A Systematic Review of Inequalities in the Mental Health Experiences of Black African, Black Caribbean and Black-mixed UK Populations: Implications for Action

Devonport, Tracey J.; Ward, Gavin; Morrissey, Hana; Burt, C; Harris, Jonathan M.; Burt, S; Patel, Rashmi; Manning, Rachel M; Paredes, Roger; Nicholls, Wendy

doi:10.1007/s40615-022-01352-0

Cited by 13 publications

(8 citation statements)

References 62 publications

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“…Compulsory treatment is also frequently reported [ 9 ]. Themes of mistrust in services, stigma, and coerciveness have also featured in the narratives of Black and minority individuals receiving mental health treatment [ 50 ]. Thus, treatment trajectories, including pathways out of EIS, warrant in-depth exploration, particularly as our racial minority groups were less likely to be discharged out of mental health service 2 years following EIS discharge.…”

Section: Discussionmentioning

confidence: 99%

Five-year illness trajectories across racial groups in the UK following a first episode psychosis

Griffiths

Bogatsu

Longhi

et al. 2023

Soc Psychiatry Psychiatr Epidemiol

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Purpose Psychosis disproportionally affects ethnic minority groups in high-income countries, yet evidence of disparities in outcomes following intensive early intervention service (EIS) for First Episode Psychosis (FEP) is less conclusive. We investigated 5-year clinical and social outcomes of young people with FEP from different racial groups following EIS care. Method Data were analysed from the UK-wide NIHR SUPEREDEN study. The sample at baseline (n = 978) included White (n = 750), Black (n = 71), and Asian (n = 157) individuals, assessed during the 3 years of EIS, and up to 2 years post-discharge (n = 296; Black [n = 23]; Asian [n = 52] and White [n = 221]). Outcome trajectories were modelled for psychosis symptoms (positive, negative, and general), functioning, and depression, using linear mixed effect models (with random intercept and slopes), whilst controlling for social deprivation. Discharge service was also explored across racial groups, 2 years following EIS. Results Variation in linear growth over time was accounted for by racial group status for psychosis symptoms—positive (95% CI [0.679, 1.235]), negative (95% CI [0.315, 0.783]), and general (95% CI [1.961, 3.428])—as well as for functioning (95% CI [11.212, 17.677]) and depressive symptoms (95% CI [0.261, 0.648]). Social deprivation contributed to this variance. Black individuals experienced greater levels of deprivation (p < 0.001, 95% CI [0.187, 0.624]). Finally, there was a greater likelihood for Asian (OR = 3.04; 95% CI [2.050, 4.498]) and Black individuals (OR = 2.47; 95% CI [1.354, 4.520]) to remain in secondary care by follow-up. Conclusion Findings suggest variations in long-term clinical and social outcomes following EIS across racial groups; social deprivation contributed to this variance. Black and Asian individuals appear to make less improvement in long-term recovery and are less likely to be discharged from mental health services. Replication is needed in large, complete data, to fully understand disparities and blind spots to care.

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Section: Discussionmentioning

confidence: 99%

Five-year illness trajectories across racial groups in the UK following a first episode psychosis

Griffiths

Bogatsu

Longhi

et al. 2023

Soc Psychiatry Psychiatr Epidemiol

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“…Future research would benefit from recruiting a wider diversity of participants. It is possible that the difficulties in recruiting Black men and Black African people is due to both these groups being less likely to seek mental health support, which may make it less likely they have been asked about ACEs (Devonport et al, 2022; Myrie & Gannon, 2013).…”

Section: Discussionmentioning

confidence: 99%

Black people's experiences of being asked about adverse childhood experiences in the UK: A qualitative study

Sødal,

Huddy,

McKenzie

2023

Psychol Psychother

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IntroductionThe objectives for this study were to explore Black people's experiences of being asked about ACEs by mental health or counselling professionals, both broadly, and also as part of routine enquiry with a commonly used ACE questionnaire. An additional aim was to understand their perspectives on how services should be asking about ACEs.MethodsThis study used a qualitative methodology, with a critical realist reflexive thematic analysis approach. Ten people who identified as Black and had been asked about ACEs by a mental health professional or counsellor, were interviewed about their experiences and perspectives using semi‐structured interviews.ResultsFour overarching themes, some with subthemes, were established: Trust and safety as individual and systemic (subthemes: Distrust in the system; Distrust in the clinician; Racism in health care; Keeping safe); It is the person, not the questions (subthemes: Being heard and understood; Similarity and difference); Engaged client, ‘hard‐to‐reach’ clinician? and People are not tick‐boxes.ConclusionsThe results highlight that people find it important and useful to be asked about ACEs, if it is done in an appropriate manner. Establishing trust and a therapeutic relationship is key to fostering this. Participants stated that the ACE questionnaire might miss important context, and they relayed a preference for being asked about ACEs using more inclusive definitions of ACEs.

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“…To our knowledge, there are only two published empirical studies examining parents' exposure to racism and child outcomes in the United Kingdom, both derived from the Millennium Cohort sample (Bécares, Nazroo, & Kelly, 2015; Kelly, Becares, & Nazroo, 2013). This is a major research gap, given evidence for ongoing racial inequalities in mental health risk and treatment in the United Kingdom (Devonport et al., 2022).…”

Section: Figurementioning

confidence: 99%

Intergenerational consequences of racism in the United Kingdom: a qualitative investigation into parents' exposure to racism and offspring mental health and well‐being

Simela,

Akanbi‐Akinlolu,

Okundi

et al. 2024

Child Adoles Ment Health

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BackgroundExperiences of racism are linked to negative physical and mental health outcomes among those exposed. According to quantitative research derived mainly from the United States, these negative outcomes can have cascading effects in families, when parents' experiences of racism indirectly impact offspring. New research is warranted for families in the United Kingdom, informed by a qualitative approach to canvassing community knowledge and perspectives, exploring how existing findings relate to lived experiences.MethodWe conducted four online focus groups with 14 parents of school‐aged children and 14 adolescents who had experienced racism in the United Kingdom. Participants were asked what children know of parents' experiences of racism, and how these experiences can impact parent–child interactions, mental health and well‐being. Focus group recordings were transcribed, data coded and analysed through iterative categorisation.ResultsAnalyses drew four themes from participants' insights. Together, themes illuminated the pervasive nature of racism experienced by some families in the United Kingdom. Parent and child experiences of racism were connected and co‐occurring, with indirect effects impacting mental health and well‐being in both generations. These experiences were linked to both positive and negative changes in parenting behaviour and parent–child relationships, which could be moderated by intersecting identities such as the parent's generational status for immigration to the United Kingdom. Social cohesion, safe spaces and education programmes were highlighted for future intervention.ConclusionsFindings corroborate existing literature, while further emphasising a broader bidirectional picture, requiring a family system and intersectional approach to understanding the mental health impact of racism in families. Avenues for future research are discussed to support development of equitable intervention and support strategies to prevent racism and support those affected.

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A Systematic Review of Inequalities in the Mental Health Experiences of Black African, Black Caribbean and Black-mixed UK Populations: Implications for Action

Cited by 13 publications

References 62 publications

Five-year illness trajectories across racial groups in the UK following a first episode psychosis

Five-year illness trajectories across racial groups in the UK following a first episode psychosis

Black people's experiences of being asked about adverse childhood experiences in the UK: A qualitative study

Intergenerational consequences of racism in the United Kingdom: a qualitative investigation into parents' exposure to racism and offspring mental health and well‐being

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