- Email: [email protected]
ethnicity and outcomes in psychosis
Asian Journal of Psychiatry 4 (2011) 233
Contents lists available at SciVerse ScienceDirect
Asian Journal of Psychiatry journal homepage: www.elsevier.com/locate/ajp
Editorial
Race/ethnicity and outcomes in psychosis
Race and ethnicity are known to profoundly influence the epidemiology and outcomes of psychiatric and other medical disorders (Armstrong et al., 2007; Smedley et al., 2003). The distribution of medical diagnoses differs among minority ethnic groups, who generally have poorer access to healthcare and worse outcomes (Blanco et al., 2007; Busch et al., 2009). With regard to severe mental disorders, schizophrenia and other psychotic disorders are more likely to be diagnosed among ethnic minority groups (particularly those of African origin) (Dixon et al., 2011; Fearon et al., 2006; Strakowski et al., 1996), who are less likely to receive evidence-based treatments, and generally exhibit worse treatment response and illness course than the majority ethnic group in the same community (Tandon et al., 2009, 2010; Vega and Lewis-Fernandez, 2008). The report by Li and co-workers in this issue of the Journal is a useful addition to the relatively sparse literature on the topic and its findings are in concordance with previous reports. Notably, Li and colleagues found that in comparison to Caucasians, African-Americans were (i) more likely to receive a diagnosis of schizophrenia and schizoaffective disorder; (ii) showed less improvement in depressive symptoms; (iii) exhibited slower improvement in disorganization and negative symptoms; (iv) were less likely to adhere to antipsychotic treatment; and (v) demonstrated less improvement in overall functioning. In the absence of data on the nature of treatment and differences, if any, between groups, one needs to be careful in generalizing results of the study. Nevertheless, these findings underline the importance of ethnic and racial factors in influencing treatment response and outcome in psychotic disorders. A number of factors may contribute to ethnic differences in treatment response and illness course and such differences receive little
1876-2018/$ – see front matter ß 2011 Published by Elsevier B.V. doi:10.1016/j.ajp.2011.10.002
attention in treatment development and delivery. In addition to drawing attention to the importance of ethnic/racial factors in the treatment of psychotic disorders, the findings of Li and colleagues reinforce the multi-dimensional psychopathology of psychotic disorders, with some domains (positive symptoms) showing similar improvement between African-Americans and Caucasians whereas other domains (negative symptoms, depression, and disorganization) showed different patterns of improvement between the two groups. References Armstrong, K., Ravenell, K., McMurphy, S., et al., 2007. Racial/ethnic differences in physician distrust in the United States. Am. J. Public Health 97, 1283–1289. Blanco, C., Patel, S.R., Liu, L., et al., 2007. National trends in ethnic disparities in mental health care. Med. Care 45, 1012–1019. Busch, A.B., Lehman, A.F., Goldman, H., et al., 2009. Changes over time and disparities in schizophrenia treatment quality. Med. Care 47, 199–207. Dixon, L., Lewis-Fernandez, R., Goldman, H., et al., 2011. Adherence disparities in mental health: opportunities and challenges. J. Nerv. Ment. Dis. 199, 815–820. Fearon, P., Kirkbride, J.B., Morgan, C., et al., 2006. Incidence of schizophrenia and other psychoses in ethnic minority groups: results from the MRC AESOP study. Psychol. Med. 36, 1541–1550. Smedley, B.D., Stith, A.Y., Nelson, A.R., 2003. Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. National Academy Press, Washington, DC. Strakowski, S.M., Flaum, M., Amador, X., et al., 1996. Racial differences in the diagnosis of schizophrenia. Schizophr. Res. 21, 117–124. Tandon, R., Nasrallah, H.A., Keshavan, M.S., 2009. Schizophrenia, just the facts 4. Clinical features and conceptualization. Schizophr. Res. 110, 1–23. Tandon, R., Nasrallah, H.A., Keshavan, M.S., 2010. Schizophrenia, just the facts 5. Treatment and prevention. Schizophr. Res. 122, 1–23. Vega, V.A., Lewis-Fernandez, R., 2008. Ethnicity and variability of psychotic symptoms. Curr. Psychiatry Rep. 10, 223–228.
Rajiv Tandon University of Florida, USA. E-mail address: [email protected].fl.us (R. Tandon).
Contents lists available at SciVerse ScienceDirect
Asian Journal of Psychiatry journal homepage: www.elsevier.com/locate/ajp
Editorial
Race/ethnicity and outcomes in psychosis
Race and ethnicity are known to profoundly influence the epidemiology and outcomes of psychiatric and other medical disorders (Armstrong et al., 2007; Smedley et al., 2003). The distribution of medical diagnoses differs among minority ethnic groups, who generally have poorer access to healthcare and worse outcomes (Blanco et al., 2007; Busch et al., 2009). With regard to severe mental disorders, schizophrenia and other psychotic disorders are more likely to be diagnosed among ethnic minority groups (particularly those of African origin) (Dixon et al., 2011; Fearon et al., 2006; Strakowski et al., 1996), who are less likely to receive evidence-based treatments, and generally exhibit worse treatment response and illness course than the majority ethnic group in the same community (Tandon et al., 2009, 2010; Vega and Lewis-Fernandez, 2008). The report by Li and co-workers in this issue of the Journal is a useful addition to the relatively sparse literature on the topic and its findings are in concordance with previous reports. Notably, Li and colleagues found that in comparison to Caucasians, African-Americans were (i) more likely to receive a diagnosis of schizophrenia and schizoaffective disorder; (ii) showed less improvement in depressive symptoms; (iii) exhibited slower improvement in disorganization and negative symptoms; (iv) were less likely to adhere to antipsychotic treatment; and (v) demonstrated less improvement in overall functioning. In the absence of data on the nature of treatment and differences, if any, between groups, one needs to be careful in generalizing results of the study. Nevertheless, these findings underline the importance of ethnic and racial factors in influencing treatment response and outcome in psychotic disorders. A number of factors may contribute to ethnic differences in treatment response and illness course and such differences receive little
1876-2018/$ – see front matter ß 2011 Published by Elsevier B.V. doi:10.1016/j.ajp.2011.10.002
attention in treatment development and delivery. In addition to drawing attention to the importance of ethnic/racial factors in the treatment of psychotic disorders, the findings of Li and colleagues reinforce the multi-dimensional psychopathology of psychotic disorders, with some domains (positive symptoms) showing similar improvement between African-Americans and Caucasians whereas other domains (negative symptoms, depression, and disorganization) showed different patterns of improvement between the two groups. References Armstrong, K., Ravenell, K., McMurphy, S., et al., 2007. Racial/ethnic differences in physician distrust in the United States. Am. J. Public Health 97, 1283–1289. Blanco, C., Patel, S.R., Liu, L., et al., 2007. National trends in ethnic disparities in mental health care. Med. Care 45, 1012–1019. Busch, A.B., Lehman, A.F., Goldman, H., et al., 2009. Changes over time and disparities in schizophrenia treatment quality. Med. Care 47, 199–207. Dixon, L., Lewis-Fernandez, R., Goldman, H., et al., 2011. Adherence disparities in mental health: opportunities and challenges. J. Nerv. Ment. Dis. 199, 815–820. Fearon, P., Kirkbride, J.B., Morgan, C., et al., 2006. Incidence of schizophrenia and other psychoses in ethnic minority groups: results from the MRC AESOP study. Psychol. Med. 36, 1541–1550. Smedley, B.D., Stith, A.Y., Nelson, A.R., 2003. Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. National Academy Press, Washington, DC. Strakowski, S.M., Flaum, M., Amador, X., et al., 1996. Racial differences in the diagnosis of schizophrenia. Schizophr. Res. 21, 117–124. Tandon, R., Nasrallah, H.A., Keshavan, M.S., 2009. Schizophrenia, just the facts 4. Clinical features and conceptualization. Schizophr. Res. 110, 1–23. Tandon, R., Nasrallah, H.A., Keshavan, M.S., 2010. Schizophrenia, just the facts 5. Treatment and prevention. Schizophr. Res. 122, 1–23. Vega, V.A., Lewis-Fernandez, R., 2008. Ethnicity and variability of psychotic symptoms. Curr. Psychiatry Rep. 10, 223–228.
Rajiv Tandon University of Florida, USA. E-mail address: [email protected].fl.us (R. Tandon).