Ethnic Minority Psychiatric Illness Rates in the Community (EMPIRIC): Quantitative Report

Sproston, Kerry; Nazroo, James; Blanchard, Martin; Crawford, Mike; Fenton, Steve; Fuller, Elizabeth; Karlsen, Saffron; King, Micháel J.; McManus, Sally; O'Connor, William A.; Stansfeld, Stephen; Tyrer, Peter; Weich, Scott

doi:10.1037/e623492007-001

Cited by 65 publications

(119 citation statements)

References 13 publications

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“…This is at odds with the fact that OCD is at least as prevalent in individuals from ethnic minorities as it is in the White majority. [3][4][5] The observed inequalities were not specific to a particular age group (child and adolescent v. adult services) or type of service (community v. national specialist services), although the overrepresentation of people from White backgrounds was slightly higher in national and specialist services. The fact that underrepresentation of patients from ethnic minority backgrounds was comparable in community and national specialist clinics suggests that there are no specific barriers associated with the complexities of national specialist services; rather, the barriers seem broader and apply to secondary and tertiary mental health services in general.…”

Section: Main Findingsmentioning

confidence: 91%

“…Heyman et al 5 conducted a nationwide (UK) epidemiological survey to establish the prevalence of OCD in young people aged 5-15 (n410 000) and reported a significantly greater proportion of children from ethnic minorities among those with OCD (24%) compared with healthy controls (8.8%) and psychiatric controls (7.4%). Given the similar, if not higher, prevalence of OCD across ethnic groups in Britain [3][4][5] and elsewhere, 6 a proportional representation of different ethnic groups would be expected in mental health services. However, there is substantial evidence to indicate that patients from ethnic minorities, both children 7 and adults, 8 tend to be underrepresented in mental health services in Britain, although data specifically relating to OCD is lacking.…”

mentioning

confidence: 99%

“…For example, the Ethnic Minority Psychiatric Illness Rates in the Community (EMPIRIC) study 3,4 examined the prevalence of mental disorders across adult British White, Black Caribbean, Indian, Pakistani, Bangladeshi and Irish ethnic groups. A similar point prevalence of OCD of around 1% was found across all ethnicities.…”

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confidence: 99%

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Ethnic inequalities in the use of secondary and tertiary mental health services among patients with obsessive–compulsive disorder

et al. 2015

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Obsessive-compulsive disorder (OCD) has similar prevalence rates across the World.1,2 Within Western countries, including the UK, the prevalence of OCD has been shown to be roughly consistent across ethnic groups. For example, the Ethnic Minority Psychiatric Illness Rates in the Community (EMPIRIC) study 3,4 examined the prevalence of mental disorders across adult British White, Black Caribbean, Indian, Pakistani, Bangladeshi and Irish ethnic groups. A similar point prevalence of OCD of around 1% was found across all ethnicities. Heyman et al 5 conducted a nationwide (UK) epidemiological survey to establish the prevalence of OCD in young people aged 5-15 (n410 000) and reported a significantly greater proportion of children from ethnic minorities among those with OCD (24%) compared with healthy controls (8.8%) and psychiatric controls (7.4%). Given the similar, if not higher, prevalence of OCD across ethnic groups in Britain [3][4][5] and elsewhere, 6 a proportional representation of different ethnic groups would be expected in mental health services. However, there is substantial evidence to indicate that patients from ethnic minorities, both children 7 and adults, 8 tend to be underrepresented in mental health services in Britain, although data specifically relating to OCD is lacking. Research conducted in North America suggests that patients with OCD from ethnic minorities are underrepresented in clinical trials. Williams et al 9 reviewed 21 randomised controlled trials of OCD conducted in North America and found that ethnic minorities were seriously underrepresented in such studies (91% of participants were White). As OCD has rarely been studied separately, there is little data relating specifically to ethnic inequalities in access to clinical services of this major, yet treatable, psychiatric disorder. The overall aim of the present study was to explore whether individuals with OCD from ethnic minorities are underrepresented in secondary and tertiary clinical services within a large mental health trust in South London, relative to the ethnic composition of the corresponding catchment area. We also aimed to determine whether ethnic inequalities, if found, are restricted to a particular age group (children v. adults) or type of clinical service (community mental health clinics v. specialist clinics) or specific to OCD (compared with depression). Method Study settingThe South London and Maudsley (SLaM) NHS Foundation Trust is Europe's largest specialist mental healthcare trust. It serves a population of approximately 1.2 million residents of four South London boroughs: Lambeth, Southwark, Lewisham and Croydon. A proportion of SLaM services are tertiary care national referral units, 10 including three national specialist clinics for OCD: the Clinic for Young People with OCD and Related Disorders (Maudsley Hospital; child and adolescent out-and in-patients), the Centre for Anxiety Disorders and Trauma (CADAT; Maudsley Hospital, adult out-patients) and the Anxiety Disorders Residential Unit (ADRU; Bethlem Royal H...

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Section: Main Findingsmentioning

confidence: 91%

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confidence: 99%

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Ethnic inequalities in the use of secondary and tertiary mental health services among patients with obsessive–compulsive disorder

et al. 2015

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“…47 Research demonstrates that members of BME communities explicitly express their religious needs more than members of white communities. 48 Illness attributions, however, may not be bound to one particular religion. For instance, belief in demon possession as an explanation for mental illness has been noted in many Christian, Muslim and other communities in the UK.…”

Section: Spiritual and Religious Beliefsmentioning

confidence: 99%

Ethnicity, detention and early intervention: reducing inequalities and improving outcomes for black and minority ethnic patients: the ENRICH programme, a mixed-methods study

Singh

Islam

Brown

et al. 2013

Programme Grants for Applied Research

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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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“…In studies in the US and UK, when compared to "White" inpatients, "Black" inpatients have been described as younger, with significantly longer duration of hospitalization, more frequent admission through the emergency room, and more compulsory admissions (Bhugra, Bhui, & Christie, 1995;Bolden & Wicks, 2005;Fabrega et al, 1994;Jarvis, 1998). Black inpatients are also significantly more likely to be diagnosed with schizophrenia and substance abuse than White inpatients, and less likely to be diagnosed with an affective or personality disorder (Bhugra et al, 1995;Delbello et al, 2001;Strakowski et al, 1995Strakowski et al, , 1996Strakowski, Shelton, & Kolbrener, 1993;Sproston & Nazroo, 2002).…”

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confidence: 99%

Ethnic and Clinical Characteristics of a Portuguese Psychiatric Inpatient Population

Alexandre

Ribeiro

Cardoso

2010

Transcult Psychiatry

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The present study examined the association between ethnicity and clinical characteristics of patients admitted to a psychiatric inpatient unit in Portugal. The only ethnicity-related terms routinely recorded in the medical records were “Black” (mainly from the African Portuguese-speaking countries of Cape Verde, Angola, Guinea, Sao Tome and Mozambique) and “White.” Black immigrants appeared to be over-represented, comprising 19.6% of inpatients; and were younger and more frequently male when compared with White inpatients. They were more frequently diagnosed with schizophrenia and acute or transient psychosis, and less frequently diagnosed with delusional and personality disorders than White inpatients. These results are consistent with previous studies in the US and UK, and highlight the need for more culturally sensitive care in mental health services.

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Ethnic Minority Psychiatric Illness Rates in the Community (EMPIRIC): Quantitative Report

Cited by 65 publications

References 13 publications

Ethnic inequalities in the use of secondary and tertiary mental health services among patients with obsessive–compulsive disorder

Ethnic inequalities in the use of secondary and tertiary mental health services among patients with obsessive–compulsive disorder

Ethnicity, detention and early intervention: reducing inequalities and improving outcomes for black and minority ethnic patients: the ENRICH programme, a mixed-methods study

Ethnic and Clinical Characteristics of a Portuguese Psychiatric Inpatient Population

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