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Ethnic inequalities and pathways to care in psychosis in England: a systematic review and meta-analysis. / Halvorsrud , Kristoffer; Nazroo, James; Otis, Michaela; Brown Hajdukova, Eva; Bhui, Kamaldeep.

In: BMC Medicine, Vol. 16, No. 1, 223, 12.12.2018, p. 1-17.

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Halvorsrud , K, Nazroo, J, Otis, M, Brown Hajdukova, E & Bhui, K 2018, 'Ethnic inequalities and pathways to care in psychosis in England: a systematic review and meta-analysis', BMC Medicine, vol. 16, no. 1, 223, pp. 1-17. https://doi.org/10.1186/s12916-018-1201-9

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Halvorsrud , Kristoffer ; Nazroo, James ; Otis, Michaela ; Brown Hajdukova, Eva ; Bhui, Kamaldeep. / Ethnic inequalities and pathways to care in psychosis in England: a systematic review and meta-analysis. In: BMC Medicine. 2018 ; Vol. 16, No. 1. pp. 1-17.

Bibtex

@article{8cd0cb8b2ee943bd8e1ae3ed66340ab8,
title = "Ethnic inequalities and pathways to care in psychosis in England: a systematic review and meta-analysis",
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",
keywords = "Ethnicity, Meta-analysis, Pathways to care, Psychosis, Severe mental illness, Systematic review",
author = "Kristoffer Halvorsrud and James Nazroo and Michaela Otis and {Brown Hajdukova}, Eva and Kamaldeep Bhui",
note = "{\circledC} The Author(s). 2018",
year = "2018",
month = "12",
day = "12",
doi = "10.1186/s12916-018-1201-9",
language = "English",
volume = "16",
pages = "1--17",
journal = "BMC Medicine",
issn = "1741-7015",
publisher = "BioMed Central",
number = "1",

}

RIS

TY - JOUR

T1 - Ethnic inequalities and pathways to care in psychosis in England: a systematic review and meta-analysis

AU - Halvorsrud , Kristoffer

AU - Nazroo, James

AU - Otis, Michaela

AU - Brown Hajdukova, Eva

AU - Bhui, Kamaldeep

N1 - © The Author(s). 2018

PY - 2018/12/12

Y1 - 2018/12/12

N2 - 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

AB - 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

KW - Ethnicity

KW - Meta-analysis

KW - Pathways to care

KW - Psychosis

KW - Severe mental illness

KW - Systematic review

UR - http://www.scopus.com/inward/record.url?scp=85058347739&partnerID=8YFLogxK

U2 - 10.1186/s12916-018-1201-9

DO - 10.1186/s12916-018-1201-9

M3 - Article

VL - 16

SP - 1

EP - 17

JO - BMC Medicine

JF - BMC Medicine

SN - 1741-7015

IS - 1

M1 - 223

ER -