Ethnic variations in pathways into early intervention services for psychosis

Ghali, Sharif; Fisher, Helen L.; Joyce, John; Major, Barnaby; Hobbs, Lorna; Soni, Sujata; Chisholm, Brock; Rahaman, Nikola; Papada, Peggy; Lawrence, Jo; Bloy, Sally; Marlowe, Karl; Aitchison, Katherine J.; Power, Paddy; Johnson, Sonia

doi:10.1192/bjp.bp.111.097865

Cited by 55 publications

(93 citation statements)

References 36 publications

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“…10 Indeed, immigration status has been previously found to be associated with the propensity to use emergency services by people with FEP. 15,31 We also found that the involvement of the GP on the pathway to care was an independent predictor of a reduced odds of making first contact with the ED, which is consistent with prior Canadian findings.…”

Section: Discussionsupporting

confidence: 80%

“…12 Three larger studies from the United Kingdom reported a shorter DUP for ethnic minority groups [14][15][16] ; however, we found little evidence overall that differences in the pathway to care translated into differences in the DUP. 13 Many of the studies included in our review were not designed or adequately powered to examine the differences linked to specific cultural, ethnic, or racialized group membership, although there have been notable exceptions.…”

Section: Limitationscontrasting

confidence: 42%

“…15,29,34,35 Canadian studies have found a trend toward an increased likelihood of police involvement for Black racial groups, but these findings did not reach statistical significance.…”

mentioning

confidence: 75%

“…13 Many of the studies included in our review were not designed or adequately powered to examine the differences linked to specific cultural, ethnic, or racialized group membership, although there have been notable exceptions. 14,15 Our study aims to investigate pathways to care and DUP in 2 multicultural cities in Ontario. In our study, we disaggregated the African-Caribbean population into those of African origin and those of Caribbean origin, reflecting differences between these groups in culture, history of immigration, and socioeconomic conditions.…”

Section: Limitationsmentioning

confidence: 99%

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Pathways to First-Episode Care for Psychosis in African-, Caribbean-, and European-Origin Groups in Ontario

et al. 2015

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Objective: To compare the pathways to care and duration of untreated psychosis (DUP) for people of Black-African, Black-Caribbean, or White-European origin with first-episode psychosis (FEP). Methods:We recruited a sample of 171 patients with FEP of Black-African, Black-Caribbean, and White-European origin from hospital-and community-based early intervention services (EIS) in the cities of Toronto and Hamilton. We compared the 3 groups on DUP and key indicators of the pathway to care. Results:We observed differences in pathways to care across the 3 groups. Black-Caribbean participants had an increased odds of referral from an inpatient unit to EIS (OR 3.33; 95% CI 1.46 to 7.60) and a decreased odds of general practitioner involvement on the pathway to care (OR 0.17; 95% CI 0.07 to 0.46), as well as fewer total contacts (exp[β] 0.77; 95% CI 0.60 to 0.99) when compared with White-European participants. Black-African participants had an increased odds of contact with the emergency department at first contact (OR 3.78; 95% CI 1.31 to 10.92). The differences in the DUP between groups were not statistically significant. Conclusions:Our findings suggest that there are significant differences in the pathways to EIS for psychosis for people of African and Caribbean origin in our Canadian context. It is essential to gain a comprehensive understanding of the pathways that different population groups take to mental health services, and the reasons behind observed differences, to inform the development of equitable services, targeting patients in the critical early stages of psychotic disorder.

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Section: Discussionsupporting

confidence: 80%

Section: Limitationscontrasting

confidence: 42%

“…15,29,34,35 Canadian studies have found a trend toward an increased likelihood of police involvement for Black racial groups, but these findings did not reach statistical significance.…”

mentioning

confidence: 75%

Section: Limitationsmentioning

confidence: 99%

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Pathways to First-Episode Care for Psychosis in African-, Caribbean-, and European-Origin Groups in Ontario

et al. 2015

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“…We present baseline and 12-month follow-up data gathered from four EIS teams in London, UK, making use of a standardised data collection tool (MiData), which has previously been well described in published papers [19,20]. The teams all aimed to follow the UK Service Implementation Guide [21], delivering a full multidisciplinary service focused on recovery and relapse prevention for two to three years.…”

Section: Methodsmentioning

confidence: 99%

Ethnic variations in compulsory detention and hospital admission for psychosis across four UK Early Intervention Services

Mann¹,

Fisher

Major

et al. 2014

BMC Psychiatry

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BackgroundSubstantial ethnic variations have been found in incidence, pathways to care and outcomes in psychosis. It is unknown whether these remain as marked in the presence of specialist Early Intervention Services (EIS) for psychosis. We present the first UK study exploring ethnic differences in compulsory detention and hospitalization rates for EIS patients. We investigated whether the excess rates of compulsory admission for people from Black groups have persisted following nationwide introduction of EIS. We also explored variations in compulsory admission for other ethnic groups, and differences by gender and diagnosis.MethodsFour inner-city London EIS teams gathered data from first-presentation psychosis patients between 2004–2009 using the MiData audit tool. Clinical, sociodemographic and pathways to care data were recorded regarding adult patients from eight different ethnic groups at entry to EIS and one year later.ResultsBlack African EIS service users had odds of being detained and of being hospitalised three times greater than White British patients, even after adjustment for confounders. This was most marked in Black African women (seven to eight times greater odds than White British women). A post-hoc analysis showed that pathways to care and help-seeking behaviour partially explained these differences.ConclusionThese findings suggest EIS input in its current form has little impact on higher admission and detention rates in certain Black and minority groups. There is a need to tackle these differences and engage patients earlier, focusing on the needs of men and women from the most persistently affected groups.

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Family intervention in a prison environment: A systematic literature review

Roberts

Onwumere

Forrester

et al. 2016

Criminal Behav Ment Health

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Consistency in findings across the wide-ranging studies suggested that family therapies may indeed be helpful for prisoners and their families, so further research is warranted. The fact that a randomised controlled trial proved feasible should encourage researchers to seek more robust data and to determine which form of intervention is effective and in which circumstances. It would also be useful to develop an improved understanding of mechanisms of change. Copyright © 2016 John Wiley & Sons, Ltd.

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Ethnic variations in pathways into early intervention services for psychosis

Cited by 55 publications

References 36 publications

Pathways to First-Episode Care for Psychosis in African-, Caribbean-, and European-Origin Groups in Ontario

Pathways to First-Episode Care for Psychosis in African-, Caribbean-, and European-Origin Groups in Ontario

Ethnic variations in compulsory detention and hospital admission for psychosis across four UK Early Intervention Services

Family intervention in a prison environment: A systematic literature review

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