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

doi:10.1007/s00127-023-02428-w

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

^*Corresponding author for this work

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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 language	English
Pages (from-to)	569-579
Number of pages	11
Journal	Social Psychiatry and Psychiatric Epidemiology
Volume	58
Issue number	4
Early online date	30 Jan 2023
DOIs	https://doi.org/10.1007/s00127-023-02428-w
Publication status	Published - Apr 2023

Bibliographical note

Funding Information:
RU reports grants from Medical Research Council, grants from National Institute for Health Research: Health Technology Assessment, grants from European Commission—Research: The Seventh Framework Programme, and personal fees from Sunovion, outside the submitted work.

M.B. and S.P.S are part funded by the National Institute for Health Research through the Applied Research Collaboration West Midlands (ARC-WM). P.B.J. is part funded by the NIHR ARC East of England. The views expressed in this publication are those of the authors and not necessarily those of the NHS, NIHR, or Department of Health. Birmingham and Solihull NHS Foundation Trust acted as study sponsor. We would like to thank the participants of the National EDEN study and the UK Clinical Research Network for study support.

Publisher Copyright:
© 2023, The Author(s).

Keywords

Deprivation
Early psychosis
Ethnicity
Inequities
Outcomes
Original Paper

ASJC Scopus subject areas

Health(social science)
Psychiatry and Mental health
Social Psychology
Epidemiology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Cite this

Griffiths, S. L., Bogatsu, T., Longhi, M., Butler, E., Alexander, B., Bandawar, M., Everard, L., Jones, P. B., Fowler, D., Hodgekins, J., Amos, T., Freemantle, N., McCrone, P., Singh, S. P., Birchwood, M., & Upthegrove, R. (2023). Five-year illness trajectories across racial groups in the UK following a first episode psychosis. Social Psychiatry and Psychiatric Epidemiology, 58(4), 569-579. https://doi.org/10.1007/s00127-023-02428-w

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title = "Five-year illness trajectories across racial groups in the UK following a first episode psychosis",

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.",

keywords = "Deprivation, Early psychosis, Ethnicity, Inequities, Outcomes, Original Paper",

author = "Griffiths, {Si{\^a}n Lowri} and Tumelo Bogatsu and Mia Longhi and Emily Butler and Beel Alexander and Mrunal Bandawar and Linda Everard and Jones, {Peter B.} and David Fowler and Joanne Hodgekins and Tim Amos and Nick Freemantle and Paul McCrone and Singh, {Swaran P.} and Max Birchwood and Rachel Upthegrove",

note = "Funding Information: RU reports grants from Medical Research Council, grants from National Institute for Health Research: Health Technology Assessment, grants from European Commission—Research: The Seventh Framework Programme, and personal fees from Sunovion, outside the submitted work. M.B. and S.P.S are part funded by the National Institute for Health Research through the Applied Research Collaboration West Midlands (ARC-WM). P.B.J. is part funded by the NIHR ARC East of England. The views expressed in this publication are those of the authors and not necessarily those of the NHS, NIHR, or Department of Health. Birmingham and Solihull NHS Foundation Trust acted as study sponsor. We would like to thank the participants of the National EDEN study and the UK Clinical Research Network for study support. Publisher Copyright: {\textcopyright} 2023, The Author(s).",

year = "2023",

month = apr,

doi = "10.1007/s00127-023-02428-w",

language = "English",

volume = "58",

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Griffiths, SL , Bogatsu, T, Longhi, M, Butler, E, Alexander, B, Bandawar, M, Everard, L, Jones, PB, Fowler, D, Hodgekins, J, Amos, T, Freemantle, N, McCrone, P, Singh, SP, Birchwood, M & Upthegrove, R 2023, 'Five-year illness trajectories across racial groups in the UK following a first episode psychosis', Social Psychiatry and Psychiatric Epidemiology, vol. 58, no. 4, pp. 569-579. https://doi.org/10.1007/s00127-023-02428-w

TY - JOUR

T1 - Five-year illness trajectories across racial groups in the UK following a first episode psychosis

AU - Griffiths, Siân Lowri

AU - Bogatsu, Tumelo

AU - Longhi, Mia

AU - Butler, Emily

AU - Alexander, Beel

AU - Bandawar, Mrunal

AU - Everard, Linda

AU - Jones, Peter B.

AU - Fowler, David

AU - Hodgekins, Joanne

AU - Amos, Tim

AU - Freemantle, Nick

AU - McCrone, Paul

AU - Singh, Swaran P.

AU - Birchwood, Max

AU - Upthegrove, Rachel

N1 - Funding Information: RU reports grants from Medical Research Council, grants from National Institute for Health Research: Health Technology Assessment, grants from European Commission—Research: The Seventh Framework Programme, and personal fees from Sunovion, outside the submitted work. M.B. and S.P.S are part funded by the National Institute for Health Research through the Applied Research Collaboration West Midlands (ARC-WM). P.B.J. is part funded by the NIHR ARC East of England. The views expressed in this publication are those of the authors and not necessarily those of the NHS, NIHR, or Department of Health. Birmingham and Solihull NHS Foundation Trust acted as study sponsor. We would like to thank the participants of the National EDEN study and the UK Clinical Research Network for study support. Publisher Copyright: © 2023, The Author(s).

PY - 2023/4

Y1 - 2023/4

N2 - 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.

AB - 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.

KW - Deprivation

KW - Early psychosis

KW - Ethnicity

KW - Inequities

KW - Outcomes

KW - Original Paper

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ER -

Five-year illness trajectories across racial groups in the UK following a first episode psychosis

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

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Cite this