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Fiorillo A, Javed A, Azeem MW, Basu D, Lam LCW, Murthy P, Ndetei D, Okasha T, Stein DJ, Bhui KS. Education, policy and clinical care in mental health: an update on the activities of WPA Collaborating Centres. World Psychiatry 2023; 22:495-496. [PMID: 37713543 PMCID: PMC10503928 DOI: 10.1002/wps.21144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 09/17/2023] Open
Affiliation(s)
- Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | | | | | - Debasish Basu
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Linda C W Lam
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong
| | - Pratima Murthy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - David Ndetei
- Department of Psychiatry, University of Nairobi and Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Tarek Okasha
- Okasha Institute of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Dan J Stein
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Kamaldeep S Bhui
- Department of Psychiatry and Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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2
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Gómez-Carrillo A, Kirmayer LJ, Aggarwal NK, Bhui KS, Fung KPL, Kohrt BA, Weiss MG, Lewis-Fernández R. Integrating neuroscience in psychiatry: a cultural-ecosocial systemic approach. Lancet Psychiatry 2023; 10:296-304. [PMID: 36828009 DOI: 10.1016/s2215-0366(23)00006-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/12/2022] [Accepted: 12/22/2022] [Indexed: 02/24/2023]
Abstract
Psychiatry has increasingly adopted explanations for psychopathology that are based on neurobiological reductionism. With the recognition of health disparities and the realisation that someone's postcode can be a better predictor of health outcomes than their genetic code, there are increasing efforts to ensure cultural and social-structural competence in psychiatric practice. Although neuroscientific and social-cultural approaches in psychiatry remain largely separate, they can be brought together in a multilevel explanatory framework to advance psychiatric theory, research, and practice. In this Personal View, we outline how a cultural-ecosocial systems approach to integrating neuroscience in psychiatry can promote social-contextual and systemic thinking for more clinically useful formulations and person-centred care.
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Affiliation(s)
- Ana Gómez-Carrillo
- Division of Social and Transcultural Psychiatry, McGill University, Montreal, QC, Canada.
| | - Laurence J Kirmayer
- Division of Social and Transcultural Psychiatry, McGill University, Montreal, QC, Canada; Culture and Mental Health Research Unit, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Neil Krishan Aggarwal
- Department of Psychiatry, Columbia University, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Kamaldeep S Bhui
- Department of Psychiatry, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; Department of Psychiatry, Warneford Hospital, Oxford, UK
| | | | - Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | - Mitchell G Weiss
- Swiss Tropical and Public Health Institute, Basel, Switzerland; Department of Epidemiology and Public Health, University of Basel, Basel, Switzerland
| | - Roberto Lewis-Fernández
- Department of Psychiatry, Columbia University, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
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Foote IF, Jacobs BM, Mathlin G, Watson CJ, Bothongo PLK, Waters S, Dobson R, Noyce AJ, Bhui KS, Korszun A, Marshall CR. The shared genetic architecture of modifiable risk for Alzheimer's disease: a genomic structural equation modelling study. Neurobiol Aging 2022; 117:222-235. [DOI: 10.1016/j.neurobiolaging.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 02/02/2022] [Accepted: 02/08/2022] [Indexed: 11/28/2022]
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Ndetei DM, Mutiso VN, Musyimi CW, Alietsi RK, Shanley JR, Bhui KS. The feasibility of using life skills training in primary schools to improve mental health and academic performance: a pilot study in Kenya. BMC Psychiatry 2022; 22:131. [PMID: 35177007 PMCID: PMC8855590 DOI: 10.1186/s12888-022-03781-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 02/14/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND There is no Kenyan evidence on the relationship between mental illness and academic performance. We aimed to determine the effect of life skills training on mental health and academic performance. METHODS We administered to 1848 primary school children a researcher designed socio-demographic questionnaire, and the Youth Self Report (YSR) and Child Behavior Checklist (CBCL) to their parents, followed by eight sessions of life skills training. We extracted data from the individual records of each child on overall performance pre and post training separated by one year. We conducted descriptive statistics, paired sample t-tests, multivariate linear regression analysis and linear mixed model analysis to assess changing patterns of academic performance and any predictive characteristics. RESULTS There was significant (p < 0.05) improvement in overall academic performance (aggregate marks and all individual subjects) for both lower primary and upper primary classes after the life-skills training intervention. For lower classes (2-4 grades) increase in academic performance was significantly associated with fathers and mothers education levels, region and class. For upper classes, (5-7 grades) increase in academic performance was associated with region, class and age. CONCLUSIONS Life skills training is recommended as it could improve academic performance, but predicted by socio-demographic factors.
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Affiliation(s)
- David M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya. .,Department of Psychiatry, University of Nairobi, Nairobi, Kenya. .,World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya.
| | - Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.,World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Christine W Musyimi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.,World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Rita K Alietsi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.,World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Jenelle R Shanley
- School of Graduate Psychology, Pacific University, Forest Grove, USA
| | - Kamaldeep S Bhui
- Department of Psychiatry, University of Oxford, Oxford, England.,World Psychiatric Association Collaborating Centre for Research and Training, London, UK
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Fiorillo A, Bhui KS, Stein D, Okasha T, Ndetei D, Lam LC, Murthy P, Azeem MW, Javed A. The 2021-2024 Work Plan of WPA Collaborating Centres. World Psychiatry 2021; 20:457. [PMID: 34505383 PMCID: PMC8429313 DOI: 10.1002/wps.20917] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Andrea Fiorillo
- Department of PsychiatryUniversity of Campania “L. Vanvitelli”NaplesItaly
| | - Kamaldeep S. Bhui
- Department of Psychiatry & Nuffield Department of Primary Care Health Sciences, University of OxfordOxfordUK
| | - Dan J. Stein
- Department of Psychiatry, University of Cape TownCape TownSouth Africa
| | - Tarek Okasha
- Okasha Institute of Psychiatry, Faculty of Medicine, Ain Shams UniversityCairoEgyptUSA
| | - David Ndetei
- Department of Psychiatry, University of Nairobi and Africa Mental Health Research and Training FoundationNairobiKenya
| | - Linda C.W. Lam
- Department of Psychiatry, Chinese University of Hong KongHong Kong
| | - Pratima Murthy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS)BangaloreIndia
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Weiss MG, Aggarwal NK, Gómez-Carrillo A, Kohrt B, Kirmayer LJ, Bhui KS, Like R, Kopelowicz A, Lu F, Farías PJ, Becker AE, Hinton L, Lewis-Fernández R. Culture and Social Structure in Comprehensive Case Formulation. J Nerv Ment Dis 2021; 209:465-466. [PMID: 34170856 DOI: 10.1097/nmd.0000000000001346] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | | | - Ana Gómez-Carrillo
- Institute of Community and Family Psychiatry, Sir Mortimer B Davis Jewish General Hospital, Montréal, Quebec, Canada
| | - Brandon Kohrt
- Department of Psychiatry, The George Washington University, Washington, DC
| | - Laurence J Kirmayer
- Institute of Community and Family Psychiatry, Sir Mortimer B Davis Jewish General Hospital, Montréal, Quebec, Canada
| | - Kamaldeep S Bhui
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Robert Like
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Alex Kopelowicz
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Los Angeles
| | - Francis Lu
- Department of Psychiatry, University of California Davis School of Medicine, Sacramento, California
| | - Pablo J Farías
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Anne E Becker
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California
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7
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Foote IF, Jacobs BM, Noyce AJ, Korszun A, Bhui KS, Marshall CR. Exploring the shared genetic architecture of modifiable risk factors and related endophenotypes of Alzheimer’s disease: A genomic SEM study. Alzheimers Dement 2020. [DOI: 10.1002/alz.045164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | - Ania Korszun
- Queen Mary University of London London United Kingdom
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8
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Jarvis GE, Larchanché S, Bennegadi R, Ascoli M, Bhui KS, Kirmayer LJ. Cultural Consultation in Context: A Comparison of the Framing of Identity During Intake at Services in Montreal, London, and Paris. Cult Med Psychiatry 2020; 44:433-455. [PMID: 31965486 DOI: 10.1007/s11013-019-09666-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cultural diversity poses a challenge to mental Health care systems in many settings. Specialized cultural consultation services have been developed in a number of countries as a way to supplement existing services. The objective of this paper is to compare and contrast cultural consultation services in Montreal, London, and Paris to determine how culture and society have shaped the evolution of these services to meet local sensitivities and imperatives. Historical contexts of the sites, their descriptions and origins, how they categorize cultural, ethnic, and linguistic diversity, and their intake procedures are compared and contrasted according to a standardized template of themes. Data came from site visits and participant observation at each site. For historical, political, and cultural reasons, categorization of diversity and intake procedures differ markedly by site: Montreal focuses on language categories and language proficiency; London enumerates ethnic diversity according to officially mandated categories; and Paris does not gather ethnic data on its patients in any form. The process of cultural consultation, specifically its triage and intake procedures, is profoundly influenced by local histories and social norms that are maintained by professional cultures of psychiatry in each setting. To properly place their patients in context, cultural psychiatrists must not only aim to understand the culture of the other, but also must consider the culture of the mainstream society and how it shapes the delivery of services.
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Affiliation(s)
- G Eric Jarvis
- Culture and Mental Health Research Unit, 4333 Côte-Ste-Catherine Road, Montreal, QC, H3T 1E4, Canada.
| | | | | | | | - Kamaldeep S Bhui
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Laurence J Kirmayer
- Culture and Mental Health Research Unit, 4333 Côte-Ste-Catherine Road, Montreal, QC, H3T 1E4, Canada
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Abstract
The COVID-19 pandemic has stunned the global community with marked social and psychological ramifications. There are key challenges for psychiatry that require urgent attention to ensure mental health well-being for all - COVID-19-positive patients, healthcare professionals, first responders, people with psychiatric disorders and the general population. This editorial outlines some of these challenges and research questions, and serves as a preliminary framework of what needs to be addressed. Mental healthcare should be an integral component of healthcare policy and practice towards COVID-19. Collaborative efforts from psychiatric organisations and their members are required to maximise appropriate clinical and educational interventions while minimising stigma.
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Affiliation(s)
- Kenneth R Kaufman
- Departments of Psychiatry, Neurology, and Anesthesiology, Rutgers Robert Wood Johnson Medical School, USA; and Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Eva Petkova
- Departments of Population Health and Child and Adolescent Psychiatry, New York University Grossman School of Medicine; and Department of Clinical Research, Nathan Kline Institute of Psychiatric Research, USA
| | - Kamaldeep S Bhui
- Departments of Cultural Psychiatry and Epidemiology, Centre for Psychiatry, Queen Mary University of London; and Honorary Consultant Psychiatrist, East London NHS Foundation Trust, UK
| | - Thomas G Schulze
- Institute of Psychiatric Phenomics and Genomics (IPPG), Ludwig-Maximilians-University Munich, Germany; and Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, USA
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10
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Nazroo JY, Bhui KS, Rhodes J. Where next for understanding race/ethnic inequalities in severe mental illness? Structural, interpersonal and institutional racism. Sociol Health Illn 2020; 42:262-276. [PMID: 31562655 PMCID: PMC7028120 DOI: 10.1111/1467-9566.13001] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
In this article we use the example of race/ethnic inequalities in severe mental illness to demonstrate the utility of a novel integrative approach to theorising the role of racism in generating inequality. Ethnic minority people in the UK are at much greater risk than White British people of being diagnosed with a severe - psychosis related - mental illness, and this is particularly the case for those with Black Caribbean or Black African origins. There is entrenched dispute about how we might understand the drivers of this inequality. To address this dispute we build on, and to a certain extent refine, established approaches to theorising structural and institutional racism, and integrate this within a theoretical framework that also incorporates racist/discriminatory interactions (interpersonal racism). We argue that this provides a conceptually robust and thorough analysis of the role of inter-related dimensions of racism in shaping risks of severe mental illness, access to care, and policy and practice responses. This analysis carries implications for a broader, but integrated, understanding of the fundamental drives of race/ethnic inequalities in health and for an anti-racism public health agenda.
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Affiliation(s)
| | | | - James Rhodes
- Department of SociologyUniversity of ManchesterUK
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Abstract
Addictions are challenging health and social problems that need to be addressed to preserve and promote good mental health and ensure that individuals within society lead healthy and productive lives. Tackling addictions is complex and requires communities, public health, specialist services, and local and national government to act in unison and implement evidence-based interventions. This editorial raises systemic issues that need attention and proposes a range of systemic options.
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Affiliation(s)
- Kamaldeep S Bhui
- Professor of Cultural Psychiatry and Epidemiology, Head of Centre for Psychiatry, Barts & The London School of Medicine and Dentistry, Queen Mary University of London; and Honorary Consultant Psychiatrist, East London NHS Foundation Trust, UK
| | - Peter Byrne
- Consultant Liaison Psychiatrist, Royal London Hospital; and Visiting Professor, University of Strathclyde, UK
| | - Diane Goslar
- Is an Expert by Experience and Advisor on alcohol and drugs issues and policies for the Royal College of Psychiatrists
| | - Julia Sinclair
- Professor and Honorary Consultant Addiction Psychiatrist, University of Southampton and University Hospitals Southampton NHS Foundation Trust, UK
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12
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Abstract
We present an account of why we decided to retract a paper. We discovered a lack of adherence to conventional trials registration, execution, interpretation and reporting, and consequently, with the authors, needed to correct the scientific record. We set out our responses in general to strengthen research integrity.Declaration of interestK.S.B. is Editor-in-Chief of the British Journal of Psychiatry. W.L., K.R.K. and S.M.L. are members of the senior editorial committee and the research integrity committee for the journal. In the past three years, S.M.L. has received research support from Janssen and Lundbeck, and personal support from Janssen, Otsuka and Sunovion.
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Affiliation(s)
- Kamaldeep S Bhui
- Professor of Cultural Psychiatry & Epidemiology, Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry,Queen Mary University of London; andHonorary Consultant Psychiatrist,East London NHS Foundation Trust,UK
| | - William Lee
- Honorary Clinical Senior Lecturer,University of Exeter; and Consultant Psychiatrist, Devon Partnership NHS Trust,UK
| | - Kenneth R Kaufman
- Professor of Psychiatry, Neurology and Anesthesiology,Rutgers Robert Wood Johnson Medical School,New Brunswick,New Jersey,USA; andVisiting Professor,Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience,King's College London,UK
| | - Stephen M Lawrie
- Division of Psychiatry,University of Edinburgh, Royal Edinburgh Hospital,UK
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13
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Abstract
We present the reasoning behind a retraction noting that even small, honest errors can result in significant changes in findings.
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Affiliation(s)
- Kenneth R Kaufman
- Professor of Psychiatry, Neurology and Anesthesiology, Rutgers Robert Wood Johnson Medical School, USA; and Visiting Professor, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Gin S Malhi
- Professor, Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Australia
| | - Kamaldeep S Bhui
- Professor of Cultural Psychiatry & Psychiatric Epidemiology, Centre for Psychiatry, Barts & The London School of Medicine and Dentistry, Wolfson Institute of Preventive Medicine, Queen Mary University of London; and Honorary Consultant Psychiatrist, East London NHS Foundation Trust, UK
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14
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Abstract
Schizophrenia and anorexia nervosa were recently added to the list of conditions for which whole genome sequencing might be indicated as part of the 100 000 Genomes Project, reflecting the remarkable recent progress in findings emerging from psychiatric genetics research. Genetic testing methods may offer increased opportunities for diagnosis and estimation of familial risk and could have implications for management and treatment options. They also present ethical and philosophical questions about the role of testing and storage of genetic information. Mental health professionals will need to have a good understanding of this area in order for patients to fully realise the benefits of these advances.Declaration of InterestK.S.B. is Editor of the British Journal of Psychiatry.
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Affiliation(s)
- David Curtis
- Honorary Professor,Centre for Psychiatry,Barts and the London School of Medicine and Dentistry;and Honorary Professor,UCL Genetics Institute, University College London,UK
| | | | - Kamaldeep S Bhui
- Professor and Head,The Centre for Psychiatry,Wolfson Institute of Preventive Medicine,Barts and The London School of Medicine & Dentistry,Queen Mary University of London;and Honorary Consultant Psychiatrist,East London NHS Foundation Trust,UK
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Ullmann E, Perry SW, Licinio J, Wong ML, Dremencov E, Zavjalov EL, Shevelev OB, Khotskin NV, Koncevaya GV, Khotshkina AS, Moshkin MP, Lapshin MS, Komelkova MV, Feklicheva IV, Tseilikman OB, Cherkasova OP, Bhui KS, Jones E, Kirschbaum C, Bornstein SR, Tseilikman V. From Allostatic Load to Allostatic State-An Endogenous Sympathetic Strategy to Deal With Chronic Anxiety and Stress? Front Behav Neurosci 2019; 13:47. [PMID: 30967764 PMCID: PMC6442703 DOI: 10.3389/fnbeh.2019.00047] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 02/22/2019] [Indexed: 01/10/2023] Open
Abstract
The concepts of allostatic load and overload, i. e., a dramatic increase in the allostatic load that predisposes to disease, have been extensively described in the literature. Here, we show that rats engaging in active offensive response (AOR) behavioral strategies to chronic predator scent stress (PSS) display less anxiety behavior and lower plasma cortisol levels vs. rats engaging in passive defensive response (PDR) behavioral strategies to chronic PSS. In the same chronic PSS paradigm, AOR rats also have higher lactate and lower glutamate levels in amygdala but not in control-region hippocampus vs. PDR rats. The implications of these findings for regulation of allostatic and stress responses, and post-traumatic stress disorder (PTSD) are discussed.
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Affiliation(s)
- Enrico Ullmann
- Department of Medicine, Carl Gustav Carus, Technical University of Dresden, Dresden, Germany.,Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University of Leipzig, Leipzig, Germany.,School of Medical Biology, South Ural State University, Chelyabinsk, Russia
| | - Seth W Perry
- College of Medicine, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Julio Licinio
- College of Medicine, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Ma-Li Wong
- College of Medicine, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Eliyahu Dremencov
- School of Medical Biology, South Ural State University, Chelyabinsk, Russia.,Institute of Molecular Physiology and Genetics, Centre for Biosciences, Slovak Academy of Sciences, Bratislava, Slovakia.,Biomedical Research Center, Institute of Experimental Endocrinology, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Evgenii L Zavjalov
- Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Science (RAS), Novosibirsk, Russia
| | - Oleg B Shevelev
- Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Science (RAS), Novosibirsk, Russia
| | - Nikita V Khotskin
- Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Science (RAS), Novosibirsk, Russia
| | - Galina V Koncevaya
- Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Science (RAS), Novosibirsk, Russia
| | - Anna S Khotshkina
- Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Science (RAS), Novosibirsk, Russia
| | - Mikhail P Moshkin
- Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Science (RAS), Novosibirsk, Russia
| | - Maxim S Lapshin
- School of Medical Biology, South Ural State University, Chelyabinsk, Russia
| | - Maria V Komelkova
- School of Medical Biology, South Ural State University, Chelyabinsk, Russia
| | - Inna V Feklicheva
- School of Medical Biology, South Ural State University, Chelyabinsk, Russia
| | - Olga B Tseilikman
- School of Medical Biology, South Ural State University, Chelyabinsk, Russia
| | - Olga P Cherkasova
- Biophysics Laboratory, Institute of Laser Physics, Siberian Branch of the Russian Academy of Science, Novosibirsk, Russia
| | - Kamaldeep S Bhui
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Edgar Jones
- Institute of Psychiatry Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Clemens Kirschbaum
- Department of Psychology, Biopsychology, Technical University of Dresden, Dresden, Germany
| | - Stefan R Bornstein
- Department of Medicine, Carl Gustav Carus, Technical University of Dresden, Dresden, Germany.,Faculty of Life Sciences & Medicine, Endocrinology and Diabetes, Kings College London, London, United Kingdom
| | - Vadim Tseilikman
- School of Medical Biology, South Ural State University, Chelyabinsk, Russia
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16
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Duncan M, Deane J, White PD, Ridge D, Roylance R, Korszun A, Chalder T, Bhui KS, Thaha MA, Bourke L. A survey to determine usual care after cancer treatment within the United Kingdom national health service. BMC Cancer 2017; 17:186. [PMID: 28284185 PMCID: PMC5346235 DOI: 10.1186/s12885-017-3172-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 03/04/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Approximately one third of cancer survivors in the United Kingdom face ongoing and debilitating psychological and physical symptoms related to poor quality of life. Very little is known about current post-cancer treatment services. METHODS Oncology healthcare professionals (HCPs) were invited to take part in a survey, which gathered both quantitative and free text data about the content and delivery of cancer aftercare and patient needs. Analysis involved descriptive statistics and content analysis. RESULTS There were 163 complete responses from 278 survey participants; 70% of NHS acute trusts provided data. HCPs views on patient post-cancer treatment needs were most frequently: fear of recurrence (95%), fatigue (94%), changes in physical capabilities (89%), anxiety (89%) and depression (88%). A median number of 2 aftercare sessions were provided (interquartile range: 1,4) lasting between 30 and 60 min. Usually these were provided face-to-face and intermittently by a HCP. However, sessions did not necessarily address the issues HCPs asserted as important. Themes from free-text responses highlighted inconsistencies in care, uncertain funding for services and omission of some evidence based approaches. CONCLUSION Provision of post-cancer treatment follow-up care is neither universal nor consistent in the NHS, nor does it address needs HCPs identified as most important.
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Affiliation(s)
- M Duncan
- Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - J Deane
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - P D White
- Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - D Ridge
- Department of Psychology, University of Westminster, London, UK
| | - R Roylance
- University College Hospitals London, London, UK
| | - A Korszun
- Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - T Chalder
- Institute of Psychiatry, King's College London, London, UK
| | - K S Bhui
- Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - M A Thaha
- National Bowel Research Centre, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - L Bourke
- Sheffield Hallam University, Office A121, Collegiate Hall, Collegiate Crescent, Sheffield, S10 2BP, UK.
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17
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Affiliation(s)
- Dinesh Bhugra
- Institute of Psychiatry, King's College London, Health Service & Population Research Department, London, UK
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia 71100, Italy.
| | - K S Bhui
- Cultural Psychiatry & Epidemiology, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London
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Bhui KS, Fiorillo A, Stein D, Okasha T, Ndetei D, Lam L, Chaturvedi S, Maj M. Improving education, policy and research in mental health worldwide: the role of the WPA Collaborating Centres. World Psychiatry 2016; 15:300. [PMID: 27717249 PMCID: PMC5032491 DOI: 10.1002/wps.20360] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Kamaldeep S Bhui
- Department of Psychiatry, Barts and London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Andrea Fiorillo
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - Dan Stein
- University of Cape Town, Cape Town, South Africa
| | - Tarek Okasha
- Institute of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - David Ndetei
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Linda Lam
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong
| | - Santosh Chaturvedi
- National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Mario Maj
- Department of Psychiatry, University of Naples SUN, Naples, Italy
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Affiliation(s)
- Kamaldeep S Bhui
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Newton JN, Briggs ADM, Murray CJL, Dicker D, Foreman KJ, Wang H, Naghavi M, Forouzanfar MH, Ohno SL, Barber RM, Vos T, Stanaway JD, Schmidt JC, Hughes AJ, Fay DFJ, Ecob R, Gresser C, McKee M, Rutter H, Abubakar I, Ali R, Anderson HR, Banerjee A, Bennett DA, Bernabé E, Bhui KS, Biryukov SM, Bourne RR, Brayne CEG, Bruce NG, Brugha TS, Burch M, Capewell S, Casey D, Chowdhury R, Coates MM, Cooper C, Critchley JA, Dargan PI, Dherani MK, Elliott P, Ezzati M, Fenton KA, Fraser MS, Fürst T, Greaves F, Green MA, Gunnell DJ, Hannigan BM, Hay RJ, Hay SI, Hemingway H, Larson HJ, Looker KJ, Lunevicius R, Lyons RA, Marcenes W, Mason-Jones AJ, Matthews FE, Moller H, Murdoch ME, Newton CR, Pearce N, Piel FB, Pope D, Rahimi K, Rodriguez A, Scarborough P, Schumacher AE, Shiue I, Smeeth L, Tedstone A, Valabhji J, Williams HC, Wolfe CDA, Woolf AD, Davis ACJ. Changes in health in England, with analysis by English regions and areas of deprivation, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015; 386:2257-74. [PMID: 26382241 PMCID: PMC4672153 DOI: 10.1016/s0140-6736(15)00195-6] [Citation(s) in RCA: 261] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND In the Global Burden of Disease Study 2013 (GBD 2013), knowledge about health and its determinants has been integrated into a comparable framework to inform health policy. Outputs of this analysis are relevant to current policy questions in England and elsewhere, particularly on health inequalities. We use GBD 2013 data on mortality and causes of death, and disease and injury incidence and prevalence to analyse the burden of disease and injury in England as a whole, in English regions, and within each English region by deprivation quintile. We also assess disease and injury burden in England attributable to potentially preventable risk factors. England and the English regions are compared with the remaining constituent countries of the UK and with comparable countries in the European Union (EU) and beyond. METHODS We extracted data from the GBD 2013 to compare mortality, causes of death, years of life lost (YLLs), years lived with a disability (YLDs), and disability-adjusted life-years (DALYs) in England, the UK, and 18 other countries (the first 15 EU members [apart from the UK] and Australia, Canada, Norway, and the USA [EU15+]). We extended elements of the analysis to English regions, and subregional areas defined by deprivation quintile (deprivation areas). We used data split by the nine English regions (corresponding to the European boundaries of the Nomenclature for Territorial Statistics level 1 [NUTS 1] regions), and by quintile groups within each English region according to deprivation, thereby making 45 regional deprivation areas. Deprivation quintiles were defined by area of residence ranked at national level by Index of Multiple Deprivation score, 2010. Burden due to various risk factors is described for England using new GBD methodology to estimate independent and overlapping attributable risk for five tiers of behavioural, metabolic, and environmental risk factors. We present results for 306 causes and 2337 sequelae, and 79 risks or risk clusters. FINDINGS Between 1990 and 2013, life expectancy from birth in England increased by 5·4 years (95% uncertainty interval 5·0-5·8) from 75·9 years (75·9-76·0) to 81·3 years (80·9-81·7); gains were greater for men than for women. Rates of age-standardised YLLs reduced by 41·1% (38·3-43·6), whereas DALYs were reduced by 23·8% (20·9-27·1), and YLDs by 1·4% (0·1-2·8). For these measures, England ranked better than the UK and the EU15+ means. Between 1990 and 2013, the range in life expectancy among 45 regional deprivation areas remained 8·2 years for men and decreased from 7·2 years in 1990 to 6·9 years in 2013 for women. In 2013, the leading cause of YLLs was ischaemic heart disease, and the leading cause of DALYs was low back and neck pain. Known risk factors accounted for 39·6% (37·7-41·7) of DALYs; leading behavioural risk factors were suboptimal diet (10·8% [9·1-12·7]) and tobacco (10·7% [9·4-12·0]). INTERPRETATION Health in England is improving although substantial opportunities exist for further reductions in the burden of preventable disease. The gap in mortality rates between men and women has reduced, but marked health inequalities between the least deprived and most deprived areas remain. Declines in mortality have not been matched by similar declines in morbidity, resulting in people living longer with diseases. Health policies must therefore address the causes of ill health as well as those of premature mortality. Systematic action locally and nationally is needed to reduce risk exposures, support healthy behaviours, alleviate the severity of chronic disabling disorders, and mitigate the effects of socioeconomic deprivation. FUNDING Bill & Melinda Gates Foundation and Public Health England.
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Affiliation(s)
- John N Newton
- Public Health England, London, UK; University of Manchester, Manchester, UK.
| | | | | | - Daniel Dicker
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Kyle J Foreman
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Haidong Wang
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | | | | | - Ryan M Barber
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Theo Vos
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | | | | | | | | | | | | | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Harry Rutter
- London School of Hygiene & Tropical Medicine, Oxford Martin School, University of Oxford, Oxford, UK
| | - Ibrahim Abubakar
- Public Health England, London, UK; Centre for Infectious Disease Epidemiology and MRC Clinical Trials Unit, London, UK
| | - Raghib Ali
- INDOX Cancer Research Network, Oxford, UK; John Radcliffe Hospital, Oxford, UK; Green-Templeton College, University of Oxford, Oxford, UK
| | - H Ross Anderson
- Population Health Research Institute, Hamilton, ON, Canada; MRC-PHE Centre for Environment and Health, London, UK; St George's, University of London, London, UK
| | | | - Derrick A Bennett
- Clinical Trials Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Kamaldeep S Bhui
- Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, UK
| | | | - Rupert R Bourne
- Vision & Eye Research Unit, Anglia Ruskin University, Cambridge, UK
| | - Carol E G Brayne
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | | | | | - Michael Burch
- Great Ormond Street Hospital for Children, London, UK
| | | | - Daniel Casey
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | | | | | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southhampton, UK
| | | | - Paul I Dargan
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Paul Elliott
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK
| | - Majid Ezzati
- MRC-PHE Centre for Population Health, School of Public Health, Imperial College London, London, UK
| | | | - Maya S Fraser
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Thomas Fürst
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Felix Greaves
- Public Health England, London, UK; Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Mark A Green
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - David J Gunnell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | | | - Simon I Hay
- Institute for Health Metrics and Evaluation, Seattle, WA, USA; Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Harry Hemingway
- University College London, London, UK; Farr Institute of Health Informatics Research, London, UK
| | - Heidi J Larson
- Institute for Health Metrics and Evaluation, Seattle, WA, USA; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Katharine J Looker
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Raimundas Lunevicius
- University of Liverpool, Liverpool, UK; Aintree University Hospital NHS Foundation Trust, University of Liverpool, Liverpool, UK
| | - Ronan A Lyons
- Farr Institute, College of Medicine, Swansea University, Swansea, UK
| | | | - Amanda J Mason-Jones
- Department of Health Sciences, University of York, York, UK; Adolescent Health Research Unit, University of Cape Town, Cape Town, South Africa
| | - Fiona E Matthews
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK; Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Henrik Moller
- Cancer Epidemiology and Population Health, King's College London, London, UK
| | | | | | - Neil Pearce
- London School of Hygiene & Tropical Medicine, Oxford Martin School, University of Oxford, Oxford, UK
| | | | | | - Kazem Rahimi
- George Institute for Global Health and Division of Cardiovascular Medicine, Oxford Martin School, University of Oxford, Oxford, UK
| | - Alina Rodriguez
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; Mid Sweden University, Sundsvall, Sweden
| | - Peter Scarborough
- British Heart Foundation Centre on Population Approaches for NCD Prevention, University of Oxford, Oxford, UK
| | | | - Ivy Shiue
- University of Edinburgh, Edinburgh, Scotland; Northumbria University, Newcastle upon Tyne
| | - Liam Smeeth
- Farr Institute of Health Informatics Research, London, UK; London School of Hygiene & Tropical Medicine, Oxford Martin School, University of Oxford, Oxford, UK
| | | | - Jonathan Valabhji
- NHS England, Leeds, UK; Imperial College Healthcare NHS Trust, London, UK; Imperial College London, London, UK
| | | | | | | | - Adrian C J Davis
- Public Health England, London, UK; London School of Economics, London, UK; University College London, London, UK
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Bhui KS, Aslam RW, Palinski A, McCabe R, Johnson MRD, Weich S, Singh SP, Knapp M, Ardino V, Szczepura A. Interventions to improve therapeutic communications between Black and minority ethnic patients and professionals in psychiatric services: systematic review. Br J Psychiatry 2015; 207:95-103. [PMID: 26243761 PMCID: PMC4523926 DOI: 10.1192/bjp.bp.114.158899] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Communication may be an influential determinant of inequality of access to, engagement with and benefit from psychiatric services. AIMS To review the evidence on interventions designed to improve therapeutic communications between Black and minority ethnic patients and clinicians who provide care in psychiatric services. METHOD Systematic review and evidence synthesis (PROSPERO registration: CRD42011001661). Data sources included the published and the 'grey' literature. A survey of experts and a consultation with patients and carers all contributed to the evidence synthesis, interpretation and recommendations. RESULTS Twenty-one studies were included in our analysis. The trials showed benefits mainly for depressive symptoms, experiences of care, knowledge, stigma, adherence to prescribed medication, insight and alliance. The effect sizes were smaller for better-quality trials (range of d 0.18-0.75) than for moderate- or lower-quality studies (range of d 0.18-4.3). The review found only two studies offering weak economic evidence. CONCLUSIONS Culturally adapted psychotherapies, and ethnographic and motivational assessment leading to psychotherapies were effective and favoured by patients and carers. Further trials are needed from outside of the UK and USA, as are economic evaluations and studies of routine psychiatric care practices.
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Affiliation(s)
- Kamaldeep S. Bhui
- Correspondence: K. S. Bhui, Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine & Dentistry, Old Anatomy Building, Charterhouse Square, London EC1M 6Q, UK.
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Owiti JA, Greenhalgh T, Sweeney L, Foster GR, Bhui KS. Illness perceptions and explanatory models of viral hepatitis B & C among immigrants and refugees: a narrative systematic review. BMC Public Health 2015; 15:151. [PMID: 25886390 PMCID: PMC4336715 DOI: 10.1186/s12889-015-1476-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 01/27/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Hepatitis B and C (HBV, HCV) infections are associated with high morbidity and mortality. Many countries with traditionally low prevalence (such as UK) are now planning interventions (screening, vaccination, and treatment) of high-risk immigrants from countries with high prevalence. This review aimed to synthesise the evidence on immigrants' knowledge of HBV and HCV that might influence the uptake of clinical interventions. The review was also used to inform the design and successful delivery of a randomised controlled trial of targeted screening and treatment. METHODS Five databases (PubMed, CINHAL, SOCIOFILE, PsycINFO & Web of Science) were systematically searched, supplemented by reference tracking, searches of selected journals, and of relevant websites. We aimed to identify qualitative and quantitative studies that investigated knowledge of HBV and HCV among immigrants from high endemic areas to low endemic areas. Evidence, extracted according to a conceptual framework of Kleinman's explanatory model, was subjected to narrative synthesis. We adapted the PEN-3 model to categorise and analyse themes, and recommend strategies for interventions to influence help-seeking behaviour. RESULTS We identified 51 publications including quantitative (n = 39), qualitative (n = 11), and mixed methods (n = 1) designs. Most of the quantitative studies included small samples and had heterogeneous methods and outcomes. The studies mainly concentrated on hepatitis B and ethnic groups of South East Asian immigrants residing in USA, Canada, and Australia. Many immigrants lacked adequate knowledge of aetiology, symptoms, transmission risk factors, prevention strategies, and treatment, of hepatitis HBV and HCV. Ethnicity, gender, better education, higher income, and English proficiency influenced variations in levels and forms of knowledge. CONCLUSION Immigrants are vulnerable to HBV and HCV, and risk life-threatening complications from these infections because of poor knowledge and help-seeking behaviour. Primary studies in this area are extremely diverse and of variable quality precluding meta-analysis. Further research is needed outside North America and Australia.
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Affiliation(s)
- John A Owiti
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Charterhouse Square, Queen Mary University of London, Centre for Psychiatry, EC1M 6BQ, London, UK.
| | - Trisha Greenhalgh
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Centre for Primary Care and Public Health, Yvonne Carter Building, 58 Turner Street, E1 2AB, London, UK.
| | - Lorna Sweeney
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Centre for Primary Care and Public Health, Yvonne Carter Building, 58 Turner Street, E1 2AB, London, UK.
| | - Graham R Foster
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, The Liver Unit, Centre for Digestive Diseases, 4 Newark Street, E1 2AT, London, UK.
| | - Kamaldeep S Bhui
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Charterhouse Square, Queen Mary University of London, Centre for Psychiatry, EC1M 6BQ, London, UK.
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Owiti JA, Palinski A, Ajaz A, Ascoli M, De Jongh B, Bhui KS. Explanations of illness experiences among community mental health patients: an argument for the use of an ethnographic interview method in routine clinical care. Int Rev Psychiatry 2015; 27:23-38. [PMID: 25747025 DOI: 10.3109/09540261.2014.995602] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Cultural variations in perceptions of mental distress are important issues for healthcare. They can affect communication between patients and professionals and may be a root cause for misdiagnosis, patient disengagement, and disparities in access, outcomes and overall experiences of treatment by patients. Taking into account patients' explanatory models (EMs) of mental distress is fundamental to patient-centred care, and improved outcomes. This paper reports on the outcomes from the Cultural Consultation Service, commissioned in an inner-city London borough. We used a narrative-based ethnographic method of assessment, in which community mental health patients referred for a cultural consultation were interviewed using Barts Explanatory Model Inventory and Checklist (BEMI) to assess the EMs of their mental distress. Patients mainly attributed the causes and consequences of their mental distress to emotional and psychological factors, which were inextricably linked to existing social concerns and interpersonal issues. Desired solutions mainly focused on treatment, social, and systemic interventions. We found that using BEMI could contribute to a comprehensive assessment in routine care and can be used by professionals within a short timeframe and with minimal training. Ethnographic assessment method captures patients' EMs and illness experiences, opening the way for patient-centred interventions and potentially better outcomes and experiences.
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Affiliation(s)
- John A Owiti
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary, University of London , London , UK
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Bhui KS, Owiti JA, Palinski A, Ascoli M, De Jongh B, Archer J, Staples P, Ahmed N, Ajaz A. A cultural consultation service in East London: experiences and outcomes from implementation of an innovative service. Int Rev Psychiatry 2015; 27:11-22. [PMID: 25747024 DOI: 10.3109/09540261.2014.992303] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This paper reports on a feasibility study and evaluation of a new type of cultural consultation service (CCS). This multi-component and systemic complex intervention was offered over 18 months to specialist mental health providers in one of the poorest regions of the UK. The service received 900 clinically related contacts and 99 in-depth consultations. Service users who were referred to the CCS had high levels of clinical needs with an average score of 15.9 on the Health of the Nation Outcomes Scale. Overall, Global Assessment of Function scores improved and there were trends for improvements in symptoms. The level of routine care (and by implication associated costs) significantly reduced after CCS intervention, due to a reduction in use of accident and emergency (A&E) services, psychiatrists and community psychiatric nurses (CPNs)/case managers. Cost analysis indicates that savings amounted to £497 per patient. The cost of intervention was no greater than usual care, and may reduce spend per patient over a 3-month follow-up and perhaps longer. More specifically, clinicians felt the cultural consultation service helped to improve the treatment plan (71%), engagement (50%), medication compliance (21%) and earlier discharge (7%).
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Affiliation(s)
- Kamaldeep S Bhui
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Swansea University , London , UK
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Owiti JA, Ajaz A, Ascoli M, de Jongh B, Palinski A, Bhui KS. Cultural consultation as a model for training multidisciplinary mental healthcare professionals in cultural competence skills: preliminary results. J Psychiatr Ment Health Nurs 2014; 21:814-26. [PMID: 24279693 DOI: 10.1111/jpm.12124] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2013] [Indexed: 12/01/2022]
Abstract
Lack of cultural competence in care contributes to poor experiences and outcomes from care for migrants and racial and ethnic minorities. As a result, health and social care organizations currently promote cultural competence of their workforce as a means of addressing persistent poor experiences and outcomes. At present, there are unsystematic and diverse ways of promoting cultural competence, and their impact on clinician skills and patient outcomes is unknown. We developed and implemented an innovative model, cultural consultation service (CCS), to promote cultural competence of clinicians and directly improve on patient experiences and outcomes from care. CCS model is an adaptation of the McGill model, which uses ethnographic methodology and medical anthropological knowledge. The method and approach not only contributes both to a broader conceptual and dynamic understanding of culture, but also to learning of cultural competence skills by healthcare professionals. The CCS model demonstrates that multidisciplinary workforce can acquire cultural competence skills better through the clinical encounter, as this promotes integration of learning into day-to-day practice. Results indicate that clinicians developed a broader and patient-centred understanding of culture, and gained skills in narrative-based assessment method, management of complexity of care, competing assumptions and expectations, and clinical cultural formulation. Cultural competence is defined as a set of skills, attitudes and practices that enable the healthcare professionals to deliver high-quality interventions to patients from diverse cultural backgrounds. Improving on the cultural competence skills of the workforce has been promoted as a way of reducing ethnic and racial inequalities in service outcomes. Currently, diverse models for training in cultural competence exist, mostly with no evidence of effect. We established an innovative narrative-based cultural consultation service in an inner-city area to work with community mental health services to improve on patients' outcomes and clinicians' cultural competence skills. We targeted 94 clinicians in four mental health service teams in the community. After initial training sessions, we used a cultural consultation model to facilitate 'in vivo' learning. During cultural consultation, we used an ethnographic interview method to assess patients in the presence of referring clinicians. Clinicians' self-reported measure of cultural competence using the Tool for Assessing Cultural Competence Training (n = 28, at follow-up) and evaluation forms (n = 16) filled at the end of each cultural consultation showed improvement in cultural competence skills. We conclude that cultural consultation model is an innovative way of training clinicians in cultural competence skills through a dynamic interactive process of learning within real clinical encounters.
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Affiliation(s)
- J A Owiti
- Centre for Psychiatry, Queen Mary, University of London, London, UK
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Klineberg E, Kelly MJ, Stansfeld SA, Bhui KS. How do adolescents talk about self-harm: a qualitative study of disclosure in an ethnically diverse urban population in England. BMC Public Health 2013; 13:572. [PMID: 23758739 PMCID: PMC3685521 DOI: 10.1186/1471-2458-13-572] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 05/18/2013] [Indexed: 11/21/2022] Open
Abstract
Background Self-harm is prevalent in adolescence. It is often a behaviour without verbal expression, seeking relief from a distressed state of mind. As most adolescents who self-harm do not seek help, the nature of adolescent self-harm and reasons for not disclosing it are a public health concern. This study aims to increase understanding about how adolescents in the community speak about self-harm; exploring their attitudes towards and experiences of disclosure and help-seeking. Methods This study involved 30 qualitative individual interviews with ethnically diverse adolescents aged 15–16 years (24 females, 6 males), investigating their views on coping with stress, self-harm and help-seeking, within their own social context in multicultural East London. Ten participants had never self-harmed, nine had self-harmed on one occasion and 11 had self-harmed repeatedly. Verbatim accounts were transcribed and subjected to content and thematic analysis using a framework approach. Results Self-harm was described as a complex and varied behaviour. Most participants who had self-harmed expressed reluctance to talk about it and many had difficulty understanding self-harm in others. Some participants normalised self-harm and did not wish to accept offers of help, particularly if their self-harm had been secretive and ‘discovered’, leading to their referral to more formal help from others. Disclosure was viewed more positively with hindsight by some participants who had received help. If help was sought, adolescents desired respect, and for their problems, feelings and opinions to be noticed and considered alongside receiving treatment for injuries. Mixed responses to disclosure from peers, family and initial sources of help may influence subsequent behaviour and deter presentation to services. Conclusions This study provides insight into the subjective experience of self-harm, disclosure and help-seeking from a young, ethnically diverse community sample. Accounts highlighted the value of examining self-harm in the context of each adolescent’s day-to-day life. These accounts emphasised the need for support from others and increasing awareness about appropriate responses to adolescent self-harm and accessible sources of help for adolescents.
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Affiliation(s)
- Emily Klineberg
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Barts& The London School of Medicine and Dentistry, London, UK.
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Abstract
Sikhism has millions of followers in India and among the Indian diaspora. As a religion it is relatively young but carries with it unique perspectives which are often not well known. The holy book of Sikhism, Guru Granth Sahib, is not only the last Guru, but also remained a key text for this religion. Using descriptions of the religion and its followers we attempt to understand the context of spirituality within this religion and attempt to apply it to clinical settings. We explored various texts to understand the notions of spirituality and ethics and directions for living one's life. We studied both the Gurumukhi version as well as the English translation of the Sikh holy text. In the context of history of the Sikhs, various descriptions related to mental well being were identified. In this paper we describe the history, development and the core values of the religion and we also review their role on psychiatric and mental health settings for managing Sikh patients. Guru Granth Sahib offers a very useful insight into what is understood by the term equivalent to depression and its phenomenology. The notions of dukh (loosely translated as pain, but can also mean sadness or suffering) and maya (illusion) and their role in daily living are also discussed. In this paper these descriptions are explored further and their importance explained.
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Affiliation(s)
- Gurvinder Kalra
- Department of Psychiatry, Lokmanya Tilak Medical College & Sion Hospital, Sion, Mumbai 400022, India
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Korszun A, Dinos S, Ahmed K, Bhui KS. Response to Prabhakar et al. Letter. Acad Psychiatry 2012; 36:500. [PMID: 27517703 DOI: 10.1176/appi.ap.12080154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Ania Korszun
- Barts and The London School of Medicine, Queen Mary University of London Centre for Psychiatry, London, UK.
| | - Sokratis Dinos
- Barts and The London School of Medicine, Queen Mary University of London Centre for Psychiatry, London, UK
| | - Kamran Ahmed
- Postgraduate Department, Maudsley Hospital, London, UK
| | - Kamaldeep S Bhui
- Basic Medical Sciences, Barts and The London Medical School Queen Mary, London, UK
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Ascoli M, Palinski A, Owiti JA, De Jongh B, Bhui KS. The culture of care within psychiatric services: tackling inequalities and improving clinical and organisational capabilities. Philos Ethics Humanit Med 2012; 7:12. [PMID: 23020856 PMCID: PMC3509394 DOI: 10.1186/1747-5341-7-12] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 05/03/2012] [Indexed: 06/01/2023] Open
Abstract
INTRODUCTION Cultural Consultation is a clinical process that emerged from anthropological critiques of mental healthcare. It includes attention to therapeutic communication, research observations and research methods that capture cultural practices and narratives in mental healthcare. This essay describes the work of a Cultural Consultation Service (ToCCS) that improves service user outcomes by offering cultural consultation to mental health practitioners. The setting is a psychiatric service with complex and challenging work located in an ethnically diverse inner city urban area. Following a period of 18 months of cultural consultation, we gather the dominant narratives that emerged during our evaluation of our service. RESULTS These narratives highlight how culture is conceptualized and acted upon in the day-to-day practices of individual health and social care professionals, specialist psychiatric teams and in care systems. The findings reveal common narratives and themes about culture, ethnicity, race and their perceived place and meaningfulness in clinical care. These narratives express underlying assumptions and covert rules for managing, and sometimes negating, dilemmas and difficulties when considering "culture" in the presentation and expression of mental distress. The narratives reveal an overall "culture of understanding cultural issues" and specific "cultures of care". These emerged as necessary foci of intervention to improve service user outcomes. CONCLUSION Understanding the cultures of care showed that clinical and managerial over-structuring of care prioritises organisational proficiency, but it leads to inflexibility. Consequently, the care provided is less personalised and less accommodating of cultural issues, therefore, professionals are unable to see or consider cultural influences in recovery.
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Affiliation(s)
- Micol Ascoli
- Tower Hamlets Cultural Consultation Service, Queen Mary, University of London, Old Anatomy Building, Charterhouse Square, London, EC1M 6BQ, UK
| | - Andrea Palinski
- Tower Hamlets Cultural Consultation Service, Queen Mary, University of London, Old Anatomy Building, Charterhouse Square, London, EC1M 6BQ, UK
| | - John Arianda Owiti
- Tower Hamlets Cultural Consultation Service, Queen Mary, University of London, Old Anatomy Building, Charterhouse Square, London, EC1M 6BQ, UK
| | - Bertine De Jongh
- Tower Hamlets Cultural Consultation Service, Queen Mary, University of London, Old Anatomy Building, Charterhouse Square, London, EC1M 6BQ, UK
| | - Kamaldeep S Bhui
- Tower Hamlets Cultural Consultation Service, Queen Mary, University of London, Old Anatomy Building, Charterhouse Square, London, EC1M 6BQ, UK
- Cultural Consultation Service & Wolfson Institute of Preventive Medicine, Queen Mary, University of London, Old Anatomy Building, Charterhouse Square, London, EC1M 6BQ, UK
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Abstract
BACKGROUND A mental health advantage has been observed among adolescents in urban areas. This prospective study tests whether cultural integration measured by cross-cultural friendships explains a mental health advantage for adolescents. METHODS A prospective cohort of adolescents was recruited from 51 secondary schools in 10 London boroughs. Cultural identity was assessed by friendship choices within and across ethnic groups. Cultural integration is one of four categories of cultural identity. Using gender-specific linear-mixed models we tested whether cultural integration explained a mental health advantage, and whether gender and age were influential. Demographic and other relevant factors, such as ethnic group, socio-economic status, family structure, parenting styles and perceived racism were also measured and entered into the models. Mental health was measured by the Strengths and Difficulties Questionnaire as a 'total difficulties score' and by classification as a 'probable clinical case'. RESULTS A total of 6643 pupils in first and second years of secondary school (ages 11-13 years) took part in the baseline survey (2003/04) and 4785 took part in the follow-up survey in 2005-06. Overall mental health improved with age, more so in male rather than female students. Cultural integration (friendships with own and other ethnic groups) was associated with the lowest levels of mental health problems especially among male students. This effect was sustained irrespective of age, ethnicity and other potential explanatory variables. There was a mental health advantage among specific ethnic groups: Black Caribbean and Black African male students (Nigerian/Ghanaian origin) and female Indian students. This was not fully explained by cultural integration, although cultural integration was independently associated with better mental health. CONCLUSIONS Cultural integration was associated with better mental health, independent of the mental health advantage found among specific ethnic groups: Black Caribbean and some Black African male students and female Indian students.
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Affiliation(s)
- Kamaldeep S Bhui
- Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, UK.
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Abstract
BACKGROUND Very recent acts of terrorism in the UK were perpetrated by 'homegrown', well educated young people, rather than by foreign Islamist groups; consequently, a process of violent radicalization was proposed to explain how ordinary people were recruited and persuaded to sacrifice their lives. DISCUSSION Counterterrorism approaches grounded in the criminal justice system have not prevented violent radicalization. Indeed there is some evidence that these approaches may have encouraged membership of radical groups by not recognizing Muslim communities as allies, citizens, victims of terrorism, and victims of discrimination, but only as suspect communities who were then further alienated. Informed by public health research and practice, a new approach is proposed to target populations vulnerable to recruitment, rather than rely only on research of well known terrorist groups and individual perpetrators of terrorist acts. CONCLUSIONS This paper proposes public health research and practice to guard against violent radicalization.
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Affiliation(s)
- Kamaldeep S Bhui
- Wolfson Institute of Preventive Medicine, Queen Mary, University of London, UK.
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Smith NR, Clark C, Fahy AE, Tharmaratnam V, Lewis DJ, Thompson C, Renton A, Moore DG, Bhui KS, Taylor SJC, Eldridge S, Petticrew M, Greenhalgh T, Stansfeld SA, Cummins S. The Olympic Regeneration in East London (ORiEL) study: protocol for a prospective controlled quasi-experiment to evaluate the impact of urban regeneration on young people and their families. BMJ Open 2012; 2:bmjopen-2012-001840. [PMID: 22936822 PMCID: PMC3432843 DOI: 10.1136/bmjopen-2012-001840] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Recent systematic reviews suggest that there is a dearth of evidence on the effectiveness of large-scale urban regeneration programmes in improving health and well-being and alleviating health inequalities. The development of the Olympic Park in Stratford for the London 2012 Olympic and Paralympic Games provides the opportunity to take advantage of a natural experiment to examine the impact of large-scale urban regeneration on the health and well-being of young people and their families. DESIGN AND METHODS A prospective school-based survey of adolescents (11-12 years) with parent data collected through face-to-face interviews at home. Adolescents will be recruited from six randomly selected schools in an area receiving large-scale urban regeneration (London Borough of Newham) and compared with adolescents in 18 schools in three comparison areas with no equivalent regeneration (London Boroughs of Tower Hamlets, Hackney and Barking & Dagenham). Baseline data will be completed prior to the start of the London Olympics (July 2012) with follow-up at 6 and 18 months postintervention. Primary outcomes are: pre-post change in adolescent and parent mental health and well-being, physical activity and parental employment status. Secondary outcomes include: pre-post change in social cohesion, smoking, alcohol use, diet and body mass index. The study will account for individual and environmental contextual effects in evaluating changes to identified outcomes. A nested longitudinal qualitative study will explore families' experiences of regeneration in order to unpack the process by which regeneration impacts on health and well-being. ETHICS AND DISSEMINATION The study has approval from Queen Mary University of London Ethics Committee (QMREC2011/40), the Association of Directors of Children's Services (RGE110927) and the London Boroughs Research Governance Framework (CERGF113). Fieldworkers have had advanced Criminal Records Bureau clearance. Findings will be disseminated through peer-reviewed publications, national and international conferences, through participating schools and the study website (http://www.orielproject.co.uk).
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Affiliation(s)
- Neil R Smith
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Charlotte Clark
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Amanda E Fahy
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Vanathi Tharmaratnam
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Daniel J Lewis
- School of Geography, Queen Mary University of London, London, UK
| | - Claire Thompson
- School of Geography, Queen Mary University of London, London, UK
| | - Adrian Renton
- Institute for Health and Human Development, University of East London, London, UK
| | - Derek G Moore
- Institute for Research in Child Development, School of Psychology, University of East London, London, UK
| | - Kamaldeep S Bhui
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Stephanie J C Taylor
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sandra Eldridge
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mark Petticrew
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Tricia Greenhalgh
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Stephen A Stansfeld
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Steven Cummins
- School of Geography, Queen Mary University of London, London, UK
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Abstract
OBJECTIVES To investigate the influence of ethnicity on suicide, and related risk indicators including psychiatric symptoms, among patients committing suicide whilst admitted to psychiatric hospitals. DESIGN The suicide rates and standardized mortality ratios (SMRs) for inpatient suicides between 1996 and 2001 were calculated from national suicide data on the four largest ethnic groups in England and Wales: Black Caribbean, Black African, South Asian (Indian, Pakistani, and Bangladeshi), and a White British comparison group. The symptoms and risk indicators at the time of the suicide were retrospectively reported by the lead clinician who was responsible for the hospital care of the patient. RESULTS Classical suicide risk indicators such as suicidal ideas, depressive symptoms, emotional distress, and hopelessness were significantly more common among White British inpatients than other ethnic groups. Male inpatients from Black African backgrounds were significantly more likely to have committed suicide than White British men (SMR 2.05, 95% confidence interval (CI): 1.12-3.43). Women committing suicide as inpatients were significantly less likely to be of South Asian (SMR 0.4, 95% CI: 0.17-0.78) and Black Caribbean (SMR 0.26, 95% CI: 0.09-0.62) backgrounds than White British women. CONCLUSIONS Suicide rates and classical indicators of suicide risk among inpatients committing suicide vary by ethnic group. Black African men have the highest rates of suicide compared to the White British group.
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Affiliation(s)
- Kamaldeep S Bhui
- Centre for Psychiatry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
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Bache RA, Bhui KS, Dein S, Korszun A. African and Black Caribbean origin cancer survivors: a qualitative study of the narratives of causes, coping and care experiences. Ethn Health 2011; 17:187-201. [PMID: 22107269 DOI: 10.1080/13557858.2011.635785] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Although there is evidence in the U.S.A. and U.K. to suggest that ethnic minority groups have an inferior experience of cancer care, few studies investigate ethnic disparities in satisfaction and care experiences among survivors. Patients' illness perceptions (lay explanations for illness) and coping styles (emotional and behavioural) are influenced by ethnicity-related cultural beliefs and expectations. Depressive illness or fears of recurrence of cancer may also lead to poorer recovery and function. This paper investigates whether ethnic influences explain different coping behaviours, care experiences and help-seeking behaviours. DESIGN Eight participants of African or Black Caribbean origin were recruited from a London support group for a series of qualitative in-depth interviews. The interviews were recorded and transcribed, and the transcripts analysed using a framework method of qualitative data analysis. The emergent themes were tested and documented to reflect the issues of importance to patients. RESULTS Lay explanations of causes of cancer were complex and diverse reflecting cultural influences and the impact of contact with health professionals. Generally, positive views about cancer care were found, especially at the secondary care level. Primary care attracted mixed views. In contrast to American studies, no acknowledgement of discrimination on the basis of ethnicity was reported. The need to be resilient and think positively were widely acknowledged as coping strategies. Some coped by avoiding contemplation of their condition or diagnosis. Religious beliefs and practices provided coping mechanisms for some, and a means to improve confidence and avoid distressing contemplation about their condition. Family, friends and charitable groups also provided emotional and practical support. CONCLUSIONS Subjects were generally satisfied with their care; different coping styles included positive attitudes, minimisation of difficulties or more realistic consideration of the impact of cancer.
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Affiliation(s)
- Richard A Bache
- Barts and the London School of Medicine and Dentistry, Turner Street, London, E1 2AD, UK.
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Keown P, Weich S, Bhui KS, Scott J. Association between provision of mental illness beds and rate of involuntary admissions in the NHS in England 1988-2008: ecological study. BMJ 2011; 343:d3736. [PMID: 21729994 PMCID: PMC3130113 DOI: 10.1136/bmj.d3736] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine the rise in the rate of involuntary admissions for mental illness in England that has occurred as community alternatives to hospital admission have been introduced. DESIGN Ecological analysis. SETTING England, 1988-2008. DATA SOURCE Publicly available data on provision of beds for people with mental illness in the National Health Service from Hospital Activity Statistics and involuntary admission rates from the NHS Information Centre. MAIN OUTCOME MEASURES Association between annual changes in provision of mental illness beds in the NHS and involuntary admission rates, using cross correlation. Partial correlation coefficients were calculated and regression analysis carried out for the time lag (interval) over which the largest association between these variables was identified. RESULTS The rate of involuntary admissions per annum in the NHS increased by more than 60%, whereas the provision of mental illness beds decreased by more than 60% over the same period; these changes seemed to be synchronous. The strongest association between these variables was observed when a time lag of one year was introduced, with bed reductions preceding increases in involuntary admissions (cross correlation -0.60, 95% confidence interval -1.06 to -0.15). This association increased in magnitude when analyses were restricted to civil (non-forensic) involuntary admissions and non-secure mental illness beds. CONCLUSION The annual reduction in provision of mental illness beds was associated with the rate of involuntary admissions over the short to medium term, with the closure of two mental illness beds leading to one additional involuntary admission in the subsequent year. This study provides a method for predicting rates of involuntary admissions and what may happen in the future if bed closures continue.
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Affiliation(s)
- Patrick Keown
- Tranwell Unit, Queen Elizabeth Hospital, Gateshead, UK.
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Bhui KS, Dinos S, Ashby D, Nazroo J, Wessely S, White PD. Chronic fatigue syndrome in an ethnically diverse population: the influence of psychosocial adversity and physical inactivity. BMC Med 2011; 9:26. [PMID: 21418640 PMCID: PMC3072345 DOI: 10.1186/1741-7015-9-26] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 03/21/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic fatigue syndrome (CFS) is a complex multifactorial disorder. This paper reports the prevalence of chronic fatigue (CF) and CFS in an ethnically diverse population sample and tests whether prevalence varies by social adversity, social support, physical inactivity, anxiety and depression. METHODS Analysis of survey data linking the Health Survey for England (1998 and 1999) and the Ethnic Minority Psychiatric Illness Rates in the Community (EMPIRIC) study undertaken in 2000. The study population comprised a national population sample of 4,281 people ages 16 to 74 years. CF and CFS were operationally defined on the basis of an interview in the EMPIRIC study, alongside questions about psychosocial risk factors. Previous illnesses were reported in the Health Survey for England during 1998 and 1999, as was physical inactivity. RESULTS All ethnic minority groups had a higher prevalence of CFS than the White group. The lowest prevalence was 0.8% in the White group, and it was highest at 3.5% in the Pakistani group (odds ratio (OR), 4.1; 95% confidence interval (95% CI), 1.6 to 10.4). Anxiety (OR, 1.8; 95% CI, 1.4 to 2.2), depression (OR, 1.4; 95% CI, 1.1 to 1.8), physical inactivity (OR, 2.0; 95% CI, 1.1 to 3.8), social strain (OR, 1.24; 95% CI, 1.04 to 1.48) and negative aspects of social support (OR, 2.12; 95% CI, 1.4 to 3.3) were independent risk factors for CFS in the overall sample. Together these risk factors explained ethnic differences in the prevalence of CFS, but no single risk factor could explain a higher prevalence in all ethnic groups. CONCLUSIONS The prevalence of CFS, but not CF, varies by ethnic group. Anxiety, depression, physical inactivity, social strain and negative aspects of social support together accounted for prevalence differences of CFS in the overall sample.
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Affiliation(s)
- Kamaldeep S Bhui
- Centre for Psychiatry, Wolson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
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Bhui KS, Admasachew LA, Persaud A. The promotion of children's health and wellbeing: the contributions of England's charity sector. BMC Res Notes 2010; 3:188. [PMID: 20626843 PMCID: PMC2914653 DOI: 10.1186/1756-0500-3-188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Accepted: 07/13/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sports and arts based services for children have positive impacts on their mental and physical health. The charity sector provides such services, often set up in response to local communities expressing a need. The present study maps resilience promoting services provided by children's charities in England. Specifically, the prominence of sports and arts activities, and types of mental health provisions including telephone help-lines, are investigated. FINDINGS The study was a cross-sectional web-based survey of chief executives, senior mangers, directors and chairs of charities providing services for children under the age of 16. The aims, objectives and activities of participating children's charities and those providing mental health services were described overall. In total 167 chief executives, senior managers, directors and chairs of charities in England agreed to complete the survey. From our sample of charities, arts activities were the most frequently provided services (58/167, 35%), followed by counselling (55/167, 33%) and sports activities (36/167, 22%). Only 13% (22/167) of charities expected their work to contribute to the health legacy of the 2012 London Olympics. Telephone help lines were provided by 16% of the charities that promote mental health. CONCLUSIONS Counselling and arts activities were relatively common. Sports activities were limited despite the evidence base that sport and physical activity are effective interventions for well-being and health gain. Few of the charities we surveyed expected a health legacy from the 2012 London Olympics.
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Affiliation(s)
- Kamaldeep S Bhui
- Centre for Psychiatry, Barts and The London, School of Medicine and Dentistry, Old Anatomy Building, Charterhouse Square, London, UK
| | - Lul A Admasachew
- Institute for Health Services Effectiveness, Work & Organisational Psychology Group, Aston University, Birmingham, UK
| | - Albert Persaud
- The Centre for Applied Research and Evaluation International Foundation (careif), Barts and The London School of Medicine and Dentistry, Old Anatomy Building, Charterhouse Square, London, UK
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McGilloway A, Hall RE, Lee T, Bhui KS. A systematic review of personality disorder, race and ethnicity: prevalence, aetiology and treatment. BMC Psychiatry 2010; 10:33. [PMID: 20459788 PMCID: PMC2882360 DOI: 10.1186/1471-244x-10-33] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Accepted: 05/11/2010] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Although psychoses and ethnicity are well researched, the importance of culture, race and ethnicity has been overlooked in Personality Disorders (PD) research. This study aimed to review the published literature on ethnic variations of prevalence, aetiology and treatment of PD. METHOD A systematic review of studies of PD and race, culture and ethnicity including a narrative synthesis of observational data and meta-analyses of prevalence data with tests for heterogeneity. RESULTS There were few studies with original data on personality disorder and ethnicity. Studies varied in their classification of ethnic group, and few studies defined a specific type of personality disorder. Overall, meta-analyses revealed significant differences in prevalence between black and white groups (OR 0.476, CIs 0.248 - 0.915, p = 0.026) but no differences between Asian or Hispanic groups compared with white groups. Meta-regression analyses found that heterogeneity was explained by some study characteristics: a lower prevalence of PD was reported among black compared with white patients in UK studies, studies using case-note diagnoses rather than structured diagnostic interviews, studies of borderline PD compared with the other PD, studies in secure and inpatient compared with community settings, and among subjects with co-morbid disorders compared to the rest. The evidence base on aetiology and treatment was small. CONCLUSION There is some evidence of ethnic variations in prevalence of personality disorder but methodological characteristics are likely to account for some of the variation. The findings may indicate neglect of PD diagnosis among ethnic groups, or a true lower prevalence amongst black patients. Further studies are required using more precise cultural and ethnic groups.
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Affiliation(s)
- Angela McGilloway
- Barts and The London School of Medicine and Dentistry, Turner Street, London E1 2AD, UK
| | - Ruth E Hall
- Barts and The London School of Medicine and Dentistry, Turner Street, London E1 2AD, UK
| | - Tennyson Lee
- East London Foundation Trust, Trust headquarters, Eastone, 22 Commercial Street, London, E1 6LP, UK
| | - Kamaldeep S Bhui
- Centre for Psychiatry, Barts & The London School of Medicine & Dentistry, Old Anatomy Building, Charterhouse Square, London, EC1M 6BQ, UK,The Centre for Applied Research and Evaluation International Foundation (Careif), Centre for Psychiatry, Barts & The London School of Medicine & Dentistry, Old Anatomy Building, Charterhouse Square, London, EC1M 6BQ, UK,East London Foundation Trust, Trust headquarters, Eastone, 22 Commercial Street, London, E1 6LP, UK
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Dinos S, Khoshaba B, Ashby D, White PD, Nazroo J, Wessely S, Bhui KS. A systematic review of chronic fatigue, its syndromes and ethnicity: prevalence, severity, co-morbidity and coping. Int J Epidemiol 2009; 38:1554-70. [PMID: 19349479 DOI: 10.1093/ije/dyp147] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Chronic Fatigue Syndrome (CFS) is characterized by unexplained fatigue that lasts for at least 6 months alongside a constellation of other symptoms. CFS was historically thought to be most common among White women of higher socio-economic status. However, some recent studies in the USA suggest that the prevalence is actually higher in some minority ethnic groups. If there are convincing differences in prevalence and risk factors across all or some ethnic groups, investigating the causes of these can help unravel the pathophysiology of CFS. METHODS A systematic review was conducted to explore the relationship between fatigue, chronic fatigue (CF--fatigue lasting for 6 months), CFS and ethnicity. Studies were population-based and health service-based. Meta-analysis was also conducted to examine the population prevalence of CF and CFS across ethnic groups. RESULTS Meta-analysis showed that compared with the White American majority, African Americans and Native Americans have a higher risk of CFS [Odds Ratio (OR) 2.95, 95% confidence interval (CI): 0.69-10.4; OR = 11.5, CI: 1.1-56.4, respectively] and CF (OR = 1.56, CI: 1.03-2.24; OR = 3.28, CI: 1.63-5.88, respectively). Minority ethnic groups with CF and CFS experience more severe symptoms and may be more likely to use religion, denial and behavioural disengagement to cope with their condition compared with the White majority. CONCLUSIONS Although available studies and data are limited, it does appear that some ethnic minority groups are more likely to suffer from CF and CFS compared with White people. Ethnic minority status alone is insufficient to explain ethnic variation of prevalence. Psychosocial risk factors found in high-risk groups and ethnicity warrant further investigation to improve our understanding of aetiology and the management of this complex condition.
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Affiliation(s)
- Sokratis Dinos
- Centre for Psychiatry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
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Abstract
OBJECTIVE This study compared suicide rates, clinical symptoms, and perceived preventability of suicide among persons in four ethnic groups who completed suicide within 12 months of contact with mental health services. METHODS The rates and standardized mortality ratios (SMRs) of suicide following contact with mental health services were calculated by using national suicide data from 1996 to 2001 for the four largest ethnic groups in England and Wales: black Caribbean, black African, South Asian (Indian, Pakistani, and Bangladeshi), and white. The study also investigated whether clinical indices of risk show ethnic variations. RESULTS A total of 8,029 suicides in the four ethnic groups were investigated. Overall, compared with the SMRs for their white counterparts, low SMRs were found for South-Asian men and women (SMR=.5, 95% confidence interval [CI]=.4-.6 for South-Asian men and SMR=.7, CI=.5-.9 for South-Asian women). High SMRs were found for black Caribbean and black African men aged 13-24 (SMR=2.9, CI=1.4-5.3 for black Caribbean men and SMR=2.5, CI=1.1-4.8 for black African men). High SMRs were found for young women aged 25-39 of South-Asian origin (SMR=2.8, CI=1.9-3.9), black Caribbean origin (SMR=2.7, CI=1.3-4.8), and black African origin (SMR=3.2, CI=1.6-5.7). Some widely accepted suicide risk indicators were less common in the ethnic minority groups than in the white group. There were more symptoms of active psychosis for people from ethnic minority groups who later committed suicide, and perceived preventability was highest among black Caribbean people. CONCLUSIONS Rates and SMRs varied across ethnic groups. Specific preventive actions must take account of the ethnic variations of clinical indices of risk and include more effective treatment of psychosis.
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Affiliation(s)
- Kamaldeep S Bhui
- Centre for Psychiatry, Barts and The London School of Medicine and Dentistry, Old Anatomy Bldg., Charterhouse Square, London EC1M 6BQ, United Kingdom.
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Klineberg E, Clark C, Bhui KS, Haines MM, Viner RM, Head J, Woodley-Jones D, Stansfeld SA. Social support, ethnicity and mental health in adolescents. Soc Psychiatry Psychiatr Epidemiol 2006; 41:755-60. [PMID: 16838091 DOI: 10.1007/s00127-006-0093-8] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2006] [Indexed: 11/24/2022]
Abstract
OBJECTIVE In this study, we explored whether social support varied with ethnic group in young people, and if it explained ethnic differences in prevalence of psychological distress. METHODS A representative sample of 2790 East London adolescents (11-14 years) completed a classroom-based self-report questionnaire for this cross sectional survey. Social support was assessed using the Multidimensional Scale of Perceived Social Support (MSPSS). Mental health was assessed using the Strengths and Difficulties Questionnaire (SDQ) and the Short Moods and Feelings Questionnaire (SMFQ). RESULTS High levels of social support were reported by most participants, with some variation by ethnic group and gender. Participants reporting low family and overall social support had an increased likelihood of psychological distress compared with those who reported high support. Low support from friends, family and overall was also associated with depressive symptoms. These relationships did not alter with adjustment for ethnic group. CONCLUSIONS This study identified an independent association between different sources of social support and mental health in a young, ethnically diverse sample. Differences in social support did not explain ethnic differences in psychological distress.
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Affiliation(s)
- Emily Klineberg
- Centre for Psychiatry, Queen Mary's School of Medicine and Dentistry, University of London, Old Anatomy Building, Charterhouse Square, London, EC1M 6BQ, UK.
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Jayakody AA, Viner RM, Haines MM, Bhui KS, Head JA, Taylor SJC, Booy R, Klineberg E, Clark C, Stansfeld SA. Illicit and traditional drug use among ethnic minority adolescents in East London. Public Health 2006; 120:329-38. [PMID: 16543028 DOI: 10.1016/j.puhe.2005.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2004] [Revised: 06/02/2005] [Accepted: 10/13/2005] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To explore ethnic variations in the use of illicit and traditional drugs, and the association of indicators of acculturation with drug use among an ethnically diverse representative sample of early adolescents in East London. STUDY DESIGN A cross-sectional questionnaire survey. METHODS Confidential questionnaires were used to assess 2789 male and female pupils in years 7 and 9, aged 11-14 years old, from a representative sample of 28 secondary schools in East London. RESULTS In total, 10.8% reported having ever tried illicit drugs and 7.3% reported ever using cannabis. Compared with white British adolescents, cannabis use in the previous month was significantly higher amongst black Caribbean adolescents. Lifetime cannabis use was significantly higher amongst black Caribbean and mixed ethnicity young people, but was lower amongst Bangladeshi, Indian and Pakistani adolescents. Living in UK for 5 years or less markedly reduced the risk of lifetime and recent cannabis use when controlled for ethnicity and social class. Glue or solvent use was reported in 3.2% of adolescents, with use significantly higher amongst Bangladeshi young people. Lifetime paan use was reported by 14.1% of the sample, and was almost completely confined to South Asian or mixed ethnicities. CONCLUSIONS Ethnic differences in illicit drug use were found in the study population, and significant differences were found between ethnic groups often identified as 'black.' Further research is needed in understanding cultural-specific risk and protective factors in different ethnic groups, and the importance of cultural identity in mediating health risk behaviors. The high use of paan and glue/gas/solvents by Bangladeshi young people poses an unappreciated public health problem that may require targeted interventions.
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Affiliation(s)
- A A Jayakody
- Department of Paediatrics, Royal Free and University College London Medical School, London, UK
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