Abstract
BackgroundStudies demonstrate ethnic variations in pathways to care during first episode psychosis (FEP). There are no extant studies, however, that have statistically examined the influence of culturally mediated illness attributions on these variations.MethodsWe conducted an observational study of 123 (45 White; 35 Black; 43 Asian) patients recruited over a two-year period from an Early Intervention Service (EIS) in Birmingham, UK. Sociodemographic factors (age; sex; education; country of birth; religious practice; marital status; living alone), duration of untreated psychosis (DUP), service contacts (general practitioner; emergency services; faith-based; compulsory detention; criminal justice) and illness attributions (“individual;” “natural;” “social;” “supernatural;” “no attribution”) were assessed.ResultsEthnic groups did not differ in DUP (p = 0.86). Asian patients were more likely to report supernatural illness attributions in comparison to White (Odds Ratio: 4.02; 95 % Confidence Intervals: 1.52, 10.62) and Black (OR: 3.48; 95 % CI: 1.25, 9.67) patients. In logistic regressions controlling for confounders and illness attributions, Black (OR: 14.00; 95 % CI: 1.30, 151.11) and Asian (OR: 13.29; 95 % CI: 1.26, 140.47) patients were more likely to consult faith-based institutions than White patients. Black patients were more likely to be compulsorily detained than White patients (OR: 4.56; 95 % CI: 1.40, 14.85).ConclusionIllness attributions and sociodemographic confounders do not fully explain the ethnic tendency to seek out faith-based institutions. While Asian and Black patients are more likely to seek help from faith-based organisations, this does not appear to lead to a delay in contact with mental health services.
Highlights
Studies demonstrate ethnic variations in pathways to care during first episode psychosis (FEP)
Studies examining ethnic variations in illness attributions and subsequent help seeking in early psychosis are sparse, and to the best of our knowledge there are no studies with FEP populations in the UK
In a quantitative study with chronic schizophrenia patients, McCabe and Priebe [6] found that White patients were significantly more likely to attribute their symptoms to biological causes than non-white (i.e., Bangladeshis, African-Caribbeans and West Africans) patients, who were significantly more likely to cite supernatural causes
Summary
Studies demonstrate ethnic variations in pathways to care during first episode psychosis (FEP). There are no extant studies, that have statistically examined the influence of culturally mediated illness attributions on these variations. A clear understanding of the pathways to care during first episode psychosis (FEP) is especially important as initial experiences and interactions may have lasting impact on subsequent help-seeking, service engagement and adherence to treatment. Studies examining ethnic variations in illness attributions and subsequent help seeking in early psychosis are sparse, and to the best of our knowledge there are no studies with FEP populations in the UK. As this study did not adjust for relevant confounders (e.g., religion; education; country of birth), it is difficult to draw conclusions regarding the independent effects of ethnicity and culturally mediated illness models on service experience
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