Psychotic symptoms in the general population of England

A comparison of ethnic groups (The EMPIRIC study)
  • Michael King
  • James Nazroo
  • Scott Weich
  • Kwame McKenzie
  • Kam Bhui
  • Saffron Karlson
  • Stephen Stansfeld
  • Peter Tyrer
  • Martin Blanchard
  • Keith Lloyd
  • Sally McManus
  • Kerry Sproston
  • Bob Erens



There is considerable evidence that incidence of schizophrenia and other psychoses varies across ethnic groups in the UK, with particularly high rates for people of African-Caribbean origin. Aims The aims of this shady were to estimate in a community-based sample of people from ethnic minorities: 1) the prevalence of psychotic symptoms; and 2) risk factors for reporting psychotic symptoms.


Face-to-face interviews were carried out with a probabilistic sample of 4281 adults from six ethnic groups living in the UK. Psychotic symptoms were measured using the psychosis screening questionnaire (PSQ).


There was a twofold higher rate of reporting psychotic symptoms on the PSQ in Black Caribbean people compared with Whites. Adjustment for demographic factors had little effect on this association.


Prevalence rates of psychotic symptoms were higher in people from ethnic minorities, but were not consistent with the much higher first contact rates for psychotic disorder reported previously, particularly in Black Caribbeans.

Key words

schizophrenia epidemiology psychiatric symptoms ethnicity 


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  1. 1.
    Aesop study team (2002) Raised incidence of all psychosis in UK migrant populations. Schizophr Res 53:33Google Scholar
  2. 2.
    Bebbington P, Nayani T (1995) The psychosis screening questionnaire. Int J Meth Psychiatr Res 5:11–19Google Scholar
  3. 3.
    Bhugra D, Hilwig M, Hossein B, Marceau H, Neehall J, Leff J, Mallett R, Der G (1996) First-Contact Incidence Rates of Schizophrenia in Trinidad and One-Year Follow-up. Br J Psychiatry 169:587–592PubMedGoogle Scholar
  4. 4.
    Bhugra D, Leff J, Mallet R, Der G, Corridan B, Rudge S (1997) Incidence and outcome of schizophrenia in Whites, African-Caribbeans and Asians in London. Psychol Med 27:791–798PubMedGoogle Scholar
  5. 5.
    Bhui K, Brown P, Hardie T, Watson JP, Parrott J (1998) African-Caribbean men remanded to Brixton prison. Br J Psychiatry 172:337–344PubMedGoogle Scholar
  6. 6.
    Blane D, Power C, Bartley M (1996) Illness Behaviour and the Measurement of Class Differentials in Morbidity. J R Stat Soc 156:77–92Google Scholar
  7. 7.
    Chakraborty A, McKenzie K, King M Discrimination, ethnicity and psychosis- a qualitative study. Cul Med Psychiatry (in press)Google Scholar
  8. 8.
    Clayton D, Hills M (1993) Statistical Models in Epidemiology. Oxford University Press, OxfordGoogle Scholar
  9. 9.
    Cole E, Leavey G, King M, Johnson-Sabine E, Hoar A (1995) Pathways to care for patients with a first episode of psychosis. A comparison of ethnic groups. Br J Psychiatry 167:770–776PubMedGoogle Scholar
  10. 10.
    Eagles JM (1991) The relationship between schizophrenia and immigration. Are there alternative hypotheses? Br J Psychiatry 159:783–789PubMedGoogle Scholar
  11. 11.
    Erens B, Primatesta P (1999) Health Survey for England: Cardiovascular Disease ’98. London: TSOGoogle Scholar
  12. 12.
    Erens B, Primatesta T, Prior G Health (1999) Survey for England: The Health of Minority Ethnic Groups. The Stationery Office London 2001Google Scholar
  13. 13.
    Fabrega H (1989) Cultural relativism and psychiatric illness. J Nerv Ment Dis 177:415–425PubMedGoogle Scholar
  14. 14.
    Gilvarry CM, Walsh E, Samele C, Hutchinson G, Mallett R, Rabe-Hesketh S, Fahy T, van Os J, Murray R (1999) Life events, ethnicity and perceptions of discrimination in patients with severe mental illness. Soc Psyciatry Psychiatr Epidemiol 34:600–608Google Scholar
  15. 15.
    Goater N, King M, Cole E, Leavey G, Johnson-Sabine E, Blizard R, Hoar A (1999) Ethnicity and outcome of psychosis. Br J Psychiatry 175:34–42PubMedGoogle Scholar
  16. 16.
    Goldberg DP, Cooper B, Eastwood MR, Kedward HB, Shepherd MA 1970) standardised psychiatric interview for use in community surveys. Br J Prev Soc Med 24:18–23PubMedGoogle Scholar
  17. 17.
    Goldberg D, Williams D (1988) A User’s Guide to the General Health Questionnaire NFER_Nelson, Windsor, UKGoogle Scholar
  18. 18.
    Goodman R, Richards H (1995) Child and adolescent psychiatric presentations of second-generation Afro-Caribbeans in Britain. Br J Psychiatry 167:362–369PubMedGoogle Scholar
  19. 19.
    Harrison G, Owens D, Holton A, Nielson D, Boot D (1988) A prospective study of severe mental disorder in Afro-Caribbean patients. Psychol Med 18:643–657PubMedGoogle Scholar
  20. 20.
    Harrison G, Amin S, Singh SP, Croudace T, Jones P (1999) Outcome of psychosis in people of African-Caribbean origin. Br J Psychiatry 175:43–49PubMedGoogle Scholar
  21. 21.
    Harrison G, Hopper K, Craig T, Laska E, Siegel C, Wanderling J, Dube KC, Ganev K, Giel R, an der Heiden W, Holmberg SK, Janca A, Lee PWH, León CA, Malhotra S, Marsella A J, Nakane Y, Sartorius N, Shen Y, Skoda C, Thara R, Tsirkin SJ, Varma VK, Walsh D, Wiersma D (2001) Recovery from psychotic illness: a 15- and 25-year international follow-up study. Br J Psychiatry 178:506–517CrossRefPubMedGoogle Scholar
  22. 22.
    Harrison-Read P, Lucas B, Tyrer P, Ray J, Shipley K, Simmonds S, Knapp M, Lowin A, Patel A, Hickman M (2002) Heavy users of acute psychiatric beds: randomised controlled trial of enhanced community management in an outer London borough. Psychol Med 32:413–426Google Scholar
  23. 23.
    Hickling FW, Rodgers-Johnson P (1995) The incidence of first contact schizophrenia in Jamaica. Br J Psychiatry 167:193–196PubMedGoogle Scholar
  24. 24.
    Johns LC, van Os J (2001) The continuity of psychotic experiences in the general population. Clin Psychol Rev 21:1125–1141PubMedGoogle Scholar
  25. 25.
    King M, Coker E, Leavey G, et al (1994) Incidence of psychotic illness in London: comparison of ethnic groups. Br Med J 309:1115–1119Google Scholar
  26. 26.
    Krueger RF (1999) The structure of the common mental disorders. Arch Gen Psychiatry 56:921–926PubMedGoogle Scholar
  27. 27.
    Lewis G, Croft-Jeffreys C, David A (1990) Are British psychiastrists racist? Br J Psychiatry 157:410–415PubMedGoogle Scholar
  28. 28.
    Lewis G, Pelosi AJ, Araya R, Dunn G (1992) Measuring psychiatric disorder in the community: a standardised assessment for use by lay interviewers. Psychol Med 22:465–486PubMedGoogle Scholar
  29. 29.
    Littlewood R, Lipsedge M (1988) Psychiatric illness among British Afro-Caribbeans. Br Med J 296:950–951Google Scholar
  30. 30.
    Lloyd K (1998) Ethnicity, social inequality and mental illness. Br Med J 316:1763Google Scholar
  31. 31.
    Mahy GE, Mallett R, Leff J, Bhugra D (1999) First-contact incidence rate of schizophrenia on Barbados. Br J Psychiatry 175:28–33PubMedGoogle Scholar
  32. 32.
    McKenzie K, Van Os J, Fahy T, Jones P, Toone B, Murray RM (1995) Psychosis with good prognosis in Afro-Caribbean people now living in the United Kingdom. Br Med J 311:1325–1328Google Scholar
  33. 33.
    McKenzie K (1999) Moving the misdiagnosis debate forward. Int Rev Psychiatry 1:153–161Google Scholar
  34. 34.
    McKenzie K, Samele C, Van Horn E, Tattan T, Van Os J, Murray R (2001) Comparison of the outcome and treatment of psychosis in people of Caribbean origin living in the UK and British whites. Br J Psychiatry 178:160–165PubMedGoogle Scholar
  35. 35.
    Meltzer H, Gill B, Petticrew M (1995) OPCS Surveys of Psychiatric Morbidity in Great Britain. Report No 1. The prevalence of psychiatric morbidity among adults aged 16–64 living in private households in Great Britain. London: HMSOGoogle Scholar
  36. 36.
    Nazroo JY (1997) Ethnicity and Mental Health: Findings from a National Community Survey, London: Policy Studies InstituteGoogle Scholar
  37. 37.
    Platt S, Weyman A, Hirsch S, Hewett S (1980) The social behaviour assessment schedule (SBAS): rationale, contents, scoring and reliability of a new interview schedule. Soc Psychiatry 15:43–55Google Scholar
  38. 38.
    Singleton N, Bumpstead R, O’Brien M, Lee A, Meltzer H (2001) Psychiatric morbidity among adults living in private households, 2000, London: The Stationery OfficeGoogle Scholar
  39. 39.
    Sharpley M, Hutchinson G, McKenzie K, Murray RM (2001) Understanding the excess of psychosis among the African-Caribbean population in England.Review of current hypotheses. Br J Psychiatry—(Suppl 40):s60–68Google Scholar
  40. 40.
    Smith P, Prior G (1997) The Fourth National Survey of Ethnic Minorities: Technical Report. London: Social and Comunity Planning ResearchGoogle Scholar
  41. 41.
    Sproston K, Pitson L, Whitfield G (1998) The health and lifestyles of Chinese people living in England, London HMSOGoogle Scholar
  42. 42.
    Sproston K, Nazroo J (eds) (2002) Ethnic Minority Psychiatric Illness Rates in the Community (EMPIRIC). London: TSOGoogle Scholar
  43. 43.
    StataCorp. Stata Statistical Software: Release 7.0. Stata Corporation, 702 University Drive East, College Station, Texas, USA, 2001Google Scholar
  44. 44.
    Takei N, Persaud R, Woodruff P, Brockington I, Murray R (1998) First episode of psychosis in Afro-Caribbean and White people. Br J Psychiatry 172:147–153PubMedGoogle Scholar
  45. 45.
    Tyrer P (1990) Personality disorder and social functioning. In: Peck DF, Shapiro CM (eds) Measuring Human Problems: a Practical Guide Wiley London, pp 119–142Google Scholar
  46. 46.
    Tyrer P, Evans K, Gandhi N, Lamont A, Harrison-Read P, Johnson T (1998) Randomised controlled trial of two models of care for discharged psychotic patients. Br Med J 316:106–109Google Scholar
  47. 47.
    Van Os J, Hanssen M, Bijl RV, Vollebergh W (2001) Prevalence of psychotic disorder and community level psychotic symptoms. Arch Gen Psychiatry 58:663–668PubMedGoogle Scholar
  48. 48.
    Weich S, Nazroo J, Sproston K, McManus S, Blanchard M, Erens B, Karlsen S, King M, Lloyd K, Stansfeld S, Tyrer P Common Mental Disorders and Ethnicity in England: The EMPIRIC Study. Psychological Medicine (in press)Google Scholar

Copyright information

© Steinkopff Verlag 2005

Authors and Affiliations

  • Michael King
    • 1
  • James Nazroo
    • 2
  • Scott Weich
    • 1
  • Kwame McKenzie
    • 1
  • Kam Bhui
    • 3
  • Saffron Karlson
    • 2
  • Stephen Stansfeld
    • 3
  • Peter Tyrer
    • 4
  • Martin Blanchard
    • 1
  • Keith Lloyd
    • 5
  • Sally McManus
    • 6
  • Kerry Sproston
    • 6
  • Bob Erens
    • 6
  1. 1.Dept. of Mental Health SciencesRoyal Free & University College Medical School Royal Free CampusLondon NW3 2PFUK
  2. 2.Dept. of Epidemiology & Public HealthRoyal Free & University College Medical SchoolLondonUK
  3. 3.Dept. of PsychiatryBarts and The London Queen Mary’s School of Medicine and DentistryLondonUK
  4. 4.Dept. of Psychological Medicine Division of Neuroscience and Psychological MedicineImperial College (Charing Cross Campus)LondonUK
  5. 5.The Clinical SchoolUniversity of WalesSwanseaUK
  6. 6.National Centre for Social Research London and ExeterUK

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