The effect of ethnicity and gender on first-contact rates for schizophrenia-like psychosis in Bangladeshi, Black and White elders in Tower Hamlets, London.

Abstract

A recent study of very-late onset schizophrenia-like psychosis (SLP) in South London showed an increase in first contact rates amongst African- and Caribbean-born elders compared to British-born ones. This study investigates incident first contact rates in an area of East London with a high Bangladeshi population, to investigate if Bangladeshi-born elders also have an increased referral rate for SLP. Retrospective case note review of first contacts to the old age psychiatry service from 1997 to 2002 identifying cases of schizophrenia-like psychosis. In addition, a one-year review of first contacts for all diagnostic categories was completed. Gender, ethnicity and place of birth were established from the case notes. Among the African- and Caribbean-born, but not the Bangladeshi-born, the odds ratio (OR) of being referred with SLP was significantly higher than for the British-born population. We observed a loss of the reported effect of female gender. For Whites the odds ratio for female gender and psychosis was 2.5 (1.0-6.1) and for non-Whites 0.8 (0.3-2.7) which was a trend away from the expected male to female ratio. In the one-year review there was a higher rate of referrals for organic disease in Bangladeshi men compared to Bangladeshi women and British-born men and women. Bangladeshi elderly migrants do not have an increased rate of SLP compared to indigenous elders. The usual female preponderance of SLP is not apparent in this elderly migrant population. Old age psychiatry services in the UK should take into account the increasing needs of Bangladeshi elders with dementia.