Incidence of Schizophrenia and Other Psychoses in England, 1950–2009: A Systematic Review and Meta-Analyses

Kirkbride, James; Errázuriz, Antonia; Croudace, Tim; Morgan, Craig; Jackson, Dan; Boydell, Jane; Murray, Robin M.; Jones, Peter B.

doi:10.1371/journal.pone.0031660

Cited by 434 publications

(430 citation statements)

References 186 publications

(569 reference statements)

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“…It was important not to import stereotypical views of rural 148,149 or urban mental health landscapes. However, research does show higher levels of psychosis within inner cities and deprived communities, 150 which could impact on our data. Neuroscientists are also interested in the impact of place.…”

Section: Placementioning

confidence: 76%

Improving community health networks for people with severe mental illness: a case study investigation

Pinfold

Sweet

Porter³

et al. 2015

Health Services and Delivery Research

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IntroductionPolicy drivers in mental health to address personal recovery, stigma and poor physical health indicate that new service solutions are required. This study aimed to understand how connections to people, places and activities were utilised by individuals with severe mental illness (SMI) to benefit health and wellbeing.MethodsA five-module mixed-methods design was undertaken in two study sites. Data were collected from 150 network-mapping interviews and 41 in-depth follow-up interviews with people with SMI; in-depth interviews with 30 organisation stakeholders and 12 organisation leaders; and 44 telephone interviews with practitioners. We undertook a three-stage synthesis process including independent lived experience feedback, and a patient and public involvement team participated in tool design, data collection, analysis and write-up.ResultsThree personal network types were found in our study using the community health network approach: diverse and active; family and stable; formal and sparse. Controlled for other factors we found only four variables significantly associated with which network type a participant had: living alone or not; housing status; formal education; long-term sickness or disability. Diagnosis was not a factor. These variables are challenging to address but they do point to potential for network change. The qualitative interviews with people with SMI provided further understanding of connection-building and resource utilisation. We explored individual agency across each network type, and identified recognition of the importance and value of social support and active connection management alongside the risks of isolation, even for those most affected by mental illness. We identified tensions in personal networks, be that relationships with practitioners or families, dealing with the impact of stigma, or frustrations of not being in employment, which all impact on network resources and well-being. The value of connectedness within personal networks of people, place and activity for supporting recovery was evident in shaping identity, providing meaning to life and sense of belonging, gaining access to new resources, structuring routines and helping individuals ‘move on’ in their recovery journey.Health-care practitioners recognised that social factors were important in recovery but reported system-level barriers (workload, administrative bureaucracy, limited contact time with clients) in addressing these issues fully. Even practitioners working in third-sector services whose remit involved increasing clients’ social connection faced restrictions due to being evaluated by outcome criteria that limited holistic recovery-focused practices. Service providers were keen to promote recovery-focused approaches. We found contrasts between recovery ideology within mental health policy and recovery practice on the ground. In particular, the social aspects of supporting people with SMI are often underprioritised in the health-care system. In a demanding and changing context, strategic multiagency working was seen as crucial but we found few examples of embedded multisector organisation partnerships.ConclusionWhile our exploratory study has limitations, findings suggest potential for people with SMI to be supported to become more active managers of their personal networks to support well-being regardless of current network type. The health and social care system does not currently deliver multiagency integrated solutions to support SMI and social recovery.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Placementioning

confidence: 76%

Improving community health networks for people with severe mental illness: a case study investigation

Pinfold

Sweet

Porter³

et al. 2015

Health Services and Delivery Research

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Section: Introductionmentioning

confidence: 99%

“…Specifically, reports from samples ascertained in clinical settings have suggested that compared to Caucasians, individuals of African heritage have higher rates of schizophrenia [Robins and Regier, 1991;Strakowski et al, 1993Strakowski et al, , 1996Strakowski et al, , 2003Bresnahan et al, 2007;Gara et al, 2012;Kirkbride et al, 2012] and higher rates of affective psychosis [Kirkbride et al, 2012]. Individuals of African heritage diagnosed with schizophrenia relative to Caucasians diagnosed with schizophrenia exhibited more Neuropsychiatric Genetics severe psychotic symptoms [Mukherjee et al, 1983;Strakowski et al, 2003;Arnold et al, 2004] and less severe negative symptoms [Sharpley et al, 2001].…”

Section: Introductionmentioning

confidence: 99%

Symptoms of psychosis in schizophrenia, schizoaffective disorder, and bipolar disorder: A comparison of African Americans and Caucasians in the Genomic Psychiatry Cohort

Perlman

Kotov

et al. 2015

American J of Med Genetics Pt B

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Several studies have reported differences between African Americans and Caucasians in relative proportion of psychotic symptoms and disorders, but whether this reflects racial bias in the assessment of psychosis is unclear. The purpose of this study was to examine the distribution of psychotic symptoms and potential bias in symptoms assessed via semi-structured interview using a cohort of 3,389 African American and 5,692 Caucasian participants who were diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder. In this cohort, the diagnosis of schizophrenia was relatively more common, and the diagnosis of bipolar disorder and schizoaffective disorder-bipolar type was less relatively common, among African Americans than Caucasians. With regard to symptoms, relatively more African Americans than Caucasians endorsed hallucinations and delusions symptoms, and this pattern was striking among cases diagnosed with bipolar disorder and schizoaffective-bipolar disorder. In contrast, the relative endorsement of psychotic symptoms was more similar among cases diagnosed with schizophrenia and schizoaffective disorder-depressed type. Differential item function analysis revealed that African Americans with mild psychosis over-endorsed "hallucinations in any modality" and underendorsed "widespread delusions" relative to Caucasians. Other symptoms did not show evidence of racial bias. Thus, racial bias in assessment of psychotic symptoms does not appear to explain differences in the proportion of symptoms between Caucasians and African Americans. Rather, this may reflect ascertainment bias, perhaps indicative of a disparity in access to services, or differential exposure to risk factors for psychosis by race. Key words: schizophrenia; race; psychosis INTRODUCTIONOver the last 50 years, several studies have reported differences between individuals of African heritage and Caucasians in relative proportion of psychotic symptoms and diagnosis of schizophrenia versus bipolar disorder. Specifically, reports from samples ascertained in clinical settings have suggested that compared to Caucasians, individuals of African heritage have higher rates of schizophrenia [Robins and Regier, 1991;Strakowski et al., 1993Strakowski et al., , 1996Strakowski et al., , 2003Bresnahan et al., 2007;Gara et al., 2012;Kirkbride et al., 2012] 546Neuropsychiatric Genetics severe psychotic symptoms [Mukherjee et al., 1983;Strakowski et al., 2003;Arnold et al., 2004] and less severe negative symptoms [Sharpley et al., 2001]. Other studies of psychotic symptoms have found race differences in the quality and scope of hallucinations and delusions [Barrio et al., 2003;Yamada et al., 2006].To date, the underlying source of these apparent differences is unknown. It has been argued that the difference could reflect clinician or instrument bias [Neighbors et al., 2003;Trierweiler et al., 2006], although differences remained when clinicians were blinded to ethnicity information [Arnold et al., 2004]. On the other hand, race differences may reflect t...

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“…As such it begins to illuminate those communities that are likely to face the largest inequalities in regard to the burden of severe mental illness. A body of international research (van Os et al 2000;Allardyce et al 2005;Veling et al 2008;Zammit et al 2010), including our own work in England (Kirkbride et al 2008(Kirkbride et al , 2012a, now suggests that social inequalities themselves are associated with increased rates of psychotic illness. Tools to identify and tackle regional inequalities in the social and economic determinants of mental health and well-being, as well as in inequalities in the allocation of resources within and beyond the mental health system, can serve as the evidence base upon which to found effective service delivery for the prevention and management of mental health disorders.…”

Section: Resultsmentioning

confidence: 99%

Parity of esteem begins at home: translating empirical psychiatric research into effective public mental health

Kirkbride

Jones

2013

Psychol. Med.

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There is increasing recognition that parity of esteem between mental and physical health disorders is essential to improve the course, outcome and quality of life of individuals within different populations. Achieving this parity now underpins the objectives of several nations. Here, we argue that parity of esteem between mental and physical health can only be realized when parity of esteem also exists across mental health disorders, particularly in terms of service commissioning and planning. Using first-episode psychosis and early intervention in psychosis services as a motivating example, we demonstrate how carefully conducted psychiatric epidemiology can be translated to develop precise forecasts of the anticipated incidence of first-episode psychosis in different populations, based on an understanding of underlying local needs and inequalities. Open-access prediction tools such as PsyMaptic will allow commissioners of mental health services to more effectively allocate resources across services, based on empirical evidence and local need, thus reducing inequalities in access to mental health care.

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Incidence of Schizophrenia and Other Psychoses in England, 1950–2009: A Systematic Review and Meta-Analyses

Cited by 434 publications

References 186 publications

Improving community health networks for people with severe mental illness: a case study investigation

Improving community health networks for people with severe mental illness: a case study investigation

Symptoms of psychosis in schizophrenia, schizoaffective disorder, and bipolar disorder: A comparison of African Americans and Caucasians in the Genomic Psychiatry Cohort

Parity of esteem begins at home: translating empirical psychiatric research into effective public mental health

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