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Ethnic disparities in psychotic experiences explained by area-level syndemic effects

  • Jeremy Coid (a1), Rafael Gonzalez Rodriguez (a2), Constantinos Kallis (a3), Yamin Zhang (a4), Kamaldeep Bhui (a5), Bianca De Stavola (a6), Paul Bebbington (a7) and Simone Ullrich (a8)...

Abstract

Background

Ethnic inequalities in health outcomes are often explained by socioeconomic status and concentrated poverty. However, ethnic disparities in psychotic experiences are not completely attenuated by these factors.

Aims

We investigated whether disparities are better explained by interactions between individual risk factors and place-based clustering of disadvantage, termed a syndemic.

Method

We performed a cross-sectional survey of 3750 UK men, aged 18–34 years, oversampling Black and minority ethnic (BME) men nationally, together with men residing in London Borough of Hackney. Participants completed questionnaires covering psychiatric symptoms, substance misuse, crime and violence, and risky sexual health behaviours. We included five psychotic experiences and a categorical measure of psychosis based on the Psychosis Screening Questionnaire.

Results

At national level, more Black men reported psychotic experiences but disparities disappeared following statistical adjustment for social position. However, large disparities for psychotic experiences in Hackney were not attenuated by adjustment for social factors in Black men (adjusted odds ratio, 3.24; 95% CI 2.14–4.91; P < 0.002), but were for South Asian men. A syndemic model of joint effects, adducing a four-component latent variable (psychotic experiences and anxiety, substance dependence, high-risk sexual behaviour and violence and criminality) showed synergy between components and explained persistent disparities in psychotic experiences. A further interaction confirmed area-level effects (Black ethnicity × Hackney residence, 0.834; P < 0.001).

Conclusions

Syndemic effects result in higher rates of non-affective psychosis among BME persons in certain inner-urban settings. Further research should investigate how syndemics raise levels of psychotic experiences and related health conditions in Black men in specific places with multiple deprivations.

Declaration of interest

K.B. is Editor in Chief of the British Journal of Psychiatry but played no part in the review and decision process.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Correspondence: Professor Jeremy Coid, Mental Health Center, West China Hospital of Sichuan University, No. 28 Dianxin South Street, Chengdu, Sichuan 610041, China. Email: j.w.coid@qmul.ac.uk

References

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Ethnic disparities in psychotic experiences explained by area-level syndemic effects

  • Jeremy Coid (a1), Rafael Gonzalez Rodriguez (a2), Constantinos Kallis (a3), Yamin Zhang (a4), Kamaldeep Bhui (a5), Bianca De Stavola (a6), Paul Bebbington (a7) and Simone Ullrich (a8)...

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Ethnic disparities in psychotic experiences explained by area-level syndemic effects

  • Jeremy Coid (a1), Rafael Gonzalez Rodriguez (a2), Constantinos Kallis (a3), Yamin Zhang (a4), Kamaldeep Bhui (a5), Bianca De Stavola (a6), Paul Bebbington (a7) and Simone Ullrich (a8)...
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