Black Caribbean Origin Research Articles

The role of ethnicity in pathways to emergency psychiatric services for clients with psychosis

BackgroundThis study investigates the role of ethnicity in pathways to emergency mental health care in Toronto for clients with psychosis, while taking into account neighborhood factors. Previous literature has focused on Afro-Caribbean clients, reporting an increased risk of accessing mental health care through negative pathways.MethodsA retrospective chart review for clients from 6 different ethnic origin groups presenting with psychosis – East Asian, South Asian, Black African, Black Caribbean, White European, and White North American – was undertaken in a psychiatric emergency department (ED). Logistic regression models were constructed to examine the relationship between pathways to care (involuntary detention under the Mental Health Act (MHA), police or ambulance referral, accompaniment by family or friends) with individual and neighbourhood factors.ResultsA total of 765 clients were included in the study. East Asian (OR =2.36, p < 0.01) and South Asian (OR 2.99, p < 0.01) origin clients have increased odds of presenting to the ED while involuntarily detained under the MHA. Involuntary status under the MHA increased the odds of presenting via police or ambulance (OR 8.27, p < 0.001). East Asian origin clients have increased odds of presenting to the ED by police or ambulance (OR =2.10, p < 0.05). Clients from neighbourhoods with higher levels of residential instability have increased odds of presenting by police or ambulance (OR =1.35, p < 0.01), while clients from neighbourhoods with higher levels of ethnic concentration have increased odds of being accompanied to the ED by family or friends (OR =1.33, p < 0.01).ConclusionIn contrast to previous studies, East Asian and South Asian origin clients with psychosis have increased odds of a coercive pathway to emergency psychiatric services in Toronto. Black African and Black Caribbean origin clients do not have increased odds of a coercive pathway. Clients living in areas with high levels of residential instability are more likely to encounter a negative pathway. Ethnic concentration may be a supportive factor in family and friend accompaniment.

Ethnic minority membership and depression in the UK and America

PurposeThe purpose of this paper is to discuss two recent studies on depression in members of ethnic minorities, one based in the UK with older people, and one in the USA. The aim was to examine what might lead to depression in these groups, and what might protect people from it.Design/methodology/approachThe UK-based study examined depression and physical health in older members of the two largest ethnic minority groups in the UK: African Caribbean and South Asian. The US-based study examined whether a sense of belonging to the population group African Americans protected people from depression, as one social theory might predict, or whether racism prevented this protection, as predicted by another theory.FindingsIn London-based older South Asians, depression was explained by their poorer physical health compared to white Europeans. In older people of black Caribbean origin, depression was linked to their social disadvantage. The researchers did not measure people’s experience of discrimination, and other research suggests this can explain both physical illness and depression. The US-based study reported better well-being for people who identified with other African Americans, but not if they also felt negative about African Americans. However, these were weak links, so other things may affect well-being more, such as day-to-day relationships and a range of group memberships.Originality/valueThe London-based study was new in studying depression in older people belonging to the two largest ethnic minority groups in the UK and in white Europeans. The US study tested two competing social theories with different predictions about depression in relation to belonging to an ethnic minority. Both studies highlight the need for more research on discrimination and how to reduce it and its negative effects on both mental and physical health.

Symptom profiles and explanatory models of first‐episode psychosis in African‐, Caribbean‐ and European‐origin groups in Ontario

To assess variability in symptom presentation and explanatory models of psychosis for people from different ethnic groups. Clients with first-episode psychosis (n = 171) who identified as black African, black Caribbean or white European were recruited from early intervention programmes in Toronto and Hamilton. We compared results by ethnic group for symptom profiles and explanatory models of illness. Clients of black Caribbean origin had a lower odds of reporting that they were speaking incomprehensibly (OR = 0.36; 95% CI: 0.14-0.90) and black African clients had a greater odds of reporting persistent aches or pains (OR = 2.92; 95% CI: 1.32-6.50). Black African clients had a lower odds of attributing the cause of psychosis to hereditary factors (OR = 0.41; 95% CI: 0.19-0.89) or to substance abuse (OR = 0.29; 95% CI: 0.13-0.67) and had a lower odds of assigning responsibility for their illness to themselves (OR = 0.41; 95% CI: 0.19-0.89). Understanding the differences in illness models for ethnic minority groups may help improve the cultural competence of mental health services.

Why are you cast down, o my soul? Exploring intersections of ethnicity, gender, depression, spirituality and implications for Black British Caribbean women’s mental health

Ethnic disparities in UK mental healthcare persist despite decades of policy and practice initiatives to eradicate them. Inequalities in access, care and outcomes are most evident among people of Black Caribbean origin. However, much of this evidence is derived from clinical practice and research among men with serious mental illness. Lack of evidence about common mental health issues in Black British Caribbean women is an important omission as reducing inequalities in mental healthcare and providing effective interventions require improved understanding of aetiology, epidemiology, symptom profile and ways of coping. In this paper, I explore the conundrum of apparently low levels of perinatal depression among Black British Caribbean women despite significant levels of psychosocial risk and against the backdrop of high prevalence of diagnosed mental illness among Black British Caribbean men. I posit that the intersections of ethnicity, gender and spirituality might provide at least a partial explanation for apparent underdiagnosis in this group of women. Understanding Black British Caribbean women’s mental health needs, coping styles, help-seeking strategies and their relationship with formal systems of care has important ramifications for research, policy and practice aimed at reducing mental health disparities in the context of the UK’s equity-based healthcare system.

African and Black Caribbean origin cancer survivors: a qualitative study of the narratives of causes, coping and care experiences

Objectives. Although there is evidence in the USA and UK to suggest that ethnic minority groups have an inferior experience of cancer care, few studies investigate ethnic disparities in satisfaction and care experiences among survivors. Patients’ illness perceptions (lay explanations for illness) and coping styles (emotional and behavioural) are influenced by ethnicity-related cultural beliefs and expectations. Depressive illness or fears of recurrence of cancer may also lead to poorer recovery and function. This paper investigates whether ethnic influences explain different coping behaviours, care experiences and help-seeking behaviours. Design. Eight participants of African or Black Caribbean origin were recruited from a London support group for a series of qualitative in-depth interviews. The interviews were recorded and transcribed, and the transcripts analysed using a framework method of qualitative data analysis. The emergent themes were tested and documented to reflect the issues of importance to patients. Results. Lay explanations of causes of cancer were complex and diverse reflecting cultural influences and the impact of contact with health professionals. Generally, positive views about cancer care were found, especially at the secondary care level. Primary care attracted mixed views. In contrast to American studies, no acknowledgement of discrimination on the basis of ethnicity was reported. The need to be resilient and think positively were widely acknowledged as coping strategies. Some coped by avoiding contemplation of their condition or diagnosis. Religious beliefs and practices provided coping mechanisms for some, and a means to improve confidence and avoid distressing contemplation about their condition. Family, friends and charitable groups also provided emotional and practical support. Conclusions. Subjects were generally satisfied with their care; different coping styles included positive attitudes, minimisation of difficulties or more realistic consideration of the impact of cancer.

Rates and Risk Factors by Ethnic Group for Suicides Within a Year of Contact With Mental Health Services in England and Wales

This study compared suicide rates, clinical symptoms, and perceived preventability of suicide among persons in four ethnic groups who completed suicide within 12 months of contact with mental health services. The rates and standardized mortality ratios (SMRs) of suicide following contact with mental health services were calculated by using national suicide data from 1996 to 2001 for the four largest ethnic groups in England and Wales: black Caribbean, black African, South Asian (Indian, Pakistani, and Bangladeshi), and white. The study also investigated whether clinical indices of risk show ethnic variations. A total of 8,029 suicides in the four ethnic groups were investigated. Overall, compared with the SMRs for their white counterparts, low SMRs were found for South-Asian men and women (SMR=.5, 95% confidence interval [CI]=.4-.6 for South-Asian men and SMR=.7, CI=.5-.9 for South-Asian women). High SMRs were found for black Caribbean and black African men aged 13-24 (SMR=2.9, CI=1.4-5.3 for black Caribbean men and SMR=2.5, CI=1.1-4.8 for black African men). High SMRs were found for young women aged 25-39 of South-Asian origin (SMR=2.8, CI=1.9-3.9), black Caribbean origin (SMR=2.7, CI=1.3-4.8), and black African origin (SMR=3.2, CI=1.6-5.7). Some widely accepted suicide risk indicators were less common in the ethnic minority groups than in the white group. There were more symptoms of active psychosis for people from ethnic minority groups who later committed suicide, and perceived preventability was highest among black Caribbean people. Rates and SMRs varied across ethnic groups. Specific preventive actions must take account of the ethnic variations of clinical indices of risk and include more effective treatment of psychosis.

Inner London collaborative audit of admissions in two health districts. II: Ethnicity and the use of the Mental Health Act.

Twenty-six per cent of patients in two Inner London districts were admitted to acute wards under the provisions of the Mental Health Act. Compared with those not under compulsion, they were young, male, more likely to be of black Caribbean origin, and to have a diagnosis of schizophrenia of short duration. The hypothesis is tested that ethnicity determines rates of compulsory admission independently of the other factors. Sampling and data collection methods were described in the first paper. Statistical analyses included a log-linear analysis of six key variables: compulsory admission, challenging behaviour, diagnosis, ethnicity, age, and sex. There were no substantial differences between districts. Analysis provided two similar statistical models. In both, admission under the Act was strongly associated with challenging behaviour and diagnosis of schizophrenia. In the model of best fit there was no significant interaction term for ethnicity and compulsion. In the second model there was a weak association. Ethnicity did not appear to be of outstanding importance in decisions to use the Mental Health Act. There was a strong link between ethnicity and diagnosis, independent of compulsion. Differences between the districts made no major contribution to the rates of compulsory admission.