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

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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.
Original languageEnglish
Pages (from-to)569–579
Number of pages11
JournalSocial Psychiatry and Psychiatric Epidemiology
Volume58
Issue number4
Early online date30 Jan 2023
DOIs
Publication statusPublished - Apr 2023

Keywords

  • Deprivation
  • Early psychosis
  • Ethnicity
  • Inequities
  • Outcomes

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