Ethnicity and PTSD

To be diagnosed with post-traumatic stress disorder (PTSD) people have to have experienced a traumatic event, to have developed symptoms and to have sought help from - and been diagnosed by - medical professionals. Researchers don't really know whether these factors vary between different ethnic groups so a team from Harvard School of Public Health surveyed 34,653 people in an attempt to find out. Black people were most likely to develop PTSD over the course of their life (8.7%) than White people (7.4%) and Hispanic people (7%) with Asian people (4%) being the least likely. Overall White people were more likely to experience trauma but Black and Hispanic people were more likely to have suffered child abuse or domestic violence; and Asians, Black men and Hispanic women had a higher risk of war-related events than White people. Among those who had experienced trauma Black people were 22% more likely and Asian people only two-thirds as likely to develop PTSD. All minority groups were less likely to seek treatment for PTSD than White people and fewer than half of minorities with PTSD sought treatment.

Roberts, A. L. ... [et al] - Race/ethnic differences in exposure to traumatic events, development of post-traumatic stress disorder, and treatment-seeking for post-traumatic stress disorder in the United States (2011), 41, 71–83.
Psychological Medicine

Race, psychosis and brain scanners

Compared to the White population the incidence of psychosis among people from the African-Caribbean community living in the U.K. has been estimated as from anything between two and 18 times higher. The reasons for this are not completely clear but some people have suggested that it reflects institutional racism on the part of mental health services who are more likely to diagnose Black people as suffering from psychosis. A team of researchers from the Institute of Psychiatry, King's College London studied 143 people. Half were suffering from their first episode of psychosis and half were healthy controls; within the two groups half were White and half Black. The researchers thought that the Black people diagnosed with psychosis would have less brain abnormalities associated with the condition reflecting the fact that at least some of their diagnoses were due to institutional racism. In fact there were no differences in brain structure between the Afro-Caribbean patients and the White ones and the Afro-Caribbean patients showed a greater loss of grey matter overall than the White ones; showing, that in this sample at least, genuine changes to brain structure may have been behind the diagnoses of the Black patients not just institutional racism. Other conclusions one could draw from this study include: (i) psychosis is a complex social and cultural phenomenon not easily reduced to questions of brain structure (ii) the changes to brain structure observed are the consequences not the causes of psychosis (iii) Afro-Caribbean people aremore vulnerable to psychosis but this is due to poverty, racism, prejudice and, for immigrants at least, isolation and culture shock (iv) Afro-Caribbean people are more vulnerable to psychosis for other reasons. Whatever the theories it will be a long, tortuous and controversial process before the higher rates of psychosis among Black people are properly explained.

Morgan, K.D. ... [et al] - Differing patterns of brain structural abnormalities between black and white patients with their first episode of psychosis Psychological Medicine July 2010, 40(7), 1137-1147

Lesbian, gay and bisexual people and mental-health services

Lesbian, gay and bisexual people are twice as likely as heterosexual men and women to seek help from mental-health professionals, according to a survey of 2,074 people carried out by researchers at the University of California Los Angeles School of Public Health. 48.5% of lesbian, gay and bisexual people reported receiving treatment in the last year compared to 22.5% of heterosexuals. Overall lesbians and bisexual women were most likely to receive treatment and heterosexual men least likely. The researchers thought that this could be because of the discrimination faced by lesbian, gay and bisexual people, because certain ethnic groups perceived homosexuality to be a psychological problem and because there is more willingness to see a mental-health professional among lesbian, gay and bisexual people. The study also found that ethnic and racial minorities were less likely to use mental-health services.

You can find out more about this research at

http://www.medicalnewstoday.com/articles/160761.php

Immigration and suicide in Asian Americans

Asian-American women (who tend to come from the Far East and the Philippines rather than Pakistan, India and Bangladesh) who are born in the U.S. have higher rates of thinking about, and attempting suicide, than other groups. Asian-Americans as a whole have lower rates of suicidal behaviour and a 2006 study found that Asian immigrants had significantly lower rates of psychiatric disorders than American-born Asians and other native-born Americans. Based on a sample of nearly 2,100 people researchers from the University of Washington found that 15.93% of U.S. born Asian-American women had contemplated suicide and 6.29% had made a suicide bid over the course of their lives compared to 13.5% and 4.6% respectively in the population as a whole. The research fits in with the "healthy immigrant" theory which says that immigrants tend to be healthier than the native population at first (because healthier people are more likely to emigrate and/or come from a culture with healthier habits) and then become less healthy as they adopt the habits of the native population.

You can find out more about this research at

http://www.sciencedaily.com/releases/2009/08/090817190650.htm

Alzheimer's, risk and race

Alzheimer's disease and milder forms of dementia are associated with an increased risk of death but the risks are the same for both black and white people. Some studies have found that African Americans live longer after being diagnosed with the condition than white people but a study of 1715 older adults by researchers at the Rush University Medical Center in Chicago found no differences between racial groups. At the start of the study 802 participants had no cognitive problems, 597 had mild impairment, 296 had Alzheimer's disease and 20 had other forms of dementia. Over the 10 years of the study 634 of the participants died. Compared to unaffected people the risk of death was around 50% higher in people with mild cognitive impairment and 200% higher in those with Alzheimer's.

http://uk.reuters.com/article/idUKTRE55M6TE20090623?feedType=RSS&feedName=healthNews

Suicide among Asians in England

People from India who move overseas tend to have high rates of suicide. There are a large number of people either from India or of Indian descent in the U.K. now and an article in the journal Mental Health in Family Medicine reviews the research into suicides in this group. It found that women were more likely than men to kill, or try and kill, themselves. Asians who attempt to, or succeed in, killing themselves are more likely to be suffering from stress but less likely to have been diagnosed as mentally ill. Their psychological problems had either been overlooked by their GPs or never presented to them. Hindus were more likely to kill themselves than Muslims.

Ineichen, Bernard - Suicide and attempted suicide among South Asians in England: who is at risk? Mental Health in Family Medicine 2008, 5(3), 135-138

Asian Americans' mental health

There are known to be large differences in the way in which ethnic minorities access, and are treated by, mental-health services. This is just as true of the U.S. as of the U.K. and Asian Americans - a group that includes Chinese, Korean, Japanese, Indian, Filipino and Micronesian people - are no exception. Only 17% of Asian Americans with a mental illness seek some form of care and less than 6% of these people seek out a mental-health service. This could be for a number of different reasons:

• They have different views about mental illness
• They feel a stigma about using mental-health services
• They have little faith in psychotherapy
• They fear being institutionalized
• They have a limited awareness of services
• Services are culturally insensitive

A survey of data from New York City (where Asians make up 10% of the population) found that Asian Americans were more likely to be admitted as emergencies and to be diagnosed with schizophrenia or affective psychoses. Asians were 70% less likely to use inpatient services but stayed longer than non-Asian people when they did.

Shin, Jinah K. - Inpatient stays of Asian patients with psychiatric diagnoses in New York City Issues in Mental Health Nursing 30(2), 112-121

Racism and mental health on the Internet

It seems that all human life is on the Internet and sadly racism is no exception. A study of adolescents by researchers at the University of Illinois found that 71% of African-American, 71% of White and 67% of multiracial/'other' adolescents had come across racism online. 29% of African-American teenagers, 20% of White children and 42% of multiracial/other youngsters had experienced racial discrimination aimed at themselves via the Internet. Regardless of a victim's racial background discrimination was significantly related to increased depression with girls being more vulnerable than boys. Victimization occurred via instant messaging, discussion forums, online games and social-networking sites.

You can find out more about this research by clicking on the link in the title of this post.

Diversity and the Mental Capacity Act

The Mental Health Foundation has just published a report on how the 2007 Mental Capacity Act has affected people from Black and minority ethnic communities. You can download a copy of the report by clicking on the title of this post.

Disadvantage, isolation, ethnicity and psychosis

There have been a number of studies pointing to higher rates of schizophrenia and other psychoses in the Black Caribbean population in the U.K. The AESOP (aetiology and ethnicity in schizophrenia and other psychoses) study found rates of schizophrenia and manic psychosis in this group to be nine times greater than in the White British population. There has been a lot of speculation about the reasons for this disparity, most of them centring on the role of socio-economic disadvantage and racial discrimination. A study of 781 people in South-East London and Nottingham compared those experiencing a first episode of psychosis with those from a similar background unaffected by the condition. On all the indicators the people who had developed psychosis were more socially disadvantaged and isolated than healthy people. The more disadvantaged people were the more likely they were to develop psychosis, a pattern which held true for White British and Black Caribbean people. The indicators of social disadvantage and isolation were more common in Black Caribbean participants than White British ones.

Morgan, C. ... [et al] - Cumulative social disadvantage, ethnicity and first-episode psychosis: a case-control study Psychological Medicine December 2008, 38(12), 1701-1715

Immigration and psychosis

There has long been known to be a link between immigration and psychosis. Researchers from St Bartholomew's Hospital, London studied 484 people in three inner-city East London boroughs who first developed psychoses between 1996 and 2000. The participants, aged 18-64 were asked about their ethnicity, their place of birth and the place where their parents were born and were then divided into six ethnic groups: white British, white other, black Caribbean, black African, Asian (Indian, Pakistani and Bangladeshi) and 'other'. All the groups, apart from the white British one, had a raised incidence of psychosis but there were differences in how first- and second-generation immigrants fared between different ethnic groups. Black Caribbean second-generation immigrants were at higher risk than first-generation immigrants. Asian women of both generations were at a higher risk compared to white British people but Asian men did not suffer from an increased risk. The discrimination, isolation and alienation experienced by immigrants are all thought to be risk factors for psychosis.

You can find out more about this research at

http://psychcentral.com/news/2008/11/04/psychosis-among-minority-immigrants/3260.html

Ethnicity and learning difficulties

It has long been recognised that people from different ethnic groups receive different levels of care from mental-health services. People from ethnic minorities have higher rates of compulsory admission, longer average lengths of stay and are more likely to be prescribed drugs or ECT rather than psychotherapy or counselling. They are also less likely to use mental-health services in the first place. Ethnicity and learning disability is an under-researched area although what research there is suggests that services often offer a 'tokenistic' approach in meeting individual needs, resulting in under usage of service and creating a general environment of 'lack of engagement'.

You can read more about the existing research on this topic and plans for future research at

http://www.library.nhs.uk/ethnicity/viewResource.aspx?resid=296479&code=13e349d0c83a1a920e3672f92df146f0

Hallucinations, ethnicity and social adversity

In Europe people from ethnic minorities are more likely to suffer from psychosis. This is thought to be due to social rather than biological factors as the rates of schizophrenia are increased in migrants from a wide variety of countries of origin, there is no increased incidence of schizophrenia in the countries people come from and it is unlikely that people predisposed towards psychosis would be more likely to emigrate from their country of origin. A Dutch study looked into the links between ethnicity, social adversity and people's experience of auditory and visual hallucinations as recent research suggests many people may experience these without developing full-blown psychosis. The study found that Turkish women, Moroccan men, Surinamese/Antilleans, Indonesians and other non-Western immigrants were all more likely to report hallucinations whereas Western immigrants, Turkish men and Moroccan women did not differ from their Dutch counterparts. Once social adversity was taken into account some, but not all of the increased incidence of hallucinations disappeared.

Vanheusen, K. ... [et al] - Associations between ethnicity and self-reported hallucinations in a population sample of young adults in the Netherlands Psychological Medicine August 2008, 38(8), 1095-1102

Psychosis and ethnicity in East London

Raised rates of psychoses have been reported in immigrant groups since the 1930s and a recent analysis of over 40 studies found that the incidence of schizophrenia was, on average, nearly three times as high among immigrants than in the rest of the population. In the UK Black Caribbean and Black African groups have consistently been observed to have a higher rate of psychoses than other groups with conservative estimates suggesting a rate four to six times greater than the rest of the population. A study of 484 people suffering from psychosis in East London found that, even after socioeconomic status was taken into account, certain ethnic groups remained at more risk of developing psychoses. Black Caribbean were 3.1x more likely to develop psychosis, Black African 2.6x, Pakistani women 3.1x and Bangladeshi women 2.3x.

Kirkbride, J.B. ... [et al] - Psychoses, ethnicity and socio-economic status British Journal of Psychiatry July 2008, 193, 18-24

Young people in PICUs and ethnicity

A U.S. study of 2,991 patients under the age of 22 admitted to an emergency paediatric psychiatry department has found strikingly different patterns of diagnosis among different ethnic groups. 4.5% of African-Americans and 4.9% of Hispanics received diagnoses of psychotic disorder compared to only 2.5% of white children. Diagnoses of behavioural problems were also more common in African-American and Hispanic children (50.3% and 46.4% respectively) compared to white children (34.9%). However, white children (37.8%) were more likely to receive diagnoses of depression than African American (28.5%) or Hispanic (30.1%) children. White children were also more likely to be diagnosed with bipolar disorder and alcohol and substance abuse.

You can find out more about this research at

http://psychcentral.com/news/2008/05/20/childs-mental-health-diagnosis-influenced-by-ethnicity/2317.html

DoH report shows extent of stigma

Research by the Department of Health has found that there is still a considerable amount of prejudice and discrimination against people with a mental-health problem. 1 in 8 people would not want to live next door to someone with a mental illness, while nearly six out of ten people described a person with mental illness as 'someone who has to be kept in a psychiatric or mental hospital'. One third of people thought that those with mental-health problems should not have the same right to a job as everyone else. Seperate research by the mental-health charity Rethink found that 9 out of 10 people with mental-health problems had been affected by stigma and discrimination with two-thirds saying that they had stopped doing things because of other people's prejudice.

You can find out more about this research at

http://psychcentral.com/news/2008/05/09/mental-illness-stigma-alive-and-well-in-uk/2260.html

Traditional dress and mental health

A study of White British and Bangladeshi schoolgirls aged between 11 and 14 has found that Bangladeshi girls who wear traditional clothing have a lower risk of developing mental health problems. The researchers speculated that a traditional upbringing might include greater religious adherence and less exposure to unfamiliar, culturally-challenging life events.

Bhui, K. ... [et al] - Cultural identity, clothing and common mental disorder: a prospective school-based study of White British and Bangladeshi adolescents Journal of Epidemiology and Community Health 62, 435-441

Helping mixed-race children in Sheffield

'Multiple heritage' or 'mixed race' is one of the fastest growing ethnic categories in British society, and, because of its high concentration in the younger age groups is set to expand rapidly in the next decade. Studies have shown that people of mixed race suffer disproportionately from social exclusion, experience high levels of family breakdown, underachieve in school attainment and experience distinct patterns of racism. Sheffield's Multiple Heritage Service aims to help mixed-race children by carrying out group work aimed at increasing children's understanding of their cultural heritage and raising their self-esteem and by providing one-to-one mentoring for children at risk of school exclusion and/or having serious problems with identity or self-confidence. A study evaluating the work of the Multiple Heritage Service found that the group work had led to: improvements in the children's self-esteem, with more improvement among younger children and boys; improvements in well-being, with more improvement among older children and an improvement in problem behaviour among boys. Two-thirds of mothers commended the mentoring service on its positive impact on the children's well-being and happiness; a half reported positive impacts on identity. The mothers commended the positive-role-model effect same-sex mentors had on their children's behaviour, but only a third said mentoring had boosted their children's self-esteem.

Phillips, David ... [et al]- Exploring the impact of group work and mentoring for multiple heritage children's self-esteem, well-being and behaviour Health and Social Care in the Community May 2008, 16(3), 310-321

Ethnicity and suicide in the U.S.

In the U.S. the suicide rate among older White people is significantly higher than that among older Black people. For men the rates are 27.8 per 100,000 in Whites versus 11.1 per 100,000 in Blacks and for women the rates are 5.1 per 100,000 versus 1.1 per 100,000 respectively. A study of 1,074 people in Brooklyn, New York looked at the levels of suicidality (thoughts about wanting to kill oneself) in both races. Whites were more likely than Blacks to display suicidality currently (5.8% vs 2.3%) and over the course of their lifetime (14.8% vs 10.2%) although neither of these differences were statistically significant. Four variables were associated with suicidality in both races: depression, anxiety, coping by using medication and lower religiosity. Two variables were associated with suicidality only among Whites: a higher use of spiritualists and coping by keeping calm. One variable, a greater use of doctors for mental-health problems, was significant only among Blacks.

Cohen, Carl I. ... [et al] - Racial differences in suicidality in an older urban population The Gerontologist 2008, 48(1), 71-78

Religious coping and ethnicity

Recent studies suggest that religious behaviour and beliefs can have a protective influence that moderates the impact of adverse interpersonal life events and social adversity on physical and mental health. An in-depth study of 116 people compared religious coping in six different ethnic groups: Bangladeshi, Caribbean, Indian, Irish, Pakistani and White British. Religious coping was most commonly practiced by Bangladeshi Muslims and African Caribbean Christians. Coping included prayer, listening to religious radio, using amulets, talking to God, having a relationship with God and having trust in God. Cultural or spiritual coping practices were indistinguishable from religious coping among Muslims. There was a greater degree of choice and personal responsibility for change among Christians who showed a less deferential and more conversational quality to their relationship with God. Religious and spiritual coping practices were frequently used, and led to changes in emotional states.

Bhui, Kamaldeep ... [et al] - Ethnicity and religious coping with mental distress Journal of Mental Health April 2008, 17(2), 141-151