Compulsory admission at first presentation to services for psychosis: does ethnicity still matter? Findings from two population-based studies of first episode psychosis

Abstract

Objectives Compared with the majority population, those from minority ethnic groups in the UK are more likely to be admitted compulsorily during a first episode of psychosis (FEP). We investigated whether these disparities in pathways in to care continue. Methods We analysed data from two first episode psychosis studies, conducted in the same geographical area in south London 15 years apart: the Aetiology and Ethnicity in Schizophrenia and Other Psychosis (AESOP) and the Clinical Record Interactive Search-First Episode Psychosis (CRIS-FEP) studies. The inclusion/exclusion criteria for case ascertainment for first episode psychosis were identical across the two studies. We performed multivariable logistic regression to estimate odds of compulsory admission by ethnic group, controlling for confounders. Participants Two hundred sixty-six patients with first episode psychosis, aged 18–64 years, who presented to mental health services in south London in 1997–1999 and 446 with FEP who presented in 2010–2012. Results When the two samples were compared, ethnic differences in compulsory admission appear to have remained the same for black African patients, i.e. three times higher than white British in both samples: AESOP (adj. OR = 3.96; 95% CI = 1.80–8.71) vs. CRIS-FEP (adj. OR = 3.12; 95% CI = 1.52–6.35). Black Caribbean patients were three times more likely to be compulsorily admitted in AESOP (adj. OR = 3.20; 95% CI = 1.56–6.54). This was lower in the CRIS-FEP sample (adj. OR = 1.68; 95% CI = 0.71–3.98) and did not meet conventional levels for statistical significance. Conclusion Ethnicity is strongly associated with compulsory admissions at first presentation for psychosis with evidence of heterogeneity across groups, which deserves further research.

Change in incidence rates for psychosis in different ethnic groups in south London: findings from the Clinical Record Interactive Search-First Episode Psychosis (CRIS-FEP) study

“…Therefore, it is possible that social networks for the black Caribbean group may have improved, which has been documented to be a protective factor from mental illness (Bhugra and Becker, 2005). We showed in our recent study that black Caribbean patients are now more likely to live with family and friends (41.7% v. 61.1%), compared with 15 years ago (Oduola et al, 2019). In addition, the lower IRR among the black Caribbean group are partly explained by the higher incidence rate that we observed among the white British group in this study compared with the AESOP study.…”

“…According to the Indices of Deprivation (2015), London has relatively low levels of deprivation in education (Ministry of Housing and Local Goverment, 2015). Data from our recent study showed that the proportion of first episode psychosis patients with university level of education rose from 14.9% in AESOP to 27.5% in CRIS-FEP (Oduola et al, 2019), which may suggest an improvement in this well documented social risk factor of psychosis. However, this may at most only partly explain our findings, since elevated rates are still present in some minority ethnic groups but not others, as discussed above.…”

Unmet needs for treatment in 102 individuals with brief and limited intermittent psychotic symptoms (BLIPS): implications for current clinical recommendations

“…Accordingly, about 16% of BLIPS received a compulsory admission at 4 years. A recent population-based study in the same NHS Trust showed comparable rates of first-episode psychosis cases receiving compulsory admission (106/446 = 23.76%) (Oduola et al ., 2019 ). These findings, taken altogether, clearly indicate that BLIPS individuals are at high risk of developing serious mental health outcomes beyond the development of psychosis and that these outcomes are not currently addressed by existing mental health services.…”

Ethnic variations in duration of untreated psychosis: report from the CRIS-FEP study

“…ICD F20-29, F30-33). The methods used in our case identification have been extensively described and published elsewhere [ 30 – 32 ]. In summary, we identified all patients presenting to the South London and Maudsley NHS Trust adult mental health services in Lambeth and Southwark for the first time with a psychotic disorder between May 2010 and April 2012 using the South London and Maudsley NHS Trust (SLaM) Clinical Records Interactive Search (CRIS) system [ 33 ], which provides fully anonymised access to all SLaM electronic clinical records.…”