Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-28T04:12:45.510Z Has data issue: false hasContentIssue false
  • English
  • Français

The Influence of Ethnicity and Family Structure on Relapse in First-Episode Schizophrenia

A Comparison of Asian, Afro-Caribbean, and White Patients

Published online by Cambridge University Press:  02 January 2018

Max Birchwood ,
Ray Cochrane ,
Fiona Macmillan ,
Sonja Copestake ,
Jo Kucharska  and
Margaret Cariss
Max Birchwood*
Affiliation:
All Saints Hospital, Lodge Road, Birmingham B18 5SD; Honorary Senior Lecturer, University of Birmingham
Ray Cochrane
Affiliation:
School of Psychology, University of Birmingham
Fiona Macmillan
Affiliation:
University of Birmingham; Honorary Consultant Psychiatrist, All Saints Hospital
Sonja Copestake
Affiliation:
All Saints Hospital, Birmingham
Jo Kucharska
Affiliation:
All Saints Hospital, Birmingham
Margaret Cariss
Affiliation:
All Saints Hospital, Birmingham
*
∗Correspondence
Get access Rights & Permissions [Opens in a new window]

Abstract

There is overwhelming evidence that the outcome for people with schizophrenia in Western industrialised countries is inferior to that of those living in the Third World. Extended family structures, greater opportunities for social reintegration, and more positive constructions of mental illness have been offered as possible explanations for this effect. The Asian community in the UK retains many of these features as well as strong links with native cultures of origin. The issue arises as to whether similar differences in outcome may be observed in the UK. An exploratory study was undertaken, examining the early progress of schizophrenia in a first-episode sample (n=137), and based on systematic examination of case-note data. A lower rate of relapse/readmission in the first 12 months after discharge was found in the Asian (16%) as compared with white (30%) and Afro-Caribbean (49%) patients. Available evidence suggested that speed of access to care, living with a family, and employment may account for this effect. Medication compliance may have contributed to differences in relapse between white and Afro-Caribbeans but was not a factor influencing the low rate among Asians. The limitations and strengths of case-note studies are discussed at length, and it is concluded that a prospective study is warranted and would be highly instructive.

Type
Papers
Information
The British Journal of Psychiatry , Volume 161 , Issue 6 , December 1992 , pp. 783 - 790
Copyright
Copyright © 1992 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Blumenthal, R., Kreisman, D. & O'Connor, P. A. (1982) Return to the family and its consequences for rehospitalisation among recently discharged patients. Psychological Medicine, 12, 141–147.Google Scholar
Bowden, P. (1978) Men remanded into custody for medical reports: the outcome of the treatment recommendation. British Journal of Psychiatry, 133, 332–338.Google Scholar
Brown, G. W., Bone, M., Dalison, B., et al (1966) Schizophrenia and Social Care. Maudsley Monograph No. 17. London: Oxford University Press.Google Scholar
Cochrane, R. (1977) Mental illness in immigrants to England and Wales: an analysis of mental hospital admissions, 1971. Social Psychiatry, 12, 25–35.Google Scholar
Cochrane, R. & Bal, S. (1987) Migration and schizophrenia: an examination of five hypotheses. Social Psychiatry, 22, 181–191.Google Scholar
El-Islam, M. F. (1979) A better outlook for schizophrenics living in extended families. British Journal of Psychiatry, 135, 343–347.Google Scholar
Falloon, I. R. H. (1988) Expressed emotion: current status. Psychological Medicine, 18, 269–274.Google Scholar
Fleiss, J. L. (1981) Statistical Methods for Rates and Proportions (2nd edn). Chichester: Wiley.Google Scholar
Harrison, G., Owens, D., Holton, A., et al (1988) A prospective study of severe mental disorder in Afro-Caribbean patients. Psychological Medicine, 18, 643–657.Google Scholar
Karno, M., Jenkins, J. H., De La Selva, A., et al (1987) Expressed emotion and schizophrenic outcome among Mexican-American families. Journal of Nervous and Mental Disease, 175, 143–151.Google Scholar
Leff, J., Wig, N., Ghosh, A., et al (1987) Influence of relatives' expressed emotion on the course of schizophrenia in Chandigarh. British Journal of Psychiatry, 151, 166–173.Google Scholar
Leff, J., Wig, N. N., Bedi, H., et al (1990) Relatives' expressed emotion and the course of schizophrenia in Chandigarh. British Journal of Psychiatry, 156, 351–356.Google Scholar
Lin, K. & Kleinmann, A. M. (1988) Psychopathology and clinical course of schizophrenia: a cross-cultural perspective. Schizophrenia Bulletin, 14, 555–568.Google Scholar
Macmillan, J. F., Crow, T. J., Johnson, A. L., et al (1986) The Northwick Park first episodes of schizophrenia study. British Journal of Psychiatry, 148, 128–133.CrossRefGoogle Scholar
McGlashan, T. H. (1988) A selective review of recent North American long-term follow-up studies of schizophrenia. Schizophrenia Bulletin, 14, 515–542.Google Scholar
McGovern, D. & Cope, R. V. (1987) First psychiatric admission rates of first and second generation Afro-Caribbeans. Social Psychiatry, 22, 139–149.Google Scholar
Mendis, N. (1986) The outcome of schizophrenia in Sri Lanka: a ten-year follow-up study. Ceylon Medical Journal, 31, 119–134.Google Scholar
Murphy, H. B. M. & Rahman, A. C. (1971) The chronicity of schizophrenia in indigenous tropical peoples. British Journal of Psychiatry, 118, 489–497.Google Scholar
Sartorius, M., Jablensky, A., Korten, A., et al (1986) Early manifestations and first-contact incidence of schizophrenia in different cultures. A preliminary report of the initial evaluation phase of the WHO study of determinants of outcome of severe mental disorder. Psychological Medicine, 16, 909–928.Google Scholar
Stevens, J. (1987) Brief psychoses: do they contribute to the good prognosis and equal prevalence of schizophrenia in developing countries? British Journal of Psychiatry, 151, 393–396.Google Scholar
Verghese, A., John, J. K., Rajkumar, S., et al (1989) Factors associated with the course and outcome of schizophrenia in India. British Journal of Psychiatry, 154, 499–503.Google Scholar
Warner, R. (1983) Recovery from schizophrenia in the Third World. Psychiatry, 46, 197–212.CrossRefGoogle ScholarPubMed
Waxler, N. E. (1979) Is outcome for schizophrenia better in non-industrial societies? The case of Sri Lanka. Journal of Nervous and Mental Disease, 167, 144–158.CrossRefGoogle Scholar
Wing, J., Cooper, J. & Sartorius, N. (1974) The Description and Classification of Psychiatric Symptomatology: An Instruction Manual for the PSE and catego. London: Cambridge University Press.Google Scholar
World Health Organization (1979) Schizophrenia: An International Follow-Up Study. New York: Wiley.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.