RESUMO
It has been shown that an excess of pregnancy and birth complications (PBCs) does not contribute to the excess rates of schizophrenia reported for the population of Caribbean origin in Britain compared with the native Caucasian British population. We therefore attempted to compare the rate of PBCs between a sample of schizophrenics in Britain with that of a sample from Trinidad where some of the Caribbean migrants to Britain originated. First contact patients with schizophrenia according to the CATEGO system diagnosis were identified in Trinidad and London. Their mothers, where available, were interviewed using the Lewis-Murray scale for pregnancy and birth complications. Data from Trinidad and Tobago concerning 56 patients were compared with those of the Caucasian (n = 61) and African-Caribbean (n = 50) patients in London. The rate of PBCs was similar for the Caucasian British patients (24.6%) and the patients in Trinidad and Tobago (21.7%). The rates were lowest in the African-Caribbean patients in London (14.0%), though this difference was not statistically significant. These findings suggest that pregnancy and birth complications are a risk factor for a substantial minority of patients with schizophrenia in Trinidad and London. It also confirms that the excess rates of schizophrenia reported for the Caribbean population in Britain are not due to these complications.
Assuntos
População Negra , Complicações do Trabalho de Parto/epidemiologia , Complicações na Gravidez/epidemiologia , Resultado da Gravidez , Esquizofrenia/epidemiologia , População Branca , Adolescente , Adulto , Distribuição por Idade , Idade de Início , Traumatismos do Nascimento/epidemiologia , Peso ao Nascer , Distribuição de Qui-Quadrado , Estudos de Coortes , Emigração e Imigração , Feminino , Humanos , Incidência , Recém-Nascido , Recém-Nascido Prematuro , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Gravidez , Fatores de Risco , Estudos de Amostragem , Esquizofrenia/diagnóstico , Distribuição por Sexo , Trinidad e Tobago/epidemiologia , População UrbanaRESUMO
OBJECTIVE: Sociodemographic factors play an important role in the genesis of mental disorders. High rates of unemployment and other social factors have been reported previously among African-Caribbeans with schizophrenia in London. The aim of the present study was to compare these factors in Trinidad with London African-Caribbeans. METHOD: Using internationally defined criteria, patients with first-onset schizophrenia were recruited in both countries, and information on the onset of symptoms, help-seeking, pathways into care, premorbid personality and educational and employment status were collected. These two samples are compared on a number of these factors. A total of 56 cases of first onset of psychosis coming into contact with psychiatric services in Trinidad were studied. Of these, 46 cases were diagnosed as having schizophrenia using the CATEGO program. Over a period of 2 years, 38 African-Caribbean patients with schizophrenia were recruited in London. RESULTS: African-Caribbean patients with schizophrenia in London were more likely to be admitted for perceived threat to others and to have shown loss of interest and serious neglect and to have assaulted others. A lower proportion were admitted via a psychiatrist and a higher proportion by the police. The unemployment rate among the London sample of African-Caribbeans was much higher than that in the general population, whereas this was not the case for the Trinidad patients. CONCLUSION: These findings are discussed in the context of culture and aetiology of schizophrenia, and suggestions with regard to future research are made.
Assuntos
Esquizofrenia/epidemiologia , Esquizofrenia/etiologia , Adulto , Idade de Início , Escolaridade , Feminino , Humanos , Londres/epidemiologia , Masculino , Aceitação pelo Paciente de Cuidados de Saúde , Transtornos da Personalidade/diagnóstico , Esquizofrenia/diagnóstico , Índice de Gravidade de Doença , Fatores Socioeconômicos , Trinidad e Tobago/epidemiologia , Desemprego/psicologiaRESUMO
BACKGROUND: Incidence rates of schizophrenia among UK African-Caribbeans have been reported as high. Various explanations including selective migration and genetic vulnerability have been proposed. METHOD: In one calendar year, all new cases of psychosis presenting to various psychiatric services in two clearly defined geographical catchment areas in Trinidad-one in the rural south and the other an urban area-were studied. Standardised diagnostic instruments were applied and information collected using WHO screening and measurement instruments. RESULTS: A total of 56 cases were collected, giving an incidence rate of 2.2/1000 of broad schizophrenia with a rate of 1.6 for S+ schizophrenia. CONCLUSION: These rates are similar to those from the WHO study in Honolulu and Aarhus, and much lower than the rates for African-Caribbeans in London. The cases were followed up for one year and the poor outcome rate for schizophrenia was 19%. The findings are discussed in a cross-cultural context and suggestions for future research made.
Assuntos
Comparação Transcultural , Países em Desenvolvimento , Esquizofrenia/epidemiologia , Psicologia do Esquizofrênico , Adulto , Estudos Transversais , Feminino , Seguimentos , Humanos , Incidência , Masculino , Escalas de Graduação Psiquiátrica , Fatores de Risco , Esquizofrenia/diagnóstico , Meio Social , Trinidad e Tobago/epidemiologiaRESUMO
Several studies have reported alarmingly high rates psychiatric morbidity among West Indians in Great Britain, in particular a high rate of schizophrenia in the Afro-Caribbean population. Studies done in the Caribbean have not been consistent in their findings. Therefore, a prospective study was done in Trinidad, with the aim of investigating every patient presenting to the psychiatric services with psychotic symptoms for the first time. The study does not confirm the high rates seen in Britain, though significant differences in incidence rates and diagnostic patterns between the two major ethnic groups were found. The incidence of psychosis was found to be 2.4 per 10,000 for males and 1.9 per 10,000 for females. In the Afro-Trinidadian population, the incidence rate was more than twice as high compared to the Indo-Trinidadians, 3.6 and 1.4 per 10,000 respectively. More than three times as many Indo-Trinidadians as compared to Afro-Trinidadian were diagnosed with a depressive psychosis, while all the manic and mixed affective psychoses were found among the Afro-Trinidadian population. Factors like maternal exposure to infectious agents, obstetrical complications, excess of compulsory admissions, misdiagnosis, social adversity, hostile behaviour and religious and persecutory delusions could not be confirmed in this study as valid explanations for these findings. Referral practices, health-seeking behaviour and illness presentation are more likely to explain the differences (AU)
Assuntos
Humanos , Masculino , Feminino , Transtorno Bipolar , Esquizofrenia/mortalidade , Negro ou Afro-Americano , Etnicidade , Transtorno Bipolar/mortalidade , Obstetrícia , Trinidad e TobagoRESUMO
The aim of the study was to describe the pattern of first admissions to a psychiatric outpatient clinic in Trinidad. During 1990 a prospective study was done on 147 consecutive new cases that presented at the Tacarigua Health Centre. An incidence of 1.2/1000 was found with an average of 12 new patients/month. There were no differences in sex distribution. The average age of males was 35.6 years and 38.8 for females. Fifty-five point seven per cent of the sample were of African origin and 36.7 percent were of East Indian origin (p<0.005). Mood disorders were almost twice as common in females (37.0 percent) as in males (21.6 percent) p<0.01. Schizophrenia was almost twice as common in males as females (16.2 percent vs 8.2 percent, p<0.1). Psychoactive substances use disorders were four times more common in organic mental disorders in the men (12.2 percent). Major differences in demographic and diagnostic data in the two major ethnic groups suggest a need for culturally relevant programmes. Community clinics at the moment are underutilised and there is a need for the use of these clinics as a first illness contact station. The treatment of substance abusers is a burden to the psychiatric services and ought to be separated (AU)