Abstract
BackgroundEthnic minority service users with schizophrenia and schizoaffective disorders may experience inequalities in care. There have been no recent studies assessing access to evidence-based treatments for psychosis amongst the main ethnic minority groups in the UK.MethodsData from nationally representative surveys from England and Wales, for 10,512 people with a clinical diagnosis of schizophrenia or schizoaffective disorders, were used for analyses. Multi-level multivariable logistic regression analyses were used to assess ethnic minority inequalities in access to pharmacological treatments, psychological interventions, shared decision making and care planning, taking into account a range of potential confounders.ResultsCompared with white service users, black service users were more likely prescribed depot/injectable antipsychotics (odds ratio 1.56 (95% confidence interval 1.33–1.84)). Black service users with treatment resistance were less likely to be prescribed clozapine (odds ratio 0.56 (95% confidence interval 0.39–0.79)). All ethnic minority service users, except those of mixed ethnicity, were less likely to be offered cognitive behavioural therapy, compared to white service users. Black service users were less likely to have been offered family therapy, and Asian service users were less likely to have received copies of care plans (odds ratio 0.50 (95% confidence interval 0.33–0.76)), compared to white service users. There were no clinician-reported differences in shared decision making across each of the ethnic minority groups.ConclusionRelative to white service users, ethnic minority service users with psychosis were generally less likely to be offered a range of evidence-based treatments for psychosis, which included pharmacological and psychological interventions as well as involvement in care planning.
Highlights
Ethnic minority service users with schizophrenia and schizoaffective disorders may experience inequalities in care
It is possible that inequalities in treatments may be a concern for other ethnic minority groups as well
Ethnic minority service users within the sample were younger than white service users, with a similar sex profile
Summary
Ethnic minority service users with schizophrenia and schizoaffective disorders may experience inequalities in care. There have been no recent studies assessing access to evidence-based treatments for psychosis amongst the main ethnic minority groups in the UK. It is well documented that ethnic minority groups, and in particular black people with psychosis, are more likely to experience complex [1] and coercive pathways into care [1, 4]. A recent systematic review of studies, mostly from the USA, suggested that ethnic minority groups were more likely to be prescribed typical antipsychotics over atypical antipsychotics [5]. Evidence from the UK has not indicated differences in prescribing quality by ethnicity; these studies have been based on inpatient populations, with relatively small numbers and have only assessed differences between black and white patients [6, 7]. It is possible that inequalities in treatments may be a concern for other ethnic minority groups as well
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