RESUMO
BACKGROUND: Many studies have found high levels of compulsory admission to psychiatric hospital in the UK among African-Caribbean and Black African patients with a psychotic illness. AIMS: To establish whether African-Caribbean and Black African ethnicity is associated with compulsory admission in an epidemiological sample of patients with a first episode of psychosis drawn from two UK centres. METHOD: All patients with a first episode of psychosis who made contact with psychiatric services over a 2-year period and were living in defined areas were included in the (AESOP) study. For this analysis we included all White British, other White, African-Caribbean and Black African patients from the AESOP sampling frame. Clinical, socio-demographic and pathways to care data were collected from patients, relatives and case notes. RESULTS: African-Caribbean patients were significantly more likely to be compulsorily admitted than White British patients, as were Black African patients. African-Caribbean men were the most likely to be compulsorily admitted. CONCLUSIONS: These findings suggest that factors are operating at or prior to first presentation to increase the risk of compulsory admission among African-Caribbean and Black African patients.
Assuntos
Internação Compulsória de Doente Mental/estatística & dados numéricos , Transtornos Psicóticos/etnologia , Adolescente , Adulto , Idoso , População Negra/etnologia , Distribuição de Qui-Quadrado , Inglaterra/epidemiologia , Feminino , Acessibilidade aos Serviços de Saúde , Hospitalização/estatística & dados numéricos , Hospitais Psiquiátricos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Psicóticos/terapia , Índias Ocidentais/etnologiaRESUMO
BACKGROUND: Previous research has found that African-Caribbean and Black African patients are likely to come into contact with mental health services via more negative routes, when compared with White patients. We sought to investigate pathways to mental health care and ethnicity in a sample of patients with a first episode of psychosis drawn from two UK centres. METHOD: We included all White British, other White, African-Caribbean and Black African patients with a first episode of psychosis who made contact with psychiatric services over a 2-year period and were living in defined areas. Clinical, socio-demographic and pathways to care data were collected from patients, relatives and case notes. RESULTS: Compared with White British patients, general practitioner referral was less frequent for both African-Caribbean and Black African patients and referral by a criminal justice agency was more common. With the exception of criminal justice referrals for Black African patients, these findings remained significant after adjusting for potential confounders. CONCLUSIONS: These findings suggest that factors are operating during a first episode of psychosis to increase the risk that the pathway to care for Black patients will involve non-health professionals.
Assuntos
Internação Compulsória de Doente Mental/estatística & dados numéricos , Direito Penal/estatística & dados numéricos , Medicina de Família e Comunidade/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Transtornos Psicóticos/etnologia , Encaminhamento e Consulta/estatística & dados numéricos , Adolescente , Adulto , Idoso , População Negra/etnologia , Inglaterra/epidemiologia , Métodos Epidemiológicos , Feminino , Acessibilidade aos Serviços de Saúde , Hospitalização/estatística & dados numéricos , Hospitais Psiquiátricos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Psicóticos/terapia , Fatores de Risco , Índias Ocidentais/etnologiaRESUMO
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
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 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. (AU)
Assuntos
Adulto , Feminino , Estudo Comparativo , Humanos , Masculino , Esquizofrenia/epidemiologia , Esquizofrenia/etiologia , Idade de Início , Escolaridade , Londres/epidemiologia , 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: The incidence rate for broad schizophrenia among second-generation African-Caribbean people in the United Kingdom has been reported as high. Ethnicity, migration and psychosocial stressors have been suggested as causal factors. AIMS: To determine the incidence of schizophrenia for the whole population of Barbados using an identical methodology to two previous studies in Trinidad (Bhugra et al, 1996) and London (Bhugra et al, 1997). METHOD: A 12-month study of all persons in the 18-54-year age group presenting with a psychosis for the first time was carried out on the population of Barbados. Information was collected using World Health Organization screening and measurement instruments. RESULTS: On an island of just over a quarter of a million, 40 out of the 53 patients that met the inclusion criteria were categorised as S+ (narrow) schizophrenia, giving an incidence rate of 2.8/10,000 (95% CI 1.97-3.7). The incidence rate for broad schizophrenia was calculated at 3.2/10,000 (95% CI 2.3-4.1), which is significantly lower than the comparable rate for London's African-Caribbeans of 6.6/10,000 (95% CI 4.5-8.7). CONCLUSIONS: The very high rate for broad schizophrenia among African-Caribbean people in the UK is probably due to environmental factors.
Assuntos
Esquizofrenia/epidemiologia , Adolescente , Adulto , Barbados/epidemiologia , Barbados/etnologia , Feminino , Humanos , Incidência , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Fatores de Risco , Esquizofrenia/etnologia , Esquizofrenia/terapia , Fatores SocioeconômicosRESUMO
BACKGROUND: It has been suggested that the increased rate of psychotic illness among African-Caribbeans living in Britain is due to an excess of pregnancy and birth complications (PBCs). METHOD: We therefore compared the frequency of PBCs in a group of White psychotic patients (n = 103) and a comparable group of patients of African-Caribbean origin (n = 61); the latter consisted of 30 first-generation (born in the Caribbean) and 31 second-generation (born in Britain) individuals. RESULTS: White psychotic patients were more than twice as likely to have a history of PBCs as their African-Caribbean counterparts (odds ratio = 2.34, 95% confidence interval (CI) 0.88-6.47, P = 0.062). The same trend was observed among patients with a DSM-III diagnosis of schizophrenia (odds ratio = 1.65, 95% CI 0.56-4.97, P = 0.32). The rate of PBCs was similar among the first- and second-generation Caribbean psychotic patients. CONCLUSIONS: The increased rate of psychotic illness that has been reported among the African-Caribbean population in Britain is not due to an increased prevalence of PBCs.
Assuntos
Traumatismos do Nascimento/etnologia , Complicações na Gravidez/etnologia , Transtornos Psicóticos/etnologia , Adulto , África/etnologia , Feminino , Humanos , Londres/epidemiologia , Masculino , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/psicologia , Prevalência , Transtornos Psicóticos/epidemiologia , Esquizofrenia/epidemiologia , Esquizofrenia/etnologia , Índias Ocidentais/etnologia , População Branca/estatística & dados numéricosRESUMO
BACKGROUND: The high rate of schizophrenia among the second-generation African-Caribbean population in Britain has prompted much concern and speculation. Sugarman and Craufurd have reported that the morbid risk in the siblings of second-generation African-Caribbean schizophrenic patients was unusually high compared with that of the siblings of White patients. METHOD: We sought to replicate these findings by comparing the morbid risk for schizophrenia in the first-degree relatives of 111 White and 73 African-Caribbean psychotic probands. The latter comprised 35 first-generation (born in the Caribbean) and 38 second-generation (born in Britain) probands. RESULTS: The morbid risk for schizophrenia was similar for the parents and siblings of White and first-generation African-Caribbean patients, and for the parents of the second-generation African-Caribbean probands. However, the siblings of second-generation African-Caribbean psychotic probands had a morbid risk for schizophrenia that was seven times that of their White counterparts (P = 0.007); similarly, the siblings of second-generation African-Caribbean schizophrenic probands had a morbid risk for schizophrenia that was four times that of their White counterparts (P = 0.05). CONCLUSIONS: These findings replicate those of the earlier report of Sugarman and Craufurd, and suggest either that the second-generation African-Caribbean population in Britain is particularly vulnerable to some environmental risk factors for schizophrenia, or that some environmental factors act selectively on this population in Britain.
Assuntos
População Negra/genética , Negro ou Afro-Americano/psicologia , Transtornos Psicóticos/genética , Esquizofrenia/genética , População Branca/genética , População Branca/psicologia , Adulto , África/etnologia , Filho de Pais com Deficiência/psicologia , Comparação Transcultural , Feminino , Humanos , Masculino , Fenótipo , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/etnologia , Risco , Esquizofrenia/diagnóstico , Esquizofrenia/etnologia , Meio Social , Reino Unido/epidemiologia , Índias Ocidentais/etnologiaRESUMO
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
The proportion of births to women of New Commonwealth origin in different Area Health Authorities (AHAs) varies widely. The influence of this varying proportion in contributing to differences in perinatal mortality rate (PNMR) between authorities is examined. Firstly, it is shown that the two main 'immigrant' groups have adverse PNMRs compared with Europeans, and that there is a positive correlation between the proportion of immigrant births in an Area and the PNMR. Secondly it is shown that immigrants have PNMRs (standardised for birth weight distribution) better than those of Europeans, and that there is a negative correlation between the proportion of immigrant births in an Area and the standardised PNMR of the whole Area. Thirdly, based on data from Birmingham a correction factor is developed and applied to the standardised PNMR to examine the effect of adjusting for racial mix. Factors other than birthweight contributint to variation between races in their PNMRs are discussed. It is concluded that the effect of race in contributing independently of birthweight to variation between Areas in respect of PNMRs is insufficient to invalidate inter-Area comparisons.