Five-year illness trajectories across racial groups in the UK following a first episode psychosis

Siân Lowri Griffiths; Tumelo Bogatsu; Mia Longhi; Emily Butler; Beel Alexander; Mrunal Bandawar; Linda Everard; Peter B Jones; David Fowler; Joanne Hodgekins; Tim Amos; Nick Freemantle; Paul McCrone; Swaran P Singh; Max Birchwood; Rachel Upthegrove

doi:10.1007/s00127-023-02428-w

Five-year illness trajectories across racial groups in the UK following a first episode psychosis

Soc Psychiatry Psychiatr Epidemiol. 2023 Apr;58(4):569-579. doi: 10.1007/s00127-023-02428-w. Epub 2023 Jan 30.

Authors

Siân Lowri Griffiths¹, Tumelo Bogatsu², Mia Longhi², Emily Butler², Beel Alexander², Mrunal Bandawar², Linda Everard³, Peter B Jones⁴, David Fowler⁵, Joanne Hodgekins⁶, Tim Amos⁷, Nick Freemantle⁸, Paul McCrone⁹, Swaran P Singh¹⁰, Max Birchwood^#¹⁰, Rachel Upthegrove^#²

Affiliations

¹ Institute for Mental Health, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. s.l.griffiths@bham.ac.uk.
² Institute for Mental Health, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
³ Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK.
⁴ Department of Psychiatry, University of Cambridge and CAMEO, Cambridge and Peterborough NHS Foundation Trust, Fulbourn, UK.
⁵ Department of Psychology, University of Sussex, Brighton, UK.
⁶ Norwich Medical School, University of East Anglia, Norwich, UK.
⁷ Academic Unit of Psychiatry, University of Bristol, Bristol, UK.
⁸ Institute of Clinical Trials and Methodology, University College London, London, UK.
⁹ Institute for Life Course Development, University of Greenwich, London, UK.
¹⁰ Mental Health and Wellbeing Warwick Medical School, University of Warwick, Coventry, UK.

^# Contributed equally.

Abstract

Purpose: Psychosis disproportionally affects ethnic minority groups in high-income countries, yet evidence of disparities in outcomes following intensive early intervention service (EIS) for First Episode Psychosis (FEP) is less conclusive. We investigated 5-year clinical and social outcomes of young people with FEP from different racial groups following EIS care.

Method: Data were analysed from the UK-wide NIHR SUPEREDEN study. The sample at baseline (n = 978) included White (n = 750), Black (n = 71), and Asian (n = 157) individuals, assessed during the 3 years of EIS, and up to 2 years post-discharge (n = 296; Black [n = 23]; Asian [n = 52] and White [n = 221]). Outcome trajectories were modelled for psychosis symptoms (positive, negative, and general), functioning, and depression, using linear mixed effect models (with random intercept and slopes), whilst controlling for social deprivation. Discharge service was also explored across racial groups, 2 years following EIS.

Results: Variation in linear growth over time was accounted for by racial group status for psychosis symptoms-positive (95% CI [0.679, 1.235]), negative (95% CI [0.315, 0.783]), and general (95% CI [1.961, 3.428])-as well as for functioning (95% CI [11.212, 17.677]) and depressive symptoms (95% CI [0.261, 0.648]). Social deprivation contributed to this variance. Black individuals experienced greater levels of deprivation (p < 0.001, 95% CI [0.187, 0.624]). Finally, there was a greater likelihood for Asian (OR = 3.04; 95% CI [2.050, 4.498]) and Black individuals (OR = 2.47; 95% CI [1.354, 4.520]) to remain in secondary care by follow-up.

Conclusion: Findings suggest variations in long-term clinical and social outcomes following EIS across racial groups; social deprivation contributed to this variance. Black and Asian individuals appear to make less improvement in long-term recovery and are less likely to be discharged from mental health services. Replication is needed in large, complete data, to fully understand disparities and blind spots to care.

Keywords: Deprivation; Early psychosis; Ethnicity; Inequities; Outcomes.

MeSH terms

Adolescent
Aftercare
Ethnicity* / psychology
Humans
Minority Groups
Patient Discharge
Psychotic Disorders* / psychology
Racial Groups
United Kingdom / epidemiology