Abstract
Background
Our aim was to examine whether variations in the prevalence of neurosis and psychosis between ethnic minorities throughout Great Britain are explained by social disadvantage.
Method
A total of 10,108 adult householders throughout Great Britain were assessed in a two-stage survey with the Revised Clinical Interview Schedule (CIS-R) and Psychosis Screening Questionnaire (PSQ). Respondents with a positive PSQ or who received a diagnosis of, or treatment for, psychosis were examined by a psychiatrist using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Data on respondents’ preferred ethnic group were collapsed into four groups: Whites, African-Caribbean or Africans, south Asians and other.
Results
Ethnic grouping was strongly associated with: unemployment; lone parent status; lower social class; low perceived social support; poverty (indicated by lack of car ownership) and having a primary social support group of less than three close others. All these associations applied to the group Africans and Afro-Caribbeans, but only some applied to the other groups. No ethnic group had significantly increased rates of neurosis. Only the African-Caribbean group were at significantly increased risk of a psychotic disorder (odds ratio 4.55; 95% CI: 1.13, 18.30). After adjustment for risk factors, the odds of psychosis were lower (odds ratio 2.97; 95% CI: 0.66, 13.36).
Conclusions
The excess of psychosis in Africans and Afro-Caribbeans in Great Britain appears to be partly explained by socio-economic disadvantage, but larger studies are needed to confirm this.
Similar content being viewed by others
References
Andrews B, Brown GW (1993) Self-esteem and vulnerability to depression: the concurrent validity of interview and questionnaire measures. J Abn Psychol 102:565–572
Bebbington P, Brugha T, Meltzer H, Farrell M, Ceresa C, Jenkins R, Lewis G (2000a) Psychiatric disorder and dysfunction in the UK national survey of psychiatric morbidity. Soc Psychiatry Psychiatr Epidemiol 35:191–197
Bebbington P, Brugha T, Meltzer H, Jenkins R, Ceresa C, Farrell M, Lewis G (2000b) Neurotic disorders and the receipt of psychiatric treatment. Psychol Med 30:1369–1376
Bebbington, P, Meltzer H, Brugha T, Farrell M, Jenkins R, Ceresa C, Lewis G (2000c) Unequal access and unmet need: Neurotic disorders and the use of primary care services. Psychol Med 30:1359–1368
Bebbington PE, Nayani T (1995) The psychosis screening questionnaire. Int J Methods Psychiatr Res 5:11–20
Bhugra D, Hilwig M, Mallett R, Corridan B, Leff J, Neehall J, Rudge S (2000) Factors in the onset of schizophrenia: a comparison between London and Trinidad samples. Acta Psychiatr Scand 101:135–141
Bhui K, Bhugra D (1997) Cross-cultural competencies in the psychiatric assessment. Br J Hosp Med 57:492–496
Boydell J, van Os J, McKenzie K, Allardyce J, Goel R, McCreadie RG, Murray RM (2001) Incidence of schizophrenia in ethnic minorities in London: ecological study into interactions with environment. BMJ 323:1–4
Brugha T, Bebbington P, Tennant C, Hurry J (1985) The List of Threatening Experiences: a subset of 12 life event categories with considerable long-term contextual threat. Psychol Med 15:189–194
Brugha T, Conroy R, Walsh N, Delaney W, O’Hanlon J, Dondero E, Daly L, Hickey N, Bourke G (1982) Social networks, attachments and support in minor affective disorders: a replication. Br J Psychiatry 141:249–255
Brugha TS, Bebbington P, Jenkins R, Meltzer H, Taub NA, Janas M,Vernon J (1999) Cross validation of a household population survey diagnostic interview: a comparison of CIS-R with SCAN ICD-10 diagnostic categories. Psychol Med 29:1029–1042
Brugha TS, Sturt E, MacCarthy B, Potter J, Wykes T, Bebbington PE (1987) The Interview Measure of Social Relationships: the description and evaluation of a survey instrument for assessing personal social resources. Soc Psychiatry 22:123–128
Brugha TS, Wing JK, Brewin CR, MacCarthy B, Lesage A (1993) The relationship of social network deficits with deficits in social functioning in long-term psychiatric disorders. Soc Psychiatry Psychiatr Epidemiol 28:218–224
Cannon M, Jones P (1996) Schizophrenia. J Neurol Neurosurg Psychiatry 60:604–613
Cochrane R, Stopes-Roe M (1981) Psychological symptom levels in Indian immigrants to England–a comparison with native English. Psychol Med 11:319–327
Commander MJ, Cochrane R, Sashidharan SP, Akilu F, Wildsmith E (1999) Mental health care for Asian, black and white patients with non-affective psychoses: pathways to the psychiatric hospital, in-patient and after-care. Soc Psychiatry Psychiatr Epidemiol 34:484–491
Cox BD, Blaxter M, Buckle ALJ, Fenner NP, Golding JF, Gore M, Huppert FA, Nickson J, Roth M, Stark J, Wadsworth MEJ, Wichelow M (1987) The Health and Lifestyle Survey. Health Promotion Research Trust
Der G, Glover G, Brugha TS, Wing JK (1998) SCAN version 1: algorithms and CAPSE 10.1. In: Wing JK, Sartorius N, Ustün TB (eds) Diagnosis and Clinical Measurement in Psychiatry. A Reference Manual for SCAN/PSE-10. Cambridge University Press: Cambridge, pp 110–115
Farrell M, Howes S, Taylor C, Lewis G, Jenkins R, Bebbington P, Jarvis M, Brugha T, Gill B, Meltzer H (1998) Substance misuse and psychiatric comorbidity: an overview of the OPCS national psychiatric morbidity survey. Addictive Behaviors 23:909–918
Gilvarry CM, Walsh E, Samele C, Hutchinson G, Mallett R, Rabe-Hesketh S, Fahy T, van Os J,Murray RM (1999) Life events, ethnicity and perceptions of discrimination in patients with severe mental illness. Soc Psychiatry Psychiatr Epidemiol 34:600–608
Glover G (1993) Sex ratio errors in census data. BMJ Clin Res Ed 307:506
Harrison G, Owens D, Holton A, Neilson D, Boot D (1988) A prospective study of severe mental disorder in Afro-Caribbean patients. Psychol Med 18:643–657
Henderson S, Duncan Jones P, McAuley H, Ritchie K (1978) The patient’s primary group. Br J Psychiatry 132:1–86
Hutchinson G, Takei N, Fahy TA, Bhugra D, Gilvarry C, Moran P, Mallett R, Sham P, Leff J, Murray RM (1996) Morbid risk of schizophrenia in first-degree relatives of white and African-Caribbean patients with psychosis. Br J Psychiatry 169:776–780
Jenkins R, Bebbington P, Brugha T, Farrell M, Gill B, Lewis G, Meltzer H, Petticrew M (1997a) The national psychiatric morbidity surveys of Great Britain–strategy and methods. Psychol Med 27:765–774
Jenkins R, Lewis G, Bebbington P, Brugha T, Farrell M, Gill B, Meltzer H (1997b) The national psychiatric morbidity surveys of great Britain–initial findings from the household survey. Psychol Med 27:775–789
Jones P, Rodgers B, Murray R, Marmot M (1994) Child developmental risk factors for adult schizophrenia in the British 1946 birth cohort. Lancet 344:1398–1402
Jones PB, Bebbington P, Foerster A, Lewis SW, Murray RM, Russell A, Sham PC, Toone BK, Wilkins S (1993) Premorbid social underachievement in schizophrenia. Results from the Camberwell Collaborative Psychosis Study. Br J Psychiatry 162:65–71
King M, Coker E, Leavey G, Hoare A, Johnson-Sabine E (1994) Incidence of psychotic illness in London: comparison of ethnic groups (see comments). BMJ Clin Res Ed. 309:1115–1119
Kish L (1965) Survey Sampling. John Wiley and Sons Ltd: London
Lewis G, Bebbington P, Brugha T, Farrell M, Gill B, Jenkins R, Meltzer H (1998) Socioeconomic status, standard of living and neurotic disorder. Lancet 352:605–608
Lewis G, Pelosi AJ, Araya R, Dunn G (1992) Measuring psychiatric disorder in the community: a standardized assessment for use by lay interviewers. Psychol Med 22:465–486
Littlewood R (1997) Forward. In: Nazroo JY (ed) Ethnicity and Mental Health: findings from a National Community Survey. Policy Studies Institute: London, pp vii-viii
Mahy GE, Mallett R, Leff J, Bhugra D (1999) First-contact incidence rate of schizophrenia on Barbados. Br J Psychiatry 175:28–33
McKenzie K, Whitley R, Weich S (2002) Social capital and mental health. Br J Psychiatry 181:280–283
Meltzer H, Gill B, Petticrew M, Hinds K (1995a) Editor: Office of Population Censuses and Surveys Social Survey Division. OPCS Surveys of Psychiatric Morbidity in Great Britain. Report 1: The prevalence of psychiatric morbidity among adults living in private households. HMSO. 174 p. OPCS Surveys of Psychiatric Morbidity in Great Britain. Her Majesty’s Stationary Office
Meltzer H, Gill B, Petticrew M, Hinds K (1995b) Editor: Office of Population Censuses and Surveys Social Survey Division. OPCS Surveys of Psychiatric Morbidity in Great Britain. Report 2: Physical complaints, service use and treatment of adults with psychiatric disorder. HMSO. 174 p. OPCS Surveys of Psychiatric Morbidity in Great Britain. Her Majesty’s Stationary Office
Meltzer H, Gill B, Petticrew M, Hinds K (1995c) Editor: Office of Population Censuses and Surveys Social Survey Division. OPCS Surveys of Psychiatric Morbidity in Great Britain. Report 3: Economic activity and social functioning of adults with psychiatric disorders. HMSO. 168 p. OPCS Surveys of Psychiatric Morbidity in Great Britain. HMSO
Modood T, Berthoud R, Lakey J, Nazroo JY, Smith P, Virdee S, Beishon S (1996) Ethnic Minorities in Great Britain: Diversity and Disadvantage. Policy Studies Institute: London
Nazroo JY (1997) Ethnicity and Mental Health: findings from a National Community Survey. Policy Studies Institute: London
Paykel ES, Abbott RD, Jenkins R, Brugha T, Meltzer H (2000) Urban-rural mental health differences in Great Britain: findings from the National Morbidity Survey. Psychol Med 30:269–280
Power C, Matthews S (1997) Origins of health inequalities in a national population sample. Lancet 350:1584–1589
Robins LN, Wing J, Wittchen HU, Helzer JE, Babor TF, Burke J, Farmer A, Jablensky A, Pickens R, Regier DA, Sartorius N, Towle MS (1988) The Composite International Diagnostic Interview. An epidemiologic Instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Arch Gen Psychiatry 45:1069–1077
Sashidharan SP, Francis E (1999) Racism in psychiatry necessitates reappraisal of general procedures and Eurocentric theories (letter). BMJ Clin Res Ed. 319:254
Selten JP, Veen N, Feller W, Blom JD, Schols D, Camoenie W, Oolders J, van der Welden M, Hoek HW, Riverro VM, van der Graph Y, Kahn R (2001) Incidence of psychotic disorders in immigrant groups to The Netherlands. Br J Psychiatry 178:367–372
Singleton N, Bumpstead R, O’Brien M, Lee A, Meltzer H (2001) Editor: National Statistics. Psychiatric Morbidity Among Adults Living in Private Households. The Stationary Office, p 154
Sproston K, Nazroo JY (2002) Ethnic Minority Psychiatric Illness Rates in the Community (EMPIRIC)—Quantitative Report. The Stationary Office, p 210
Stata Statistical Software, Release 6.0. STATA Corp. 1999
Takei N, Persaud R, Woodruff P, Brockington I, Murray RM (1998) First episodes of psychosis in Afro-Caribbean and White people. An 18-year follow-up population-based study. Br J Psychiatry 172:147–153
Tarrant CJ, Jones PB (1999) Precursors to schizophrenia: do biological markers have specificity? Can J Psychiatry 44:335–349
Ustün TB, Harrison GL, Chatterji S (1998) Training in the Use of SCAN. In: Wing JK, Sartorius N, Ustün TB (eds) Diagnosis and Clinical Measurement in Psychiatry. A Reference Manual for SCAN/PSE-10. Cambridge University Press: Cambridge, pp 68–85
Wilson PR, Elliot DJ (1987) An evaluation of the Postcode Address File as a sampling frame and its use within OPCS. Journal of the Royal Statistical Society Series A (General) 150:230–240
Wing JK, Babor T, Brugha T, Burke J, Cooper JE, Giel R, Jablensky A, Regier D, Sartorius N (1990) SCAN. Schedules for Clinical Assessment in Neuropsychiatry. Arch Gen Psychiatry 47:589–593
World Health Organization (1993) The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. WHO: Geneva
Zolkowska K, Cantor-Graae E, McNeil TF (2003) Increased rates of psychosis among immigrants to Sweden: is migration a risk factor for psychosis? Psychol Med 31:669–678
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Brugha, T., Jenkins, R., Bebbington, P. et al. Risk factors and the prevalence of neurosis and psychosis in ethnic groups in Great Britain. Soc Psychiatry Psychiatr Epidemiol 39, 939–946 (2004). https://doi.org/10.1007/s00127-004-0830-9
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s00127-004-0830-9