Skip to main content
×
×
Home

Psychoses, ethnicity and socio-economic status

  • J. B. Kirkbride (a1), D. Barker (a2), F. Cowden (a2), R. Stamps (a2), M. Yang (a2), P. B. Jones (a1) and J. W. Coid (a2)...
Abstract
Background

Consistent observation of raised rates of psychoses among Black and minority ethnic (BME) groups may possibly be explained by their lower socio-economic status

Aims

To test whether risk for psychoses remained elevated in BME populations compared with the White British, after adjustment for age, gender and current socio-economic status

Method

Population-based study of first-episode DSM–IV psychotic disorders, in individuals aged 18–64 years, in East London over 2 years

Results

All BME groups had elevated rates of a psychotic disorder after adjustment for age, gender and socio-economic status. For schizophrenia, risk was elevated for people of Black Caribbean (incidence rate ratios (IRR)=3.1, 95% CI 2.1–4.5) and Black African (IRR=2.6, 95% CI 1.8–3.8) origin, and for Pakistani (IRR=3.1, 95% CI 1.2–8.1) and Bangladeshi (IRR=2.3, 95% CI 1.1–4.7) women. Mixed White and Black Caribbean (IRR=7.7, 95% CI 3.2–18.8) and White Other (IRR=2.1, 95% CI 1.2–3.8) groups had elevated rates of affective psychoses (and other non-affective psychoses)

Conclusions

Elevated rates of psychoses in BME groups could not be explained by socio-economic status, even though current socio-economic status may have overestimated the effect of this confounder given potential misclassification as a result of downward social drift in the prodromal phase of psychosis. Our findings extended to all BME groups and psychotic disorders, though heterogeneity remains

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Psychoses, ethnicity and socio-economic status
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Psychoses, ethnicity and socio-economic status
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Psychoses, ethnicity and socio-economic status
      Available formats
      ×
Copyright
Corresponding author
J. B. Kirkbride, Box 189, University Department of Psychiatry, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, UK. Email: jbk25@cam.ac.uk
Footnotes
Hide All

Declaration of interest

None.

Funding detailed in Acknowledgements.

Footnotes
References
Hide All
1 Kirkbride, JB, Fearon, P, Morgan, C, Dazzan, P, Morgan, K, Tarrant, J, Lloyd, T, Holloway, J, Hutchinson, G, Leff, JP, Mallett, RM, Harrison, GL, Murray, RM, Jones, PB. Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes: findings from the 3-center ÆSOP Study. Arch Gen Psychiatry 2006; 63: 250–8.
2 Odegaard, O. Emigration and insanity. Acta Psychiatr Neurol 1932 (suppl 4): 1206.
3 Cantor-Graae, E, Selten, J-P. Schizophrenia and migration: a meta-analysis and review. Am J Psychiatry 2005; 162: 1224.
4 Harrison, G, Owens, D, Holton, A, Neilson, D, Boot, D. A prospective study of severe mental disorder in Afro-Caribbean patients. Psychol Med 1988; 18: 643–57.
5 Fearon, P, Kirkbride, JB, Morgan, C, Dazzan, P, Morgan, K, Lloyd, T, Hutchinson, G, Tarrant, J, Fung, WL, Holloway, J, Mallett, R, Harrison, G, Leff, J, Jones, PB, Murray, RM. Incidence of schizophrenia and other psychoses in ethnic minority groups: results from the MRC AESOP Study. Psychol Med 2006; 36: 1541–50.
6 Singh, SP, Burns, T. Race and mental health: there is more to race than racism. BMJ 2006; 333: 648–51.
7 Bhugra, D, Leff, J, Mallett, R, Der, G, Corridan, B, Rudge, S. Incidence and outcome of schizophrenia in Whites, African-Caribbeans and Asians in London. Psychol Med 1997; 27: 791–8.
8 King, M, Coker, E, Leavey, G, Hoare, A, Johnson-Sabine, E. Incidence of psychotic illness in London: comparison of ethnic groups. BMJ 1994; 309: 1115–9.
9 Sharpley, M, Hutchinson, G, McKenzie, K, Murray, RM. Understanding the excess of psychosis among the African-Caribbean population in England. Review of current hypotheses. Br J Psychiatry 2001; 178 (suppl 40): s608.
10 Cooper, B. Immigration and schizophrenia: the social causation hypothesis revisited. Br J Psychiatry 2005; 186: 361–3.
11 National Institute for Mental Health in England. Inside Outside: Improving Mental Health Services for Black and Minority Ethnic Communities in England. Department of Health, 2003.
12 Jablensky, A, Sartorius, N, Ernberg, G, Anker, M, Korten, A, Cooper, JE, Day, R, Bertelsen, A. Schizophrenia: manifestations, incidence and course in different cultures. A World Health Organization ten-country study. Psychol Med Monogr Suppl 1992; 20: 197.
13 World Health Organization. Schedule for Clinical Assessment in Neuropsychiatry. WHO, 1992.
14 American Psychiatric Assocation. Diagnostic and Statistical Manual of Mental Disorder (4th edn) (DSM–IV). APA, 1994.
15 Office for National Statistics. The National Statistics Socio-economic Classification User Manual. 2005 (http://www.statistics.gov.uk/methods_quality/ns_sec/).
16 Jones, PB, Bebbington, P, Foerster, A, Lewis, SW, Murray, RM, Russell, A, Sham, PC, Toone, BK, Wilkins, S. Premorbid social underachievement in schizophrenia. Results from the Camberwell Collaborative Psychosis Study. Br J Psychiatry 1993; 162: 6571.
17 Byrne, M, Agerbo, E, Eaton, WW, Mortensen, PB. Parental socio-economic status and risk of first admission with schizophrenia – a Danish national register based study. Soc Psychiatry Psychiatr Epidemiol 2004; 39: 8796.
18 Goldberg, EM, Morrison, SL. Schizophrenia and social class. Br J Psychiatry 1963; 109: 785802.
19 Bhopal, RS, Phillimore, P, Kohli, HS. Inappropriate use of the term ‘Asian’: an obstacle to ethnicity and health research. J Public Health Med 1991; 13: 244–6.
20 Leao, TS, Sundquist, J, Frank, G, Johansson, LM, Johansson, SE, Sundquist, K. Incidence of schizophrenia or other psychoses in first- and second-generation immigrants: a national cohort study. J Nerv Ment Dis 2006; 194: 2733.
21 Cantor-Graae, E, Pedersen, CB, McNeil, TF, Mortensen, PB. Migration as a risk factor for schizophrenia: a Danish population-based cohort study. Br J Psychiatry 2003; 182: 117–22.
22 Fearon, P, Morgan, C. Environmental factors in schizophrenia: the role of migrant studies. Schizophr Bull 2006; 32: 405–8.
23 Bhugra, D, Hilwig, M, Hossein, B, Marceau, H, Neehall, J, Leff, J, Mallett, R, Der, G. First-contact incidence rates of schizophrenia in Trinidad and one-year follow-up. Br J Psychiatry 1996; 169: 587–92.
24 Hickling, FW, Rodgers-Johnson, P. The incidence of first contact schizophrenia in Jamaica. Br J Psychiatry 1995; 167: 193–6.
25 Mahy, GE, Mallett, R, Leff, J, Bhugra, D. First-contact incidence rate of schizophrenia on Barbados. Br J Psychiatry 1999; 175: 2833.
26 Harrison, G, Brewin, J, Cantwell, R, Dalkin, T, Fox, R, Medley, I, Walder, C. The increased risk of psychosis in African-Caribbean migrants to the UK: a replication. Schizophr Res 1996; 18: 102.
27 Veling, W, Selten, JP, Veen, N, Laan, W, Blom, JD, Hoek, HW. Incidence of schizophrenia among ethnic minorities in the Netherlands: a four-year first-contact study. Schizophr Res 2006; 86: 189–93.
28 Lundberg, P, Cantor-Graae, E, Kahima, M, Ostergren, PO. Delusional ideation and manic symptoms in potential future emigrants in Uganda. Psychol Med 2007; 37: 505–12.
29 Hjern, A, Wicks, S, Dalman, C. Social adversity contributes to high morbidity in psychoses in immigrants – a national cohort study of two generations of Swedish residents. Psychol Med 2004; 34: 1025–33.
30 Morgan, C, Kirkbride, JB, Leff, J, Craig, T, Hutchinson, G, McKenzie, K, Morgan, K, Dazzan, P, Doody, GA, Jones, P, Murray, R, Fearon, P. Parental separation, loss and psychosis in different ethnic groups: a case-control study. Psychol Med 2007; 37: 495503.
31 Kirkbride, JB, Morgan, C, Fearon, P, Dazzan, P, Murray, RM, Jones, PB. Neighbourhood-level effects on psychoses: re-examining the role of context. Psychol Med 2007; 37: 1413–25.
32 Silver, E, Mulvey, EP, Swanson, JW. Neighborhood structural characteristics and mental disorder: Faris and Dunham revisited. Soc Sci Med 2002; 55: 1457–70.
33 Veling, W, Selten, J-P, Susser, E, Laan, W, Mackenbach, JP, Hoek, HW. Discrimination and the incidence of psychotic disorders among ethnic minorities in The Netherlands. Int J Epidemiol 2007; 36: 761–8.
34 Zubin, J, Spring, B. Vulnerability – a new view of schizophrenia. J Abnorm Psychol 1977; 86: 103–26.
35 Selten, JP, Cantor-Graae, E. Social defeat: risk factor for schizophrenia? Br J Psychiatry 2005; 187: 101–2.
36 Garety, PA, Kuipers, E, Fowler, D, Freeman, D, Bebbington, PE. A cognitive model of the positive symptoms of psychosis. Psychol Med 2001; 31: 189–95.
37 Weiser, M, van Os, J, Reichenberg, A, Rabinowitz, J, Nahon, D, Kravitz, E, Lubin, G, Shmushkevitz, M, Knobler, HY, Noy, S, Davidson, M. Social and cognitive functioning, urbanicity and risk for schizophrenia. Br J Psychiatry 2007; 191: 320–4.
38 Boydell, J, van Os, J, McKenzie, K, Allardyce, J, Goel, R, McCreadie, RG, Murray, RM. Incidence of schizophrenia in ethnic minorities in London: ecological study into interactions with environment. BMJ 2001; 323: 1336–8.
39 Allardyce, J, Gilmour, H, Atkinson, J, Rapson, T, Bishop, J, McCreadie, RG. Social fragmentation, deprivation and urbanicity: relation to first-admission rates for psychoses. Br J Psychiatry 2005; 187: 401–6.
40 Kirkbride, JB, Fearon, P, Morgan, C, Dazzan, P, Morgan, K, Murray, RM, Jones, PB. Neighbourhood variation in the incidence of psychotic disorders in Southeast London. Soc Psychiatry Psychiatr Epidemiol 2007; 42: 438–45.
41 Norman, RM, Malla, AK. Stressful life events and schizophrenia. I: a review of the research. Br J Psychiatry 1993; 162: 161–6.
42 Office for National Statistics. International Migration (http://www.statistics.gov.uk/cci/nugget.asp?id=1311).
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Psychoses, ethnicity and socio-economic status

  • J. B. Kirkbride (a1), D. Barker (a2), F. Cowden (a2), R. Stamps (a2), M. Yang (a2), P. B. Jones (a1) and J. W. Coid (a2)...
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *