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Otis M, Barber S, Amet M, Nicholls D. Models of integrated care for young people experiencing medical emergencies related to mental illness: a realist systematic review. Eur Child Adolesc Psychiatry 2023; 32:2439-2452. [PMID: 36151355 PMCID: PMC9510153 DOI: 10.1007/s00787-022-02085-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 09/10/2022] [Indexed: 11/30/2022]
Abstract
Mental illness heightens risk of medical emergencies, emergency hospitalisation, and readmissions. Innovations for integrated medical-psychiatric care within paediatric emergency settings may help adolescents with acute mental disorders to get well quicker and stay well enough to remain out of hospital. We assessed models of integrated acute care for adolescents experiencing medical emergencies related to mental illness (MHR). We conducted a systematic review by searching MEDLINE, PsychINFO, Embase, and Web of Science for quantitative studies within paediatric emergency medicine, internationally. We included populations aged 8-25 years. Our outcomes were length of hospital stay (LOS), emergency hospital admissions, and rehospitalisation. Limits were imposed on dates: 1990 to June 2021. We present a narrative synthesis. This study is registered on PROSPERO: 254,359. 1667 studies were screened, 22 met eligibility, comprising 39,346 patients. Emergency triage innovations reduced admissions between 4 and 16%, including multidisciplinary staffing and training for psychiatric assessment (F(3,42) = 4.6, P < 0.05, N = 682), and telepsychiatry consultations (aOR = 0.41, 95% CI 0.28-0.58; P < 0.001, N = 597). Psychological therapies delivered in emergency departments reduced admissions 8-40%, including psychoeducation (aOR = 0.35, 95% CI 0.17-0.71, P < 0.01, N = 212), risk-reduction counselling for suicide prevention (OR = 2.78, 95% CI 0.55-14.10, N = 348), and telephone follow-up (OR = 0.45, 95% CI 0.33-0.60, P < 0.001, N = 980). Innovations on acute wards reduced readmissions, including guided meal supervision for eating disorders (P = 0.27), therapeutic skills for anxiety disorders, and a dedicated psychiatric crisis unit (22.2 vs 8.5% (P = 0.008). Integrated pathway innovations reduced readmissions between 8 and 37% including family-based therapy (FBT) for eating disorders (X2(1,326) = 8.40, P = 0.004, N = 326), and risk-targeted telephone follow-up or outpatients for all mental disorders (29.5 vs. 5%, P = 0.03, N = 1316). Studies occurred in the USA, Canada, or Australia. Integrated care pathways to psychiatric consultations, psychological therapies, and multidisciplinary follow-up within emergency paediatric services prevented lengthy and repeat hospitalisation for MHR emergencies. Only six of 22 studies adjusted for illness severity and clinical history between before- and after-intervention cohorts and only one reported socio-demographic intervention effects.
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Affiliation(s)
- Michaela Otis
- Imperial College London, South Kensington, London, SW7 2BX UK
- NIHR Applied Research Collaboration (ARC) Northwest London, London, UK
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Susan Barber
- Imperial College London, South Kensington, London, SW7 2BX UK
- NIHR Applied Research Collaboration (ARC) Northwest London, London, UK
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Mona Amet
- Imperial College London, South Kensington, London, SW7 2BX UK
| | - Dasha Nicholls
- Imperial College London, South Kensington, London, SW7 2BX UK
- NIHR Applied Research Collaboration (ARC) Northwest London, London, UK
- Chelsea and Westminster NHS Foundation Trust, London, UK
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Barber S, Otis M, Greenfield G, Razzaq N, Solanki D, Norton J, Richardson S, Hayhoe BWJ. Improving Multidisciplinary Team Working to Support Integrated Care for People with Frailty Amidst the COVID-19 Pandemic. Int J Integr Care 2023; 23:23. [PMID: 37303477 PMCID: PMC10253239 DOI: 10.5334/ijic.7022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 05/18/2023] [Indexed: 06/13/2023] Open
Abstract
Multidisciplinary team (MDT) working is essential to optimise and integrate services for people who are frail. MDTs require collaboration. Many health and social care professionals have not received formal training in collaborative working. This study investigated MDT training designed to help participants deliver integrated care for frail individuals during the Covid-19 pandemic. Researchers utilised a semi-structured analytical framework to support observations of the training sessions and analyse the results of two surveys designed to assess the training process and its impact on participants knowledge and skills. 115 participants from 5 Primary Care Networks in London attended the training. Trainers utilised a video of a patient pathway, encouraged discussion of it, and demonstrated the use of evidence-based tools for patient needs assessment and care planning. Participants were encouraged to critique the patient pathway, reflect on their own experiences of planning and providing patient care. 38% of participants completed a pre-training survey, 47% a post-training survey. Significant improvement in knowledge and skills were reported including understanding roles in contributing to MDT working, confidence to speak in MDT meetings, using a range of evidence-based clinical tools for comprehensive assessment and care planning. Greater levels of autonomy, resilience, and support for MDT working were reported. Training proved effective; it could be scaled up and adopted to other settings.
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Affiliation(s)
- Susan Barber
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, The Reynolds Building, St Dunstan’s Road, London W6 8RP, UK
- Chelsea & Westminster Hospital NHS Foundation Trust, UK
| | - Michaela Otis
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, The Reynolds Building, St Dunstan’s Road, London W6 8RP, UK
- Chelsea & Westminster Hospital NHS Foundation Trust, UK
| | - Geva Greenfield
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, The Reynolds Building, St Dunstan’s Road, London W6 8RP, UK
| | - Nasrin Razzaq
- Harrow CCG The Heights, Middlesex 59-65 Lowlands Road Harrow HA1 3AW, UK
| | - Deepa Solanki
- Integrated Care Education, Harrow ICP and Training Hub, UK
| | - John Norton
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, The Reynolds Building, St Dunstan’s Road, London W6 8RP, UK
| | - Sonia Richardson
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, The Reynolds Building, St Dunstan’s Road, London W6 8RP, UK
| | - Benedict W. J. Hayhoe
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, The Reynolds Building, St Dunstan’s Road, London W6 8RP, UK
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Otis M, Barber S, Green Hofer S, Straus J, Kay M, Hargreaves DS, Hayhoe B, Anokye N, Lennox L, Nicholls D. Evaluating the implementation and impact of a new model of care for integrating children and young people's acute mental healthcare in a paediatric setting: a protocol for a realist, mixed-methods approach. BMJ Open 2023; 13:e067074. [PMID: 36669846 PMCID: PMC9872460 DOI: 10.1136/bmjopen-2022-067074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/23/2022] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION The mental health of children and young people in the UK has been declining and has continued to worsen throughout the pandemic, leading to an increase in mental health-related emergencies. In response, the Best for You programme was developed as a new service designed to integrate mental healthcare for children and young people between acute hospital and community services. The programme is comprised of four new services: a rapid assessment young people's centre with dual-trained staff, a co-located day service offering family-based care,a digital hub, designed to integrate with the fourth element of the model, namely community support and mental health services. This evaluation protocol aims to assess the development, implementation and outcomes of the Best for You programme and develops a scalable model that could be implemented in other parts of the National Health Service (NHS). METHODS AND ANALYSIS This mixed-methods realist evaluation aims to delineate the components of the system to assess their interdependent relationships within a wider context. Data collection will include interviews, participant observations, focus groups and the collection of local quantitative healthcare data. The research will be conducted across four phases. Phase 1-captures the development of the underlying programme theory. Phase 2-a process evaluation testing the programme theory. Phase 3- an outcome and economic evaluation. Phase 4-consolidation of learning from phases 1-3 to identify barriers, facilitators and wider contextual factors that have shaped implementation drawing on the Consolidated Framework for Implementation Research. ETHICS AND DISSEMINATION Ethical approval for the evaluation was received from the NHS local ethics committee. Embedded within the evaluation is a formative review to feedback and share learning with stakeholders to scale-up the programme. Findings from this study will be disseminated in peer-reviewed journals as well as presentations to be useful to service user organisations and networks.
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Affiliation(s)
- Michaela Otis
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
- NIHR ARC Northwest London, London, UK
| | - Susan Barber
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
- NIHR ARC Northwest London, London, UK
| | - Stuart Green Hofer
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
- NIHR ARC Northwest London, London, UK
| | | | | | - Dougal S Hargreaves
- NIHR ARC Northwest London, London, UK
- Mohn Centre for Children's Health and Wellbeing, Imperial College London, London, UK
| | - Benedict Hayhoe
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
- NIHR ARC Northwest London, London, UK
| | - Nana Anokye
- NIHR ARC Northwest London, London, UK
- College of Health and Life Sciences, Brunel University London, Uxbridge, UK
| | - Laura Lennox
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
- NIHR ARC Northwest London, London, UK
| | - Dasha Nicholls
- NIHR ARC Northwest London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
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Bhui K, Shakoor S, Mankee-Williams A, Otis M. Creative arts and digitial interventions as potential tools in prevention and recovery from the mental health consequences of adverse childhood experiences. Nat Commun 2022; 13:7870. [PMID: 36550111 PMCID: PMC9772595 DOI: 10.1038/s41467-022-35466-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Kamaldeep Bhui
- grid.4991.50000 0004 1936 8948Department of Psychiatry, Nuffield Department of Primary Care Health Sciences and Wadham College at the University of Oxford. Oxford Health and East London NHS Foundation Trusts. World Psychiatric Association Collaborating Centre, Oxford, UK ,grid.4868.20000 0001 2171 1133Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Sania Shakoor
- grid.4868.20000 0001 2171 1133Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | | | - Michaela Otis
- grid.7445.20000 0001 2113 8111Imperial College; North West London Applied Research Collaborative, London, UK
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Kapilashrami A, Otis M, Omodara D, Nandi A, Vats A, Adeniyi O, Speed E, Potter JL, Eder B, Pareek M, Bhui K. Ethnic disparities in health & social care workers’ exposure, protection, and clinical management of the COVID-19 pandemic in the UK. Critical Public Health 2021. [DOI: 10.1080/09581596.2021.1959020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- A. Kapilashrami
- School of Health & Social Care, University of Essex, Colchester, UK
- People’s Health Movement, UK
| | - M. Otis
- NIHR Applied Research Collaboration Northwest London
- Imperial College London Imperial College London
| | - D. Omodara
- Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - A. Nandi
- Institute for Social and Economic Research, University of Essex, Colchester, UK
| | - A. Vats
- Rowley Bristow Unit, Department of Orthopaedics, Ashford and St Peter's Hospitals NHS Foundation Trust
| | - O. Adeniyi
- School of Management, Nottingham Business School, Nottingham Trent University, UK
| | - E. Speed
- School of Health & Social Care, University of Essex, Colchester, UK
| | - J. L. Potter
- North Middlesex University Hospital, Nottingham, UK
| | - B. Eder
- People’s Health Movement, UK
| | - M. Pareek
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Infection and HIV Medicine, University Hospitals Leicester NHS Trust, Leicester, UK
| | - K. Bhui
- Department of Psychiatry & Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
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Bhui K, Otis M, Halvorsrud K, Freestone M, Jones E. Assessing risks of violent extremism in depressive disorders: Developing and validating a new measure of Sympathies for Violent Protest and Terrorism. Aust N Z J Psychiatry 2020; 54:1078-1085. [PMID: 32702996 DOI: 10.1177/0004867420944520] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Clinicians are tasked with assessing the relationship between violence and mental illness. Yet, there is now a legal expectation in some countries that public services, including health professionals, assess risk of violent extremism - with few available measures. We previously developed a new measure of Sympathies for Radicalisation, using items that measure Sympathies for Violent Protest and Terrorism. In this paper, we present the detailed psychometric properties of a reduced item measure of Sympathies for Violent Protest and Terrorism. We use data from two studies to test replication and then validity against outcomes of self-reported violence and convictions in the entire sample and in those with depressive symptoms. METHODS Data from two cross-sectional neighbourhood surveys, consisting of Pakistani and Bangladeshi adults (survey 1, n = 608) and White British and Pakistani adults (survey 2, n = 618), were used to undertake confirmatory factor analysis of Sympathies for Radicalisation and produce a short measure of Sympathies for Violent Protest and Terrorism. Survey 2 data were used to test the Sympathies for Violent Protest and Terrorism's convergent validity to classify presence/absence of violence and convictions in the whole sample and for subgroups by depressive disorder. RESULTS The seven-item measure's structure was a consistent measure of extremist attitudes across the two surveys. A threshold score of zero to classify violence was optimal (specificity = 89.7%; area under the curve = 0.75), but sensitivity to a risk of violence was poor (34.5%). The short version Sympathies for Radicalisation was a better classifier of violence in respondents with depression, dysthymia or both (area under the curve = 0.78) than respondents with neither (area under the curve = 0.69; β = 0.62, 95% confidence interval = [-0.67, 1.92]; standard error = 0.66). CONCLUSION The seven-item measure of Sympathies for Violent Protest and Terrorism is an accessible and valid measure for clinical assessments and helpfully identifies low risk of violence. It enables clinicians to conduct detailed assessments of people endorsing one or more of the items, although further research is needed.
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Affiliation(s)
- Kamaldeep Bhui
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.,Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.,World Psychiatric Association UK Collaborating Centre, London, UK.,Centre for Understanding Personality (CUSP) at East London NHS Foundation, London, UK
| | - Michaela Otis
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.,World Psychiatric Association UK Collaborating Centre, London, UK
| | - Kristoffer Halvorsrud
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.,Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.,World Psychiatric Association UK Collaborating Centre, London, UK
| | - Mark Freestone
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.,World Psychiatric Association UK Collaborating Centre, London, UK.,The Alan Turing Institute, British Library, London, UK
| | - Edgar Jones
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Bhui K, Otis M, Silva MJ, Halvorsrud K, Freestone M, Jones E. Extremism and common mental illness: cross-sectional community survey of White British and Pakistani men and women living in England. Br J Psychiatry 2020; 217:547-554. [PMID: 30873926 PMCID: PMC7525107 DOI: 10.1192/bjp.2019.14] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Mental illnesses may explain vulnerability to develop extremist beliefs that can lead to violent protest and terrorism. Yet there is little evidence. AIMS To investigate the relationship between mental illnesses and extremist beliefs. METHOD Population survey of 618 White British and Pakistani people in England. Extremism was assessed by an established measure of sympathies for violent protest and terrorism (SVPT). Respondents with any positive scores (showing sympathies) were compared with those with all negative scores. We calculated associations between extremist sympathies and ICD-10 diagnoses of depression and dysthymia, and symptoms of anxiety, personality difficulties, autism and post-traumatic stress. Also considered were demographics, life events, social assets, political engagement and criminal convictions. RESULTS SVPT were more common in those with major depression with dysthymia (risk ratio 4.07, 95% CI 1.37-12.05, P = 0.01), symptoms of anxiety (risk ratio 1.09, 95% CI 1.03-1.15, P = 0.002) or post-traumatic stress (risk ratio 1.03, 95% CI 1.01-1.05, P = 0.003). At greater risk of SVPT were: young adults (<21 versus ≥21: risk ratio 3.05, 95% CI 1.31-7.06, P = 0.01), White British people (versus Pakistani people: risk ratio 2.24, 95% CI 1.25-4.02, P = 0.007) and those with criminal convictions (risk ratio 2.23, 95% CI 1.01-4.95, P = 0.048). No associations were found with life events, social assets and political engagement. CONCLUSION Depression, dysthymia and symptoms of anxiety and post-traumatic stress are associated with extremist sympathies.
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Affiliation(s)
- Kamaldeep Bhui
- Professor of Cultural Psychiatry and Epidemiology, Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary University of London; and Honorary Consultant Psychiatrist, East London NHS Foundation Trust, UK; Head of Centre for Psychiatry and Director of Collaborating Centre, World Psychiatric Association,Correspondence: Kamaldeep Bhui, Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Charterhouse Square, LondonEC1M 6BQ, UK.
| | - Michaela Otis
- Statistician, Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Maria Joao Silva
- Statistician, Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Kristoffer Halvorsrud
- Research Fellow, Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Mark Freestone
- Senior Lecturer, Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Edgar Jones
- Professor in History of Medicine and Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Halvorsrud K, Nazroo J, Otis M, Brown Hajdukova E, Bhui K. Ethnic inequalities and pathways to care in psychosis in England: a systematic review and meta-analysis. BMC Med 2018; 16:223. [PMID: 30537961 PMCID: PMC6290527 DOI: 10.1186/s12916-018-1201-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/29/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND As part of a national programme to tackle ethnic inequalities, we conducted a systematic review and meta-analysis of research on ethnic inequalities in pathways to care for adults with psychosis living in England and/or Wales. METHODS Nine databases were searched from inception to 03.07.17 for previous systematic reviews, including forward and backward citation tracking and a PROSPERO search to identify ongoing reviews. We then carried forward relevant primary studies from included reviews (with the latest meta-analyses reporting on research up to 2012), supplemented by a search on 18.10.17 in MEDLINE, Embase, PsycINFO and CINAHL for primary studies between 2012 and 2017 that had not been covered by previous meta-analyses. RESULTS Forty studies, all conducted in England, were included for our updated meta-analyses on pathways to care. Relative to the White reference group, elevated rates of civil detentions were found for Black Caribbean (OR = 3.43, 95% CI = 2.68 to 4.40, n = 18), Black African (OR = 3.11, 95% CI = 2.40 to 4.02, n = 6), and South Asian patients (OR = 1.50, 95% CI 1.07 to 2.12, n = 10). Analyses of each Mental Health Act section revealed significantly higher rates for Black people under (civil) Section 2 (OR = 1.53, 95% CI = 1.11 to 2.11, n = 3). Rates in repeat admissions were significantly higher than in first admission for South Asian patients (between-group difference p < 0.01). Some ethnic groups had more police contact (Black African OR = 3.60, 95% CI = 2.15 to 6.05, n = 2; Black Caribbean OR = 2.64, 95% CI = 1.88 to 3.72, n = 8) and criminal justice system involvement (Black Caribbean OR = 2.76, 95% CI = 2.02 to 3.78, n = 5; Black African OR = 1.92, 95% CI = 1.32 to 2.78, n = 3). The White Other patients also showed greater police and criminal justice system involvement than White British patients (OR = 1.49, 95% CI = 1.03 to 2.15, n = 4). General practitioner involvement was less likely for Black than the White reference group. No significant variations over time were found across all the main outcomes. CONCLUSIONS Our updated meta-analyses reveal persisting but not significantly worsening patterns of ethnic inequalities in pathways to psychiatric care, particularly affecting Black groups. This provides a comprehensive evidence base from which to inform policy and practice amidst a prospective Mental Health Act reform. TRIAL REGISTRATION CRD42017071663.
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Affiliation(s)
- Kristoffer Halvorsrud
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - James Nazroo
- Sociology, School of Social Sciences, University of Manchester, Humanities, Bridgeford Street, Oxford Road, Manchester, M13 9PL, UK
| | - Michaela Otis
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Eva Brown Hajdukova
- Centre for Research in Public Health and Community Care (CRIPACC), University of Hertfordshire, Health Research Building, College Lane, Hatfield, AL10 9AB, UK
| | - Kamaldeep Bhui
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
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Chamoux E, Otis M, Gallo-Payet N. A connection between extracellular matrix and hormonal signals during the development of the human fetal adrenal gland. Braz J Med Biol Res 2005; 38:1495-503. [PMID: 16172742 DOI: 10.1590/s0100-879x2005001000006] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The human adrenal cortex, involved in adaptive responses to stress, body homeostasis and secondary sexual characters, emerges from a tightly regulated development of a zone-specific secretion pattern during fetal life. Its development during fetal life is critical for the well being of pregnancy, the initiation of delivery, and even for an adequate adaptation to extra-uterine life. As early as from the sixth week of pregnancy, the fetal adrenal gland is characterized by a highly proliferative zone at the periphery, a concentric migration accompanied by cell differentiation (cortisol secretion) and apoptosis in the central androgen-secreting fetal zone. After birth, a strong reorganization occurs in the adrenal gland so that it better fulfills the newborn's needs, with aldosterone production in the external zona glomerulosa, cortisol secretion in the zona fasciculata and androgens in the central zona reticularis. In addition to the major hormonal stimuli provided by angiotensin II and adrenocorticotropin, we have tested for some years the hypotheses that such plasticity may be under the control of the extracellular matrix. A growing number of data have been harvested during the last years, in particular about extracellular matrix expression and its putative role in the development of the human adrenal cortex. Laminin, collagen and fibronectin have been shown to play important roles not only in the plasticity of the adrenal cortex, but also in cell responsiveness to hormones, thus clarifying some of the unexplained observations that used to feed controversies.
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Affiliation(s)
- E Chamoux
- CRRI, Centre de Recherches, Centre Hospitalier, Université Laval, Québec, Canada.
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