Some ethnic groups may be more vulnerable to extremes of social deprivation

BMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6975.332b (Published 04 February 1995) Cite this as: BMJ 1995;310:332
  1. Rachel Perkins,
  2. Nigel Fisher
  1. Consultant clinical psychologist Consultant psychiatrist Pathfinder, Springfield Hospital, London SW17 7DJ

    EDITOR,—Michael King and colleagues report a strikingly increased risk of psychotic disorders of new onset across all ethnic minority groups.1 Their data do not allow an examination of the relative risks of long term psychotic illness within these groups. By analysing data from a register of long term users of services we are able to estimate the relative risk of receiving diagnosis of a long term psychotic disorder for white (United Kingdom/Irish), black (African/African Caribbean), and Asian (Indian/Pakistani/Bangladeshi) groups living in two London boroughs.

    Pathfinder provides a locality based specialist mental health service to most of the inner London borough of Wandsworth (Jarman index 23.1) and all of the outer London borough of Merton (Jarman index 13.4). For the past five years an annual census of people aged 16–75 who are currently in contact with the service and who had their first psychiatric contact two or more years ago has been completed by one of us (RP). This long term case register includes the psychiatric diagnosis and ethnic group in addition to data on accommodation, role disturbance, and use of services.

    We have analysed the data for the past five years to give estimates of the prevalence and relative risk, by ethnic group, of schizophrenia (table). Overall, the data for chronic psychosis parallel the findings of King and colleagues. The relative risk of being a long term service user with a diagnosis of schizophrenia is increased for black people and Asians compared with the local white population in Merton and Wandsworth. There seems, however, to be an additional risk for black people living in Wandsworth. There is a non-significant trend to a slightly increased risk of bipolar affective disorder.

    As a service driven instrument the long term case register does not have the epidemiological robustness of King and colleagues' study, but we do not consider our findings to be artefacts. The differences among ethnic groups have been stable over five years despite a 47% turnover of people on the register and a 70% change in the consultants making the clinical diagnoses. Furthermore, as mental health services are often considered to be inaccessible to ethnic minorities the long term case register may be expected to underestimate the prevalence of psychotic disorders within these populations.

    Our data support King and colleagues' view that factors conferring vulnerabilty to non-affective psychoses cross ethnic boundaries. The differences we have found between inner and outer London boroughs, however, suggest that some groups may be more vulnerable to extremes of social deprivation.


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