information on the users and mental health activities of the Departments of Mental Health, Lombardy, a region of about 10 million people; 139,775 adult users were treated in mental health services in 2010. RESULTS Mental health services are used by 11.3 immigrant users out of 1,000 immigrants (with marked differences depending on country of origin) compared with 17.0 native users. Acute mental health services are used more frequently by immigrant patients; the types of intervention provided to immigrants differ from those provided to the native population (mainly as far as psychotherapeutic interventions is concerned), while gender differences are substantial. CONCLUSIONS The number of immigrant users using mental health services has increased notably in recent years, and in Lombardy it has been observed that the use of such services differs from service unit to service unit. This raises the problem of how to increase the cultural awareness of mental health professionals dealing with the mental health needs of the immigrant population. On the whole, immigrants use community mental health services less than the native population; however, immigrants tend to be more frequently admitted to general hospital psychiatric units during acute phases and both the utilization rates and gender differ greatly, depending on the country of origin.
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Weich S, McBride O, Twigg L, Keown P, Cyhlarova E, Crepaz-Keay D, Parsons H, Scott J, Bhui K. Variation in compulsory psychiatric inpatient admission in England: a cross-sectional, multilevel analysis. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02490] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundRates of compulsory admission have increased in England in recent decades, and this trend is accelerating. Studying variation in rates between people and places can help identify modifiable causes.ObjectivesTo quantify and model variances in the rate of compulsory admission in England at different spatial levels and to assess the extent to which this was explained by characteristics of people and places.DesignCross-sectional analysis using multilevel statistical modelling.SettingEngland, including 98% of Census lower layer super output areas (LSOAs), 95% of primary care trusts (PCTs), 93% of general practices and all 69 NHS providers of specialist mental health services.Participants1,287,730 patients.Main outcome measureThe study outcome was compulsory admission, defined as time spent in an inpatient mental illness bed subject to the Mental Health Act (2007) in 2010/11. We excluded patients detained under sections applying to emergency assessment only (including those in places of safety), guardianship or supervision of community treatment. The control group comprised all other users of specialist mental health services during the same period.Data sourcesThe Mental Health Minimum Data Set (MHMDS). Data on explanatory variables, characterising each of the spatial levels in the data set, were obtained from a wide range of sources, and were linked using MHMDS identifiers.ResultsA total of 3.5% of patients had at least one compulsory admission in 2010/11. Of (unexplained) variance in the null model, 84.5% occurred between individuals. Statistically significant variance occurred between LSOAs [6.7%, 95% confidence interval (CI) 6.2% to 7.2%] and provider trusts (6.9%, 95% CI 4.3% to 9.5%). Variances at these higher levels remained statistically significant even after adjusting for a large number of explanatory variables, which together explained only 10.2% of variance in the study outcome. The number of provider trusts whose observed rate of compulsory admission differed from the model average to a statistically significant extent fell from 45 in the null model to 20 in the fully adjusted model. We found statistically significant associations between compulsory admission and age, gender, ethnicity, local area deprivation and ethnic density. There was a small but statistically significant association between (higher) bed occupancy and compulsory admission, but this was subsequently confounded by other covariates. Adjusting for PCT investment in mental health services did not improve model fit in the fully adjusted models.ConclusionsThis was the largest study of compulsory admissions in England. While 85% of the variance in this outcome occurred between individuals, statistically significant variance (around 7% each) occurred between places (LSOAs) and provider trusts. This higher-level variance in compulsory admission remained largely unchanged even after adjusting for a large number of explanatory variables. We were constrained by data available to us, and therefore our results must be interpreted with caution. We were also unable to consider many hypotheses suggested by the service users, carers and professionals who we consulted. There is an imperative to develop and evaluate interventions to reduce compulsory admission rates. This requires further research to extend our understanding of the reasons why these rates remain so high.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Scott Weich
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Orla McBride
- School of Psychology, University of Ulster, Londonderry, UK
| | - Liz Twigg
- Department of Geography, University of Portsmouth, Portsmouth, UK
| | - Patrick Keown
- Academic Psychiatry, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Helen Parsons
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jan Scott
- Academic Psychiatry, Newcastle University, Newcastle upon Tyne, UK
| | - Kamaldeep Bhui
- Centre for Psychiatry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Kim G, Parton JM, Ford KL, Bryant AN, Shim RS, Parmelee P. Geographic and racial-ethnic differences in satisfaction with and perceived benefits of mental health services. Psychiatr Serv 2014; 65:1474-82. [PMID: 25123928 PMCID: PMC4329273 DOI: 10.1176/appi.ps.201300440] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined whether racial-ethnic differences in satisfaction with and perceived benefits from mental health services vary by geographic region among U.S. adults. METHODS Drawn from the Collaborative Psychiatric Epidemiology Surveys (CPES), selected samples consisted of 2,160 adults age 18 and older from diverse racial-ethnic groups (Asian, black, Hispanic/Latino, and white) who had used mental health services in the past 12 months. Generalized linear model analysis was conducted for the United States as a whole and separately by geographic region (Northeast, South, Midwest, and West) after adjustment for covariates. RESULTS In the national sample, no significant main effects of race-ethnicity and geographic region were found in either satisfaction with or perceived benefits from mental health services. In the stratified analyses for geographic regions, however, significant racial-ethnic differences were observed in the West; blacks in the West were significantly more likely to report higher satisfaction and perceived benefits, whereas Hispanics/Latinos in the West were significantly less likely to do so. CONCLUSIONS The findings suggest that there are regional variations of racial-ethnic differences in satisfaction with and perceived benefits from mental health services among U.S. adults and that addressing needs of Hispanics/Latinos in the West may help reduce racial-ethnic disparities in mental health care. Clinical and policy implications are discussed.
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Affiliation(s)
- Giyeon Kim
- Dr. Kim and Dr. Parmelee are with the Center for Mental Health and Aging and Department of Psychology, University of Alabama, Tuscaloosa (e-mail: ). Dr. Parton is with the Department of Information Systems, Statistics, and Management Science and Ms. Ford and Ms. Bryant are with the Department of Psychology, also at the University of Alabama. Dr. Shim is with the Department of Psychiatry and Behavioral Sciences and National Center for Primary Care, Morehouse School of Medicine, Atlanta
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Motivation for Psychotherapy and Illness Beliefs in Turkish Immigrant Inpatients in Germany: Results of a Cultural Comparison Study. J Racial Ethn Health Disparities 2014; 2:112-23. [PMID: 26863248 DOI: 10.1007/s40615-014-0054-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 08/07/2014] [Accepted: 08/22/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Some immigrant populations, for instance, Turkish immigrants, suffer from worse mental health than the general population. Moreover, psychotherapeutic treatment does not work well in this group. This might be explained by lower motivation for psychotherapy and particular illness beliefs as important early predictors of treatment outcome. We investigate differences in these predictors between Turkish immigrant inpatients and inpatients without a migration background and evaluate whether particular illness beliefs have a negative impact on motivation for psychotherapy. METHOD Turkish immigrant inpatients and inpatients without a migration background (N = 100), suffering from depressive disorder, somatoform disorder, and/or adjustment disorder, completed questionnaires assessing motivation for psychotherapy, depressive and somatic symptoms, illness perception, illness-related locus of control, and causal illness attributions. RESULTS Despite a higher symptom burden, motivation for psychotherapy was lower in Turkish immigrant inpatients than in inpatients without a migration background (d = 0.54). This was fully explained by stronger beliefs in supernatural causes of illness and higher fatalistic-external illness-related locus of control in the Turkish immigrant sample (mediation analysis; R (2) = 0.27). CONCLUSIONS Turkish immigrants believe in supernatural or fatalistic causes of illness and fatalistic-external locus of control to a greater extent than German inpatients without a migration background. These beliefs reduce motivation for psychotherapy and need to be addressed in psychotherapeutic treatment in order to secure positive treatment outcomes.
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Lipsicas CB, Mäkinen IH, Wasserman D, Apter A, Kerkhof A, Michel K, Renberg ES, Van Heeringen K, Värnik A, Schmidtke A. Repetition of attempted suicide among immigrants in Europe. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:539-47. [PMID: 25565687 PMCID: PMC4197788 DOI: 10.1177/070674371405901007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 02/01/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To compare frequencies of suicide attempt repetition in immigrants and local European populations, and the timing of repetition in these groups. METHOD Data from 7 European countries, comprising 10 574 local and 3032 immigrant subjects, were taken from the World Health Organization European Multicentre Study on Suicidal Behaviour and the ensuing Monitoring Suicidal Behaviour in Europe (commonly referred to as MONSUE) project. The relation between immigrant status and repetition of suicide attempt within 12-months following first registered attempt was analyzed with binary logistic regression, controlling for sex, age, and method of attempt. Timing of repetition was controlled for sex, age, and the recommended type of aftercare. RESULTS Lower odds of repeating a suicide attempt were found in Eastern European (OR 0.50; 95% CI 0.41 to 0.61, P < 0.001) and non-European immigrants (OR 0.68; 95% CI 0.51 to 0.90, P < 0.05), compared with the locals. Similar patterns were identified in the sex-specific analysis. Eastern European immigrants tended to repeat their attempt much later than locals (OR 0.58; 95% CI 0.35 to 0.93, P < 0.05). In general, 32% of all repetition occurred within 30 days. Repetition tended to decrease with age and was more likely in females using harder methods in their index attempt (OR 1.29; 95% CI 1.08 to 1.54, P < 0.01). Large variations in the general repetition frequency were identified between the collecting centres, thus influencing the results. CONCLUSIONS The lower repetition frequencies in non-Western immigrants, compared with locals, in Europe stands in contrast to their markedly higher tendency to attempt suicide in general, possibly pointing to situational stress factors related to their suicidal crisis that are less persistent over time. Our findings also raise the possibility that suicide attempters and repeaters constitute only partially overlapping populations.
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Affiliation(s)
- Cendrine Bursztein Lipsicas
- Doctoral Graduate, National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institute and Stockholm County Council's Centre for Suicide Research and Prevention, Stockholm, Sweden
| | - Ilkka Henrik Mäkinen
- Professor, Department of Sociology, Uppsala University, Uppsala, Sweden; Professor, Stockholm Centre on Health of Societies in Transition, School of Social Sciences, Södertörn University, Södertörn, Sweden
| | - Danuta Wasserman
- Professor, National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institute and Stockholm County Council's Centre for Suicide Research and Prevention, Stockholm, Sweden; Head of World Health Organization Lead Collaborating Centre of Mental Health Problems and Suicide across Europe, Stockholm, Sweden
| | - Alan Apter
- Professor, Feinberg Child Study Center and the Department of Child and Adolescent Psychiatry, Schneider Children Medical Center, Petah-Tikva, Israel
| | - Ad Kerkhof
- Professor, Department of Clinical Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Konrad Michel
- Professor, University Psychiatric Services, Bern, Switzerland
| | - Ellinor Salander Renberg
- Professor, Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden
| | - Kees Van Heeringen
- Professor, University Department of Psychiatry and Medical Psychology, Unit for Suicide Research, University Hospital, Gent, Belgium
| | - Airi Värnik
- Professor, Estonian-Swedish Mental Health and Suicidology Institute, Tallinn, Estonia; Professor, Tallinn University, Tallinn, Estonia
| | - Armin Schmidtke
- Professor, Unit for Clinical Psychology, Department of Psychiatry and Psychotherapy, University of Würzburg, Würzburg, Germany
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“You don't know what you are saying ‘Yes’ and what you are saying ‘No’ to”: hospital experiences of older people from minority ethnic communities. AGEING & SOCIETY 2014. [DOI: 10.1017/s0144686x14000919] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTImproving responsiveness to the needs of older people from minority ethnic communities has been emphasised as a goal in England since the publication of the National Service Framework for Older People in 2001. Despite this, people from minority ethnic groups consistently give poorer ratings of their health services than ‘majority’ populations, both in England and across many other health-care systems. Language barriers have been shown to play a particularly important role, and appear to be a stronger predictor of perceived quality of care than ethnic origin per se. This paper reports findings from a larger study exploring older people's experiences of care transitions, focusing on the findings from one case study area which explored the hospital and discharge experiences of older people from minority ethnic communities. A participatory approach was adopted, with older people from the local area collaborating in the design, delivery and analysis of the research as ‘co-researchers’. Twenty-four in-depth narrative interviews were carried out with people who had experienced a recent hospital stay as a patient or a family member providing care and support. Our findings show that many aspects of the hospital experience, including the desire for personalised and humanistic approaches to care, are important to older people irrespective of ethnic background. However, older people from minority ethnic communities can also face language and cultural barriers which negatively affect the quality and experience of care. People who had limited English proficiency struggled to understand, communicate and participate in their care. Where professional services were not available or requested, interpreting was provided informally by other patients, family members, hospital staff in clinical and domestic roles, or not at all. We conclude that targeted strategies are required to ensure appropriate and effective hospital services for a multicultural population.
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Ahmad F, Jhajj AK, Stewart DE, Burghardt M, Bierman AS. Single item measures of self-rated mental health: a scoping review. BMC Health Serv Res 2014; 14:398. [PMID: 25231576 PMCID: PMC4177165 DOI: 10.1186/1472-6963-14-398] [Citation(s) in RCA: 242] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 09/09/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND A single-item measure of self-rated mental health (SRMH) is being used increasingly in health research and population health surveys. The item asks respondents to rate their mental health on a five-point scale from excellent to poor. This scoping study presents the first known review of the SRMH literature. METHODS Electronic databases of Medline, CINAHL, PsycINFO, EMBASE and Cochrane Reviews were searched using keywords. The databases were also searched using the titles of surveys known to include the SRMH single item. The search was supplemented by manually searching the bibliographic sections of the included studies. Two independent reviewers coded articles for inclusion or exclusion based on whether articles included SRMH. Each study was coded by theme and data were extracted about study design, sample, variables, and results. RESULTS Fifty-seven studies included SRMH. SRMH correlated moderately with the following mental health scales: Kessler Psychological Distress Scale, Patient Health Questionnaire, mental health subscales of the Short-Form Health Status Survey, Behaviour and Symptom Identification Scale, and World Mental Health Clinical Diagnostic Interview Schedule. However, responses to this item may differ across racial and ethnic groups. Poor SRMH was associated with poor self-rated health, physical health problems, increased health service utilization and less likelihood of being satisfied with mental health services. Poor or fair SRMH was also associated with social determinants of health, such as low socioeconomic position, weak social connections and neighbourhood stressors. Synthesis of this literature provides important information about the relationships SRMH has with other variables. CONCLUSIONS SRMH is associated with multi-item measures of mental health, self-rated health, health problems, service utilization, and service satisfaction. Given these relationships and its use in epidemiologic surveys, SRMH should continue to be assessed as a population health measure. More studies need to examine relationships between SRMH and clinical mental illnesses. Longitudinal analyses should look at whether SRMH is predictive of future mental health problems.
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Affiliation(s)
- Farah Ahmad
- />School of Health Policy and Management, Faculty of Health, York University, 4700 Keele Street, HNES 414, Ontario, M3J 1P3 Canada
| | - Anuroop K Jhajj
- />OPTIMUS | SBR, 30 Adelaide St. E, Suite 600, Toronto, ON M5C 3G8 Canada
| | - Donna E Stewart
- />Women’s Health Program at University Health Network, University of Toronto, 200 Elizabeth St, Toronto, M5G 2C4 Canada
| | - Madeline Burghardt
- />School of Heath Policy and Management, Critical Disability Studies, Faculty of Health, York University, 4700 Keele Street, Ontario, M3J 1P3 Canada
| | - Arlene S Bierman
- />Lawrence S. Bloomberg Faculty of Nursing; Institute of Health Policy, Management and Evaluation; Dalla Lana School of Public Health and Department of Medicine, Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, 30 Bond Street, Toronto, ON M5B 1 W8 Canada
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Lawrence RE, Rasinski KA, Yoon JD, Curlin FA. Physician race and treatment preferences for depression, anxiety, and medically unexplained symptoms. ETHNICITY & HEALTH 2014; 20:354-364. [PMID: 24870971 PMCID: PMC4247803 DOI: 10.1080/13557858.2014.921893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Studies have repeatedly shown racial and ethnic differences in mental health care. Prior research focused on relationships between patient preferences and ethnicity, with little attention given to the possible relationship between physicians' ethnicity and their treatment recommendations. DESIGN A questionnaire was mailed to a national sample of US primary care physicians and psychiatrists. It included vignettes of patients presenting with depression, anxiety, and medically unexplained symptoms. Physicians were asked how likely they would be to advise medication, see the patient regularly for counseling, refer to a psychiatrist, or refer to a psychologist or licensed mental health counselor. RESULTS The response rate was 896 of 1427 (63%) for primary care physicians and 312 of 487 (64%) for psychiatrists. Treatment preferences varied across diagnoses. Compared to whites (referent), black primary care physicians were less likely to use antidepressants (depression vignette), but more likely to see the patient for counseling (all vignettes), and to refer to a psychiatrist (depression vignette). Asian primary care physicians were more likely to see the patient for counseling (anxiety and medically unexplained symptoms vignettes) and to refer to a psychiatrist (depression and anxiety vignettes). Asian psychiatrists were more likely to recommend seeing the patient regularly for counseling (depression vignette). CONCLUSIONS Overall, these findings suggest that physician race and ethnicity contributes to different patterns of treatment for basic mental health concerns.
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Affiliation(s)
- Ryan E. Lawrence
- Department of Psychiatry, Columbia University Medical Center and the New York State Psychiatric Institute, 1051 Riverside Drive, Box 103, New York, NY 10032, (212)543-5553
| | | | - John D. Yoon
- Department of Medicine and the MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL
| | - Farr A. Curlin
- Department of Medicine and the MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL
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Singh SP, Islam Z, Brown LJ, Gajwani R, Jasani R, Rabiee F, Parsons H. Ethnicity, detention and early intervention: reducing inequalities and improving outcomes for black and minority ethnic patients: the ENRICH programme, a mixed-methods study. PROGRAMME GRANTS FOR APPLIED RESEARCH 2013. [DOI: 10.3310/pgfar01030] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundBlack and minority ethnic (BME) service users experience adverse pathways into care. Ethnic differences are evident even at first-episode psychosis (FEP); therefore, contributory factors must operate before first presentation to psychiatric services. The ENRICH programme comprised three interlinked studies that aimed to understand ethnic and cultural determinants of help-seeking and pathways to care.Aims and objectivesStudy 1: to understand ethnic differences in pathways to care in FEP by exploring cultural determinants of illness recognition, attribution and help-seeking among different ethnic groups. Study 2: to evaluate the process of detention under the Mental Health Act (MHA) and determine predictors of detention. Study 3: to determine the appropriateness, accessibility and acceptability of generic early intervention services for different ethnic groups.MethodsStudy 1: We recruited a prospective cohort of FEP patients and their carers over a 2-year period and assessed the chronology of symptom emergence, attribution and help-seeking using semistructured tools: the Nottingham Onset Schedule (NOS), the Emerging Psychosis Attribution Schedule and the ENRICH Amended Encounter Form. A stratified subsample of user–carer NOS interviews was subjected to qualitative analyses. Study 2: Clinical and sociodemographic data including reasons for detention were collected for all MHA assessments conducted over 1 year (April 2009–March 2010). Five cases from each major ethnic group were randomly selected for a qualitative exploration of carer perceptions of the MHA assessment process, its outcomes and alternatives to detention. Study 3: Focus groups were conducted with service users, carers, health professionals, key stakeholders from voluntary sector and community groups, commissioners and representatives of spiritual care with regard to the question: ‘How appropriate and accessible are generic early intervention services for the specific ethnic and cultural needs of BME communities in Birmingham?’ResultsThere were no ethnic differences in duration of untreated psychosis (DUP) and duration of untreated illness in FEP. DUP was not related to illness attribution; long DUP was associated with patients being young (< 18 years) and living alone. Black patients had a greater risk of MHA detention, more criminal justice involvement and more crisis presentations than white and Asian groups. Asian carers and users were most likely to attribute symptoms to faith-based or supernatural explanations and to seek help from faith organisations. Faith-based help-seeking, although offering comfort and meaning, also risked delaying access to medical care and in some cases also resulted in financial exploitation of this vulnerable group. The BME excess in MHA detentions was not because of ethnicity per se; the main predictors of detention were a diagnosis of mental illness, presence of risk and low level of social support. Early intervention services were perceived to be accessible, supportive, acceptable and culturally appropriate. There was no demand or perceived need for separate services for BME groups or for ethnic matching between users and clinicians.ConclusionsStatutory health-care organisations need to work closely with community groups to improve pathways to care for BME service users. Rather than universal public education campaigns, researchers need to develop and evaluate public awareness programmes that are specifically focused on BME groups.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- SP Singh
- Division of Mental Health and Wellbeing, Warwick Medical School, Warwick University, Coventry, UK
- Research and Innovation Department, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Z Islam
- Division of Mental Health and Wellbeing, Warwick Medical School, Warwick University, Coventry, UK
- Research and Innovation Department, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - LJ Brown
- Division of Mental Health and Wellbeing, Warwick Medical School, Warwick University, Coventry, UK
- Research and Innovation Department, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - R Gajwani
- School of Psychology, University of Birmingham, Birmingham, UK
| | - R Jasani
- Humanitarian and Conflict Response Institute (HCRI), University of Manchester, Manchester, UK
| | - F Rabiee
- Centre for Health and Social Care Research, Faculty of Health, Birmingham City University, Birmingham, UK
| | - H Parsons
- Division of Health Sciences, Warwick Medical School, Warwick University, Coventry, UK
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Sinnott C, Quigley F, Morris M. Promoting exercise in patients with depression: lessons learned from a brief educational intervention. Eur J Gen Pract 2013; 20:32-5. [PMID: 23971997 DOI: 10.3109/13814788.2013.819849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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van Loon A, van Schaik A, Dekker J, Beekman A. Bridging the gap for ethnic minority adult outpatients with depression and anxiety disorders by culturally adapted treatments. J Affect Disord 2013; 147:9-16. [PMID: 23351566 DOI: 10.1016/j.jad.2012.12.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 12/18/2012] [Accepted: 12/18/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Culturally adapted guideline driven depression and anxiety treatments have been developed for ethnic minority patients in Western countries to boost effectiveness for these growing and vulnerable groups. The aims of this study are to systematically review the empirical literature of outcomes associated with culturally adapted guideline driven depression and anxiety interventions, to describe the cultural adaptation and to identify the contribution of the cultural adaptation and approach as such. METHOD Comprehensive search of the major bibliographical databases (Cochrane Central Register of Controlled Trials, Pubmed; Psychinfo) for randomized controlled trials. RESULTS Nine eligible studies were identified and all were conducted in the USA. The pooled random standardized differences in means of the culturally adapted depression and anxiety treatment on clinical outcome was 1.06 (CI 95% 0.51-1.62, P=0.00). Two studies demonstrated effectiveness of the population specific cultural adaptation per se. All studies incorporated a focus on cultural values and beliefs as a cultural adaptation. LIMITATION We only identified a small number of USA studies so generalisation of the findings to other western countries can be discussed. CONCLUSION Culturally adapted guideline driven depression and anxiety treatment was effective for USA minority patients from different cultural backgrounds. There is some evidence for the effectiveness of the population specific cultural adaptation as such.
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Hatch SL, Thornicroft G. Report from England I: innovative approaches to reducing mental health disparities related to ethnicity. J Nerv Ment Dis 2012; 200:843-6. [PMID: 23034573 DOI: 10.1097/nmd.0b013e31826b6d34] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Stephani L Hatch
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, England.
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Boydell J, Morgan C, Dutta R, Jones B, Alemseged F, Dazzan P, Morgan K, Doody G, Harrison G, Leff J, Jones P, Murray R, Fearon P. Satisfaction with inpatient treatment for first-episode psychosis among different ethnic groups: a report from the UK AeSOP study. Int J Soc Psychiatry 2012; 58:98-105. [PMID: 20851828 DOI: 10.1177/0020764010382691] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is concern about the level of satisfaction with mental healthcare among minority ethnic patients in the UK, particularly as black patients have more compulsory admissions to hospital. AIMS To determine and compare levels of satisfaction with mental healthcare between patients from different ethnic groups in a three-centre study of first-onset psychosis. METHOD Data were collected from 216 patients with first-episode psychosis and 101 caregivers from South London, Nottingham and Bristol, using the Acute Services Study Questionnaire (Patient and Relative Version) and measures of sociodemographic variables and insight. RESULTS No differences were found between ethnic groups in most domains of satisfaction tested individually, including items relating to treatment by ward staff and number of domains rated as satisfactory. However, logistic regression modelling (adjusting for age, gender, social class, diagnostic category and compulsion) showed that black Caribbean patients did not believe that they were receiving the right treatment and were less satisfied with medication than white patients. Black African patients were less satisfied with non-pharmacological treatments than white patients. These findings were not explained by lack of insight or compulsory treatment. CONCLUSIONS The study found that black patients were less satisfied with specific aspects of treatment, particularly medication, but were equally satisfied with nursing and social care. Understanding the reasons behind this may improve the acceptability of psychiatric care to black minority ethnic groups.
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Affiliation(s)
- Jane Boydell
- Psychosis Clinical Academic Group, Institute of Psychiatry, King's Health Partners, King's College London, UK.
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Lawlor C, Johnson S, Cole L, Howard LM. Ethnic variations in pathways to acute care and compulsory detention for women experiencing a mental health crisis. Int J Soc Psychiatry 2012; 58:3-15. [PMID: 21059630 PMCID: PMC3257000 DOI: 10.1177/0020764010382369] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Much recent debate on excess rates of compulsory detention and coercive routes to care has focused on young black men; evidence is less clear regarding ethnic variations among women and factors that may mediate these. AIM To explore ethnic variations in compulsory detentions of women, and to explore the potential role of immediate pathways to admission and clinician-rated reasons for admission as mediators of these differences. METHOD All women admitted to an acute psychiatric inpatient ward or a women's crisis house in four London boroughs during a 12-week period were included. Data were collected regarding their pathways to care, clinician-rated reasons for admission, hospital stays, and social and clinical characteristics. RESULTS Two hundred and eighty seven (287) women from white British, white other, black Caribbean, black African and black other groups were included. Adjusting for social and clinical characteristics, all groups of black patients and white other patients were significantly more likely to have been compulsorily admitted than white British patients; white British patients were more likely than other groups to be admitted to a crisis house and more likely than all the black groups to be admitted because of perceived suicide risk. Immediate pathways to care differed: white other, black African and black other groups were less likely to have referred themselves in a crisis and more likely to have been in contact with the police. When adjustment was made for differences in pathways to care, the ethnic differences in compulsory admission were considerably reduced. DISCUSSION There are marked ethnic inequities not only between white British and black women, but also between white British and white other women in experiences of acute admission. Differences between groups in help-seeking behaviours in a crisis may contribute to explaining differences in rates of compulsory admission.
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Weich S, Griffith L, Commander M, Bradby H, Sashidharan SP, Pemberton S, Jasani R, Bhui KS. Experiences of acute mental health care in an ethnically diverse inner city: qualitative interview study. Soc Psychiatry Psychiatr Epidemiol 2012; 47:119-28. [PMID: 21046068 DOI: 10.1007/s00127-010-0314-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 10/18/2010] [Indexed: 09/29/2022]
Abstract
PURPOSE Ethnic inequalities in experiences of mental health care persist in the UK, although most evidence derives from in-patient settings. We aimed to explore service users' and carers' accounts of recent episodes of severe mental illness and of the care received in a multi-cultural inner city. We sought to examine factors impacting on these experiences, including whether and how users and carers felt that their experiences were mediated by ethnicity. METHODS Forty service users and thirteen carers were recruited following an acute psychotic episode using typical case sampling. In-depth interviews explored illness and treatment experiences. Ethnicity was allowed to emerge in participants' narratives and was prompted if necessary. RESULTS Ethnicity was not perceived to impact significantly on therapeutic relationships, and nor were there ethnic differences in care pathways, or in the roles of families and friends. Ethnic diversity was commonplace among both service users and mental health professionals. This was tolerated in community settings if efforts were made to ensure high-quality care. Home Treatment was rated highly, irrespective of service users' ethnicity. In-patient care was equally unpopular and was the one setting where ethnicity appeared to mediate unsatisfactory care experiences. These findings highlight the risks of generalising from reports of (dis)satisfaction with care based predominantly on in-patient experiences. CONCLUSIONS Home treatment was popular but hard to deliver in deprived surroundings and placed a strain on carers. Interventions to enhance community treatments in deprived areas are needed, along with remedial interventions to improve therapeutic relationships in hospital settings.
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Affiliation(s)
- Scott Weich
- Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK.
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Harris MG, Burgess PM, Pirkis JE, Slade TN, Whiteford HA. Policy initiative to improve access to psychological services for people with affective and anxiety disorders: population-level analysis. Br J Psychiatry 2011; 198:99-108. [PMID: 21160055 DOI: 10.1192/bjp.bp.109.073650] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND In 2006, Australia introduced new publicly funded psychological services for people with affective and anxiety disorders (the Better Access programme). Despite massive uptake, it has been suggested that Better Access is selectively treating socioeconomically advantaged people, including some who do not warrant treatment, and people already receiving equivalent services. AIMS To explore potential disparities in Better Access treatment using epidemiological data from the 2007 National Survey of Mental Health and Wellbeing. METHOD Logistic regression analyses examined patterns and correlates of service use in two populations: people who used the new psychological services in the previous 12 months; and people with any ICD-10 12-month affective and anxiety disorder, regardless of service use. RESULTS Most (93.2%) Better Access psychological services users had a 12-month ICD-10 mental disorder or another indicator of treatment need. Better Access users without affective or anxiety disorders were not more socioeconomically advantaged, and received less treatment than those with these disorders. Among the population with affective or anxiety disorders, non-service users were less likely to have a severe disorder and more likely to have anxiety disorder, without a comorbid affective disorder, than Better Access users. Better Access users comprised more new allied healthcare recipients than other service users. A substantial minority of non-service users (13.5%) had severe disorders, but most did not perceive a need for treatment. CONCLUSIONS Better Access does not appear to be overservicing individuals without potential need or contributing to social inequalities in mental healthcare. It appears to be reaching people who have not previously received psychological care. Treatment rates could be improved for some people with anxiety disorders.
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Affiliation(s)
- Meredith G Harris
- Queensland Centre for Mental Health Research, Locked Bag 500, Sumner Park BC, Queensland 4077, Australia.
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Cooper J, Murphy E, Webb R, Hawton K, Bergen H, Waters K, Kapur N. Ethnic differences in self-harm, rates, characteristics and service provision: three-city cohort study. Br J Psychiatry 2010; 197:212-8. [PMID: 20807966 DOI: 10.1192/bjp.bp.109.072637] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Studies of self-harm in Black and minority ethnic (BME) groups have been restricted to single geographical areas, with few studies of Black people. AIMS To calculate age- and gender-specific rates of self-harm by ethnic group in three cities and compare characteristics and outcomes. METHOD A population-based self-harm cohort presenting to five emergency departments in three English cities during 2001 to 2006. RESULTS A total of 20 574 individuals (16-64 years) presented with self-harm; ethnicity data were available for 75%. Rates of self-harm were highest in young Black females (16-34 years) in all three cities. Risk of self-harm in young South Asian people varied between cities. Black and minority ethnic groups were less likely to receive a psychiatric assessment and to re-present with self-harm. CONCLUSIONS Despite the increased risk of self-harm in young Black females fewer receive psychiatric care. Our findings have implications for assessment and appropriate management for some BME groups following self-harm.
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Affiliation(s)
- Jayne Cooper
- Centre for Suicide Prevention, University of Manchester, UK.
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Antonysamy A, Wieck A, Wittkowski A. Service satisfaction on discharge from a psychiatric mother and baby unit: a representative patient survey. Arch Womens Ment Health 2009; 12:359-62. [PMID: 19575280 DOI: 10.1007/s00737-009-0085-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Accepted: 06/12/2009] [Indexed: 11/26/2022]
Abstract
In this representative survey of 57 women before discharge from a psychiatric mother and baby unit satisfaction levels were high for most aspects of the service. However, the qualitative part of the study highlighted issues that were not captured by completion of the satisfaction questionnaire. These included a need for greater support from nursing staff and a high level of distress about interactions with children's social workers in some patients. The latter aspect requires further exploration. For future surveys we recommend to use quantitative as well as qualitative methodology.
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Affiliation(s)
- Arokia Antonysamy
- Department of Psychiatry, Laureate House, Manchester Mental Health and Social Care Trust, Wythenshawe Hospital, Southmoor Road, Manchester, M23 9LT, UK
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