The dominance of capital cities (urban primacy) is an enduring characteristic of Australian states. There has been limited empirical research examining the drivers of primacy in states despite some being extreme examples of the phenomenon, both in magnitude and scale. In light of institutional theories of settlement patterns, we developed a profile of Australian urbanization using a century of time-series data, descriptive statistics, and an empirical model of city populations. In Australian states high measures of primacy have endured with little evidence of disruption despite the enormous size of these states, their wealth, and population growth – factors associated with declining and low primacy. Statistically, state capital city status has a significant effect on city population size variation, with results suggesting primacy in states is in part a product of Australian federalism. This contrasts with views that suggest Australia’s scarcity of large non-capital cities is due to isolation, low population, and environmental determinism. The findings in this paper have major implications relative to national and/or state strategies that aim to decentralize population away from the primate cities.

Background. Numerous studies have reported high rates of psychosis in the Black Caribbean and Black African populations in the UK. However, few studies have investigated the role of specific risk factors in different ethnic groups. We sought to investigate the relationship between long-term separation from, and death of, a parent before the age of 16 and risk of adult psychosis in different ethnic groups.

Method. All patients with a first episode of psychosis who made contact with psychiatric services in defined catchment areas in London and Nottingham, UK and a series of community controls were included in the AESOP (Aetiology and Ethnicity in Schizophrenia and Other Psychoses) study. Data relating to clinical and social variables, including parental separation and loss, were collected from patients and controls.

Results. Separation from, and death of, a parent before the age of 16 were both strongly associated with a two- to threefold increased risk of psychosis. The strength of these associations were similar for White British and Black Caribbean (but not Black African) subjects. Separation from (but not death of) a parent was more common among Black Caribbean controls than White British controls.

Conclusions. Early separation may have a greater impact in the Black Caribbean population, because it is more common, and may contribute to the excess of psychosis in this population.

Background. There is a common assumption that Black patients with a psychotic mental illness experience longer treatment delays during a first episode. We sought to investigate this issue in a large cohort of patients with a first episode of psychosis.

Method. All patients with a first episode of psychosis presenting to secondary mental health services within tightly defined catchment areas in south-east London and Nottingham over a 2-year period were included in the study. Data relating to duration of untreated psychosis (DUP) and clinical and sociodemographic characteristics were collected from patients, relatives and case-notes.

Results. There was no evidence that African-Caribbean or Black African patients experienced longer periods of untreated psychosis than White British patients prior to first contact with services. There was evidence that Black African patients experienced shorter periods of untreated psychosis than White British patients.

Conclusions. Contrary to what is commonly assumed, our study suggests that Black patients with a psychotic mental illness do not experience longer treatment delays prior to first contact with services than White British patients. This suggests that strategies to reduce treatment delays targeted specifically at Black patients will be of limited value.