Social Psychiatry and Psychiatric Epidemiology

, Volume 46, Issue 9, pp 915–923

Perceived racism, medication adherence, and hospital admission in African-Caribbean patients with psychosis in the United Kingdom

  • Apu Chakraborty
  • Michael King
  • Gerard Leavey
  • Kwame McKenzie
Original Paper

DOI: 10.1007/s00127-010-0261-8

Cite this article as:
Chakraborty, A., King, M., Leavey, G. et al. Soc Psychiatry Psychiatr Epidemiol (2011) 46: 915. doi:10.1007/s00127-010-0261-8



Differences in outcome between African-Caribbean and white British patients with psychosis may be due to perceived racism and a difficulty in trusting services seen as discriminatory.


In 100 participants, racism was measured at baseline using the Perceived Racism Scale; with adherence, using the Drug Attitudes Inventory and Kemp Scale, and hospital admission data determined after 12 months.


We found associations between total perceived racism for the previous year (b = −0.0074, P = 0.013), lifetime racism (b = −0.0068, P = 0.038), and everyday racism for the previous year (b = −0.051, P = 0.0046), with subsequent medication adherence. Shame felt about health system racism was associated with increased adherence (b = 0.20, P = 0.015), and powerlessness about it was associated with fewer subsequent hospital bed days (b = −14.49, P = 0.025). Finally, health system racism was associated with both the number of subsequent hospital bed days (b = 5.54, P = 0.010), and admission length (b = 4.92, P = 0.021). In addition, stratified analyses showed that both baseline adherence and 6-month estimated adherence appeared to mediate these effects.


In this cohort of African-Caribbean patients with psychosis, perceived racism is a determinant of adherence over 12 months. We propose a model whereby perceived racism contributes to an individual rejecting mental health services (manifested by the mediating effect of poor adherence) which leads to a poorer outcome, evidenced by a longer hospital stay. Secondly, powerlessness about perceived health-service racism may represent a sense of resignation about the “system”, leading paradoxically to greater adherence and better outcome.


Perceived racism Psychosis African-Caribbeans 

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Apu Chakraborty
    • 1
  • Michael King
    • 1
  • Gerard Leavey
    • 3
  • Kwame McKenzie
    • 2
  1. 1.Department of Mental Health SciencesUniversity College Medical School, University College LondonLondonUK
  2. 2.Social Equity and Health ResearchCentre for Addiction and Mental HealthTorontoCanada
  3. 3.Northern Ireland Association for Mental Health, Central OfficeBelfastUK

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