Abstract
In this follow-up study, a group of black and white patients were followed up between 4 years 9 months and 10 years after a first admission with a clinical diagnosis of schizophrenia. It was possible to trace 98% of the sample, and historical, clinical and social data were obtained from case notes and interviews with patients and informants. There was no evidence of greater misdiagnosis in black patients, but their outcome was poorer in terms of readmissions and allocation to schizophrenic catego classes on follow-up (almost significant at 5% level). On follow-up, no differences were found in physical treatments and after-care arrangments or contacts with services. However, more black patients were readmitted on forensic sections and from prison, and more were treated in secure units. Explanations for the increased contact with penal and forensic services are discussed. The poorer clinical outcome found in black patients was associated with four factors apparent before first admission; living alone, unemployment, conviction and imprisonment.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
American Psychiatric Association (1987) Diagnostic and statistical manual of mental disorders, 3rd edn revised (DSM III-R). APA, Washington, D. C.
Andreason NC (1982) Negative symptoms in schizophrenia: definition and reliability. Arch Gen Psychiatry 39:748–788
Birchwood M, Cochrane R, MacMillan F, Copestake S, Kucharska J, Carriss M (1992) The influence of ethnicity and family structure on relapse in first episode schizophrenia: a comparison of Asian, Afro-Caribbean and White Patients. Br J Psychiatry 161:783–790
Bullard H, Bond M (1988) Secure units: why are they needed? Med Sci Law 28:312–18
Carpenter L, Brockington IF (1980) A study of mental illness in Asians, West Indians and Africans living in Manchester. Br J Psychiatry 139:201–5
Chen EYH, Harrison G, Standen PJ (1991) Management of first episode psychotic illness in Afro-Caribbean patients. Br J Psychiatry 158:517–522
Cochrane R, Bal S (1987) Migration and schizophrenia: an examination of five hypotheses. Soc Psychiatry 22:180–191
Cochrane R, Bal S (1989) Mental hospital admission rates of immigrants to England: a comparison of 1971 and 1981. Soc Psychiatry Psychiatr Epidemiol 24:2–11
Cole J, Pilisuk M (1976) Differences in the provision of mental health services by race. Am J Orthopsychiatry 46:510–525
Cope R (1989) The compulsory detention of Afro-Caribbeans under the Mental Health Act. New Community 15:343–56
Cope R, Ndegwa D (1990) Ethnic differences in admission to a regional secure unit. J Forensic Psychiatry 1:365–378
Dunn J, Fahy TA (1990) Police admissions to a psychiatric hospital. Demographic and clinical differences between ethnic groups. Br J Psychiatry 156:373–378
Economic Development Committee of the West Midlands County Council (1984) A statistical profile of unemployment in the West Midlands. Report of 5.9.84
Fernando S (1991) Mental health, race and culture. Macmillan, London
Francis E, Johnson N, Sashidharan SP (1989) Black people and psychiatry in the UK. Psychiatr Bull 13:482–483
Glover G (1989) The pattern of psychiatric admissions of Caribbean born immigrants in London. Soc Psychiatry Psychiatr Epidemiol 24:49–56
Glover G, Malcolm G (1988) The prevalence of depot neuroleptic treatment among West Indians and Asians in the London borough of Newham. Soc Psychiatry Psychiatr Epidemiol 23:281–284
Gordon ED (1965) Mentally ill West Indian immigrants. Br J Psychiatry 111:877–887
Harding CM, Zubin J, Strauss JS (1992) Chronicity in schizophrenia revisited. Br J Psychiatry 161 [Suppl 18]:27–37
Harrison G, Ineichen B, Smith J et al (1984) Psychiatric hospital admissions in Bristol: II social and clinical aspects of compulsory admissions. Br J Psychiatry 145:605–611
Harrison G, Owens D, Holton A et al (1988) A prospective study of severe mental disorder in Afro-Caribbean patients. Psychol Med 18:643–657
Harrison G, Holton A, Neilson D et al (1989) Severe mental disorder in Afro-Caribbean patients: some social, demographic and service factors. Psychol Med 19:683–696
Harvey I, Williams M, McGuffin P, Toone BK (1990) The functional psychoses in Afro-Caribbeans. Br J Psychiatry 157:515–522
HMSO (1983) In-patient statistics from the Mental Health Enquiry for England 1978. HMSO, London
Kleinman A (1987) Anthropology and psychiatry: the role of culture in cross-cultural research on illness. Br J Psychiatry 151:447–454
Krawiecka M Goldberg D, Vaughan M (1977) A standardised psychiatric assessment for rating chronic psychotic patients. Acta Psychiatr Scand 55:299–308
Leary J, Johnstone EC, Owens DGC (1991) Disabilities and circumstances of schizophrenic patients. A follow-up study. II Social outcome. Br J Psychiatry 159 [Suppl 13]:13–20
Lewis G, Croft-Jeffreys C, David A (1990) Are British psychiatrists ricist? Br J Psychiatry 157:410–415
Littlewood R (1992) Psychiatric diagnosis and racial bias. An empirical and interpretative approach. Soc Sci Med 34:141–149
Littlewood R, Cross S (1980) Ethnic minorities and psychiatric services. Sociol Health Illness 2:194–201
Littlewood R, Lipsedge M (1981) Acute psychotic reactions in Caribbean born patients. Psychol Med 11:303–318
Lloyd K, Moodley P (1992) Psychotropic medication and ethnicity: an in-patient survey. Soc Psychiatry Psychiatr Epidemiol 27:95–101
Loring M, Powell B (1988) Gender, race and DSM-III: a study of the objectivity of psychiatric diagnostic behaviour. J Health Soc Behav 29:1–22
MacMillan JF, Crow TJ, Johnson AL, Johnstone EC (1986) Northwick Park Study of first episodes of schizophrenia: III. Short-term outcome in trial entrants and trial eligible patients. Br J Psychiatry 148:128–133
McGovern D (1988) Psychiatric admissions of second-generation Afro-Caribbeans. Paper presented at the forensic section of the Royal. College of Psychiatrists annual conference, Stratfordepon-Avon, 20 February 1988
McGovern D, Cope R (1987a) First psychiatric admission rates of first and second-generation Afro-Caribbeans. Soc Psychiatry 22: 139–149
McGovern D, Cope R (1987b) The compulsory detention of males of different ethnic groups, with special reference to offender patients. Br J Psychiatry 150:505–512
McGovern D, Cope R (1991) Second-generation Afro-Caribbeans and young whites with a first admission diagnosis of schizophrenia. Soc Psychiatry Psychiatr Epidemiol 26:95–99
McGovern D, Hemmings P (1994) A follow-up of second-generation Afro-Caribbean and white British with a first admission diagnosis of schizophrenia. Attitudes to mental illness and psychiatric services of patient and relatives. Soc Sci Medicine 34:117–127
Milner G, Hayes G (1988) Psychiatric illness among British Afro-Caribbeans (letter). BMJ 297 (6647):562
Moodley M, Thornicroft G (1988) Ethnic group and compulsory admission. Med Sci Law 28:324–328
Office of Population Consensus and Surveys [OPCS] (1982) Census 1981 County Report, West Midlands part I. HMSO, London
Owens D, Harrison G, Boot D (1991) Ethnic factors in voluntary and compulsory admissions. Psychol Med 21:185–196
Perera R, Owens DEC, Johnstone EC (1991) Disabilities and circumstances of schizophrenic patients—a follow-up study. Ethnic aspects: a comparison of three matched groups. Br J Psychiatry 159 [Suppl 13]:40–42
Prado R, Munroe-Blum H (1987) Five-year outcome and prognosis in schizophrenia: a report from the London Field Research Centre of the International Pilot Study of Schizophrenia. Br J Psychiatry 144:345–354
Rack P (1982) Race, culture and mental disorders. Tavistock, London
Rogers A, Faulkner A (1987) A place of safety. MIND RAPZT, Rochdale
Rutter M (1981) Maternal deprivation reassessed. Penguin, Harmondsworth, England
Rwegellera GGC (1980) Differential use of psychiatric services by West Indians, West Africans and English in London. Br J Psychiatry 137:428–432
Sartorius N, Jablensky A, Korten A, Ernberg G, Auber M, Cooper JE, Day R (1986) Preliminary communications. Early manifestations and first-contact incidence of schizophrenia in different cultures. Psychol Med 16:909–928
Schneider K (1959) Clinical psychopathology. (English translation by Hamilton) Crown and Stratton, New York
Simon RJ, Fleiss JG, Gurland BJ, Stiller PR, Sharpe L (1973) Depression and schizophrenia in hospitalized Black and White mental patients. Arch Gen Psychiatry 28:509–12
Sims ACP, Symonds RL (1975) Psychiatric referrals from the police. Br J Psychiatry 127:171–178
Sugarman P (1992) Outcome of schizophrenia in the Afro-Caribbean community. Soc Psychiatry Psychiatr Epidemiol 27:102–105
Tewfik GI, Okasha A (1965) Psychosis and immigration. Postgrad Med J 41:603–612
Thomas A, Sillen S (1972) Racism and psychiatry. Brunner/Mazel, New York
Warner R (1985) Recovery from schizophrenia. Routledge & Kegan Paul, London
Watt DC, Katz K, Shepherd M (1983) The natural history of schizophrenia: a 5-year prospective follow-up of a respresentative sample of schizophrenia by means of a standardised clinical and social assessment. Psychol Med 13:663–670
Wessely S, Castle D, Der G, Murray R (1991) Schizophrenia and Afro-Caribbeans. A case control study. Br J Psychiatry 159:795–801
Wing JK, Cooper JE, Sartorius N (1974) The measurement and classification of psychiatric symptoms. Cambridge University Press, London
WHO (1988) The Disability Assessment Schedule. WHO, Geneva
Author information
Authors and Affiliations
Additional information
We used the term “black” to refer to people of Afro-Caribbean ancestry and the term “white” to refer to people of European ancestry born in the UK.
Rights and permissions
About this article
Cite this article
McGovern, D., Hemmings, P., Cope, R. et al. Long-term follow-up of young Afro-Caribbean Britons and white Britons with a first admission diagnosis of schizophrenia. Soc Psychiatry Psychiatr Epidemiol 29, 8–19 (1994). https://doi.org/10.1007/BF00796443
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00796443