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Ethnic isolation and psychosis: re-examining the ethnic density effect

Published online by Cambridge University Press:  22 September 2010

P. Schofield ,
M. Ashworth  and
R. Jones
P. Schofield*
Affiliation:
Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, Kings College, LondonUK
M. Ashworth
Affiliation:
Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, Kings College, LondonUK
R. Jones
Affiliation:
Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, Kings College, LondonUK
*
*Address for correspondence: Dr P. Schofield, Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, Kings CollegeLondon, Capital House, 42 Weston Street, London SE1 3QD, UK. (Email: peter.1.schofield@kcl.ac.uk)
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Abstract

Background

Elevated incidence of psychotic illness has been consistently shown among migrant populations. Ethnic density, the proportion of an ethnic group in a defined area, is cited as one factor with a reduced risk of psychosis where ethnicity is shared. However, UK studies have shown mixed results. We set out to re-examine the ethnic density effect at a greater level of geographic detail than previous studies.

Method

Using a large sample of patient records from general practitioners in South East London, we were able to assess neighbourhood factors at the detailed lower super output area level. This comprises, on average, 1500 people compared with around 6000 per ward, the measure used in previous studies. We compared black (Afro-Caribbean) and white psychosis incidence by neighbourhood ethnic density over a 10-year period.

Results

We found a clear negative association between ethnic density and psychosis incidence. In neighbourhoods where black people comprised more than 25% of the population, there was no longer a statistically significant ethnic difference in psychosis rates. However, where black people were less well represented, their relative risk increased nearly threefold [odds ratio (OR) 2.88, 95% confidence interval (CI) 1.89–4.39]. Furthermore, incidence rates for black people in the lowest density quintiles were over five times greater than in the most dense quintile (OR 5.24, 95% CI 1.95–14.07). However, at ward level this association was much weaker and no longer statistically significant.

Conclusions

Ethnic density is inversely related to psychosis incidence at a detailed local neighbourhood level.

Keywords

Ethnicityincidencepsychosissocial determinants
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 6 , June 2011 , pp. 1263 - 1269
Copyright
Copyright © Cambridge University Press 2010

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References

Becares, L, Nazroo, J, Stafford, M (2009). The buffering effects of ethnic density on experienced racism and health. Health & Place 15, 700–708.CrossRefGoogle ScholarPubMed
Boydell, J, van Os, J, McKenzie, K, Allardyce, J, Goel, R, McCreadie, RG, Murray, RM (2001). Incidence of schizophrenia in ethnic minorities in London: ecological study into interactions with environment. British Medical Journal 323, 1336.CrossRefGoogle ScholarPubMed
Cantor-Graae, E, Selten, JP (2005). Schizophrenia and migration: a meta-analysis and review. American Journal of Psychiatry 162, 12–24.CrossRefGoogle ScholarPubMed
Cochrane, R, Bal, S (1988). Ethnic density is unrelated to incidence of schizophrenia. The British Journal of Psychiatry 153, 363–366.CrossRefGoogle ScholarPubMed
Department for Communities and Local Government (2008). The English Indices of Deprivation 2007. HMSO: London.Google Scholar
Faris, R, Dunham, W (1939). Mental Disorders in Urban Areas: An Ecological Study of Schizophrenia and Other Psychoses. The University of Chicago Press: Chicago.Google Scholar
Fearon, P, Kirkbride, JB, Morgan, C, Dazzan, P, Morgan, K, Lloyd, T, Hutchinson, G, Tarrant, J, Lun, A, Fung, WAI, Holloway, J, Mallett, R, Harrison, G, Leff, J, Jones, PB, Murray, RM (2006). Incidence of schizophrenia and other psychoses in ethnic minority groups: results from the MRC AESOP Study. Psychological Medicine 36, 1541–1550.CrossRefGoogle ScholarPubMed
Fung, WLA, Bhugra, D, Jones, PB (2009). Ethnicity and mental health: the example of schizophrenia and related psychoses in migrant populations in the Western world. Psychiatry 8, 335–341.CrossRefGoogle Scholar
Groenewegen, PP, van den Berg, AE, de Vries, S, Verheij, RA (2006). Vitamin G: effects of green space on health, well-being, and social safety. BMC Public Health 6, 149.CrossRefGoogle ScholarPubMed
Halpern, D, Nazroo, J (2000). The ethnic density effect: results from a national community survey of England and Wales. International Journal of Social Psychiatry 46, 34–46.CrossRefGoogle ScholarPubMed
Harrison, G, Gunnell, D, Glazebrook, C, Page, K, Kwiecinski, R (2001). Association between schizophrenia and social inequality at birth: case–control study. The British Journal of Psychiatry 179, 346–350.CrossRefGoogle ScholarPubMed
Jick, H, Jick, SS, Derby, LE (1991). Validation of information recorded on general practitioner based computerised data resource in the United Kingdom. British Medical Journal 302, 766–768.CrossRefGoogle ScholarPubMed
Kirkbride, JB, Barker, D, Cowden, F, Stamps, R, Yang, M, Jones, PB, Coid, JW (2008). Psychoses, ethnicity and socio-economic status. British Journal of Psychiatry 193, 18–24.CrossRefGoogle ScholarPubMed
Kirkbride, JB, Fearon, P, Morgan, C, Dazzan, P, Morgan, K, Murray, RM, Jones, PB (2007 a). Neighbourhood variation in the incidence of psychotic disorders in Southeast London. Social Psychiatry and Psychiatric Epidemiology 42, 438–445.CrossRefGoogle ScholarPubMed
Kirkbride, JB, Morgan, C, Fearon, P, Dazzan, P, Murray, RM, Jones, PB (2007 b). Neighbourhood-level effects on psychoses: re-examining the role of context. Psychological Medicine 37, 1413–1425.CrossRefGoogle ScholarPubMed
Koffman, J, Fulop, NJ, Pashley, D, Coleman, K (1997). Ethnicity and use of acute psychiatric beds: one-day survey in north and south Thames regions. British Journal of Psychiatry 171, 238–241.CrossRefGoogle ScholarPubMed
Kumarapeli, P, Stepaniuk, R, de Lusignan, S, Williams, R, Rowlands, G (2006). Ethnicity recording in general practice computer systems. Journal of Public Health 28, 283–287.CrossRefGoogle ScholarPubMed
McCracken, CFM, Boneham, MA, Copeland, JRM, Williams, KE, Wilson, K, Scott, A, McKibbin, P, Cleave, N (1997). Prevalence of dementia and depression among elderly people in Black and ethnic minorities. British Journal of Psychiatry 171, 269–273.CrossRefGoogle ScholarPubMed
March, D, Hatch, SL, Morgan, C, Kirkbride, JB, Bresnahan, M, Fearon, P, Susser, E (2008). Psychosis and place. Epidemiological Review 30, 84–100.CrossRefGoogle ScholarPubMed
Martin, D (2002). Geography for the 2001 census in England and Wales. Population Trends 108, 7–15.Google Scholar
Morgan, C, Hutchinson, G (2010). The social determinants of psychosis in migrant and ethnic minority populations: a public health tragedy. Psychological Medicine 40, 705–709.CrossRefGoogle ScholarPubMed
Nazareth, I, King, M, Haines, A, Rangel, L, Myers, S (1993). Accuracy of diagnosis of psychosis on general practice computer system. British Medical Journal 307, 32–34.CrossRefGoogle ScholarPubMed
Office for National Statistics (2002). Census 2001. HMSO: London.Google Scholar
Office for National Statistics (2007). Beginners' guide to UK geography. Census geography. (http://www.statistics.gov.uk/geography/census_geog.asp.) Accessed 30 March 2010.Google Scholar
Pickett, K, Wilkinson, R (2008). People like us: ethnic group density effects on health. Ethnicity and Health 13, 321–334.CrossRefGoogle ScholarPubMed
Pinto, R, Ashworth, M, Seed, P, Rowlands, G, Schofield, P, Jones, R (2010). Differences in the primary care management of patients with psychosis from two ethnic groups: a population-based cross-sectional study. Family Practice 27, 439–446.CrossRefGoogle ScholarPubMed
Selten, JP, Cantor-Graae, E (2010). The denial of a psychosis epidemic. Psychological Medicine 40, 731–733.CrossRefGoogle ScholarPubMed
Stafford, M, Becares, L, Nazroo, J (2009). Objective and perceived ethnic density and health: findings from a United Kingdom general population survey. American Journal of Epidemiology 170, 484–493.CrossRefGoogle ScholarPubMed
Thunhurst, C (2009). Measuring the health of urban populations: what progress have we made? Public Health 123, e40–e44.CrossRefGoogle Scholar
Veling, W, Susser, E, van Os, J, Mackenbach, JP, Selten, J-P, Hoek, HW (2008). Ethnic density of neighborhoods and incidence of psychotic disorders among immigrants. American Journal of Psychiatry 165, 66–73.CrossRefGoogle ScholarPubMed
Wechsler, H, Pugh, TF (1967). Fit of individual and community characteristics and rates of psychiatric hospitalization. American Journal of Sociology, 73, 331–338.CrossRefGoogle Scholar
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