Skip to main content Accessibility help
×
Home

Perceptions of disadvantage, ethnicity and psychosis

  • Claudia Cooper (a1), Craig Morgan (a2), Majella Byrne (a2), Paola Dazzan (a2), Kevin Morgan (a3), Gerard Hutchinson (a4), Gillian A. Doody (a5), Glynn Harrison (a6), Julian Leff (a7), Peter Jones (a8), Khalida Ismail (a2), Robin Murray (a2), Paul Bebbington (a7) and Paul Fearon (a9)...

Abstract

Background

People from Black ethnic groups (African-Caribbean and Black African) are more prone to develop psychosis in Western countries. This excess might be explained by perceptions of disadvantage.

Aims

To investigate whether the higher incidence of psychosis in Black people is mediated by perceptions of disadvantage.

Method

A population-based incidence and case-control study of first-episode psychosis (Aetiology and Ethnicity in Schizophrenia and Other Psychoses (ÆSOP)). A total of 482 participants answered questions about perceived disadvantage.

Results

Black ethnic groups had a higher incidence of psychosis (OR=4.7, 95% CI 3.1–7.2). After controlling for religious affiliation, social class and unemployment, the association of ethnicity with psychosis was attenuated (OR=3.0, 95% CI 1.6–5.4) by perceptions of disadvantage. Participants in the Black non-psychosis group often attributed their disadvantage to racism, whereas Black people in the psychosis group attributed it to their own situation.

Conclusions

Perceived disadvantage is partly associated with the excess of psychosis among Black people living in the UK. This may have implications for primary prevention.

  • 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.

      Perceptions of disadvantage, ethnicity and psychosis
      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.

      Perceptions of disadvantage, ethnicity and psychosis
      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.

      Perceptions of disadvantage, ethnicity and psychosis
      Available formats
      ×

Copyright

Corresponding author

Professor Paul Bebbington, UCL Department of Mental Health Sciences, Charles Bell House, Riding House Street, London W1W 7EY, UK. Email: p.bebbington@ucl.ac.uk

Footnotes

Hide All

Declaration of interest

None.

Footnotes

References

Hide All
1 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, ÆSOP Study Group. Incidence of schizophrenia and other psychoses in ethnic minority groups: results from the MRC ÆSOP study. Psychol Med 2006; 36: 1541–50.
2 Sharpley, M, Hutchinson, G, Murray, RM, McKenzie, K. Understanding the excess of psychosis among the African-Caribbean population in England: review of current hypotheses. Br J Psychiatry 2001; 178, s608.
3 Gilvarry, CM, Walsh, E, Samele, C, Hutchinson, G, Mallett, R, Rabe-Hesketh, S, Fahy, T, van Os, J, Murray, RM. Life events, ethnicity and perceptions of discrimination in patients with severe mental illness. Soc Psychiatry Psychiatr Epidemiol 1999; 34: 600–8.
4 Karlsen, S, Nazroo, J. The relationship between racism, social class and physical and mental health among different ethnic groups in England. Ethn Health, 2004; 9: S467.
5 Chakraborty, A, McKenzie, K. Does racial discrimination cause mental illness? Br J Psychiatry 2002; 180: 475–7.
6 Wamala, S, Bostrom, G, Nyqvist, K. Perceived discrimination and psychological distress in Sweden. Br J Psychiatry 2007; 190: 75–6.
7 Veling, W, Selten, JP, 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.
8 World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Description and Diagnostic Guidelines. WHO, 1992.
9 Jenkins, R, Meltzer, H. The National Survey of Psychiatric Morbidity in Great Britain. Soc Psychiatry Psychiatr Epidemiol 1995; 30: 14.
10 Bebbington, PE, Nayani, T. The Psychosis Screening Questionnaire. Int J Methods Psychiatr Res 1995; 5: 1119.
11 Morgan, C, Dazzan, P, Morgan, K, Jones, P, Harrison, G, Leff, J, Murray, R, Fearon, P, ÆOP Study Group. First episode psychosis and ethnicity: initial findings from the ÆSOP study. World Psychiatry 2006; 5: 40–6.
12 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.
13 Mallett, R. Sociodemographic Schedule. Institute of Psychiatry, 1997.
14 Bhugra, D, Bhui, K, Mallett, R, Desai, M, Singh, J, Leff, J. Cultural identity and its measurement: a questionnaire for Asians. Int Rev Psychiatry 1999; 11: 244–9.
15 World Health Organization. Schedules for Clinical Assessment in Neuropsychiatry (SCAN) Version 2.0. WHO, 1994.
16 Wing, JK, Sturt, E. The PSE-ID-CATEGO System: Supplementary Manual. Medical Research Council, 1978.
17 Roe, D. A prospective study on the relationship between self-esteem and functioning during the first year after being hospitalized for psychosis. J Nerv Ment Dis 2003; 191: 45–9.
18 Rosenberg, M. Society and the Adolescent Self-image. Princeton Associated Press, 1965.
19 Robson, P. Development of a new self-report questionnaire to measure self-esteem. Psychol Med 1989; 19: 513–18.
20 Baron, RM, Kenny, DA. The moderator mediator variable distinction in social psychological research – conceptual, strategic, and statistical considerations. J Pers Soc Psychol 1986; 51: 1173–82.
21 Raune, D, Bebbington, P, Dunn, GD. Event attributes and the content of psychotic experiences in first episode psychosis. Psychol Med 2006; 36: 221–30.
22 Garety, PA, Bebbington, P, Fowler, D, Freeman, D, Kuipers, E. Implications for neurobiological research of cognitive models of psychosis. Psychol Med 2007; 37: 1377–91.
23 British Broadcasting Corporation News. Q & A: Expelled Pupils. BBC, 2004. (http://news.bbc.co.uk/1/hi/education/4022123.stm).
24 Fowler, D, Freeman, D, Smith, B, Kuipers, E, Bebbington, P, Bashforth, H, Coker, S, Hodgekins, J, Gracie, A, Dunn, G, Garety, P. The Brief Core Schema Scales (BCSS): psychometric properties and associations with paranoia and grandiosity in non-clinical and psychosis samples. Psychol Med 2006; 36: 749–59.
25 Smith, B, Fowler, DG, Freeman, D, Bebbington, P, Bashforth, H, Garety, P, Dunn, G, Kuipers, E. Emotion and psychosis: links between depression, self-esteem, negative schematic beliefs and delusions and hallucinations. Schizophr Res 2006; 86: 181–8.
26 Garety, P, Kuipers, E, Fowler, D, Freeman, D, Bebbington, PE. A cognitive model of the positive symptoms of psychosis. Psychol Med 2001; 31: 189–95.
27 Morrison, AP. The interpretation of intrusions in psychosis: an integrative cognitive approach to hallucinations and delusions. Behav Cogn Psychother 2001; 2: 257–76.
28 Freeman, D, Garety, P, Kuipers, E, Fowler, D, Bebbington, PE. A cognitive model of persecutory delusions. Br J Clin Psychol 2002; 41: 331–47.
29 Birchwood, M. Pathways to emotional dysfunction in first-episode psychosis. Br J Psychiatry 2003; 182: 373–5.
30 Aluja, A, Rolland, J.-P., Garcia, LF, Rossier, J. Dimensionality of the Rosenberg Self-Esteem Scale and its relationships with the three-and the five-factor personality models. J Pers Assess 2007; 88: 246–9.
31 Barrowclough, C, Tarrier, N, Humphreys, L, Ward, J, Gregg, L, Andrews, B. Self-esteem in schizophrenia: relationships between self-evaluation, family attitudes, and symptomatology. J Abnorm Psychol 2003; 112: 92–9.
32 Sharpley, MS, Peters, E. Ethnicity, class and schizotypy. Soc Psychiatry Psychiatr Epidemiol 1999; 34: 507–12.
33 Byrne, M. A baseline and 8-year follow-up study of first onset psychosis: self-esteem and locus of control in the Aetiology and Ethnicity of Schizophrenia and Other Psychosis (ÆSOP) Study. DClinPsy Thesis, King's College London, 2006.

Perceptions of disadvantage, ethnicity and psychosis

  • Claudia Cooper (a1), Craig Morgan (a2), Majella Byrne (a2), Paola Dazzan (a2), Kevin Morgan (a3), Gerard Hutchinson (a4), Gillian A. Doody (a5), Glynn Harrison (a6), Julian Leff (a7), Peter Jones (a8), Khalida Ismail (a2), Robin Murray (a2), Paul Bebbington (a7) and Paul Fearon (a9)...

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

Perceptions of disadvantage, ethnicity and psychosis

  • Claudia Cooper (a1), Craig Morgan (a2), Majella Byrne (a2), Paola Dazzan (a2), Kevin Morgan (a3), Gerard Hutchinson (a4), Gillian A. Doody (a5), Glynn Harrison (a6), Julian Leff (a7), Peter Jones (a8), Khalida Ismail (a2), Robin Murray (a2), Paul Bebbington (a7) and Paul Fearon (a9)...
Submit a response

eLetters

Perception of Disadvantage: A Third World View

Hari D. Maharajh, Senior Lecturer
11 June 2008

PERCEPTION OF DISADVANTAGE: A THIRD WORLD VIEW.

The AESOP study of Cooper et al BJPsych (2008) stated that people from Black ethnic groups were more prone to develop psychosis in Western countries. This excess might be explained by perception of disadvantage. Also, people with psychosis would report more disadvantage than controls. The authors underline two theoretical issues on causation- the effects of the social context on the genesis of psychosis and secondly, that perceived disadvantage will cause paranoid thoughts resulting in persecutory delusions.

This is a very difficult study with qualitative analyses done on a number of confounding variables, albeit, utilizing small numbers. A notable observation is the pointed questionnaire administered to psychoticpatients and the validity of their responses- “Do you believe that you experience any disadvantage when compared with other individuals in British society?’ On a Likert scale, they were then asked to rate given causation of skin colour, culture and cultural beliefs, religion, social class and other. Is this not too leading?

In mixed communities like Trinidad and Guyana, some studies have reported higher rates of psychosis among Afro-Caribbeans (Lewis 1973, Maharajh et al 2006). This has also been consistently reported in Britain (Gordon 1967, Harrison et al 1988).

In Trinidad, the hypothesis of perception of disadvantage is difficult to accept. There is less psychosis among the disadvantaged Indo-Trinidadian group when compared to the advantaged Afro-Trinidadian group. The second hypothesis is also unlikely - that perceived disadvantage will lead to paranoid thoughts. Afro-Caribbeans at home are seen as being more paranoid. This is associated with drug use, an important variable not controlled in this study. A possible explanation is that the Indo-Trinidadian group has developed protective mechanisms in order to neutralize disadvantages such as economic investment, family life and education.

According to the authors, among Africans, a paranoid view of the world may increase the perception of experiences as disadvantageous, seemsmore plausible. Experiences at home suggest that the African population ina mixed community show total loyalty and allegiance to that which they perceive belonging to them without the purposeful need to be introspective, to scrutinize or to challenge their beliefs. They do not fare well in mixed communities.

This study is difficult to accept due to sampling size, methodology and hypotheses. The question must also be asked, do Psychiatrists engage in research with a perception of advantage or disadvantage to a given hypothesis? Aesop’s Fable or Grimm Fairy Tale?

Lewis, LFE (1976) Schizophrenia in Female Inpatients at St Anns Hospital, Archives, St Anns Hospital, Port of Spain, Trinidad.

Maharajh, H.D, Konings, M, Baboolal, N.S (2006) Gender and Ethnic differences in Urban and Rural First Contact Schizophrenia Outpatients in Trinidad. Reviews on Environmental Health, Vol 21, No 1 p 69-79.

Hari D Maharajh FRCPsychSenior Lecturer, PsychiatryDepartment of Clinical MedicineUniversity of the West IndiesChamp FleursTrinidad, WI.
... More

Conflict of interest: None Declared

Write a reply

Perceived disadvantage is subjective

Dr Arun Viswanath, Speciality Registrar
09 April 2008

The case control study by Claudia et al. (1) was very fascinating. Though it is very hard to define what exactly a ‘perceived disadvantage’ is as it is very variable and subjective.

Given that the sample was from tightly defined catchment area like Nottingham and South East London where people may be living in disadvantageous condition, it may not be surprising to perceive the same. There is possibility that the people may perceive disadvantage or racism because of their premorbid personality. The author should have commented if the perceptions were before the illness or part of the illness or related to personality. Also, the case and the control group were significantly different in terms of numbers and the assessor was not blinded. There are also chances that the disadvantage experienced may be because of their nature of their illness like for example being less communicative, not socialising etc.Their understanding of English and cognitive abilities are also not explained in detail.

Mental health research in areas like this may run the risk of medicalising social struggle and distress (2). Though the outcome is not very conclusive it is a good effort in raising a clearly significant issuewhich may lead to further research. Most of the research on social perceived disadvantages like racism for example is cross sectional .There is need for more longitudinal studies to establish causality.

Competing interests: None declared

References:

1. Perceptions of disadvantage, ethnicity and psychosisThe British Journal of Psychiatry (2008) 192: 185-190. doi: 10.1192/bjp.bp.107.0422912. Does racial discrimination cause mental illness? APU CHAKRABORTY, MRCPsych ,St Ann's Hospital, London KWAME McKENZIE, MRCPsych .The British Journal of Psychiatry (2002) 180: 475-477
... More

Conflict of interest: None Declared

Write a reply

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *